ECOLOGIC MODEL:

A. Hypothesis:

Asthma is a chronic inflammation of the bronchial tubes (airways) that

causes swelling and narrowing (constriction) of the airways. The result is
difficulty breathing. The bronchial narrowing is usually either totally or at least
partially reversible with treatments. Asthma affects people differently. Each
individual is unique in their degree of reactivity to environmental triggers. This
naturally influences the type and dose of medication prescribed, which may
vary from one individual to another. Asthma is caused by environmental and
genetic factors, which can influence how severe asthma is and how well it
responds to medication. Some environmental and genetic factors have been
confirmed by further research, while others have not been. Underlying both
environmental and genetic factors is the role of the upper airway in
recognizing the perceived dangers and protecting the more vulnerable lungs
by shutting down the airway.

In the case of Anderson Agno. He has Bronchial Asthma with Acute

Exacerbation. The client’s asthma has been present since he was 8 years
old. He has wheezing sound upon breathing and as well as use of accessory
muscle upon inhalation and exhalation. This is probably due to his familial
history of asthma. He is a 9 year old, school-aged child and asthma is most
common in school-aged children. Although these are not the possible direct
causes, but these may have lead to the weakening of the patient’s immune
system and thus increasing the susceptibility factor of the patient to the
disease.

B. Pre-Disposing Factors:
• Host
-male
-9 years old
-familial history of Asthma
• Agent
-allergens
• Environment
-living conditions
-economic level

Host
-male
-9 years old
-familial history of Asthma

Environment Agent
-living conditions -allergens
- economic level
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)

Some individuals will have stable asthma for weeks or months and then
suddenly develop an episode of acute asthma. Different asthmatic individuals
react differently to various factors. However, most individuals can develop severe
exacerbation of asthma from several triggering agents.

Home factors that can lead to exacerbation include dust, house mites,
animal dander (especially cat and dog hair), cockroach allergens and molds at
any given home. Perfumes are a common cause of acute attacks in females and
children. Both virus and bacterial infections of the upper respiratory tract infection
can worsen asthma.(www.wikipedia.com)

Many of these genes are related to the immune system or to modulating

inflammation. One theory is that asthma is a collection of several diseases, and
that genes might have a role in only subsets of asthma. Asthma often runs in
families and you can inherit the tendency to get inflamed airways.
(www.wikipedia.com)

For most kids, breathing is simple: They breathe in through their noses or
mouths and the air goes into the windpipe. From there, it travels through the
airways and into the lungs. But for kids with asthma, breathing can be a lot more
difficult because their airways are very sensitive. Asthma affects about 1 or 2 kids
out of 10. That means if you have 20 kids in your class, 2-4 of them might have
asthma. Asthma can start at any age — even in a little baby or an adult — but it's
most common in school-age kids.
(http://kidshealth.org/kid/health_problems/allergy/asthma.html#)

C. Conclusion:

It can be inferred in the statements above that the client is suffering from
Bronchial Asthma with Acute Exacerbation, and can plausibly be caused by the
lowered
immune system of the client from the identified pre-disposing risk factors. It may
have been caused by the client’s familial history.

D. Medical Management:
Long term care of the asthmatic child involves taking certain medications on a
regular basis even when no symptoms are present. In this case, the nurse has to
ensure that long term asthma medications like inhaled corticosteroids,
leukotriene inhibitors, long acting bronchodilators, cromolyn and theophylline are
administered as prescribed by the physician.

E. Nursing Management:

• Administer inhaled rapid acting bronchodilators like albuterol to open up

the child's airways.
• Administer corticosteroids such as prednisone to reduce inflammation in
the airways.
• Administer low flow humidified oxygen to prevent hypoxemia.
• Administer intravenous fluids to prevent dehydration and liquefy secretions
in the airways.
• Prepare for mechanical ventilation if the child cannot breathe on his own.