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Background of the Study
Hypertension is an abnormal elevation of Blood Pressure where in the
systolic pressure is above 140mmHg and the diastolic pressure is above 90mmHg
for at least two readings. Positive family history strongly supports the diagnosis of
hypertension. It is classified in to 6 such as primary hypertension which accounts
for 90% to 95% of all cases of hypertension with an unknown cause, Secondary
hypertension which is due to known causes such as renal failure,
hyperthyroidism, pheochomocytoma, Cushings disease: malignant
hypertension which is severe rapidly progressive elevation in blood pressure that
causes rapid onset of end target organ complications, Labile hypertension
which is intermittently elevated blood pressure, hypertensive crisis in a situation
that requires immediate blood pressure lowering within 1 hour systolic pressure
above 240mmHg and diastolic pressure above 120mmHg (Udan, Josie 2009).
Blood pressure tends to rise with age. High blood pressure increases your
chance for getting heart diseases and kidney disease, and for having a stroke. It
is especially dangerous because it often has no warning signs and symptoms.
Regardless of race, age, or gender, anyone can develop high blood pressure.Once high blood pressure develops, it usually lasts a lifetime. Following a healthy
lifestyle helps some people delay or prevent this rise in blood pressure
(www.enjoymoringa.com).
Nowadays, due to the current declining economical status of the
Philippines, people were forced to find alternatives for those expensive
medications that less fortunate individuals cannot afford. Even professionals
advise their hypertensive clients to take alternative medications that are readily
available. A person with high blood pressure needs food rich in zinc,
magnesium, calcium, vitamin E, and potassium and all of those are abundant in
malunggay plant (www.themoringaplant.com).
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The vitamin C in malunggay helps the body reduce nitric oxide which is
essential elements for the blood vessel to function normally. The calcium content
on the other hand helps to make the muscles in body smoothly relax and
contracts. The potassium in malunggay is 15 times more than what one can
have in banana helps the body to excrete more sodium through urine. Less
sodium in the body helps blood vessels dilate. Magnesium, zinc, and vitamin E all
contributes to make the job of the blood vessels easier so high blood pressure is
prevented (www.themoringaplant.com).
As presented by Dr. Romulo A. Virola Secretary General of National
Statistical Coordination Board, both 2009 Official Poverty Statistics food and
poverty thresholds increased by 26% from 2006 to 2009, compared to only 22%
between 2003 and 2006. According to the latest study of Philippine Society of
Hypertension, more than 11 million Filipino have hypertension and its alarming.
Due to the increasing poverty rate, the researchers would like to respond
to the current demand for alternative medicines on lowering blood pressure onselected hypertensive clients considering the affordability and availability of
such alternative medications.
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Theoretical Framework
This study is anchored on Dorothea Orems Theory of Self Care and Nola
Penders Health Promotion Theory.
The theory of Self-Care
Orem (2001) supports the World Health Organizations definition of health
as a state of physical, mental, and social well-being and not merely the
absence of disease or infirmity as well as speaking to the relationship between
health, well-being and being whole or sound. Orem also presents health based
on the concept of preventive healthcare. This health care includes the
promotion and maintenance of health (primary prevention), the treatment of
disease or injury (secondary prevention), and the prevention of complications
(tertiary prevention).
Nursing is required whenever the maintenance of continues self-care.
Requires the use of special techniques and the application of scientific
knowledge in providing care or designing it (Orem, 2001).
The condition that validates the existence of a requirement for nursing in
an adult is the health associated absence of the ability to maintain continuity
that amount and quality self-care that is therapeutic in sustaining life and health,
in recovering from disease or injury, or in coping with their effects.
Orems Self-Care Model focuses on each individuals ability to perform
self-care, defined as the practice of activities that individuals initiate and
perform on their own behalf in maintaining life, health, and well-being. Ability to
care for ones self is referred to as self-care agency, and the ability to care for
others is referred to as dependent-care agency (Orem, 2001).
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In Orems model, the goal of nursing is to help people meet their own
therapeutic self-care demands. Orem demands identified three types of nursing
systems: (1) wholly compensatory, wherein the nurse compensates for the
patients total inability to perform self-care activities; (2) partially compensatory,
wherein the nurse compensates for the patients partial inability to perform these
activities; and (3) supportive-educative, wherein the nurse assists the patient in
making decisions and acquiring skills and knowledge.
The Health Promotion Model
Nola Penders (1996) Health Promotion Model (HPM) focuses on
explaining health-promoting behaviors, using a wellness orientation. According
to the model, health promotion entails activities directed toward developing
resources that maintain or enhance a persons well-being. The HPM
encompasses two phases: the decision-making phase and an action phase.
In the decision-making phase, the model emphasizes seven cognitive or
perceptual factors that compose motivational mechanisms for acquiring and
maintaining health-promoting behaviors and five modifying factors that
indirectly influence patterns of health behavior. In the action phase, barriers and
cues to action trigger activity in health-promoting behavior. Nurse researchers
have used the HPM in numerous studies of health promoting behaviors.
Other supporting studies:
The parts of the plant that can be eaten as vegetable are the flowers,
leaves, and pods. It is a significant source of calcium, iron, phosphorus, and
vitamins A, B, C. It has also been reported to be beneficial in diabetes because
it can lower blood glucose. This wonder vegetable can be mixed with a
variety of food like tinola, fish with coconut milk, corn soup
(www.gonatural.com.ph).
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For daily medicinal use, just prepare malunggay tea which is about one
cup leaves boiled in glass of water. Drink this daily. You can improve the taste
by adding lemon grass (tanglad) or pandan leaves. A single preparation can
be stored up to 2 days in a thermos bottle, however, a fresh preparation is
always recommended (www.gonatural.com.ph).
Moringa is the well known tree which is use to treat more than 300
diseases and disorders of the body. Moringa is the richest source of potassium as
it contains 15 times the potassium content compared to banana. When the
level potassium in the blood decreases, the absorption of sodium naturally
increases leading to hypertension. As moringa contains sufficient potassium
content it prevents excess absorption of sodium thereby decreasing the blood
pressure. Regular consumption of moringa can increase the level of potassium
and helps to reduce the pressure of the blood flowing cells and tissues.
Moringa contains calcium which is seventeen times that of milk. Calcium is
needed for blood coagulation. It was noted that increase calcium intake will
decline the incidence of hypertension. Moringa contains both potassium and
calcium in greater proportion makes the hypertension patient to reduce theirpressure. Moringa is the best supplement for the healthy life as it contains 90 plus
nutrients and 46 antioxidants. All the nutrients when consumed regularly will
improve our nutritional status of our body. It is difficult for us to take moringa
daily as the present world need variety in their diet (www.articlesbase.com).
Potassium and calcium play an important role against the hypertension as
sodium retention in the blood is restricted due to the presence of potassium.
Moringa as a source of this important nutrient helps to decrease blood pressure.
High amount of potassium in the moringa helps to reduce the absorption of
sodium (www.news-malunggay-moringa-by-youmanitas.blogspot.com).
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Malunggay is a backyard tree whose leaves and immature pods are
eaten by Filipinos as vegetable. Malunggay (moringa olifeira is the best known
local specie) has long been recognize as a good source of nutrients. In the
countryside, lactating mothers are encourage to include the leaves in their diet,
either simply blanch or added to tinola.
It is easily grown. One just break are branch from a tree and sticks it into
the ground and in no time theres a fully grown tree it can be easily be grown in
plantations. And most of the tree parts have one use or another.
Modern science has validated traditional medicines claimed that
malunggay oil has medicinal properties. It is an antidiabetic, antihypertensive,
anti-inflammatory, antimicrobial, antiviral, antiparasitic, and antitumor.
Recently, the unique oil caught the atytention of a senior US medical
researcher. Dr. W. John Martin, former director of the University of Southern
Californias molecular pathology laboratory, was impressed by the potency of
the oil extracted from the malunggay leaves. He explained that the oil belongs
to a category of food products known as enerceuticals. Enerceutical products
can activate the alternative cellular energy or ACE pathway, which is the major
missing dietary component of many cooked or processed foods. Base on
research, ACE pathway provides a much different form of energy from the
calories of food.
Enerceuticals are believe to radiate an energy filled in the body which
can help improve overall cellular functions. As such, they can help improve the
capacity of human body to naturally fight many known illnesses such asdiabetes, hypertension, cancer, insomnia, skin asthma, etc. Ongoing research
also indicates the critical role of ace pathway in the functioning of the brain. If
so, malunggay oil can even help reverse age and illnesses associated with brain
impairments.
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Dr. Martin is conducting his research under the auspices of the Institute of
Progressive Medicine in the United States.
The doctor was specifically impressed by Life Oil capsules which are being
produce in the Philippines. The capsules contain oil extracted from malunggay
leaves. This is the only one in the world which has maintain the natural potency
of moringa olifeira, Martin said. This oil form is far superior to dried malunggay
leaves.
According to clinical researches, moringa olifeira can provide the right
quantity of vitamins, minerals, phyto-chemicals and chlorophyll. These are
needed by the human body every day, especially in the present world where
stress and sicknesses are the usual challenges that are hard to avoid. The
Philippines must seriously look into the many health benefits from the humble
malunggay tree, acknowledged as a miracle tree, he said.
Chlorophyll which is abundant in moringa, can cleanse organs, deliver
oxygen to tissues, and encourage the growth of good aerobic intestinal
bacteria. It can also alkalize bodies to be more resistant to diseases. The
potential for malunggay as a commercial crop is there.
There is no reason the Philippines cannot be a global leader in its
propagation and processing.
Ordinary backyard plants, like malunggay, can have an extraordinary role in
health and well- being.
Ms. Alicia Ilaga, Director of the Department of Agriculture (DA)
Biotechnology Program Implementation Unit, called the malunggay as the
powergulay in a seminar on malunggay as a functional food. The seminar
was held at the FNRI Training Room last March 18, 2008.
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Scientifically called Moringa oleifera, the malunggay is considered a
natural nutrition for the tropics by the Church World Service and Educational
Concerns for Hunger Organization because of the amazing benefits derived
from its small leaves.
Dr. Ilaga cited that on a gram-per-gram basis, dried malunggay leaves
contain seven times more vitamin C than oranges, four times more calcium and
twice protein than milk, four times more vitamin A than carrots, thrice more
potassium than bananas and three-quarters the iron of spinach. Five grams
of malunggay leaves can contribute about 19.7 percent of the vitamin A
requirement of a 1-3 year-old child, according to Dr. Maria Pura Rayco-Solon ofthe Nutrition Center of the Philippines (NCP).
Prospectively, the malunggay leaves and seeds, particularly seed oil, are
seen as promising in food and drink fortification and nutraceuticals. Moringa oil
is 13 percent saturated fatty acid and 82 percent unsaturated fatty acid.
The malunggaycan potentially aid in limiting the burden of chroniclifestyle diseases like cardiovascular diseases and hypertension. Dr. Trinidad P.
Trinidad, Scientist II of the Department of Science and Technology (DOST) based
at the FNRI, presented the research agenda formalunggay of the Technical
Working Group on Functional Foods. Said research agenda include studies on
the characterization of bioactive compounds, establishment of health benefits
and safety, efficacy studies, product development and awareness
(www.fnri.dost.gov.ph).
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Conceptual Framework
INPUT PROCESS OUTPUT
1. What is the profile of the
hypertensive clients in BarangayLahug, Cebu City in terms of:
1.1 Age
1.2 Gender
1.3 Civil status
1.4 Family History
1.5 Length of time
1.6 Occupation
1.7 Diet practices
1.7.1 high salt
1.7.2highsugar
1.7.3high cholesterol
1.8 Lifestyle
1.8.1 smoking
1.8.2alcoholism
2.) What is the mean blood pressure
of selected hypertensive clients
before treatment of malunggay?
3.) Is there a significant difference
in blood pressure after?
4.) What information should be
disseminatedbased on thefindings
ofthe study?
The researchers used the
quasi experimental design
as their research proposal.
As a statistical tool the
researcher made the Blood
Pressure Monitoring Sheet in
getting before and after
results for 5 consecutive
days.
The researcher will do as
follows:
1. Prepare the Malunggay
leaves decoction which is
about 1 cup leaves boiled
in 1 and glass of water.
2. Before giving the
readymade Malunggay
leaves decoction,
researcher will get the initial
blood pressure.
3. After taking the
Malunggay leaves
decoction, researchers will
get the blood pressure on
the selected hypertensive
clients in the morning of the
following day.
4. The procedure will be
repeated for 5 consecutive
days with the same clients
and same time of the day.
Awareness
Program in
the use of
Malunggay
leaves
decoction as
alternative
treatment in
lowering
high blood
pressure.
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Statement of the Problem
This study aims to determine the effectiveness of Malunggay leaves
decoction in lowering blood pressure among selected hypertensive clients in
Barangay Lahug, Cebu City as basis for an alternative treatment in managing
hypertension.
Specifically, it will answer the following questions:
1. What is the profile of the hypertensive clients in Barangay Lahug, Cebu City in
terms of:
1.1 Age
1.2 Gender
1.3 Civil status
1.4 Family History
1.5 Length of time
1.6 Occupation
1.7 Diet practices
1.7.1 high salt
1.7.2 high sugar
1.7.3 high cholesterol
1.8 Lifestyle
1.8.1 smoking
1.8.2 alcoholism
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2.) What is the mean blood pressure of selected hypertensive clients before
treatment of malunggay?
3.) Is there a significant difference in blood pressure after?
4.) What information should be disseminated based on the findings of the study?
Statement of the Hypotheses:
There is no significant difference on the mean blood pressure before and after
administration of malunggay leaves decoction.
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Significance of the Study
The study is significant since whatever outcomes will be beneficial to the
following:
Unfortunate Individuals. It serves as an alternative medicine for hypertension
individuals. It is affordable and readily available
Hypertensive Clients. It will help them gain knowledge in different nutrients and
minerals necessary to maintain normal BP.
Clinical Instructor. It will help them for lecture purposes and in imparting to the
minds of students the effectiveness of malunggay in lowering hypertension.
Nursing Students. It will help them gain knowledge on alternative medicine on
hypertension for additional patient health teaching.
Researchers. It will help them to gain knowledge on the effectiveness of
malunggay in lowering blood pressure.
Future Researchers. It will serve as additional reference for future study if they
make related researches.
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Scope and Limitation
Scope
The study focuses on the effectiveness of Malunggay leaves in Lowering
The Blood Pressure in selected hypertensive clients. It will be conducted in
Barangay Lahug, Cebu City. The data will be gathered on January 2012. The
respondents will be the selected hypertensive clients ranging from 40-60 years
old. Five hypertensive clients will be selected. Those respondents with 140-180
mmHg systolic blood pressure and 100-120 mmHg diastolic blood pressure will be
chosen. Their BP will be assessed to check for baseline and comparison.
Limitations
The study is limited to the following areas of concern. The outcome of the
study will depend on the cooperation of the respondents in terms of constancy
and honesty, in adherence, their beliefs, financial constraints in conducting the
study. This study is also limited to hypertensive clients who have maintenance
medication.
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Research Methodology
Research Design
The research design tha t will be used in this study is one group quasi
experimental design. The research design will be used in determining theeffectiveness of malunggay leaves decoction in lowering blood pressure among
selected hypertensive clients. It will be used to measure the degree of change
in their blood pressure as a result of treatment which is in this study, the amount
of malunggay leaves decoction taken daily.
Research Environment
The research will be conducted in Brgy. Lahug Cebu City among selected
hypertensive clients without maintenance medication or not complying with
their medication. This area was chosen because of its accessibility to theresearchers. The respondents will be given malunggay leaves decoction daily in
their respective residences.
Sampling Technique
The non-random purposive sampling technique will be utilizd in this
research study because not all residents will be given the chance to participate
in this study. Only 10 residents who will qualify in the criteria of having blood
pressure range of 140-180mmHg, without prescribed maintenance medication
or not complying to medications will be chosen.
Instrumentation
The researchers will make use of the researcher-made Blood Pressure
Monitoring Sheet where blood pressure of each respondent will be recorded
every day. The table will contain the baseline blood pressure, amount of
malunggay leaves decoction taken, and the post mean blood pressure.
The researchers will also make use of the blood pressure apparatus in
taking the blood pressures and comparing changes.
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Gathering
Before the actual conduct of experiment, written letter of approval will be
obtained from the Dean of the College of Nursing of the University of Southern
Philippines Foundation. Upon approval, another letter of consent will be secured
from the Baranggay Health Center and respondents. Thereafter, the researcher
will conduct free blood pressure assessment to screen 10 respondents that will
qualify to the qualifications of 140-180mmHg blood Pressure range and non-
compliance to prescribed medications.
On the first of actual experiment, the researchers will take the
respondents baseline blood pressure. Each respondent will be given a glass of
malunggay decoction to drink that will be prepared by the researchers. The
blood pressure will be assessed and recorded daily in the researcher-made
blood pressure monitoring sheet to inspect observable changes. The procedurewill be repeated for five consecutive days with same clients and same time of
the day.
Statistical Tools
The gathered data will be treated using the simple percentage and
weigthed mean with the following formula:
1. To determine the demographic profile of the respondents, simplepercentage will be used, with the formula:
Simple Percentage % = F/nx100
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Where,
% = percentage
F = Actual frequency for the category
n = total number of respondents
% = percentage
F = Frequency
N = number of respondents
100 = constant
2. To determine the degree of effectiveness of Malunggay leaves decoctionin lowering blood pressure among the selected hypertensive clients in
Barangay Lahug, Cebu City, the Standard Deviation was used with the
formula:
Weighted Mean:
Wm=(fWp)/N Wm weighted mean
f Frequency
Wp weighted points
N total population
For the purpose of experimentation the researchers will set values to
determine the effectiveness of Malunggay leaves decoction scaled as
follows:
y Very effective in decreasing blood pressure a decrease of 11-20mmHg both or either systolic or diastolic blood pressure
y Moderately effective in decreasing blood pressure a decrease of 1-10 mmHg both or either systolic or diastolic blood pressure
y No change in both or either systolic or diastolic blood pressure
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3. Mean X= x/nWhere: x is the sum of scores
N is the sample size
4. SD= Where: n = Total population
is the summation of the squared sums
( is the squared of the summation of scores
To determine whether there is a significant change in the mean blood
pressure before and after administration of malunggay leaves decoction,
paired t-test will be used. The t-value which is greater than the value with
an alpha level of 0.05 would be considered significant. Results will be
presented in statistical tables.
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Definition of Terms
For better understanding of the study, the following terms are
operationally defined:
Effectiveness refers to the change in blood pressure.
Malunggay leaves decoction refers to the utilization of the leaves of
malunggay and obtaining its extract by boiling the leaves over water and
creating a solution from the water.
Blood Pressure pressure of blood against the walls of the main arteries.
Hypertensive Clients refers to a person who has an above normal blood
pressure ranging from 140-180 mmHg
Brgy. Lahug, Cebu City it is the place where the research will be conducted.
Malunggay scientific name is Moringa olifeira, refers to a plant that is rich in
nutrients.
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Bibliography
Books:
y Denise F. Polit, et al Nursing Research: Principles and Methods 7thEdition, Lippincot Williams and Wilkins Co., Copyright 2004
y Eufermia F. Octaviano and Carl E. Balita, Theoretical Foundations ofNursing (The Philippine Perspective), Ultimate Learning Series, Copyright
2008
y Nancy Burns and Susan K. Groove, Understanding Nursing Research:Building an Evidence- Based Practice, 4th Edition, Elsevier (Singapore)
Pte Ltd., 3 Killiney Road #08-01 Windslad House 1 Singapore 239519,
Copyright 2007y Martha Raile Alligood and Ann Marriner Tomey, Nursing Theorists and
Their Work, 6th Edition, Elsevier (Singapore) Pte Ltd., Copyright 2008
E-Journals:
y http://gonatural.com.ph/herbalblog/malunggay-moringa-oleifera/y http://www.articlesbase.com/supplements-and-vitamins-
articles/moringa-hypertension-reliever-439006.htmly http://news-malunggay-moringa-by-
youmanitas.blogspot.com/2009/03/moringa-tea-hypertension-
reliever.html
y http://www.malaya.com.ph/june14/busi7.htmly http://www.fnri.dost.gov.ph/index.php?option=content&task=view&id
=1632
y http://all-about-news.com/more-than-11-million-filipino-have-hypertension/-moringa-by-
youmanitas.blogspot.com/2009/03/moringa-tea-hypertension-
reliever.html
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Internet Sources:
y http://www.themoringaplant.com/y http://www.enjoymoringa.com/y http://moringamalunggay.com/
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Table of Contents
Chapter
1. THE PROBLEM AND ITS SCOPE
Background of the study.1-2
Theoretical Framework.3-8
Conceptual Framework...9
THE PROBLEM
Statement of the Problem.10-11
Significance of the Study...12
Scope and Limitation of the Study.13RESEARCH METHODOLOGY
Research Design14
Research Environment14
Sampling Technique...14
Instrumentation....14
Data Gathering...15
Statistical Tool...15-17Definition of Terms...18
BIBLIOGRAPHY.19-20
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Researcher-made Blood Pressure Monitoring Sheet
Day 1
Respondent Mean
Bloodpressure
(Before)
Time
BloodPressure
was
Taken
Amount of
Malunggayleaves
decoction
in ml
Mean
BloodPressure
(After)
Time
BloodPressure
was
Taken
Difference
1
2
3
4
5
Day 2
Respondent Mean
Blood
pressure
(Before)
Time
Blood
Pressure
was
Taken
Amount of
Malunggay
leaves
decoction
in ml
Mean
Blood
Pressure
(After)
Time
Blood
Pressure
was
Taken
Difference
1
2
3
4
5
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Day 3
Respondent Mean
Blood
pressure(Before)
Time
Blood
Pressurewas
Taken
Amount of
Malunggay
leavesdecoction
in ml
Mean
Blood
Pressure(After)
Time
Blood
Pressurewas
Taken
Difference
1
2
3
4
5
Day 4
Respondent Mean
Blood
pressure
(Before)
Time
Blood
Pressure
was
Taken
Amount of
Malunggay
leaves
decoction
in ml
Mean
Blood
Pressure
(After)
Time
Blood
Pressure
was
Taken
Difference
1
2
3
4
5
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Day 5
Respondent Mean
Blood
pressure(Before)
Time
Blood
Pressurewas
Taken
Amount of
Malunggay
leavesdecoction
in ml
Mean
Blood
Pressure(After)
Time
Blood
Pressurewas
Taken
Difference
1
2
3
4
5
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