Malunggay And Guava Leaves Decoction

1. MALUNGGAY AND GUAVA LEAVES DECOCTION
ON WOUND HEALING: BASIS FOR HEALTH EDUCATION
_______________________
A Research Proposal
Presented to the
Faculty of the Graduate School
Cebu Normal University
__________________________
In Partial Fulfillment
Of the Course Requirement
for the Research Process I
___________________
Dave Jay S. Manriquez
September 2008
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2. ACKNOWLEDGMENTS
“There is no failure except in no longer trying. There is no defeat except from
within, no really insurmountable barrier save our own inherent weakness of
purpose.”
A. Kin Hubbard
The researcher is extremely grateful to the very significant people who helped
him realize this study …
My parents Patricio & Celestina, for their imperishable support, inspiration and
encouragement…
My sisters, who have been pushing and giving me their friendly pieces of advice,
constantly prod me to finish...
My brothers, whose love and kindness and prayer thoughts make me strong…
My friends and relatives, who boost my morale, always inspire me…
To the respondents for their support, help, and sparing time to answer the
questionnaire…
ALMIGHTY GOD, my perpetual guide, praised for the indescribable gift...
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3. This research work is dedicated to:
God Almighty
My parents Patricio & Celestina
To my brothers & sisters
And to nurses who endure………………
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4. TABLE OF CONTENTS
Page
Title Page…………………………………………………………………. i
Acknowledgment…………………………………………………………. ii
Dedication…………………………………………………………… …… iii
Table of Contents………………………………………………………… iv
List of figures……………………………………………………………… v
CHAPTER
I THE PROBLEM AND ITS SCOPE
Rationale of the Study…………………………… 1
Theoretical Framework………………………….. 3
Conceptual Framework………………………….. 12
Statement of the Problem……………………….. 14
Hypothesis………………………………………… 14
Significance of study……………………………… 15
Definition of terms………………………………… 17
Scope and delimitation of the study……………. 18
II RESEARCH METHODOLOGY
Research Design…………………………………. 19
Research Locale………………………………….. 19
Research Respondents………………………….. 19
Research Procedure……………………………… 20
Statistical Treatment……………………………… 25
BIBLIOGRAPHY………………………………………….. 27
CURRICULUM VITAE……………………………………. 28
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5. LIST OF FIGURES
Figure Title Page
1. Theoretical Framework 11
2. Conceptual Framework 13
3. Guava Leaves Decoction-Steps of Application 23
4. Malunggay Leaves Decoction-Steps of Application 24
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6. Presented by: Dave Jay S. Manriquez RN.
MALUNGGAY AND GUAVA LEAVES DECOCTION
ON WOUND HEALING: BASIS FOR HEALTH EDUCATION
RATIONALE:
Human being as known to all have this great thirst for knowledge.
Through the years technology has gone advanced. The introduction of medicines
which has become a big part to human race. The increasing cost of medicines
nowadays prompts the people to use herbs efficiently. In the past few years, a
renewed interest on this natural method of treatment arose not only in the
Philippines but worldwide. Research and studies have been made and
conducted and so far it was found out that medicinal plants are also effective as
well.
To bring back to natural healing the utilization of medicinal plants is need
in our time. We need practical remedies for our common illness how we must
rediscover the healing powers in our nature.
Plants known for their efficacy and usefulness is observe to be beneficial
to countrymen for a numbers of reasons. Firstly, this would provides on
alternative mode of theory for common ailments which otherwise would be
treated with pharmaceuticals medicines. Secondly, there would be less
dependency imported medicines for our health needs and consequently minimize
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7. dollar drain. Lastly, these herbal plants would be readily available and would
serves as a cheap source of relief to the people.
People are exposed to environmental hazards as sharp objects and others
that can inflict wound. Untreated wounds can result into some complication like
infection, thus it must be proper to treat it promptly and effectively.
Among Filipino two must common herbal plants use in their immediate
environment known for centuries are malunggay (moringa lietera) and guava
(psidium guajava). Malunggay or horse radish, is particularly valuable on account
of its iron and phosphorus content, especially calcium. Calcium plays a very
important function is wound healing. While guava in rural folks used to treat fresh
wound in a procedure they call “hunad” no result have ever been documented to
confirm any positive or negative outcome of such practice hence this study was
considered the proper approach of finding out possible effective use of these two,
herbs and which of these two herbs is more effective in enhancing wound healing
that would later become an alternative treatment for people who have less
access to antiseptics or antibiotics
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8. Theoretical Framework
Wound is a break in the continuity of the skin .the body’s response to
injury and the healing process is both local and systemic, that is, the total body
as well the local area is involved.
Classification of wounds
Close and Open wounds – A close wound, wound that has no
break in skin integrity .In an open wound, there is desruption in the continuity of
the skin and mucus membrane.
Intentional and Accidental wound –A surgical operation is an
intentional wound wherein there is disruption of the skin integrity.
Incision and Lacerated wound – An intentional wound made up with
sharp instruction is often called an incised wound and characterized by sharp.
Clean cut edges. An accidental wounds is laceration wherein the wound edges
maybe similar confused star like or ovules with tissue
Abrasion and Superficial wounds –covered by scraping of skin
directly over a firm fixed surface wherein the epidermis or possibly the dermis is
removed.
When skin is broken, wound is exposed to additional hazards, since the
tissue may be invaded by foreign materials such as bacterial, dirt and general
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9. complication. The seriousness of and open wound depends on the extent of
tissues damage skin being tough and elastic and with a rich blood supply, role
rates injury well and recovers quickly while subcutaneous fatty tissue are more
easily deprived of their blood supply(Benton 1991)
Wound Healing Process
Healing is a result of a series of complex biological events taking place
over the period of time. Viewed in a simplest way, in untreated but complicated
wound, the steps are as follows: when tissues are cut, the edges of the wound
separates, apparently pulled apart by the elasticity of the skin. Blood from the
severed blood vessels fill the cavity of the wound and overflows from its edges.
Blood clots and eventually the surface of the dries out and becomes shard
forming scab. During the first twenty four hours the scab shrinks drawing the
edges of wound close together. If the scab sloughs off or is removed after a week
layer of reddish granulation tissue will be seen to have covered the cut edges of
the subcutaneous tissue. Gradually, grayish thin membranes extend out from the
skin edges and eventually covered the whole surface. The actual size of the
wound, meanwhile is steadily reduced by a process of contraction until finally no
raw surface is seen.
After the wound is sustained, several changes occur simultaneously bleeding
either stops spontaneously or is controlled by other means. If the surface of the
wounds are in fairly close contact, the area is filled with blood and tissue juices
which is addition to other functions, effectively cover the wound. A scaffold
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10. consisting of a fine network of protein molecules called fibrin then forms, and into
this grow two tissues essential for repair: these are the connective tissues and
tiny capillary blood vessels. At this stage the repair tissues called granulation
tissue, can be seen in healing open wound as red, velvety granular surface. As
time passes, several changes take place simultaneously. The fibroblasts produce
fibrous protein called collagen which gives the wound strength. The histocytes
scavenge cellular debris and foreign bodies. The replacement of red capillaries
by white collagen explain why a new scar is red at first but then gradually
becomes white over the course of weeks (Benton, 1991:345).
In wound healing, scaling occurs within hours by the formation of blood
clots the surface of which becomes dehydrated to create a scab. Epithelial
continuity is restored within the twenty-four hours to forty-eight hours. Fibroblastic
bridging does not become evident until three to five days following the incision
and demonstrable collagenation only begins to appear in the later part of the first
week. Thereafter, the process of accumulation of collagen and the slow
compression and devascularization of the newly formed connective tissue occur
within twenty-four hours; neutrophils appear at the margins of the incision,
moving forward along the margins of the dermis beneath the surface scab, to
fuse in the midline, thus producing a more continuous but thin epithelial layer,
this epithelial response is amazingly fast and epidermal continuity is
reestablished in twenty-four to forty -eight hours, long before the subjacent
connective tissue reaction has begun to evolve.
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11. By day three, the neutrophils have largely disappeared and are replaced
by macrophages. Granulation tissue progressively invades the incisional space.
Collagen fibers are now present in the margins of the wound. Epithelial cell
proliferation continues, thickening the epidermal layer covering. By day five and
seven the incisional space is filled with granulation tissue, neovascularization is
maximal.
Collagen fibrin become more abundant and begins to bridge the incision.
The epidermis recoveres its normal thickness and differentiation surface cell
yields natural epidermal architecture, with surface keratinization. During the
second week there is continued accumulation of collagen and proliferation of the
fibroblasts and leukocytic infiltrates edema and increased vascularity disappear.
At this time, the long process begins, accompanied by increased accumulation of
collagen within the incisional scar, accompanied by a regression of vascular
channels.
By the end of the first month, the scar compresses a cellular connective
tissue devoid of inflammatory infiltrates covered now by intact epidermis
(Robbins, 1985).
Factors Affecting Wound Healing
These are several factors that affect healing the wound according to
Luckmann and Sorensen (1988:85-89).
1. Age. Years of exposure to the ultraviolet lights results in decreased
blood perfusion to the skin and atrophy of tissue macrophages system
in older people. Healing is therefore faster and less complicated by
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12. infection in younger person. But it is of less importance compared to
the other factors.
2. Nutritional Status. Optimal body functioning is most like to occur in a
well nourished person. The malnourished person may not have the
nutritional reserve to facilitate healing. Wound in obese person heals
slowly because adipose tissue has poor perfusion.
3. Tissue Involved. Tissues with good blood supply heal better than those
with less vascular tissue. Wounds on hand and head heal faster than
those on the leg and foot. Muscle tissue heals faster than those
adipose tissue.
4. Blood Supply to Injured Tissue. Although tissues with blood supply
heal faster, inflammation of the wound site may reduce circulation and
impede healing.
5. Presence of Infection. Infection inhibits wound healing and should be
prevented by strict asepsis. Wound should be cleansed first with soap
and water thoroughly before its treatment. Hence, to prevent infection,
materials for wound treatment should be cleansed and sterilized.
6. Presence of Foreign Bodies. Foreign bodies inhibits wound heal and
may cause infection. Removing penetrating objects is usually done.
Wound must also be covered with dressing not to tightly place.
7. Wound Treatment. In the Philippines, the medicinal plants have
acquired great significance, considering their availability in the
community and the arising cause of drugs. However these medicinal
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13. herbs are not fully endorsed by the Bureau of Food and Drug
especially, if there are herbal supplements to be taken in orally. Clinical
data on many herbs are scare, making predictions for interactions with
medication difficult or impossible. Most human trials performed with
these herbs have been small scale fewer than 100-200 subjects.
Safety assumes appropriate when the utilization of the herb is short-
term and not medically contraindicated (Nettina, 2001:1680).
Guava (Psidium guajava). Bayabasa originated form south America,
where the Spaniards found it as a cultivated tree and supposed to have carried it
from one country to another, across the Pacific to the Philippines. Being hardy
and resistant to drought, it readily adjusted to the new climate. Its seeds were
easily dispersed by birds and it rapidly grew and formed thickly. The plant is
known scientifically as Psidium Guajava Linn and is a member of the family
Myrtaceae.
It has many local names in the country, among them are; Bayabas in
Bicol; Geyabas in Bontoc; Bayabas in Cebu Bisaya, Ibanag and Tagalog;
Gaiyabit in Ifugao; Bagabas in Igorot; and Baibes in Sulu.
The Guava is one of the most popular and common fruits in the
Philippines. The fruit is a favorite of the Filipinos. It is extensively used iin the
manufacture of jellies, owing to the presence of a considerable amount of pectin.
The ripe fruit is eaten as a vegetable and is used as seasoning for food. It is also
used to induce contraction of the tissue or to arrest bleeding. A decoction of the
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14. unripe fruit, leaves, cortex of the bark and roots, is used in washing ulcers and
wounds. The bark and leaves are utilized to promote the healing of wounds.
They are also anti-diarrhetic. The dry bark decoctions are internally given to
remedy stomachaches. Guavas are excellent sources of Vitamin C.
The tree reaches a height of about 8 meters. The young branches are
four-angled. The 5-to12-centimeter-long oblong leaves are oppositely arranged
and are pointed at the tip and rounded at the base. The stalks bear 3-to 4-
centimeters wide white, solitary or 2 to 3 flowers. The fruit is rounded, 4 to 9
centimeters long, and green but yellowish when ripe. It contains numerous seeds
imbedded in an aromatic and edible pulp (Gutierrez, 1980).
Malunggay (Moringa Oleifera). Malunggay, moringa oleifera Lam., of the
family Morinngaceae, was introduced from Asia or Malayasia during the
prehistoric times. It is generally found in the tropics and is widely cultivated
throughout the Philippines; Malunggay, Malunggai, Kalungai, Kalamungi;
Malnagai in Tagalog; Arunggai in Pangasinan; Balungai in Bisaya, Maronggay in
Ilocano and Ibang; Monongoi in Sambali. The plant is known in English as Horse-
radish tree.
Filipinos are not fully aware of the medicinal qualities of this common
backyard. Its pods, flowers, leaves and twigs are, however, frequently used as
vegetables which are considered to be rich in Calcium, Phosphorus and Iron. A
decoction of the roots is externally employed to cleanse sores and ulcers, and to
cure scurvy and high fever. The young roots are extensively used as local
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15. medicines for epilepsy, hysteria, urinary complaints, paralysis, chronic
rheumatism, gout, dropsy, indigestion and enlargement of the spleen and liver.
They are likewise employed as a stimulant, a diuretic and an antidote for
snakebites. Root decoction is very helpful in relaxing the throat, curing hoarse
voice, and in relieving sudden abnormal involuntary contraction of the muscles.
Root extracts are regarded as cure for hiccups, asthma, lumbago and
inflammations. They are also employed for earaches and tooth decay. The
powdered rootbark is used as a snuff for headaches. The bark is considered as
cardiac stimulant, a cure for asthma and cough, and as relief for pain. The young
leaves are popularly used as stimulant for secretion and flow of milk. They are
also employed to promote digestion and nausea, and to alleviate constipation,
hysteria and flatulence. Leaf intake is recommended for gonorrhea. Similarly, leaf
extracts are employed as a poultice on the abdomen to expel intestinal worms,
and are mixed with honey to produce a healing ointment for the eyes. The
flowers, boiled in milk, are employed as an aphrodisiac.
This tree attains a height of 8 meters. It grows rapidly even in poor soil. It
has a corky, grummy bark and soft, white wood. The compound leaf is composed
of 3 to 9 thin, egg-shaped, 1-to 2-centimeter-long leaflets arranged on a
compound (thrice pinnate) leafstalk. The white and fragrant flowers are 1.5 to 2
centimeters wide. The fruit is a 15- to 30-centimeter-long pendulous, three
angled pods. The 3-angled seeds are winged. The roots posses the pungent
taste of horse-radish (Gutierrez, 1980).
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16. WOUND
Close and open wound
Intention and accidental wound
Incision and lacerated wound
Abrasion and superficial wound
Wound healing process
Wound Treatment
Guava decoction Malunggay decoction
Figure 1. Theoretical Framework of the Study
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17. Conceptual Framework
The study focus primarily on determining the effectiveness of guava and
malunggay leaves decoction on wound healing among selected individuals in
San Fernando, Cebu. The following subsidiary problems were formulated to
answer the main problem.
First, the profile of the selected study participants in terms of: age, height
and weight are determine. This is followed buy obtaining the total measurement
of the wounds before and three days after application of the medicinal herb
decoction of guava and malunggay. The significant mean difference in the wound
size before and after application of the leave decoction was tested. The outcome
of the study is the basis for a propose health education program.
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18. SELECTED CHILDREN WITH WOUNDS
SAN FERNANDO, CEBU
Guava Leaves Decoction Malunggay Leaves Decoction
Effectiveness in promoting wound
healing
Basis for Health Education Program
Figure 2. CONCEPTUAL FRAMEWORK
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19. Statement of the Problem
This study aims to determine the effectiveness of malunggay and guava
leaves decoction on wound healing among selected individuals in Brgy. Tisa,
Cebu City.
It will answer the following specific questions:
1. What is the profile of the selected study participants in terms of:
1.1 age;
1.2 height and
1.3 Weight (in cm)?
2. What is the total measurement of the wounds in terms of length,
width and depth:
2.1 before and 3 days after application of the guava leaves
decoction, and
2.2 before and 3 days after application of the malunggay leaves
decoction?
3. Is there a significant mean difference in the wound size before and after
application of decoction?
4. What health education program can be proposed based on the findings?
Statement of Hypothesis
Ho1 There is no significant mean difference of the wound size before
and after the application of the two types of decoction.
Significance of the Study
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20. Nowadays, pharmaceutical medicines are getting expensive in addition to
the minimal income of our people. The chances of purchasing these medicines
are getting slender and more people are suffering great complications that
sprung only from small-uninfected wounds. As a remedy, there is a need to find
some alternatives that can be equally effective bit less in cost.
Nursing Education. The findings of this study would serve as a valuable
reference in classroom discussions on indigenous medicinal sources that can be
benefit the larger population of the Philippines society due to its accessibility to
the masses and affordability.
Nursing Practice. For nursing practice to be more effective, it needs to be
affordable and more accessible to the masses. With the rising cost of antiseptic
agents, some people with wound fails to take appropriate measures for the
promotion of wound healing. This would be where herbal plants can do so much
help. Wait its accessibility and very low cost more and more people could have
more options in “nursing wounds”.
Nursing research. The findings of this study would serve as a significant
contribution to the field of nursing research. Presenting remarkable results will
stimulate researchers to conduct further studies on local and overlooked plants
that would provide cure to wounds, hence creating a breakthrough on the
effectiveness of herbal medication. Furthermore, this may attract the attention of
drug laboratories and prompt them to do more scientific studies could be utilized
for therapeutic purpose.
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21. Families. The intrinsic, health promoting value of the study will surely
contribute to the community’s self-help programs. This will be beneficial to
families in the community especially those considered less fortunate. The
knowledge that natural resources are readily available to treat fresh out wounds
reduces the waste of money and effort in purchasing pharmaceutical medicines.
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22. Definition of Terms
The terms use in the study are operationally define as follows:
Effectiveness – this terms refers to the ability of an herbal leaves
decoction in desired wound healing.
Wound – this terms refers to the fresh, uninfected break in the skin caused by
physical injury located between the knee and ankle.
Decoction – this phase refers to the liquid obtain by boiling a desired amount of
leaves in one liter of water for five minutes.
Healing – the process or act of regaining skin integrity through granulation
formation as evidence by decrease in length, width and depth of
wound in milliliters and absence of discharges.
Health Education – this term refers to the proposal health teaching program
base on the outcome of the study.
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23. Scope and Delimitation of the Study
The study focus on the effectiveness of the guava leaves decoction
versus malunggay leaves decoction (independent variable) in promoting wound
healing (dependent variable) after three days application. It covers ten
respondents who are living in San Fernando, Cebu between the ages 6 to 12
years old, regardless of sex. Furthermore, each individual did not have conditions
which could affect the normal healing process, like Diabetes Mellitus and
presence of foreign bodies, infection and malnutrition. The open is found in the
areas between the ankle and knee, regardless of length, width and depth. They
are one day old uninfected wounds. The criteria set for selection on study
subjects serve as the means of controlling extraneous variables as nutritional
status, blood supply to the area affected, and presence of infection and some
factors that may influence healing.
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24. RESEARCH METHODOLOGY
Research Design
This study utilize the two groups before and after quasi-experimental
design to determine the effectiveness of guava and malunggay leaves decoction
in the promotion of wound healing after three (3) days application.
Research Locale
The location of the study is in Barangay Tisa, Cebu City. It has a
population of 500 individuals.
Research Respondents
Ten study participants coming from Brgy Tisa, Cebu City are selected
by non-probability purposive sampling considering the criteria for selection of
subjects set as follows:
B. An individual with a one day old uninfected, open wound located
between the knee and ankle regardless of length, width and
depth.
C. Non-diabetic and absence of foreign bodies.
D. Children between the age of 6-12 years old regardless of sex.
E. Children whose wound is evaluated by the doctor to be
uninfected.
F. Children with height and weight in proportion to age according
to the standards set by the Department of Health.
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25. Research Procedure
Data collection methods and instrumentation
Data Gathering
A. For Guava Leaves Decoction
150grams young guava leaves
1 liter of water
1 sterile container
1 sterile strainer
B. For Malunggay Leaves Decoction
150grams malunggay leaves
1 liter of water
1 sterile container
1 sterile strainer
The steps in preparing the herbal decoction are as follows:
1. Add the desired amount of guava/malunggay leaves to liter of boiling
water.
2. Let it boil for 5 minutes.
3. Strain using sterile strainer.
4. Cool the decoction then transfer it to a sterile container.
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26. Upon permission from the Barangay Captain, the subjects are sought.
Each time the subject is found to have a one day old, uninfected open wound,
he/she is assume for any history of familial disease of Diabetes Mellitus with
ages between 6-12years old, without early signs of infection as swelling,
redness, warmth and loss of function; and whose height and weight is in
proportion to age according to height/weight standards set by the Philippine
Department of Health.
A written consent from the parents of the study subject regarding the
decoction treatment is sought.
The study subjects one day uninfected, open wound is cleanse with
running tap water and refer to the physician at Brgy Tisa Health Center for
medical prescription of Tetanus Toxoid as prophylaxis if needed.
The length, width and depth of the wound is measure with a sterile
paper ruler calibrated in milliliters. The measurements as well as the
presence of discharges are recorded as the baseline data, to describe the
description of the wound before the application of the leaf decoction.
After the assessment procedures, the wound is then cleanse with
guava and malunggay respectively. It is left uncover to promote dryness and
thus promote wound healing.
For the next two days of treatment, the guava and malunggay leaves
decoction is use to cleanse the wounds ( 5 respondents for guava decoction
and 5 respondents for malunggay decoction ) once a day at 8:00 o’clock in
the morning.
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27. Subjects are seen for the last time for final assessment of the wound
on the fourth day. The length, width and depth are again measure using the
sterile paper ruler calibrated in milliliters. The presence or absence of
discharges is noted. All the assessment findings are recorded as data to
describe the condition of the wound after three days application of guava
leaves decoction and malunggay leaves decoction.
The research instruments that are utilize in data collection are the
following: observation sheet, sterile paper ruler, height and weight chart,
weighing scale and tape measure to determine the height.
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28. Figure 3. Guava Leaves Decoction
Steps of application
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29. Figure 3. Malunggay Leaves Decoction
Steps of application
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30. Statistical Treatment
To facilitate analysis, the data recorded in the observation sheet
are assign corresponding scores as follows:
4.1. As to the profile of the correspondents age, weight and height are
computed as to mean values.
4.2. The measurements of the length, depth and width in milliliters are taken
as the raw scores.
4.3. The scores before guava leaves decoction and malunggay leaves
decoction treatment in the observation sheet are sum up to represent the
X1 and all the scores of the three days of treatment are sum up to
represent the X2.
The sum of X1 and X2 are subject to computation for the mean
using the formula:
Σx
X=
n
Where:
Σx = sum of X
n = number of the study subject
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31. To determine if there is a significant difference in the length, width and
depth of the wound before and after application of the guava and malunggay
decoction, of one of each group the correlated or paired t-test will be perform
at 0.05 level of significance. The computed t-value will be obtain using the
formula:
d
t=
sd/√n
Where:
d= mean difference before and after decoction
sd = standard deviation of the difference
n = is the number of the samples
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32. Bibliography:
BOOKS
“Wounds and its Classification”
Benton, Williams. Encyclopedia Americana, Vol.9, U.S.A.
Grolier Incorporation, 1991.
“Healing Powers of Herbal Medicines”
Gutierrez, Hermes. Philippine Materia Medical, Vol.1
Public National Research Council of the Philippines, 1980.
“Wound”
Luckmann and Sorensen. Medical-Surgical Nursing,
Philippine Publishing House, 1985.
Nettina, Sandra M. The Lippincott Manual of Nursing Practice
7th Edition Philadelphia: Lippincott Williams and Wilkins, 2001.
“Wound Healing Process
Robbins, George. Pathological Basis of Disease, St. Louis:
C.V. Mosby Company, 1985.
INTERNET
http//:www.philippineherbalmedicine.org/bayabas.htm
http//:www.gonatural.com/herbs.htm
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