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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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