5 Cystic Fibrosis Nursing Care Plans

Cystic Fibrosis Nursing Care Plans|Cystic fibrosis is an autosomal recessive genetic disorder that is caused by a mutation in the gene for the protein cystic fibrosis transmembrane conductance regulator (CFTR) present in the mucus-secreting cells of the body, primarily affecting the respiratory, reproductive, and gastrointestinal tracts.

Cystic fibrosis is a serious genetic condition that causes severe damage to the respiratory and digestive systems. This damage often results from a buildup of thick, sticky mucus in the organs. The most commonly affected organs include the:

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  • Lungs
  • Pancreas
  • Liver
  • Intestines

Cystic fibrosis affects the cells that produce sweat, mucus, and digestive enzymes. Normally, these secreted fluids are thin and smooth like olive oil. They lubricate various organs and tissues, preventing them from getting too dry or infected. In people with cystic fibrosis, however, a faulty gene causes the fluids to become thick and sticky. Instead of acting as a lubricant, the fluids clog the ducts, tubes, and passageways in the body. This can lead to life-threatening problems, including infections, respiratory failure, and malnutrition. It’s critical to get treatment for cystic fibrosis right away. Early diagnosis and treatment are critical for improving quality of life and lengthening the expected lifespan.

Approximately 1,000 people are diagnosed with cystic fibrosis every year in the United States. Although people with the condition require daily care, they can still lead a relatively normal life and work or attend school. Screening tests and treatment methods have improved in recent years; so many people with cystic fibrosis can now live into their 40s and 50s.

What Are the Symptoms of Cystic Fibrosis?

The symptoms of cystic fibrosis can vary depending on the person and the severity of the condition. The age at which symptoms develop can also differ. Symptoms may appear at infancy, but for other children, symptoms may not begin until after puberty or even later in life. As time passes, the symptoms associated with the disease may get better or worse.

One of the first signs of cystic fibrosis is a strong salty taste to the skin. Parents of children with cystic fibrosis have mentioned tasting this saltiness when kissing their children.

Other symptoms of cystic fibrosis result from complications that affect:

  • The lungs
  • The pancreas
  • The liver
  • Other glandular organs

Respiratory Problems

The thick, sticky mucus associated with cystic fibrosis often blocks the passageways that carry air into and out of the lungs. This can cause the following symptoms:

  • Wheezing
  • A persistent cough that produces thick mucus or phlegm
  • Shortness of breath, especially when exercising
  • Recurrent lung infections
  • A stuffy nose
  • Stuffy sinuses

Digestive Problems

The abnormal mucus can also plug up the channels that carry the enzymes produced by the pancreas to the small intestine. Without these digestive enzymes, the intestine can’t absorb the necessary nutrients from food. This can result in:

  • Greasy, foul-smelling stools
  • Constipation
  • Nausea
  • A swollen abdomen
  • Loss of appetite
  • Poor weight gain in children
  • Delayed growth in children

What Causes Cystic Fibrosis?

Cystic fibrosis occurs as a result of a defect in what’s called the “cystic fibrosis transmembrane conductance regulator” gene, or CFTR gene. This gene controls the movement of water and salt in and out of your body’s cells. A sudden mutation, or change, in the CFTR gene causes your mucus to become thicker and stickier than it’s supposed to be. This abnormal mucus builds up in various organs throughout the body, including the:

  • Intestines
  • Pancreas
  • Liver
  • Lungs

It also increases the amount of salt in your sweat.

Many different defects can affect the CFTR gene. The type of defect is associated with the severity of cystic fibrosis. The damaged gene is passed on to the child from their parents. In order to have cystic fibrosis, a child must inherit one copy of the gene from each parent. If they only inherit one copy of the gene, they won’t develop the disease. However, they’ll be a carrier of the defective gene, which means that they may pass the gene on to their own children.

Who Is at Risk for Cystic Fibrosis?

Cystic fibrosis is most common among Caucasians of Northern European descent. However, it’s known to occur in all ethnic groups.

People who have a family history of cystic fibrosis are also at an increased risk because it’s an inherited disorder.

How Is Cystic Fibrosis Diagnosed?

In the United States, all newborns are screened for cystic fibrosis. Doctors use a genetic test or blood test to check for signs of the disease. The genetic test detects whether your baby has a defective CFTR gene. The blood test determines whether a baby’s pancreas and liver are working correctly. Other diagnostic tests that may be performed include:

Immunoreactive Trypsinogen (IRT) Test

The immunoreactive trypsinogen (IRT) test is a standard newborn screening test that checks for abnormal levels of the protein called IRT in the blood. A high level of IRT may be a sign of cystic fibrosis. However, further testing is required to confirm the diagnosis.

Sweat Chloride Test

The sweat chloride test is the most commonly used test for diagnosing cystic fibrosis. It checks for increased levels of salt in the sweat. The test is performed by using a chemical that makes the skin sweat when triggered by a weak electric current. Sweat is collected on a pad or paper and then analyzed. A diagnosis of cystic fibrosis is made if the sweat is saltier than normal.

Sputum Test

During a sputum test, the doctor takes a sample of mucus. The sample can confirm the presence of a lung infection. It can also show the types of germs that are present and determine which antibiotics work best to treat them.

Chest X-Ray

A chest X-ray is useful in revealing swelling in the lungs due to blockages in the respiratory passageways.

CT scan

A CT scan creates detailed images of the body by using a combination of X-rays taken from many different directions. These images allows your doctor to view internal structures, such as the liver and pancreas, making it easier to assess the extent of organ damage caused by cystic fibrosis.

Pulmonary Function Tests (PFTs)

Pulmonary function tests (PFTs) determine whether your lungs are working properly. The tests can help measure how much air can be inhaled or exhaled and how well the lungs transport oxygen to the rest of the body. Any abnormalities in these functions may indicate cystic fibrosis.

How Is Cystic Fibrosis Treated?

Although there’s no cure for cystic fibrosis, there are various treatments available that may help relieve symptoms and reduce the risk of complications.

Medications

Antibiotics may be prescribed to get rid of a lung infection and to prevent another infection from occurring in the future. They’re usually given as liquids, tablets, or capsules. In more severe cases, injections or infusions of antibiotics can be given intravenously, or through a vein.

Mucus-thinning medications make the mucus thinner and less sticky. They also help you to cough up the mucus so it leaves the lungs. This significantly improves lung function.

No steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and indomethacin, may help reduce any pain and fever associated with cystic fibrosis.

Bronchodilators relax the muscles around the tubes that carry air to the lungs, which helps increase airflow. You can take this medication through an inhaler or a nebulizer.

Bowel surgery is an emergency surgery that involves the removal of a section of the bowel. It may be performed to relieve a blockage in the bowels.

Cystic fibrosis may interfere with digestion and prevent the absorption of nutrients from food. A feeding tube to supply nutrition can be passed through the nose or surgically inserted directly into the stomach.

A lung transplant involves removing a damaged lung and replacing it with a healthy one, usually from a deceased donor. The surgery may be necessary when someone with cystic fibrosis has severe breathing problems. In some cases, both lungs may need to be replaced. This can potentially lead to serious complications after surgery, including pneumonia.

Surgical Procedures

Chest Physical Therapy

Chest therapy helps loosen the thick mucus in the lungs, making it easier to cough it up. It’s typically performed one to four times per day. A common technique involves placing the head over the edge of a bed and clapping with cupped hands along the sides of the chest. Mechanical devices may also be used to clear mucus. These include:

  1. A chest clapper, which imitates the effects of clapping with cupped hands along the sides of the chest
  2. An inflatable vest, which vibrates at a high frequency to help remove chest mucus

Home Care

Cystic fibrosis can prevent the intestines from absorbing necessary nutrients from food. If you have cystic fibrosis, you might need up to 50 percent more calories per day than people who don’t the disease. You may also need to take pancreatic enzyme capsules with every meal. Your doctor may also recommend antacids, multivitamins, and a diet high in fiber and salt.

If you have cystic fibrosis, you should do the following:

  • Drink plenty of fluids because they can help thin the mucus in the lungs.
  • Exercise regularly to help loosen mucus in the airways. Walking, biking, and swimming are great options.
  • Avoid smoke, pollen, and mold whenever possible. These irritants can make symptoms worse.
  • Get influenza and pneumonia vaccinations regularly.

What Is the Long-Term Outlook for People with Cystic Fibrosis?

The outlook for people with cystic fibrosis has improved dramatically in recent years, largely due to advances in treatment. Today, many people with the disease live into their 40s and 50s, and even longer in some cases. However, there’s no cure for cystic fibrosis, so lung function will steadily decline over time. The resulting damage to the lungs can cause severe breathing problems and other complications.

How Can Cystic Fibrosis Be Prevented?

Cystic fibrosis can’t be prevented. However, genetic testing should be performed for couples who have cystic fibrosis or who have relatives with the disease. Genetic testing can determine a child’s risk for cystic fibrosis by testing samples of blood or saliva from each parent. Tests can also be performed on you if you’re pregnant and concerned about your baby’s risk.

Also

The hallmark manifestation of CF is chronic, progressive lung disease, resulting from secretion of dehydrated mucus with airway obstruction, and malnutrition from pancreatic insufficiency. However, there is a wide range of disease variety. Pulmonary symptoms can range from nearly asymptomatic disease with undetectable changes in the lung function to severe obstructive disease early in childhood, whereas gastrointestinal symptoms may range from mild constipation, normal liver function, and intermittent pancreatitis to severe loss of pancreatic function, malabsorption with subsequent malnutrition, CF-related diabetes, and end-stage liver diseases.

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The sweat glands and reproductive glands are also affected; almost all males with CF are sterile because of absence or impairment of vas deferens, whereas females have reduced fertility. The impact on the sweat gland give rise to abnormally high chloride secretion; a simple analysis of sweat chloride content continues to be the gold standard for CF diagnosis.

Cystic Fibrosis Nursing Care Plans

Nursing care plan for clients with cystic fibrosis includes maintaining adequate oxygenation, promoting measures to remove pulmonary secretions, emphasizing the importance of adequate fluid and dietary intake, ensuring adequate nutrition, and preventing complications.

Here are five (5) nursing care plans (NCP) and nursing diagnosis (NDx) for cystic fibrosis:

  1. Impaired Gas Exchange
  2. Ineffective Airway Clearance
  3. Imbalanced Nutrition: Less Than Body Requirements
  4. Deficient Knowledge
  5. Infection
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Nursing Diagnosis

May be related to

  • Airway obstruction by nasal obstruction.
  • Airway and Alveoli inflammation.
  • Bronchiectasis with decreased surface area for gas exchange and loss of lung function.
  • Infection with lung consolidation, alveolar collapse.
  • Cystic Fibrosis Nursing Care Plans

Possibly evidenced by

Desired Outcomes

  • 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, baseline heart rate, alert response mentation and no further deterioration in the level of consciousness.

Nursing Interventions

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.
Assess for changes in respiratory status such as cyanosis, pallor, changes in the level of consciousness, labored breathing and tachypnea. Client will adapt their breathing pattern over time to facilitate gas exchange. Abnormalities may indicate respiratory compromise, hypercarbia, or hypoxia.
Monitor transcutaneous carbon dioxide as ordered. Chronic hypercarbia can be present in clients with moderate to severe cystic fibrosis lung disease; increasing levels can indicate the progression of acute infection and pending respiratory failure.
Monitor arterial blood gasses and oxygen saturation as indicated Increasing Paco2 and decreasing Pao2 are signs of respiratory failure. Severe hypoxemia and hypercarbia can lead to hypotension, dysrhythmias, and failing respiratory effort.
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.Cystic Fibrosis Nursing Care Plans
Administer oxygen therapy as indicated. (Avoid giving high oxygen concentration in clients with chronic carbon dioxide retention). Supplemental oxygen maintains adequate oxygenation, decreases the work of breathing and calorie expenditure, and relieves dyspnea, increasing the level of comfort. Maintaining an oxygen saturation greater than 90% is the goal.
Collaborate with respiratory care personnel in the monitoring and administration of noninvasive ventilation as indicated. Bilevel positive airway pressure is a noninvasive ventilation indicated for clients with severe lung disease and a superimposed acute illness or for assistance with nighttime ventilatory needs.

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