1 Case Study Cystic Fibrosis Cystic Fibrosis: Case Study The patient is a 7-year-old female. Due to the fact that the patient is a minor, her mother walked into the ER with her. The mother explained that her symptoms consist of persistent coughing throughout the day and it becomes worse at night, the coughing often results in spitting out phlegm. Along with wheezing, stuffy nose, loss of appetite, pain in the abdomen, and the taste of salty skin. The patient has been up coughing and complaining about the pain for 5 hours. Since the patient’s mother had thought it was a regular cold, she had been giving her children’s Tylenol for the past 3 days, 5 mL every 4 hours. Once the patient was taken in, a physical assessment was performed. The questions that were asked to the patients mother were about family history of CF, history of bowel obstruction as an infant, stool, and eating habits (nurses labs 2018). Because of the fact that the patient’s mom mentioned her skin having a salty taste, a sweat test has been recommended to check for cystic fibrosis. The sweat test measures the amount of chloride in sweat while the genetic test detects chromosomal mutations (Very Well Health 2019). Patient has now been diagnosed with cystic fibrous and will be admitted to the hospital for further instructions. Pathophysiology The pathophysiology of cystic fibrosis is based on the defects in the cystic fibrosis gene, which codes for protein transmembrane conductance regulator (CFTR) that functions as a chloride channel and is regulated by cyclic adenosine monophosphate (cAMP) (Nurselabs 2018). Cystic fibrosis is often caught at birth but there are cases where people begin to develop it later in life. If it is detected as birth, many persons with cystic fibrosis acquire a lung infection which incites an inflammatory response, the infection becomes established with a distinctive bacterial flora (Nurselabs 2018). If there is a case of a person developing cystic fibrosis as they get older, there are many symptoms that come along with it and it does affect many parts of your body. It can affect your GI tract, pancreas and your sweat glands which causes the skin to taste salt like. Symptoms may include pain in the abdomen, having a chronic cough that may include blood or phlegm, any gastrointestinal problems such as diarrhea, fat in the stool, heartburn, severe constipation, or bulky stools. When it affects your respiratory system, it can cause pulmonary hypertension, shortness of breath, sinusitis, wheezing, acute bronchitis, and/or pneumonia. There might also be a delay in puberty, growth, and in development. Other commons side effects include deformity of nails, different infections, male infertility, nasal polyps or weight loss (Mayo Clinic 2020). History The symptoms presented by the patient include coughing up phlegm, wheezing, stuffy nose, pain in the abdomen, salty skin and loss of appetite. In the past the patient has h ...

1. 1
Case Study Cystic Fibrosis
Cystic Fibrosis: Case Study
The patient is a 7-year-old female. Due to the fact
that the patient is a minor, her mother walked into the ER with
her. The mother explained that her symptoms consist of
persistent coughing throughout the day and it becomes worse at
night, the coughing often results in spitting out phlegm. Along
with wheezing, stuffy nose, loss of appetite, pain in the
abdomen, and the taste of salty skin. The patient has been up
coughing and complaining about the pain for 5 hours. Since the
patient’s mother had thought it was a regular cold, she had been
giving her children’s Tylenol for the past 3 days, 5 mL every 4
hours. Once the patient was taken in, a physical assessment was
performed. The questions that were asked to the patients mother
were about family history of CF, history of bowel obstruction as
an infant, stool, and eating habits (nurses labs 2018). Because
of the fact that the patient’s mom mentioned her skin having a
salty taste, a sweat test has been recommended to check for
cystic fibrosis. The sweat test measures the amount of chloride
in sweat while the genetic test detects chromosomal mutations
(Very Well Health 2019). Patient has now been diagnosed with
cystic fibrous and will be admitted to the hospital for further
instructions.
Pathophysiology
The pathophysiology of cystic fibrosis is based on the defects in
the cystic fibrosis gene, which codes for protein transmembrane
conductance regulator (CFTR) that functions as a chloride

2. channel and is regulated by cyclic adenosine monophosphate
(cAMP) (Nurselabs 2018). Cystic fibrosis is often caught at
birth but there are cases where people begin to develop it later
in life. If it is detected as birth, many persons with cystic
fibrosis acquire a lung infection which incites an inflammatory
response, the infection becomes established with a distinctive
bacterial flora (Nurselabs 2018). If there is a case of a person
developing cystic fibrosis as they get older, there are many
symptoms that come along with it and it does affect many parts
of your body. It can affect your GI tract, pancreas and your
sweat glands which causes the skin to taste salt like. Symptoms
may include pain in the abdomen, having a chronic cough that
may include blood or phlegm, any gastrointestinal problems
such as diarrhea, fat in the stool, heartburn, severe constipation,
or bulky stools. When it affects your respiratory system, it can
cause pulmonary hypertension, shortness of breath, sinusitis,
wheezing, acute bronchitis, and/or pneumonia. There might also
be a delay in puberty, growth, and in development. Other
commons side effects include deformity of nails, different
infections, male infertility, nasal polyps or weight loss (Mayo
Clinic 2020).
History
The symptoms presented by the patient include
coughing up phlegm, wheezing, stuffy nose, pain in the
abdomen, salty skin and loss of appetite. In the past the patient
has had pneumonia and was hospitalized for a couple of days
due to this condition. When the doctor said, she might be
diagnosed with cystic fibrosis the patients mother was
heartbroken but not in complete shock because of all the
symptoms that her daughter has been having.
Physical Assessment
The patient has been wheezing and has shortness of
breath, is in fact coughing with phlegm, and pain in the
abdomen. Vital signs were taken as well as a skin assessment,

3. the skin around the rectum was examined for irritation and
breakdown from frequent foul stools (Nurses lab 2018). The
sweat chloride test results have come in. For the sweat test the
results came back positive and with 60 mmol/L of chlorine
detected. The principal diagnostic test to confirm CF is a sweat
chloride test using the pilocarpine iontophoresis method to
collect sweat and perform a chemical analysis of its chloride
content is currently considered to be the only adequately
sensitive and specific type of sweat test (Nurseslab 2018).
Related treatments
There are a couple actions and medications that can be
taken to help with cystic fibrosis such as diet, exercise,
monitoring and vaccines. Medication wise there are pancreatic
enzymes, vitamins, bronchodilators, antibiotics, mucolytic, and
cystic fibrosis transmembrane conductance regulator (CFTR).
Patients are monitored in the CF clinic every 2-3 months to
achieve maintenance of growth and development, maintenance
of as nearly normal lung function as possible, intervention and
retardation of the progression of lung disease, clinical
assessment to monitor gastrointestinal tract involvement, and
monitoring for complications and their treatment (Nurses lab
2018).
Nursing Diagnosis and Treatment Goal
Based on the assessment the nurse’s diagnosis is
ineffective airway clearance, ineffective breathing pattern, risk
for infection, imbalanced nutrition: less than body requirements,
anxiety, compromised family coping, and deficient knowledge
of the caregiver. (Nurses lab 2018). In regards to the airway
clearance it pertains to the thick mucus production, which is
why the patient coughs up so much phlegm, and the breathing
pattern pertains to the tracheobronchial obstruction, and the
anxiety is from the stress of being in the hospital. There are
five major goals set out for the patient, which are maintaining
adequate oxygenation, remaining free from infection, relieving

4. the anxiety, improving nutritional status, and relieving
immediate respiratory distress (Nurses lab 2018).
Nursing Interventions
There are many ways to help the patient reach the goal
of getting healthier but these are the most important. Preventing
infection, providing family support, maintaining adequate
nutrition, reducing the child’s anxiety, improving breathing and
improving the airway clearance. By preventing infection, if
there is anyone who is sick they mustn’t visit the patient to
prevent the illness from getting worse. Whoever does come into
contact with the patient they must wash hands before engaging
and practice good hygiene. Vital signs should be taken every 4
hours as well as taking the antibiotics that have been prescribed.
By the patient’s family providing support its gives the family
and the child opportunities to voice the fears and anxiety; it’s
good for family members to provide emotional support
throughout the entire hospital stay (Nurses lab 2018). While
maintaining the adequate nutrition for the child it is greatly
encouraged to be increasing the caloric intake and to do so you
can provide the child with snacks that include peanut butter. It
is also good to administer pancreatic enzymes with all the meals
given throughout the day. Report and changes in bowel
movement and try to weigh the child weekly. When attempts in
reducing the child’s anxiety it’s good to provide the child with
age related activities that’ll get rid of the stress and boredom.
When attempting the improve the child’s breathing Maintain the
child in a semi-Fowler’s position; use pulse oximetry; maintain
oxygen saturation higher than 90%; administer oxygen as
ordered; administer mouth care every 2 to 4 hours; perform
chest physiotherapy every 2 to 4 hours as ordered; plan nursing
and therapeutic activities and diversional activities; and teach
them to exercise to help loosen the thick mucus (nurses lab
2018). And lastly when improving the airway clearance, it is
important to monitor the child for any signs of respiratory
distress, as well as teaching the child to cough effectively. By

5. doing so, it is easier for more mucus to come out of the child’s
system and its important for you to exam the mucus that has
been spit out. Encourage the child to increase the fluid intake or
drink extra fluids.
Evaluation
Overall the patient seems to be having early stages of
cystic fibrosis and doesn’t seem to be too severe. Pertaining to
the nursing interventions, if the patients mother does ever ything
that was mentioned, it will help her daughter recover smoothly
and efficiently. The goals that must be achieved are relief of
immediate respiratory distress, maintenance of adequate
oxygenation, freedom from infection, relief of anxiety and
improvement of nutritional status (Nurses lab 2018). With all
the tips, recommendations and medication provided, the patient
should be able to slowly start to recover.
Recommendations
In the future, the nurse should make it mandatory to
make calls to check in on the patient and ask for vitals, color
and consistency of phlegm and stool, asking if symptoms have
progressed or worsened, ask about caloric intake and weight
status as well as any other things that may be important. Follow
up calls should be a priority to ensure that the patient is doing
everything necessary to become healthier.
References
About cystic Fibrosis; what is cystic fibrosis?. Cystic fibrosis
foundation (N.d) retrieved on December 31, 2020 from
https://www.cff.org/What-is-CF/About-Cystic-Fibrosis/
Cystic fibrosis; overview. Mayoclinc (March 14, 2020)
retrieved on December 31, 2020 from
https://www.mayoclinic.org/diseases-conditions/cystic-
fibrosis/symptoms-causes/syc-
20353700?utm_source=Google&utm_medium=abstract&utm_co

6. ntent=Cystic-fibrosis&utm_campaign=Knowledge-panel
Cystic Fibrosis; pathophysiology. Marianna Belleza, R.N
September 3, 2018) Retrieved on December 31, 2020 from
https://nurseslabs.com/cystic-fibrosis/#nursing_management
How cystic fibrosis is diagnosed, Lori Alma (August 07, 2019)
retrieved on December 31, 2020 from
https://www.verywellhealth.com/cystic-fibrosis-diagnosis-
998227#:~:text=There%20are%20two%20tests%20commonly,tre
atment%2C%20newborns%20are%20routinely%20screened
Sweat test; the gold standard. Cystic fibrosis foundation (N.d)
retrieved on December 31, 2020 from https://www.cff.org/What-
is-CF/Testing/Sweat-
Test/#:~:text=People%20with%20CF%20have%20more,by%202
%20weeks%20of%20age.
EDUC 840
Journal Critique Grading Rubric
Criteria
Levels of Achievement
Content 70%
Advanced
Proficient
Developing
Not Present
Critique Article Topic
10 points
Selected article addresses one of the assigned topics per the
instructions regarding current trends/issues in education.
9 points
Selected article addresses a topic that coincides with current
trends/issues in education.

7. 1 to 8 points
Selected article is appropriate, but may or may not address a
topic that coincides with current trends/issues in education
0 points
Not Present
Critique Summary Paragraph
19 to 20 points
A complete summary of the article that includes 4 or more of
key points of the journal article are present and concisely
summarized with balance, clarity, and relevance of the author’s
position.
17 to 18 points
An adequate summary of the article that includes 4 or more of
key points of the journal article are present and reasonably
summarized with balance, clarity, and relevance of the author’s
position.
1 to 16 points
Less than 4 key points are present. While some key points are
addressed, there is a lack of focus and important information is
neglected.
0 points
Not present
Critique Analysis Paragraph
19 to 20 points
Relevant and legitimate information clearly supports the
critique. It is a thoughtful, focused, in-depth analysis of the
topic.
17 to 18 points
Information provides reasonable support for the critique and
displays evidence of a basic analysis of the topic.
1 to 16 points
Information mostly provides support of the critique, but the
analysis is basic and general. The reader gains few insights.
Further development is needed.
0 points
Not present

8. Personal Response
19 to 20 points
The personal response includes a statement that clearly
addresses your agreement and/or disagreement with author, and
why. A link personal experiences to the content of the article
that also clearly includes a summary statement on the overall
effectiveness of the article.
17 to 18 points
The personal response includes a statement that reasonably
addresses your agreement and/or disagreement with author, and
why. A link personal experiences to the content of the article
that also includes a summary statement on the overall
effectiveness of the article.
1 to 16 points
The personal response includes a statement that does not clearly
address your agreement and/or disagreement with author, and/or
may or may not inform why. A link personal experiences to the
content of the article that also includes a summary statement on
the overall effectiveness of the article may or may not be
included.
0 points
Not present
Structure 30%
Advanced
Proficient
Developing
Not Present
Sentence Structure, Mechanics & Grammar
12 points
Sentences are well-phrased and varied in length and structure.

9. Writing displays introductory and concluding sentences that are
concise, interesting and focused. The writing is free of errors
and clearly flows well for easy reading.
10 to 11 points
Sentences are well-phrased and there is some variety in length
and structure. Writing displays clear introductory and
concluding sentences. There are 1–3 errors, but they do not
represent a major distraction or obscure meaning. Writing
reasonably flows for easy reading.
1 to 9 points
Some sentences are awkwardly constructed so that the reader is
occasionally distracted. Writing displays vague introductory and
concluding sentences. The writing includes many errors making
it difficult to read and grasp the content.
0 points
Not present
Grammar
4 points
Correct spelling and grammar are used throughout the
assignment. There are 0–1 errors in grammar or spelling that
distract the reader.
3 points
There are occasional errors in grammar or spelling. There are 2-
3 errors in grammar or spelling that distract the reader.
1 to 2 points
There are more than 3 errors in grammar or spelling that distract
the reader from the content.
0 points
Not Present
APA
4 points
The use of current APA formatting standards is correct for each
source. A title page and reference page are included in current
APA style. No errors are present in formatting.
3 points
The use of current APA formatting standards is mostly correct

10. for each source. A title page and reference page are included in
current APA style. There are 1–3 errors are present in
formatting.
1 to 2 points
The use of current APA formatting standards is incorrect for the
majority of sources. The title page or reference page are
missing. There are more than 3 errors in formatting.
0 points
Not Present
Word Count
10 points
Word count is a minimum of 700 words.
9 points
Word count is between 600-700 words.
1 to 8 points
Word count is fewer than 650 words.
0 Points
Not Present
EDUC 840
Journal Critique Assignment Instructions
You will analyze and critique two (2) peer reviewed journal
articles from varying professional journals. The articles must
address one of the topics in the chart below that coinci de with
current issues and trends in education. You must select an
article 2 years old or less. Your article critique must include the
following:
· A summary of the author’s position
· An analysis of the author's key points and the extent to which
it is backed up; and
· A personal response that addresses your agreement and/or
disagreement with author, and why. Additionally, your personal
response should link personal experiences to the content of the
article that also includes a summary statement on the overall
effectiveness of the article.

11. Each journal article critique must be a minimum of 700 words.
The assignments must reflect current APA format and should
include a title page, and reference page. You must include the
reference to the journal article for confirmation and professor
review.
Choose from the following Topics:
Module: Week
Journal Critique
Approved Topics
Module 1: Week 1
Issues in Education
Teacher Salaries
Teacher Assignments
Teacher Turnover
Teacher Quality
Teacher Education
School Safety
School Reform
Module 7: Week 7
Trends in Education
Privatization
Home Schooling
Online Public Schooling
Low Performance in Rural Areas
Disabilities Grouping and Tracking
Bring Your Own Device
iPads (1-to1)
Religious Expression in Education