PEDIATRIC NURSING
UNFOLDING CLINICAL REASONING
CASE STUDY
CYSTIC FIBROSIS
(Justin Ewing 7 Years Old)
, History of Present Problem:
Justin Ewing is a seven-year-old boy with a history of cystic fibrosis (CF) who for the past two days has had a fever of
102.1 F (38.9 C) and has felt more tired. His cough has become more frequent, and he is bringing up thick yellow mucus.
His mother brought Justin to his CF clinic where he is diagnosed with a right lower lobe pneumonia.
Justin is admitted to the pediatric unit for IV antibiotics, and you will be the nurse responsible for his care. Justin has
an implanted port for vascular access since he frequently needs IV antibiotics for respiratory infections. Justin is below
the 5th percentile for his weight at 41 pounds (18.6 kg) and is at the 5th percentile for height at 44.5 inches (113 cm). He
has a G-tube in place for night feedings.
Personal/Social History:
Justin is in the second grade and lives at home with both parents and his 5-year-old brother who is in good health. His
mother is a stay-at-home mom, and his father works as a computer software engineer. The family has health insurance
through the father’s employer. He receives Medicaid because of his chronic illness. He has missed many days attending
school due to CF but has a tutor provided by the school district. He told his parents that sometimes the kids at school
tease because he is so small.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
- temp 102.1 F - fever is sign of infection
- weight 18.6 kg, height 113 cm - mucus buildup from CF
- hx of CF - below proper percentile in height and weight, FTT
- cough with thick, yellow mucus
- right lower lobe pneumonia
- implanted port and g-tube
RELEVANT Data from Social History: Clinical Significance:
- lives at home with parents and brother stress of chronic disease among whole family, at risk fordepression
- missed many days at school, but has a tutor due to chronic disease and being teased in school, should have
- teased at school adeuqate insurance
- has Medicaid
Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment:
T: 102.6 F/39.2 C (oral) Provoking/Palliative: Justin states he does not have any pain when assessed using the
Wong-Baker FACES Pain Rating Scale
P: 116 (reg) Quality:
R: 26 (reg) Region/Radiation:
BP: 92/60 Severity:
O2 sat: 89% room air Timing:
What VS data are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential/Health Promotion and Maintenance)
RELEVANT VS Data: Clinical Significance:
T: 102.6 F/39.2 C - high temperature is a sign of infection, may need antipyretic
P: 116 (high) - mucus buildup could be causing obstructions in airway
R: 26 (high) - low O2 sat requires supplemental oxygen
O2 sat: 89%
UNFOLDING CLINICAL REASONING
CASE STUDY
CYSTIC FIBROSIS
(Justin Ewing 7 Years Old)
, History of Present Problem:
Justin Ewing is a seven-year-old boy with a history of cystic fibrosis (CF) who for the past two days has had a fever of
102.1 F (38.9 C) and has felt more tired. His cough has become more frequent, and he is bringing up thick yellow mucus.
His mother brought Justin to his CF clinic where he is diagnosed with a right lower lobe pneumonia.
Justin is admitted to the pediatric unit for IV antibiotics, and you will be the nurse responsible for his care. Justin has
an implanted port for vascular access since he frequently needs IV antibiotics for respiratory infections. Justin is below
the 5th percentile for his weight at 41 pounds (18.6 kg) and is at the 5th percentile for height at 44.5 inches (113 cm). He
has a G-tube in place for night feedings.
Personal/Social History:
Justin is in the second grade and lives at home with both parents and his 5-year-old brother who is in good health. His
mother is a stay-at-home mom, and his father works as a computer software engineer. The family has health insurance
through the father’s employer. He receives Medicaid because of his chronic illness. He has missed many days attending
school due to CF but has a tutor provided by the school district. He told his parents that sometimes the kids at school
tease because he is so small.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
- temp 102.1 F - fever is sign of infection
- weight 18.6 kg, height 113 cm - mucus buildup from CF
- hx of CF - below proper percentile in height and weight, FTT
- cough with thick, yellow mucus
- right lower lobe pneumonia
- implanted port and g-tube
RELEVANT Data from Social History: Clinical Significance:
- lives at home with parents and brother stress of chronic disease among whole family, at risk fordepression
- missed many days at school, but has a tutor due to chronic disease and being teased in school, should have
- teased at school adeuqate insurance
- has Medicaid
Patient Care Begins:
Current VS: P-Q-R-S-T Pain Assessment:
T: 102.6 F/39.2 C (oral) Provoking/Palliative: Justin states he does not have any pain when assessed using the
Wong-Baker FACES Pain Rating Scale
P: 116 (reg) Quality:
R: 26 (reg) Region/Radiation:
BP: 92/60 Severity:
O2 sat: 89% room air Timing:
What VS data are RELEVANT and must be interpreted as clinically significant by the nurse?
(Reduction of Risk Potential/Health Promotion and Maintenance)
RELEVANT VS Data: Clinical Significance:
T: 102.6 F/39.2 C - high temperature is a sign of infection, may need antipyretic
P: 116 (high) - mucus buildup could be causing obstructions in airway
R: 26 (high) - low O2 sat requires supplemental oxygen
O2 sat: 89%
