Ecologic Model

I. Hypothesis
“The host factors of the patient have a significant effect on the client’s
predisposition to liver cirrhosis rather than the environmental factors.” Specifically, age,
alcohol consumption, Stress, Family history of cancer and eating patterns are the main
predisposing factors that made the client to have Cirrhosis of the liver.

II. Predisposing Factors

Host
 Age – the client is 54 years. old
 Alcohol consumption – client usually drinks “red horse” beer every night
alone and consumes 2 bottles of it (500ml each), he started it since his
youth and stopped drinking from the first manifestation of his disease
(November).
 History of Smoking – client is an active smoker in the past in which he
consumes 1 ½ pack of it a day. But he stopped already 4 years ago.
 Stress – As vendor of silver accessory, he and his wife should work all
day to meet the family needs and he doesn’t have any recreation or
leisure activity.
 Family history of Cancer – The client’s father and brother died of lung
and stomach cancer, respectively.
 Eating patterns- The client wants to eat fatty and meaty foods. He never
wants vegetables or fruit at all unless mixed in meaty dishes.

Environment
 Occupational exposure – The client is exposed in vehicle pollution since
the and his wife work as street vendor of silver accessory.
III- Ecologic Model

IV. Analysis
The wheel model is a form of ecologic model designed to de-emphasize the agent
factor of the ecologic triad. Specifically, our problem focuses on the multiple factors that
predispose the client to have liver cirrhosis which are mainly due to host factors based
on the assessment.

Predisposing Factors:

 Host
 Age – Human cancer is primarily an age-related disease that strikes when
an individual is 50 years old or older. (Cancer, The Role of Genes,
Lifestyle & Environment, Panno, PhD, pp. 37)
- Cancers are age related because our cells change with time,
becoming more susceptible to genetic damage and less capable of
dealing with the damage when it occurs. This is due to the reduction
 in the ability of our immune system to track down and destroy
abnormal cells as they appear. The body’s diminished immune
response gives those cells time to evolve into a potentially lethal
cancer. (Cancer, The Role of Genes, Lifestyle & Environment,
Panno, PhD, pp. 38)

 Alcohol consumption – The primary risk for cirrhosis is alcohol

ingestion, especially in the absence of proper nutrition. Any client
with a family history of alcoholism should avoid alcohol because of
the increased risk. (Medical Surgical Nursing by Black pg. 1710)
 Eating Patterns- Any chemical or organism that causes liver destruction
and irregular patchy regeneration predisposes a client to cirrhosis. If
the client is in a poor nutritional state, the damage is more likely and
more severe. (Medical Surgical Nursing by Black pg. 1710)
 Family History of Cancer- Genetic predisposition with a familial
tendency, as well as a hypersensitivity to alcohol is seen in alcoholic
cirrhosis. (Medical Surgical Nursing by Black pg. 1710)
 Smoking – The smoke from cigarettes, cigars, & pipes contains many
compounds called carcinogens that can damage cells leading to the
formation of cancer. The likelihood that a smoker will develop lung
cancer is affected by the age at which smoking began, how long the
person has smoked, the number of cigarettes smoked per day, and
how deeply the smoker inhales. (Cancer, The Role of Genes,
Lifestyle & Environment, Panno, PhD, pp. 14)
The ingredients in cigarettes affect everything from the
internal functioning of organs to the efficiency of the body's immune
system.
(http://quitsmoking.about.com/od/tobaccostatistics/a/CigaretteSm
oke.htm)

 Stress – can threaten a person’s physiologic homeostasis.

(Fundamentals of Nursing, 5th Ed., Kozier, pp. 829)
- The body’s diminished immune response gives those cells time
to evolve into a potentially lethal cancer. (Cancer, The Role of
Genes, Lifestyle & Environment, Panno, PhD, pp. 38)

 Environment

 Occupational Exposure – causes 2%-8% of all human cancers.

(Medical-Surgical Nursing, 7th Ed., Black, pp. 337)
Avoidance of industrial or chemical compounds by working in well-
ventilated areas and taking other safety measures decreases the risk
from toxins. (Medical Surgical Nursing by Black pg.1710)
Age, Alcohol consumption, stress, eating patterns, Family history of Cancer are the main
factors contributed in the development of Liver Cirrhosis in the client. Based on
assessment, already developed liver cirrhosis and together as well with nephrolithiasis.

This was explained by the statements such as the following:

1. Cancers are age related because our cells change with time, becoming more
susceptible to genetic damage and less capable of dealing with the damage when
it occurs. This is due to the reduction in the ability of our immune system to track
down and destroy abnormal cells as they appear. The body’s diminished immune
response gives those cells time to evolve into a potentially lethal cancer.
(Cancer, The Role of Genes, Lifestyle & Environment, Panno, PhD, pp. 38)
2. Laennec’s or micronodular cirrhosis is most commonly found in clients who
chronically abuse alcohol. However, it is also found in non drinkers. The quantity
of alcohol that causes the diffuse scarring of micronodular cirrhosis varies from
client to client. (Medical Surgical Nursing by Black pg.1710)
3. Any chemical or organism that causes liver destruction and irregular patchy
regeneration predisposes a client to cirrhosis. In Laennec’s cirrhosis, it is the
hepatotoxic nature of alcohol that causes the damage. (Medical Surgical
Nursing by Black pg.1710)
4. The common cause of Liver Cirrhosis is alcohol which causes fatty liver, acute
nonviral hepatitis, and cirrhosis. (Widmann’s Clinical Interpretation of
Laboratory Result)
5. The presence of fatty micronodular cirrhosis is strongly suggestive of chronic
alcoholism. (Lange: Current Medical Diagnosis and Treatment pg, 590)

V. Conclusion
“I therefore conclude that the host factors of the patient have contributed
most in the present condition of the client rather than environmental factors.”
Specifically, Length of alcohol consumption, eating patterns are the most important
contributors in the client developing liver cirrhosis.

VI. Recommendations
Since the patient already developed liver cirrhosis and in severe stage
already, only miracle now can save the life of the patient, science and medicine can’t do
anything now. As nurses, it is still our job to give hope even we see there is no hope at
all. Our recommendations for the condition of the patient are:

 Continue the patient to take less sodium and Protein intake

 Give medication as prescribe
 Ask the relatives to entertain and reminisce memories with the patient
to relieve pain, fear and anxiety in both parties.
 Tell the relatives to prepare themselves on whatever will happen to the
client.