Cystic Fibrosis
Julianne Tamoney
Objectives •Brief discussion of pathophysiology•Understand medical and nursing
interventions•Discussion of clinical relevance •Understand interventions and care
guidelines applied to specific patient
Pathophysiology •Multisystem genetic disease of the
exocrine glands•Leads to an increase in thickness
secretions that alter organ function•In the lungs, thick secretions obstruct the
bronchioles and predispose the lungs to chronic infections
Symptoms •Skin has a characteristic taste of salt •Experiences repeated upper respiratory
infections •Does not gain weight •Clubbing of the nails •Barrel-chested •May not achieve developmental milestones •Number one genetic killer of children and
young adults in the United States •CF patients only live to be about 35
Intervention before lung transplant •Patient’s with severe lung failure are put on a
lung transplant waiting list•ECMO cannula is implanted through patient’s
neck and sedation must be turned off•Patient, still attached to the ECMO, walks
around the hospital everyday while increasing their strength
•Walking with ECMO
Outcomes•Improves strength and functional status •Decrease length of stay in the hospital•Lower hospital costs
Patient Scenario •Female age 16•Height is 5’5 weighing 93 lb•BMI is 16 •Sweat test showed increased chloride in
sweat• Diagnosed with end stage cystic fibrosis •Patient complains of cold that is worsening •Developed influenza causing the clogged
lungs to shut down•Wheezing/ shortness of breath
Current Medications •Albuterol•DNase •Ibuprofen •Cephalexin •Pancrelipase•Multivitamin
Interventions •Patient is placed on
ECMO due to severe lung failure
•Patient walks around the hospital three to four hours a day with the help of nurses, physical therapists, and respiratory therapists
Patient’s Outcome•Patient was strong enough for lung
transplant• Lung transplant was successful•Patient is currently enjoying their new
lungs
Nursing Diagnosis •Ineffective airway clearance related to
excess mucus
NCLEX Questions When teaching the parents of an older infant
withCF about the type of diet the child shouldconsume, which of the following would be mostappropriate?A) low protein dietB) high fat dietC) low carbohydrate dietD) high calorie diet
D) high calorie diet
NCLEX QuestionsA 9-year-old child is admitted to the pediatric
unitfor treatment of cystic fibrosis. The nurse isassessing the child’s respiratory status. Which ofthe following findings is consistent with cysticfibrosis? A) Production of thick, sticky mucousB) Nonproductive, harsh coughC) StridorD) Unilateral decrease in breath sounds
A) Production of thick, sticky mucous
Reference • Albin, Amy. (July 2012). Lung transplant recipient defies all odds.
http://newsroom.ucla.edu/portal/ucla/lung-transplant- recipient defies-236093.aspx
• DukeMed. (Apr. 2012). ECMO -- Walking? http://www.dukehealth.org/health_library/health_articles/ecmo- walking
• PubMed. (Dec 2011). Implementing early mobilization interventions in mechanically ventilated patients in the ICU. http://
www.ncbi.nlm.nih.gov/pubmed/22147819• Turner, David A. (Dec 2011) Active rehabilitation and physical
therapy during extracorporeal membrane oxygenation while awaiting lung transplantation: A practical approach. http://journals.lww.com/ccmjournal/Abstract/2011/12000/Active_rehabilitation_and_physical_therapy_during.1.aspx
• Unbound Medicine. (2000-2012). Nursing Central. http://nursing.unboundmedicine.com/nursingcentral/ub