Situation: Christopher Parrish Is 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 at 1900 today. His mother visited him at his college dormitory and was very concerned with his health; he seemed weak and had lost weight since she last saw him. She took him to see his primary care provider, and the provider admitted him and has ordered a tube feeding. An 8-Fr, 42-inch feeding tube was placed in his right nares about an hour ago, and an x-ray confirmed its placement in the stomach. The pump is in his room.

He is up to the bathroom as needed; otherwise, bed rest. Background: Christopher was diagnosed with cystic fibrosis as a child and has had frequent hospitalizations previously. He reports fatigue and has recently lost 6 kg (13.2 lb) after registering at the local college and moving to live in a dormitory. His mother was here earlier, but she is a single parent with two younger boys, so she had to leave.

Assessment: Christopher is awake and alert. His heart rate and rhythm are regular at 80–85/min. Breath sounds are fine with a respiratory rate at 18/min. His color is a bit pale. Blood pressure is 118/78 mm Hg. He reports no pain and states he's not had much appetite the past few weeks. His abdomen is flat and non-tender. Bowel sounds are normoactive.

Recommendation: Christopher is due for vital sign assessment and a physical evaluation. The tube feeding just arrived, and you will need to initiate it on the pump. He requires 720 kilocalories over 8 hours overnight. His regular diet is high calorie, high fat, but he was not very hungry this evening, having only a bit of his chocolate shake. Before starting the tube feeding, you should administer his pancreatic enzymes orally. It is also important to assess his dietary intake and reinforce patient education regarding nutrition and disease management.

Paper For Above instruction

Managing nutrition in patients with cystic fibrosis (CF), especially during hospitalization, presents unique challenges that require a comprehensive understanding of pathophysiology, patient assessment, and tailored nutritional interventions. In this context, the case of Christopher Parrish highlights several critical nursing and clinical considerations necessary for ensuring optimal nutritional support, management of comorbidities, and patient education.

Introduction

Cystic fibrosis is a hereditary disorder characterized by defective chloride channels leading to thick, sticky mucus production in various organs, primarily affecting the lungs and the pancreas. Patients often experience malabsorption, recurrent respiratory infections, and nutritional deficiencies, which necessitate specialized management strategies. For patients like Christopher, maintaining adequate caloric intake is vital to support growth, energy needs, and overall health, especially during periods of illness or hospitalization.

Assessment of the Patient

Initial assessment is crucial to developing an appropriate nutritional plan. Christopher’s clinical presentation includes weight loss of 6 kg over a short period, pale skin, and recent fatigue—signs indicative of nutritional deficiency and possibly ongoing infection or inflammation. His vital signs, including blood pressure (118/78 mm Hg), heart rate (80-85 bpm), and respiratory rate (18/min), are within normal limits, but his pallor and weight loss warrant close monitoring.

Additional assessment measures include evaluating his nutritional intake, appetite, and gastrointestinal functioning. His recent poor intake, limited to a chocolate shake, indicates an inadequate caloric and nutrient intake for someone with CF, who typically requires a high-calorie, high-fat diet to compensate for malabsorption. Bowel sounds are normal, and abdominal assessment reveals no tenderness, suggesting no current gastrointestinal obstruction or acute issues.

Laboratory assessments, including serum prealbumin, albumin, electrolytes, and markers of inflammation, should be reviewed to evaluate his nutritional status and hydration. Pulmonary function tests and ongoing respiratory assessment are also essential given his CF background.

Nutrition Management and Interventions

The primary nutrition intervention involves initiating the prescribed tube feeding, which aims to deliver 720 kilocalories over 8 hours, supplementing his regular diet. Enteral nutrition is particularly beneficial in CF patients with inadequate oral intake, malabsorption, or increased metabolic demands due to chronic infections. The feeding should commence after administering pancreatic enzymes—crucial for digestion and absorption of fats and proteins in CF patients.

Pancreatic enzyme replacement therapy (PERT) is fundamental in CF management to improve nutrient absorption. The enzymes should be given orally before starting the tube feeding to optimize digestion, which is compromised by pancreatic insufficiency. Proper timing and dosing are vital to reduce gastrointestinal symptoms such as steatorrhea and discomfort.

Monitoring and adjusting the feeding regimen based on tolerance, residual gastric volume, and metabolic responses is key. Regular assessment of the patient’s weight, caloric intake, gastrointestinal tolerance, and signs of aspiration or intolerance should guide ongoing nutritional therapy.

Given his recent weight loss and fatigue, nutritional support should also include diet counseling to reinforce high-calorie, high-fat intake, consistent with CF dietary recommendations. Dietary modifications might include calorie-dense foods, supplemental snacks, and enrichment of meals to meet increased energy needs.

Patient Education and Support

Patient education forms an essential component of CF management. Christopher needs to understand the importance of adhering to his pancreatic enzyme regimen and dietary modifications to optimize nutrient absorption and overall health. Education should also address recognizing signs of hypoglycemia, worsening respiratory symptoms, or gastrointestinal intolerance and when to seek medical attention.

Encouraging adequate hydration and physical activity within tolerance can also assist in improving respiratory health. Since CF patients are at risk for recurrent infections, education about infection control practices, immunizations, and prompt reporting of new symptoms is crucial.

Supporting the patient and his family, especially during hospitalization, involves not only providing information but also emotional support, addressing concerns about his health, and fostering independence in disease management skills.

Conclusion

Effective management of nutritional therapy in CF patients like Christopher requires a multifaceted approach involving careful assessment, tailored nutritional interventions, timely administration of pancreatic enzymes, and patient education. The integration of multidisciplinary care teams, including dietitians, pulmonologists, and nurses, ensures comprehensive management aimed at improving clinical outcomes, enhancing quality of life, and preventing complications such as malnutrition and respiratory decline.

References

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