12 Aug The patient was diagnosed as having CF at birth.
Instruction:
Please compose a well-thought-out response. Use the proper language in your own words to create your post. Your posts must provide the completed meaningful answers to each question. Additionally, your posts must be professional, well organized, grammatically correct, free of misspellings, include all required information to enhance your post to receive full credit. I do not accept more than one post(initial post) for each student. You have several weeks to complete the activity.
Scenario
A 22-year-old, white, 105-lb female is being seen in the pulmonary clinic after being treated for 10 days at home for a mild pulmonary exacerbation of previously diagnosed CF. She has some mild weight loss and has been unable to attend her college classes because of fatigue.
History and Physical Examination:
The patient was diagnosed as having CF at birth. She is currently on dornase alpha four times a day at home and has an albuterol metered-dose inhaler to be used PRN for wheezing.
Vital signs: Heart rate, 95 beats/min, steady and bounding; blood pressure, 110/68 mm Hg; respiratory rate, 21 breaths/min; temperature, 98.9°F (oral); and Spo2, 93%.
Cardiovascular: Heart sounds bounding and slightly distant. Electrocardiogram shows changes consistent with left ventricular hypertrophy.
Respiratory: Decreased lower lobe sounds bilaterally; crackles and rhonchi noted in bases during active inspiration and expiration. Cough has been productive of thick, yellow sputum. Expiratory wheezing noted on exertion.
Laboratory Values:
- Chest radiography: Hyperinflation and increased interstitial markings in the right upper lobes. Atelectasis in bilateral lung bases.
- Electrolytes: Na+ = 138 mEq/L; K+ = 3.9 mEq/L; Cl−= 114 mEq/L; and HCO3 = 28 mEq/L.
- Hematology: White blood cell count = 14,000/mm3; hemoglobin = 12.5 g/dL; and hematocrit = 39.5%.
- Sputum culture: Sputum more than 100,000 CFU of PA. Sensitive to amikacin, cefepime, piperacillin/tazobactam, gentamicin, and tobramycin. Resistant to aztreonam, ciprofloxacin, and levofloxacin.
Diagnosis:
Resolving exacerbation of CF
Her physician wants to modify her home regimen for CF and asks his respiratory therapist to help him with these questions.
After reviewing this case, please answer the following questions:
- Because her sputum is colonized with PA, should an antibiotic be used? If so, what antibiotic at what dosage and frequency
is appropriate? Why? - What common inhaled antibiotic side effects would you discuss with the patient before discharge?
- This patient is currently wheezing and has a history of bronchospasm. She has been using a bronchodilator at home. What
instructions would you provide to the patient about administration of the inhaled antibiotic, mucolytic, and bronchodilator
therapy?
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