ECOLOGIC MODEL

A. Hypothesis:

Pneumonia is an inflammation of the one or both lungs, usually caused by an infection.

Three common causes are bacteria, viruses and fungi. You can also get pneumonia by
accidentally inhaling liquid or other microorganisms and sometimes by physical and
chemical irritants. Symptoms may include fever, chills, cough with sputum production,
chest pain, and shortness of breath. Pneumonia 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. Pneumonia is caused by environmental and genetic factors, which can influence
how severe pneumonia 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. People most at risk are older than 65 or younger than 2 years of age, or
already have health problems.

In the case of Patient Mr. ES the client has no familial history of Pneumonia but patient
was exposed to unhealthy environment because of his occupation. The patient started to
have cough and colds 2 days prior to ER admission when the patient experienced difficulty
in breathing while at rest... He has positive crackles, both lung fields, occasional wheezing
sound upon breathing and as well as use of accessory muscle upon inhalation and
exhalation. This is probably due to his living condition and occupation environment. He is
a 67 year old, and pneumonia is most common in older than 65 year old or already has
health problems.
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
- 67 years old
• Agent
- Allergens
• Environment
- Living conditions
- Economic level
- Occupation
Host
- Male
- 67 years old

Environment Agent
- Economic level - Allergens
- Occupation
- Living conditions

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 pneumonia for months or years and then suddenly
develop an episode of acute or chronic asthma. Different pneumoniatic individuals react
differently to various factors. However, most individuals can develop severe exacerbation of
pneumonia 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 pneumonia (www.wikipedia.com)

Many of these genes are related to the immune system or to modulating inflammation.
One theory is that pneumonia is a collection of several diseases, and that genes might have
a role in only subsets of pneumonia. Pneumonia often runs in families, and environment that
made it communicable.

Sometimes in an elderly person, symptom is rapid breathing. Sometimes when the

pneumonia is in the lower part of the lungs near the abdomen, there may be no breathing
problems, but there may be fever and abdominal pain or vomiting.
When pneumonia is caused by bacteria, an infected adult/elder usually becomes sick
relatively quickly and experiences the sudden onset of high fever and unusually rapid
breathing. When pneumonia is caused by viruses, symptoms tend to appear more gradually
and are often less severe than in bacterial pneumonia. Wheezing may be more common in
viral pneumonia.

Some types of pneumonia cause symptoms that give an important clue about which germ is
causing the illness. (http://kidshealth.org/parent/infections/lung/pneumonia.html)

Conclusion:

It can be inferred in the statements above that the client is suffering from Pneumonia, and
can probably 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 living condition and
occupation.

C. Medical Management:

Typically, oral antibiotics, rest, fluids, and home care are sufficient for complete resolution.
However, people who are having trouble breathing, with other medical problems, and the
elderly may need greater care. If the symptoms get worse, the pneumonia does not
improve with home treatment, or complications occur, then hospitalized may be
recommended. Oxygen therapy, Nebulization, Antibiotic therapy, and Intravenous Fluid
therapy may be needed. Over the counter cough medicine has not been found to be
helpful in pneumonia.

E. Nursing Management:

• Administer low flow humidified oxygen to prevent hypoxemia.

• Prepare for mechanical ventilation if the elder cannot breathe on his own.
• Appropriate diet, as ordered by the physician
• Advise to Increased fluid intake, intravenous (IV) fluids, if unable to drink well.
• Administer acetaminophen (for fever and discomfort), as ordered by the physician
• Administer medication for cough, as ordered by the physician
• Administer oral antibiotics, as ordered by the physician
• Frequent suctioning of elder nose and mouth (to help get rid of thick secretions)
• Breathing treatments, as ordered by the physician