Nursing Diagnoses

When a nurse is taking care of a patient with cystic fibrosis, there are several nursing diagnoses that she should keep in mind. Below are 5 nursing diagnoses that can commonly be applied to a patient with CF:

1) Impaired gas exchange related to increased mucus production and thick mucus secretions.

• This nursing diagnosis is especially important because it involves the oxygenation status of the patient. It is important that the nurse recognize the importance of this diagnosis and quickly intervenes to improve gas exchange and oxygenation. This diagnosis is summarized in further detail in the table below. 

2) Risk for infection related to increased mucus production.

• Nurses should be aware of this diagnosis and watch for signs of infection in the patient. Any signs of infection should be documented and communicated to the provider, so that appropriate therapy (i.e. antibiotics) can be started. 

3) Risk for imbalanced nutrition: less than body requirements related to reduced absorption of nutrients.

• The nurse should recognize this diagnosis and make sure that the child is consuming enough food. Intakes and outputs should be monitored closely and parenteral nutrition/vitamin supplements should be administered correctly and in a timely manner. 

4) Anxiety related to respiratory distress and length of stay in hospital.

• Addressing the anxiety of the patient with CF can improve the therapeutic relationship between the nurse and the patient. It is important to acknowledge that all of the medical treatment they are undergoing can be very stressful on them and measures to reduce their stress/anxiety should be put in place. 

5) Caregiver anxiety related to lack of knowledge about child's diagnosis and uncertainty about the child's prognosis.

• Most times, the patient with CF that a nurse is taking care of will be a child. Therefore, it is important to acknowledge the caregivers in the room and address any anxiety that they may be having over this whole situation. 

In this post, the focus will be on diagnosis #1. There are several different interventions that a nurse can employ to help a patient with CF improve their gas exchange and help with mucus clearance. The table below summarizes the interventions and goals for a child with this diagnosis.

Actual/Potential	Related To	Plan/Outcome	Interventions
Impaired gas exchange	Increased mucus production/thick mucus secretions	Plan is for the child to have increased mobilization of mucus secretions as evidenced by decreased respiratory distress, cyanosis, and coughing.	1) Perform chest physiotherapy frequently 2) Administer O2 3) Assist the child with deep-breathing techniques 4) Administer bronchodilators 5) Assist the child with percussion and/or vibration techniques to clear mucus

References: 

Speer, K. (n.d.). Pediatric Care Planning: Cystic Fibrosis. Retrieved February 28, 2015, from http://www.wolterskluwerhealth.com/pages/welcome.aspx

Silvestri, L. (2011). Pediatric Respiratory Disorders. In Saunders comprehensive review for the NCLEX-RN examination (5th ed., pp. 481-483). St. Louis, Missouri: Elsevier/Saunders.

Page, S. (2013, November 18). Nursing Care Plan & Diagnosis for Cystic Fibrosis with Nursing Interventions & Goals. Retrieved February 28, 2015, from http://www.registerednursern.com/nursing-care-plan-diagnosis-for-cystic-fibrosis-with-nursing-interventions-goals/