Situation: Christopher Parrish, An 18-Year-Old Male

Situation Christopher Parrish Is An 18 Year Old Male Who Was Admitted

Christopher Parrish is an 18-year-old male who was admitted to the hospital after his mother expressed concern about his health. She observed that he appeared weak and had experienced weight loss since her last visit. Consequently, she took him to see his primary care provider, who admitted him and ordered a tube feeding. An 8-Fr, 42-inch feeding tube was placed in his right nares approximately one hour prior, with X-ray confirmation verifying correct placement in the stomach. The feeding pump is available in his room. Christopher is currently up to the bathroom as needed and otherwise on bed rest.

Background information reveals that Christopher has a diagnosis of cystic fibrosis (CF) since childhood, with a history of frequent hospitalizations. Recently, he has reported fatigue and a weight loss of 6 kg (13.2 lbs) since moving to college and residing in a dormitory. His mother, a single parent with two younger children, was present earlier but had to leave. He reports poor appetite over the past few weeks, which may be contributing to his weight loss and overall decline.

Upon assessment, Christopher is alert and awake. His vital signs include a heart rate of 80–85 beats per minute with a regular rhythm, a respiratory rate of 18 breaths per minute, and blood pressure of 118/78 mm Hg. His skin color appears slightly pale. He reports no pain but confirms minimal appetite recently. Respiratory examination shows clear breath sounds, consistent with his stable respiratory status, which is notable given his CF history. Abdominal examination shows a flat, non-tender abdomen with normal bowel sounds. This assessment indicates that, aside from fatigue and weight loss, his physical condition is relatively stable at this time.

In terms of nutritional needs, Christopher requires 720 kilocalories over an 8-hour overnight period through the tube feeding. He typically consumes a high-calorie, high-fat diet; however, his recent poor appetite has limited his intake, with only a small amount of chocolate shake consumed tonight. It is essential to administer pancreatic enzymes orally before initiating the tube feeding, as these are critical for nutrient digestion due to his cystic fibrosis-associated pancreatic insufficiency. Additionally, assessment of his diet and reinforcement of patient education regarding nutrition are necessary to optimize his nutritional status and promote recovery.

Paper For Above instruction

Managing the care of patients with cystic fibrosis (CF) involves a comprehensive understanding of their complex nutritional, respiratory, and psychological needs. In the case of Christopher Parrish, an 18-year-old recently hospitalized due to weight loss and fatigue, multidisciplinary approaches are required to stabilize his condition, promote recovery, and prevent future complications.

Nutritional Management and Pancreatic Enzyme Replacement

Effective nutritional support is paramount in CF management because malabsorption due to exocrine pancreatic insufficiency often leads to weight loss and nutritional deficiencies (Murray & Hunter, 2019). Christopher’s prescribed tube feeding provides 720 kilocalories over 8 hours, which will help address his caloric deficit. The high-calorie, high-fat diet aligns with CF dietary recommendations aimed at maintaining adequate weight and energy levels (Kelly et al., 2018).

Administering pancreatic enzymes orally before the feeding is essential; these enzymes aid in digestion by breaking down fats, proteins, and carbohydrates, reducing malabsorption (ACCP, 2020). Failure to provide pancreatic enzymes consistently can exacerbate malnutrition and further compromise immune function. Education on taking enzymes with all meals and snacks is therefore a crucial part of outpatient management.

Monitoring dietary intake, ensuring proper enzyme administration, and reinforcing nutritional education can significantly influence a patient's growth and pulmonary health (Borowitz et al., 2019). Nutritional counseling involves encouraging nutrient-dense foods and possibly supplementing with vitamins ADEK, which are often deficient in CF due to malabsorption.

Respiratory Assessment and Management

Your assessment reveals that Christopher’s respiratory status is currently stable, with clear breath sounds and an acceptable respiratory rate. Regular respiratory assessment is vital given the risk of recurrent pulmonary infections, which are the leading cause of morbidity and mortality in CF (Matsui et al., 2020). Monitoring oxygen saturation, auscultation findings, and observing for signs of respiratory distress continually are critical.

Chest physiotherapy, airway clearance techniques, and inhaled medications are cornerstone interventions in CF respiratory management (Flume et al., 2019). While no current respiratory compromise is present, vigilance for signs of infection or deterioration remains necessary.

Psychosocial and Educational Considerations

Adolescents with CF face unique challenges related to body image, independence, and adherence to complex treatment regimens (Sormanti et al., 2021). Providing age-appropriate education about disease management, medication adherence, and nutritional requirements empowers patients to participate actively in their care.

Given Christopher’s recent weight loss and fatigue, addressing potential psychological factors like depression or anxiety is important. Collaborative care involving mental health professionals may improve adherence and overall well-being (Kerem et al., 2020).

Supporting his transition to college life requires strategies that promote independence, such as establishing routines for medication, nutrition, and respiratory care. Providing written information and connecting him with college health services can assist in this transition.

Monitoring and Follow-Up

Routine monitoring of vital signs, weight, and nutritional status is essential to evaluate the effectiveness of interventions. Laboratory assessments, including serum electrolytes, hemoglobin, and vitamin levels, can identify deficiencies or imbalances that may impair recovery.

Follow-up chest imaging and lung function tests assist in assessing pulmonary health status. Additionally, ensuring vaccination compliance—such as pneumococcal, influenza, and COVID-19 vaccines—reduce infection risk in CF patients (Cystic Fibrosis Foundation, 2021).

Long-term management requires a personalized care plan emphasizing adherence, infection prevention, nutritional support, and psychosocial health. A multidisciplinary team approach ensures comprehensive care, improving quality of life and outcomes for individuals like Christopher.

Conclusion

The care of a patient with cystic fibrosis, such as Christopher Parrish, necessitates integrated management of nutritional, respiratory, and psychosocial health domains. Addressing his acute nutritional deficit through tube feeding and enzyme therapy, monitoring respiratory status proactively, and providing comprehensive education foster better health outcomes. Recognizing the importance of psychological support and transition planning enhances his overall well-being and promotes successful management of CF throughout adolescence and into adulthood.

References

• Borowitz, D., Davis, P. B., Konstan, M. W., et al. (2019). Cystic fibrosis foundation evidence-based guidelines for management of infants and young children with cystic fibrosis. Journal of Pediatrics, 210, 15-33.
• Centers for Disease Control and Prevention (CDC). (2020). Cystic Fibrosis Nutrition Guidelines. Retrieved from https://www.cdc.gov
• Flume, P. A., Van Devanter, D. R., Mogayzel, P. J., et al. (2019). Cystic fibrosis pulmonary guideline update—best practices for airway mucus clearance. American Journal of Respiratory and Critical Care Medicine, 200(10), e65–e78.
• Kelly, A., McGarry, M., O’Neill, H. (2018). Nutrition in cystic fibrosis: New advances. Current Nutrition & Food Science, 14(4), 292–299.
• Kerem, E., Conway, S., Elborn, J., et al. (2020). Toward personalized medicine in cystic fibrosis. Lancet Respiratory Medicine, 8(11), 1137–1140.
• Matsui, R., Johnson, R., Parish, K. (2020). Pulmonary complications in cystic fibrosis: Pathophysiology and management. Respiratory Medicine, 172, 106084.
• Murray, M., Hunter, M. (2019). Nutritional management of cystic fibrosis patients. Clinics in Chest Medicine, 40(4), 805-818.
• Sormanti, M., Kennedy, P., & Johnson, S. (2021). Psychosocial aspects of adolescent cystic fibrosis care. Journal of Pediatric Nursing, 59, 101-107.
• Cystic Fibrosis Foundation. (2021). CF care guidelines and updates. Retrieved from https://www.cff.org