X.

ECOLOGIC MODEL

A. HYPOTHESIS:

The fact that there are certain factors present in the client physically and in his
environment, this could have predisposed him to acquire pneumonia. The client’s
condition could be due to these factors such as compromised immune system, young
age, presence of microorganisms in and out of the house, transfer of these organisms
within the family, prolonged immobility and others. However, familial history could not be
attributed as a factor since he was said to be the first member to obtain that kind of
illness and that no one in the family has any respiratory disease.

B. PREDISPOSING FACTORS

1. Host

The client is 8 years old male. He was diagnosed of having cerebral palsy
when he was still 1 month old and was admitted and stayed for 1 month at NCH. Before
in 2008, he was already confined to the hospital because of Pneumonia where he
stayed for a month. The client is also prone to coughs, colds and fever in the past year.
This is the third hospitalization and second time to be medically diagnosed of
pneumonia. There is no history of respiratory diseases in the family but it was not
assessed if other relatives living in the same house have respiratory diseases. The
client stays at home most of the time, where he is only confined to bed for long periods
of time. He doesn’t also engage himself in exercises.

2. Agent

Two origins of pneumonia can be considered here, bacterial pneumonia or

aspiration pneumonia. For bacterial pneumonia, it is caused by Streptococcus
pneumonia that remains the most common cause of all bacterial pneumonias. On the
other hand, aspiration pneumonia is defined as the inhalation of either oropharyngeal or
gastric contents into the lower airways. Inhalation of these contents can lead
to aspiration pneumonia. It occurs when a patient inhales material from the oropharynx
that is colonized by upper airway flora. Reference: Medscape.com

3. Environment

The client lives in a house with 12 members. Even though they are many,
the mother verbalized that the space of the house is big enough for all of them. In fact,
they have their own room where she has a bed of her own and a crib for her child.
There is also a good ventilation in the house enough to make them comfortable.
However, the mother’s family has a tailoring business at home which could pose a risk
to the client’s health. Moreover, there are also animal pets in the house and their house
is situated near a highway that could be harmful to the patient. Even if the client was
isolated from the area, he was often allowed to visit it. The client was sometimes taken
care of by the aunt when she goes somewhere. He is also allowed to play with kids
specifically his cousins.

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Cerebral Palsy

Weak immune system

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D. ANALYSIS

The wheel model depicts the human host at its core; the surrounding environment is
divided into three sectors: biologic, social, and physical. The wheel contains a hub with the host
at its center. For our use, humans represent the host. Also, surrounding the host is the total
environment divided into the biological, physical, and social environments. These divisions, of
course, are not true divisions--there are considerable interactions among the environment types.
Although it is a general model, the wheel of causation does illustrate the multiple etiological
factors of human infectious diseases. This figure is simply meant to illustrate some of the many
ways in which host attributes and environmental conditions can interact to increase or decrease
the likelihood that a certain disease will occur.

Reference:
http://entomology.montana.edu/historybug/napoleon/epidemiological_perspectives.htm

Risk factors of pneumonia are males, extremely young, immunocompromised,

neurologically debilitated patients like with cerebral palsy.
 Children with cerebral palsy do not frequently have problems with their lungs as a
direct result of their impairment. However, depending upon the form of Cerebral Palsy
they have, they do conditions which contribute significantly to respiratory problems.
Difficulties in swallowing, a weak cough, reflux and seizure can all contribute to the
accidental inhalation of oral secretions, food, drink, and stomach contents into the
lungs. When a child with Cerebral Palsy ends up with foreign matter in their lungs, they
do not always have the ability to cough hard enough to dispel the material or in the
midst of a seizure or for a child with a spastic form of CP, the muscles may not be
working in a coordinated fashion.

Some possible respiratory complications are: blocked or obstructed airways,

inflammation of the airways, diminished ability to clear secretions, weakened lungs, and
lung damage. Many of these potential complications greatly increase the risk for
pneumonia in individuals with Cerebral Palsy.
Pneumonia is a general term that refers to an infection of the lungs. For
individuals who do not have the physical impairments caused by CP, pneumonia often
begins after an upper respiratory tract infection. Children with Cerebral Palsy are more
likely to inhale a foreign body (such as food or drink), introducing bacteria into the lungs.
Reference: Origins of Cerebral Palsy Associated Conditions of Cerebral Palsy:
Breathing Difficulties
E. CONCLUSION

Based on the predisposing factors presented above, the pneumonia of the client
was brought about by his illness which is cerebral palsy. Since in cerebral palsy there is
a dysfunction in the neurons of the client causing diminished movements and activity
limitations, there is a difficulty of expelling out the secretions or inability to cough them
out. In turn, it the secretions would accumulate inside the lungs blocking the airways
and impeding oxygenation leading to aspiration of these secretions back into the lungs.
If this happens, the lungs will become a reservoir of bacteria that will propagate and
multiply in the lungs causing inflammation leading to pneumonia. Different signs and
symptoms will be then experienced by the client such as fever, chills, cough, unusually
rapid breathing, breathing with grunting or wheezing sounds, labored breathing that
makes a child's rib muscles retract (when muscles under the rib cage or between ribs
draw inward with each breath), decreased activity, loss of appetite (in older children) or
in extreme cases, bluish or gray color of the lips and fingernails. Other factors that may
contribute to the aggravation of this disease are the factors under the physical as well
as social as it adds up to the gravity of the problem. Medications as ordered by the
doctor need to be administered by the nurse and should be correctly followed.
Knowledge of the disease as well as the interventions to be done must be sole
responsibility of the nurse.