Question

Patient Introduction Location: Medical-Surgical Unit 2315 Report from day shift nurse: Situation: Christopher Parrish is an 18-year-old male who was admitted at 1900 today. His mother visited him at his college dormitory and was very concerned with his health; he seemed weak and had lost weight since she last saw him. She took him to see his primary care provider, and the provider admitted him and has ordered a tube feeding. I placed an 8-Fr, 42-inch feeding tube in his right nares about an hour ago, and x-ray just called and confirmed placement in the stomach. The pump is in his room. He is up to the bathroom prn; otherwise bed rest. Background: Christopher was diagnosed with cystic fibrosis as a child and has had frequent hospitalizations previously. He reports fatigue and has recently lost 6 kg (13.2 lb) after he registered at the local college and moved to live in a dormitory. Chris's mom was here earlier, but she is a single parent and has two younger boys, so she had to go home. Assessment: Christopher is awake and alert. His heart rate and rhythm are regular at 80–85/min. Breath sounds are fine with a respiratory rate at 18/min. His color is a bit pale. Blood pressure is 118/78 mm Hg. He reports no pain and states he's not had much appetite the past few weeks. His belly is flat and nontender. Bowel sounds are normoactive. Recommendation: Christopher is due for vital signs and assessment. The tube feeding just arrived, and you will need to start it on the pump. He needs 720 kilocalories over 8 hours overnight. His regular diet is high calorie, high fat, but he wasn't too hungry this evening; just had a bit of his chocolate shake. You will need to give his pancreatic enzymes orally before you start the tube feeding. You should also assess his diet and reinforce patient education on nutrition. what are the assessment objective and subjective. Expected outcomes . Interventions nurse does . Rationale (because). Evaluation (did EO happen?).

Answer 1

Nutritional recommendation for Cystic fibrosis:

christopher has to consume high calorie and high fat diet.HIs recommendations are:

• Protein: Foods high in protein, such as beef, chicken, eggs, fish, and soy, are important for preventing muscle loss.
• Zinc: Foods high in zinc include kidney beans, beef, spinach, liver, eggs and seafood. Zinc is important for staving off infections.
• Salt: People with CF have saltier sweat, which may cause electrolyte imbalance and dehydration. Salty snacks, pickles, and sports drinks can help replace the salt you lose while sweating. You can also cook vegetables in chicken broth instead of water.
• Calcium: Foods high in calcium help reduce your risk of osteoporosis, a concern for people with CF. Dairy products, such as high-fat yogurt, whole milk, and high-fat cheese are all good sources.
• Iron: Iron helps fight off infection and produces oxygen-carrying red blood cells. Foods high in iron include liver, tuna, lamb, seafood, eggs, beef, and turkey.
• Antioxidants: Fruits and vegetables are good sources of antioxidants and important for fighting off bacterial infection. People with CF may experience high amounts of airway inflammation in the lungs, making bacterial infection more likely and very dangerous to your health.
• Fiber: Your doctor may recommend eating high-fiber foods to help reduce the risk of intestinal blockages. Many high-fiber breakfast cereals are also high in protein.
• Choose high-fat ground beef.
• Opt for whole milk instead of skim.
• Sprinkle bacon and cheese on salad, into eggs, and other prepared dishes.
• Make smoothies packed with peanut butter, whole milk, and bananas.
• Fry eggs with extra butter.
• Spread an extra layer of mayonnaise on sandwiches.
• Eat pasta with olive oil and freshly-grated parmesan cheese, with Alfredo sauce, or with added bacon.
• Snack on high-quality dark chocolate.

NURSING MANAGEMENT:

1. Ineffective airway clearance related to excess tenacious mucus.

subjective assessment: Patient copmlaints cough with secretions.

Objective assessment: patient has cough.

Desired outcome: Client will maintain optimal gas exchange as evidenced by oxygen saturation of 90% or greater, arterial blood gasses (ABGs) within the client’s usual range, relaxed breathing,

Interventions with Rationale

* Monitor respiratory and heart rate for any changes --- There will be an increase in the respiratory and heart rate as a way of compensation for early hypoxia.

* Provide for adequate rest between activities during the day, with a minimal nighttime interruption in sleep ----- Activity increases oxygen needs and should be paced appropriately to avoid fatigue.

* Place the client in a semi-Fowler’s position ---- Semi-Fowler position promotes lung expansion and decreases airway collapse, dyspnea, and breath work through gravity.

* Administer oxygen therapy as indicated --- Supplemental oxygen maintains adequate oxygenation, decreases the work of breathing and calorie expenditure, and relieves dyspnea, increasing the level of comfort.

2. Imbalanced diet: less than body requirement related chronic malabsorption.

Subjective data:

Patient compaints loss of apetite

Objective data:

Patient lost his weight

Desired outcomes:

• Client will maintain adequate nutritional status or demonstrate weight gain on a trajectory to adequate nutritional status.

Interventions with Rationale

* Assess the abdomen for bloating, fullness, bowel sounds, or palpable stool mass. Monitor stool patterns for frequency, odor, consistency, and the presence of oil or grease. --- Undertreated malabsorption is common in cystic fibrosis; symptoms may be normalized by clients and families; adjustments in pancreatic enzyme supplementation are warranted with the signs or symptoms of malabsorption.

* Encourage a high protein, high-calorie diet ---- Client with cystic fibrosis has increased caloric needs as much as 1.2 to 1.5 of the daily recommended amounts.

* Administer all fat-soluble vitamins with meals and enzymes ---- Fat-soluble vitamin deficits are common in cystic fibrosis because of fat malabsorption. Vitamin supplements must be taken with pancreatic enzymes to be absorbed.

* Administer pancreatic enzymes before all meals and snack containing fat or protein as ordered --- Client with cystic fibrosis requires pancreatic enzyme supplementation to adequately digest food containing fat or protein.

3. Knowledge deficit related to incomplete information about disease condition.

Subjective data:

Patient asks for many doubts.

Objective data:

Inadequate knowledge regarding management.

Desired outcomes:

• Client and family will verbalize understanding of disease process, treatment recommendations, and goals of therapy.

Interventions with rationale:

* Assess the client’s knowledge of nutritional needs --- An understanding of nutritional needs and options for meeting those needs promotes self-management.

* Assess the client’s knowledge of medications, airway clearance therapies, and equipment --- Complex treatment regimens in CF can be difficult to maintain, and the regular assessment of knowledge can identify gaps in therapy and sources of nonadherence.

* Review ACT and breathing techniques to dislodge mucus --- Chest physiotherapy is one of the mainstays of treatment.

* Review infection control recommendations--- Care providers have a responsibility to ensure that clients and families are informed about infection control strategies for optimal prevention of new pathogen acquisition.