Nursing Diagnosis for Cystic Fibrosis

Nursing Diagnosis for Cystic Fibrosis- A Student’s Guide

Introduction

Cystic fibrosis is a genetic disorder that causes mucus build-up in the lungs and digestive system. It can be life-threatening if not treated appropriately.

Nurses play a critical role in the care of cystic fibrosis patients. The main nursing diagnosis for these patients is related to sleep deprivation and fatigue. This post will discuss how nurses can assess, prevent, and intervene on their patient with CF who has difficulty sleeping due to coughing at night. 

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

What is the Importance of Nursing Diagnosis?

The first step in understanding the role of nursing is to understand how it differs from a medical diagnosis. Medically, a “diagnosis” is defined as “a judgment based on examination and study of patient or signs and symptoms, indicating presence or probable presence of a specific disease, condition, or injury.” A medically-based diagnosis indicates a specific disease or condition.

On the other hand, the nursing diagnosis is much more specific to the needs of a patient (the individual who is being cared for). In addition, the medical diagnosis is considered “clinical,” while the nursing diagnosis identifies a problem concerning care and functioning.

One of the most important aspects of understanding nursing diagnosis is that it directly impacts patient outcomes and nurse practice.  Four main factors determine patient outcomes:

  • What specific problems have you identified for the patient(s)?
  • What specific actions will you carry out to solve the problems? 
  • What outcomes are expected in solving these problems?
  • What factors that may result in non-expected outcomes have been identified and controlled/mitigated?

An example of a nursing diagnosis would be: trouble swallowing secondary to respiratory infection. 

This particular nursing diagnosis has a direct impact on the care of many patients. The problems and resultant actions are very specific to each patient. The outcomes that result from solving this problem will differ by a patient. Finally, other factors (e.g., tracheostomy) come into play, depending upon an individual situation.

How Do You Choose a Diagnosis?

Choosing the right nursing diagnosis is dependent upon being able to recognize problems and assess specific needs. To assist in choosing an appropriate nursing diagnosis, the nurse must be familiar with the patient’s condition, history of the disease, and interventions provided already. 

The purpose of identifying a nursing diagnosis is to provide a plan for the nurse to follow. The nursing diagnosis will help determine whether or not there is a need for additional interventions and what actions are needed.

To choose an appropriate nursing diagnosis, it would be necessary to conduct an assessment using subjective (observation of the patient) and objective data (review health records, past medical history, etc.).

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What Are the Classification of Nursing Diagnosis?

Nursing diagnosis can be classified into three main categories:

Acute care diagnoses that involve temporary problems. These may occur with surgical interventions or in a medical/surgical recovery unit.  Examples include Loss of protective skin barrier related to trauma; Infection related to tracheostomy; Incisional pain related to surgical procedure.

NRN-1: Acute Care Diagnosis Using the Nursing Process, by Eileen Fry and Carolyn McClure. 2 nd Edition. Waltham, MA: Focal Press/CRC Press LLC, 2010

Chronic care diagnoses that are long-term problems. Examples include Limited mobility related to osteoarthritis, chronic pain related to trauma, Ineffective airway clearance secondary to chronic bronchitis.

Chronic Care Diagnosis using the Nursing Process, 3rd Edition by Eileen Fry and Carolyn McClure. Waltham, MA: Focal Press/CRC Press LLC, 2012

Transitional diagnoses that take place in the hospital and immediately after discharge.  Examples include Impaired family processes related to illness and long-term care; Grieving related to the death of a spouse; Disturbed sleep secondary to a medical condition.

NRN-2: Chronic & Transition Care Diagnosis Using the Nursing Process, by Eileen Fry and Carolyn McClure. 2nd Edition. Waltham, MA: Focal Press/CRC Press LLC, 2010

What is a Priority Nursing Diagnosis?

A priority nursing diagnosis is a disease or condition that requires intervention immediately; it immediately impacts patient outcomes. Examples include Hypoxemia related to respiratory failure; Fluid volume deficit related to dehydration.

What is a Nursing Process?

The nursing process is the systematic method used by nurses in planning, assessing, and implementing patient care.  It includes five major steps or phases that are performed repeatedly each time a nurse takes care of a patient or group of patients.  The steps are assessment, diagnosis, planning interventions, implementation, and evaluation.

Each nursing diagnosis has a corresponding process that is used to guide practice.  

What Are the Elements of a Nursing Diagnosis? 

A well-written nursing diagnosis is specific, clinically relevant, and measurable. It focuses on what the patient needs instead of on what the nurse does to provide care.

How Can I Evaluate a Diagnosis?

1) Assessment: Ask about recent changes in disease severity or frequency of illness episodes and any other concerns the family might have about the child’s sleep pattern (e.g., snoring).

How Do You Come Up With a Nursing Diagnosis?

Nursing diagnoses are based on the patient and their family’s health history, physical exam findings, and nursing assessment.  An accurate diagnosis requires a systematic evaluation of the patient.

What is Cystic Fibrosis?

Cystic fibrosis is a genetic disorder that causes mucus build-up in the lungs and digestive system. It can be life-threatening if not treated appropriately.

What is Cystic Fibrosis Nursing Care? 

Cystic fibrosis has a major impact on all body organs. The majority of CF patients have chronic lung infections and are at risk for bacterial pneumonia, which can be fatal if not treated promptly.

Fibrosis Nursing Care Plan Intervention

Properties of the interventions:

(1) Specific, measurable, achievable, realistic, and time-limited; individualized to meet the specific needs of an individual patient. 

(2) Patient-centered; involve patients in designing and implementing care plans.

(3) Informed by evidence from high-quality clinical research with a focus on biologic and patient-centered outcomes.

(4) Coordinated; designed to avoid duplication of services, facilitate transitions, encourage communication among providers and practitioners involved in the care of an individual patient, and promote efficient use of health care resources.

Factors that Might Compromise or Require Modification of Interventions:

(1) Financial considerations. 

(2) Lack of individual patient data required to personalize the intervention.

(3) Inability to access specialized equipment or services.

What Are Examples of Nursing Interventions?

Nurses help CF patients deal with the complications of living with cystic fibrosis. They also educate patients about their disease and direct them to therapies geared toward helping them live a more normal life. Nurses should also monitor patients closely for signs of infection and track symptoms such as coughing, fever, or excess mucus.

You may also check Comprehensive Nursing Interventions and Care Plans for Cystic Fibrosis

How Do You Diagnose Cystic Fibrosis?

The National Heart, Lung, and Blood Institute (NHLBI) recommends that doctors diagnose CF with a physical exam, chest x-ray, sweat test, blood test for elevated immunoreactive trypsinogen level (IRT), and DNA analysis of the gene called CFTR. A diagnosis can also be made by reviewing medical records from birth to adolescence when there are at least two signs or symptoms of chronic pulmonary disease such as persistent coughing, recurrent pneumonia or bronchitis; frequent lung infections; shortness of breath after minimal exertion; weight loss without an apparent cause; and prolonged hospitalizations for respiratory illness.

What Causes Cystic Fibrosis?

CF is caused by a defect in the gene that produces the CFTR protein. This protein regulates the movement of salt and water between the cells lining organs such as the lungs, pancreas, and intestines. If these cells don’t work properly, mucus is produced, which clogs the lungs and leads to infections.

Cystic fibrosis affects approximately 30,000 children and adults in the United States (U. S.), 70 percent of whom are diagnosed by age 2. Although it occurs most frequently in Caucasian populations, there is no racial or ethnic preference for getting cystic fibrosis.

What is Cystic Fibrosis Life Expectancy?

Life expectancy for CF patients has been steadily increasing over the last 30 years. The median life span for males with CF is 39.5 years, and females have a median life span of 51.9 years.  

What Are the Four Symptoms of Cystic Fibrosis?

CF is a genetic disorder that affects the cells in your body that produce fluids, such as saliva, sweat, tears, and digestive juices. In cystic fibrosis, these cells form abnormally thick, sticky mucus that can block tubes in your lungs. This build-up of mucus leads to infections and eventually damages the lungs.

The most common symptoms of CF are salty-tasting skin, extremely salty sweat, coughing, and breathing problems. Other symptoms include some family members who don’t show signs; a chronic cough, recurrent lung infections, and sinus infections.

CF’s other miscellaneous symptoms are failure to gain weight or grow at the expected rate in infancy and childhood, frequent diarrhea without an apparent cause, frequent greasy stools, constipation from intestinal blockage, bloating, and feeling full after eating a small amount, liver disease or cirrhosis.

How Many Nursing Care Plans for CF?

There are many types of nursing care plans for Cystic Fibrosis. A CF sputum specimen collection plan, a respiratory infection nurse assistive intervention care plan, IV therapy of cystic fibrosis, and mucus clearance with chest physiotherapy breath sounds over-aeration monitoring policy and procedure.

What Are the Risks of Cystic Fibrosis?

Cystic fibrosis is a chronic genetic disease that affects the lungs and digestive system of about 30,000 children and adults in the United States (75,000 worldwide) born each year. It is caused by a defective gene that encodes to produce an enzyme called CFTR: cystic fibrosis transmembrane conductance regulator.

This protein is necessary for the proper flow of salt and water across cell membranes in the body, especially those found in the respiratory and gastrointestinal tracts. Normally, this flow of water and minerals is controlled by a thin layer or hydrostatic pressure that exerts a force on the cells lining these areas known as epithelia.

CF, however, causes the cells to lose their ability to maintain this pressure and control the flow of nutrients across cell membranes resulting in thickened secretions that block ducts in the respiratory tract and inhibit a normal digestive process.

How Do You Treat Cystic Fibrosis?

The treatment for this condition is different for everyone, but there are some common courses of action. For instance, antibiotics may be prescribed to help control bacterial infections or maintain lung function.

Pulmonary rehabilitation therapy might also be used as a form of physical therapy to improve symptoms such as breathlessness or coughing, and chest tightness.

In addition, supplemental oxygen might be recommended if it’s needed to relieve shortness of breath (a symptom known as dyspnea) or high-frequency chest sounds (known medically as crackles). And, your doctor might prescribe a pill called CFTR modulator to help suppress the development of thickened mucous in the lungs.

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Can Cf Be Mild?

No, it can’t because it is a life-threatening disease. Even if you’re only mildly sick, you may suddenly have a bad day and need help from family members or the paramedics. You’ll also need to stay home from school when certain viruses are going around.

Are There Different Types of Cystic Fibrosis?

There are three main types of cystic fibrosis. The first one is the most common, and it is called autosomal recessive. This type occurs when both parents have a gene for CF but do not show any symptoms themselves (i.e., they are healthy).

Can You Have CF Without Lung Problems?

Yes, you can. However, even if you do not have any health problems linked to CF, it does not mean that you are free from the risks of cystic fibrosis. It is possible to pass down the disease to your children genetically and keep it in the family for generations.

Can a Person with Cystic Fibrosis Have Children?

With a lot of help from your CF team, it is possible. Lung transplantation should be considered the treatment option for patients who have severe lung disease and at least one other major organ outside the lungs (e.g., liver or pancreas) severely affected by the disease.

Where Can I Find Help Paying for My CF Treatments?

Cystic fibrosis is a lifelong disease that can be very expensive. The cost of treatments and medications isn’t covered by most insurance plans, which means thousands of dollars each year might be out-of-pocket expenses. You may also have to spend time away from your family or work to go to CF centers for treatment.

What Are Some Ways to Prevent Cystic Fibrosis?

A mutation in the CFTR gene causes CF. The mutation is most often passed on from parents to their children, but it can also happen through a new mutation that suddenly appears in an individual.

Why is Coughing a Symptom of Cystic Fibrosis?

Coughing can occur for several reasons in cystic fibrosis patients, but it is typically caused by mucus that has become too thick and sticky.

Do You Sweat A lot if You Have Cystic Fibrosis?

Yes, some people sweat more than others. Sweaty feet are a common CF symptom. If you have sweaty feet or your shoes feel damp inside, it is best to change them often and wear stockings (like Spanx) to prevent chafing on the skin.

What is End-Stage Cystic Fibrosis?

Once a person with CF reaches the end stage of life, all treatments are directed toward comfort. A lung transplant may be recommended for patients who have severe lung disease and at least one other major organ outside the lungs (e.g., liver or pancreas) severely affected by the disease.

How Do I Know if My Baby Has Cystic Fibrosis?

If your baby has cystic fibrosis, he will have one of the following symptoms: A sweat test is a blood test used to evaluate cystic fibrosis. Testing is done before and after running exercise to examine how much salt (sodium chloride) and water are excreted into the child’s sweat.

Can a Child With Cystic Fibrosis Live a Normal Life?

Yes, a child with cystic fibrosis can live a normal life. A healthy boy or girl who shows no signs of cystic fibrosis can be a carrier and pass the CF gene on to his or her children in as many as 1 out of 4 cases. If both parents are carriers for CF, each pregnancy has a 25% chance of resulting in a child with the disease.

Can You Get Cystic Fibrosis at Any Age?

Yes, CF is not just a disease of the newborn. However, cystic fibrosis is most commonly diagnosed in children under age 2.

Can a Blood Test Detect Cystic Fibrosis?

Yes, it’s called a sweat test. The test looks for an abnormal amount of salt in the babies’ sweat glands. It does not diagnose cystic fibrosis right away but is usually sent to a genetics center, where results will help determine if your child needs additional testing for CF.

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