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NURS 421 Nursing Grand Rounds Cystic Fibrosis in Pediatrics

NURS 421 Nursing Grand Rounds Cystic Fibrosis in Pediatrics. Annette Fernandez. Client History & Assessment. 15mo newly diagnosed with cystic fibrosis Diagnosed with CF 2 mos before current admission. Current admission chief complaint: cough & congestion / LLL pneumonia.

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NURS 421 Nursing Grand Rounds Cystic Fibrosis in Pediatrics

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  1. NURS 421 Nursing Grand RoundsCystic Fibrosis in Pediatrics Annette Fernandez

  2. Client History & Assessment • 15mo newly diagnosed with cystic fibrosis • Diagnosed with CF 2 mos before current admission

  3. Current admission chief complaint: cough & congestion / LLL pneumonia • Relationship of dx to CF • CF – thick mucus • Increased Na and Cl secretion – Cl sweat test • Increased secretion increases mucus viscosity • Chronic presence of thick mucus increases risk for infection • CF predisposes patients to frequent lung infections

  4. Client History & Physical Assessment • Diminished lung sounds – clear after CPT • CPT done manually with Albuterol Nebulizer • Patient was going to be fitted for vest • 5th percentile growth chart weight • 25th percentile growth chart height • Great grandmother briefly discussed illness in her family and closeness among family members – shared values/beliefs in this family - culture

  5. CPT – Research Article • “Comparison of Settings Used for High – Frequency Chest Wall Compression in Cystic Fibrosis” • Research take-aways: • Possible advantage to using higher-pressure/variable-frequency settings for high frequency chest wall compression devices in cystic fibrosis patients • Unbiased comparison • Further investigation is needed to assess long-term outcomes – respiratory exacerbations, PFT, quality of life Kempainen, R., Milla, C., Dunitz, J., Savik, K., Hazelwood, A., Williams, C., & ... Billings, J. (2010). Comparison of settings used for high-frequency chest-wall compression in cystic fibrosis. Respiratory Care, 55(6), 695-701.

  6. Expected Developmental Stage • Erikson: Autonomy vs. Shame and Doubt • After infants gain trust, they begin to realize that their behavior is their own • Dependency creates a sense of doubt in their own abilities • Self feeding, making the individual choice to turn away from medications, playing with stethoscope • Piaget: Sensorimotor stage • Progress from reflex activity, through simple repetitive behaviors, to imitative behaviors • Playing with the stethoscope – learning purposeful movement • “imitating” older sister

  7. Identification of Nursing Problems/Plan of Care • Nursing problems: • Risk for impaired gas exchange • Altered nutrition: less than body requirements • Risk for infection • Risk for activity intolerance • Interrupted family process

  8. Actual/Potential Problems • Risk for impaired gas exchange (potential) • O2 sats were above 96% when spot checked on RA – gas exchange was not an actual problem • Altered nutrition – less than body requirements (actual) • Weight in 5th percentile – low end of normal limits (5-95%) • Diet high-fat, high-calorie, no enzyme • No significant weight changes

  9. Actual/Potential problems con’t • Risk for infection (actual) • Admitted to hospital with infection – pneumonia • increased thick secretions due to CF • Risk for activity intolerance (potential) • Walked to play room with great grandmother • Appeared to have no issues moving around, unlabored breathing

  10. Actual/Potential problems con’t • Interrupted family process • New diagnosis • Family handled it very well – constant visitors • Family fed, played, observed treatment • Great grandmother discussed illness in the family

  11. Care given to patient • Traditional/Collaborative: • High-fat, high calorie diet • Duo cal packet with soy milk (water/juice restriction) • Sputum culture • Spot check pulse ox • PICC line • CPT • Medication • Albuterol, Pulmozyme, Antibiotics

  12. Care given to patient • Alternative: • Access to play room • “play” with stethoscope • “play” interaction with patient to build a sense of familiarity and trust

  13. Teaching/Discharge • When to call physician/911 • Fever, itchy, achey, sleeps less, urinates less, dry mouth, cracked lips • Immediately seek care if: • Coughing blood, pain in abd that does not go away, trouble breathing, blue nails/lips • Use of nebulizers at home/when to • Chest compression vest

  14. Teaching/Discharge • Antibiotic use – to full term even if “appearing better” • Diet – high calorie/high protein • Add creams, butter, cheese, peanut butter, mayonnaise, powdered milk, high calorie drinks like carnation, pediasure, etc., vitamins supplementation, salt

  15. Questions??

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