Med Surg Case Study #18: Cystic Fibrosis

Emily Johnson

16 Years Old

Chief Complaint: Emily presents with a persistent cough, recurrent lung infections, and difficulty gaining weight despite a good appetite.

Medical History:

• Diagnosed with Cystic Fibrosis (CF) at the age of 2.

• History of multiple hospitalizations for respiratory infections.

• Chronic use of pancreatic enzymes and vitamin supplements.

• Family history of CF (Emily's brother also has CF).

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0800

Nurse's Note: Emily is admitted to the pediatric unit. She reports increased cough and thick mucus production. Lung sounds reveal scattered wheezes and crackles. She denies any chest pain, but notes increased fatigue. Patient appears anxious.

Vital Signs:

• Temperature: 99.2°F

• Heart Rate: 110 bpm

• Respiratory Rate: 28/min

• Blood Pressure: 120/70 mmHg

• Oxygen Saturation: 92% on room air

Physician's Orders:

1. Administer albuterol nebulizer every 4 hours.

2. Start IV antibiotics (Ceftazidime) for respiratory infection.

3. Chest physiotherapy every 6 hours.

4. Encourage increased fluid intake.

1400

Nurse's Note: Emily reports improved breathing after nebulizer treatment. Lung sounds are clearer, and she coughs less. No signs of respiratory distress noted. She has started oral antibiotics and has been taking them without difficulty. Regular chest physiotherapy sessions have been initiated.

Vital Signs

• Temperature: 98.8°F

• Heart Rate: 100 bpm

• Respiratory Rate: 24/min

• Blood Pressure: 118/68 mmHg

• Oxygen Saturation: 95% on room air

2000

Nurse's Note: Emily is in good spirits, engaging in activities within her tolerance. Lungs remain clear, and she continues to maintain oxygen saturation. Appetite is fair, and she has consumed adequate fluids. IV antibiotics are being well-tolerated with no signs of adverse reactions.

Vital Signs

• Temperature: 98.5°F

• Heart Rate: 95 bpm

• Respiratory Rate: 20/min

• Blood Pressure: 115/65 mmHg

• Oxygen Saturation: 97% on room air

Question 1: Why is chest physiotherapy essential for Emily, and how does it benefit her?

Question 2: Why is monitoring oxygen saturation crucial in CF patients?

Question 3: Why is maintaining hydration a priority in CF management?

Question 4: How can the nursing team support Emily's nutritional needs during this admission?

Answers to Questions Below

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Answers

Question 1: Why is chest physiotherapy essential for Emily, and how does it benefit her?

Chest physiotherapy helps loosen and clear mucus from Emily's airways. It involves percussion and postural drainage, aiding in airway clearance, preventing infection, and improving lung function.

Question 2: Why is monitoring oxygen saturation crucial in CF patients?

CF patients, like Emily, are at risk of oxygen desaturation during respiratory infections. Monitoring saturation levels helps assess respiratory status and ensures timely intervention if oxygen support is needed.

Question 3: Why is maintaining hydration a priority in CF management?

CF patients have thickened mucus, making it difficult for them to clear secretions. Adequate hydration thins mucus, making it easier to expel. This helps prevent airway obstruction and reduces the risk of respiratory infections.

Question 4: How can the nursing team support Emily's nutritional needs during this admission?

Nurses can encourage Emily to consume high-calorie, high-protein meals and snacks. Monitoring daily weights and collaborating with a dietitian can help adjust her nutritional plan. Pancreatic enzyme supplementation should be given with meals to aid digestion.