ECOLOGIC MODEL

A. The client’s current diagnosis, bronchiectasis, is aggravated by her unresolved PTB

for 15 years. The infectious agent is the M. tuberculosis but it is greatly aggravated by
the age, intercurrent infection, client’s behavior and resistance to health management
and maintenance. Environment factors are still considered but it is overshadowed by the
imbalances on the host.
B. Predisposing Factors
1.  Agent
 Infectious agent Mycobacterium tuberculosis, which is the primary
agent of pulmonary TB affects the client’s pulmonary condition, with
exacerbates her pulmonary function. Her diagnosis is most likely
based on this agent.

2.  Host 
 Age- Since client is part of geriatric population, older age means
greater exposure and susceptibility on infectious agent. On the
client’s case, her age also contributed to her vulnerability on having
bronchiectasis and prolonged PTB
 Intercurrent infection- the client also have DM and HPN for 10
years. If these conditions are uncontrolled or not treated well, as in
the case of the client, this can also contribute to the increased
susceptibility of the client on bronchiectasis.
 Human behavior- worth to mention here is the client’s behavior
towards managing and maintaining her health. Client has
insufficient knowledge about the disease process and management
of the PTB. Thus, the lack of knowledge on this area contributed
again to worsen the client’s condition.
 Resistance- the client shows resistance or disinterest in her health
management and maintenance. Unmotivated attitude and certain
health beliefs (fatalism) influences the client’s tendency or response
in healing and accepting her condition.

3.    Environment

3.1.  Socio-economic
 Income- social determinants like income plays key role on
client’s compliance towards health maintenance and
management
 Urban overcrowding- although it is not clearly stated on
client’s health history, increase population density can lead
to overcrowding in one area. With that, transmission of the
infectious agent is easily spread and necessitates strict
changes on the environment.
  Availability of health services- the lack of resources to cure
or improve the health outcomes of the client may contribute
to delay of her recovery and cure from bronchiectasis.

Analysis:
The group use the ecologic model of lever to show the imbalance towards the
host. While the primary agent here is the M. tuberculosis which greatly affects her
pulmonary condition, older age, lack of sufficient knowledge and her own disinterest on
managing her own health strongly contributed to her current condition. Harding et al.
(2020) mentioned that with increasing old age, client’s immunity is dwindled and
weakened which result to client’s high susceptibility towards having bronchiectasis.
When basing also on her past health history, client discontinued her full course of
treatment with incomplete taking of anti-TB medications. Here, it is worth-noting that
identification of learning needs of the client and provision of accurate health information
regarding her condition is a must (Berman, et al., 2016).
Recommendations
Primary prevention
  Health teaching- this is the first intervention that must be done because
there is an obvious indifference, disinterest and lack of motivation to
follow, adhere, comply on her health maintenance and management.
Topics like the disease process, medications and change of lifestyle can
be provided.
 Routine immunizations program can be done for her family members to
boost their immunity against TB and other diseases.
 Teach the client and her family about the negative effects of smoking and
the benefits of balance diet.
Secondary prevention
 Adherence to follow-up especially on whether she follows her therapeutic
regimen.
 Diagnostic tests to monitor her progression of recovery serves as key
indicator for the cure of her diseases.
 Routine screening tests can also be done with her family members and to
the community.
Tertiary prevention
 Follow the prescribed medications especially the anti-TB meds and insulin
for her DM.

References:
Abad, P., Tan, M., Baluyot, M., Villa, A., Talapian, G., Reyes, M., . . . Laurino, M.
(2014). Cultural beliefs on disease causation in the Philippines: challenge and
implications in genetic counseling. Journal of Community Genetics, 5(4), 399-
407. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159471/

Berman, A., Synder, S., & Frandsen, G. (2016). Kozier’s & Erb’s fundamentals of
nursing: Concepts , Process and Practice (10th ed). Pearson

Harding, M., Kwong, J., Roberts, D., Hagler, D., & Reinisch C. (2020). Lewis’s medical-
surgical nursing: assessment and management of clinical problems (11th ed). Elsevier.

Hawley, S., & Morris, A. (2017). Cultural challenges to engaging patients in shared
decision making. Patient Education and Counseling, 100(1), 18-24. Retrieved
from https://www.sciencedirect.com/science/article/abs/pii/S0738399116303032?
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