ECOLOGIC MODEL

A. Hypothesis Communicable diseases are most often the leading causes of illnesses in the country today. Most often, they afflict the most vulnerable, the young and the elderly. They have numerous economic, psychological, and disfiguring effects to the afflicted individuals, families and communities. Tuberculosis (TB) is considered a highly infectious chronic disease caused by the tubercle bacilli. It is primarily a respiratory disease but can also affect the other organs of the body and is common among malnourished individuals living in crowded areas. In the Philippines, tuberculosis ranks sixth in the leading cause of morbidity (2002) and mortality (2002). The country ranks ninth among the 2 high burdened countries under the WHO watch list. Bronchiectasis is a chronic, irreversible dilation of the bronchi (Public Health Nursing in the Philippines) In the case of the client, B. Predisposing Factors Host Client is a 22 year old female with a diagnosis of Pregnancy Uterine 41 weeks, 5 days Age of Gestation Gravida 2 Para 1. The client had her menarche when she was 12 years old. She described the duration of her menstrual flow as 2 days. The interval between her cycles is regularly every 28 days. In 2004, she has given birth to a full term baby boy weighing 2.8 kilograms through normal spontaneous delivery at Dr. Jose Fabella Memorial Hospital and she hasnt experience any difficulties giving birth to her firstborn and no complications were reported in the delivery. Agent She had utilized pills as a contraceptive in 2006 and cannot recall when she stopped using it. The clients partner smokes in their house.

Environment The client together with her partner is currently staying at Tandang Sora Quezon City. They are renting a small room. In terms of environmental hazards, she verbalized,

Merong delikado lalo na sa bata. Yung hagdan, kasi masyado matirik at maliliit yung mga steps. They utilize purified drinking water.

C. Ecological Model

D. Analysis

The agent-host-environment model is primarily used in predicting illness rather than promoting wellness, although identification of risk factors that result from the interaction of agent, host, and environment are helpful in promoting and maintaining health. Because each of the agent-host-environment factors constantly interacts with others, health is an ever changing state. Health is seen when all three elements are in balance while illness is seen when one, two, or all three elements are not in balance.

(Fundamentals of Nursing by Kozier 2004)

Patient is a smoker, suffers from Bronchiectasis with history of Pulmonary Tuberculosis. Was infected by Mycobacterium Tuberculosis this year, was under DOTS program for 1 month until symptoms of PTB subsides then stops treatment. PTB in case of our patient is class 5, or the re current one.

Patient was admitted at Quezon Institute due to underlying illnesses, under observation and currently receiving treatment for the symptoms of disease, with Chief Complaint of Haemoptysis and Pain on the Back.

E. Conclusion and Recommendation

As Nurses we should strictly educate our patient regarding the effects of smoking into their health. We should monitor on how they used some chemicals that may cause bad effect on them. In the case of our patient proper surveillance and monitoring should be carried out to assess if patient is responding properly from the treatment given to him.

Advising patient on following certain instructions given by health care providers should also be carried out, because through compliance unhealthy practices could be checked and modified.

Proper Health Teaching regarding also other disease that might get from unhealthy lifestyle and way of living should be taught to patients as early as possible to alert them on what could possibly happen if they continue such unhealthy living.

Treatment of bronchiectasis includes controlling infections and bronchial secretions, relieving airway obstructions, removal of affected portions of lung by surgical removal or artery embolization and preventing complications. This includes the prolonged usage of antibiotics to

prevent detrimental infections, as well as eliminating accumulated fluid with postural drainage and chest physiotherapy. Surgery may also be used to treat localized bronchiectasis, removing obstructions that could cause progression of the disease. Inhaled steroid therapy that is consistently adhered to can reduce sputum production and decrease airway constriction over a period of time, and help prevent progression of bronchiectasis. One commonly used therapy is beclometasone dipropionate, which is also used in asthma treatment. Use of inhalers such as albuterol (salbutamol), fluticasone (Flovent/Flixotide) and ipratropium (Atrovent) may help reduce likelihood of infection by clearing the airways and decreasing inflammation.

Although not approved for use in any country, Mannitol dry inhalation powder, under the name Bronchitol, has been granted orphan drug status by the FDA for use in patients with bronchiectasis and with cystic fibrosis. Combination therapies, long acting bronchodilators and inhaled corticosteroids such as Symbicort and Advair Diskus are also commonly used inhaled medicines which has in many cases been effective in clearing the airways, reducing sputum and reducing inflammation.
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