MICHAEL Case study cystic fibrosis

CASE STUDY- MICHAEL

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Admitting History:

Michael is a 16-year-old male who was diagnosed with Cystic Fibrosis (CF) at the age of 6 months. His sister, who also had CF, died when she was 12-years-old. Michael is seen today in the clinic for a routine scheduled visit. Michael is complaining of a worsening cough for the last 3 weeks. He is producing more than a ½ cup of dark green and brown phlegm per day. His daily CF regime includes: Vest therapy BID, Pulmozyme 2.5mg via HHN Qday, Albuterol 2.5mg via HHN BID, Ultrase MT-20 enzymes- 6 with each meal and 3-4 with each snack, ADEK vitamins Qday, and oxygen 1-2 L/min via NC at night.

For airway clearance, he admits he uses the Vest only twice a week, but walks 30 minutes the other 5 days. He also has more shortness of breath and admits that this is why he quit doing the vest BID.

Based on the initial assessment in the clinic, the physician would like to admit Michael to the hospital. Michael reluctantly agrees, but only for “a couple of days.” He shares with you his feelings and that he knows you really can’t help him. Michael also states “I’m going to die anyway, just like my sister did, so who cares?”.

Physical Exam:

The respiratory therapist is asked to assess Michael. His heart rate is 118/min, respiratory rate 28/min, blood pressure 130/78, SpO₂ 86% on RA, and temperature 99.3⁰ F.

Michael’s weight has decreased by 15 lbs over the last year. His chest examination reveals slight intercostals retractions with each breath.

Clubbing is present in his digits. Breath sounds reveal bilateral crackles in the upper lung fields and diminished throughout all lung fields. His CXR reveals slight worsening of the cystic changes seen on his previous film 6 months earlier with increased infiltrates bilaterally.

His sputum is negative for fungus and acid-fast bacilli. The gram stain of his sputum shows moderate gram-negative bacillus and the final report shows Pseudomonas aeruginosa. See Table below.

Antibiotic Sensitivities for Michael’s Sputum Culture

Amikacin R

Cefepime R

Ciprofloxacxin R

Gentamycin R

Piperacillin S

Tobramycin S

Pulmonary Function Tests show:

FEV₁ .88L (21% of predicted)

FVC 1.82L (37% of predicted)

FEV₁/FVC .48

FEF_25%-75% 24L/s (5% of predicted)

The case study assignments that you will be completing in this course are meant to get you thinking about the big picture of disease management – not just how do we help the patient in the moment. Respiratory therapists are not just ‘neb jockeys’! We should be an integral part of helping to manage a patient’s disease.

Please be thorough and thoughtful in your answers and use correct spelling and correct medical terminology!

Please create a medical ‘problem list’ for the patient. This list can include issues deduced from the subjective AND objective data. List at least 5 with #1 being what you believe to be the most urgent problem to address. Make sure that your problems are actual problems or you will lose points! For example, ‘breath sounds’ are not a problem, but ‘rhonchi’ is!

1.)

2.)

3.)

4.)

5.)

2.) What strategy/strategies could be utilized to address each problem?

Problem 1 (please copy and paste your problem from #1 here first and then continue below to list your top strategy and additional strategies, if any):

Top Strategy: