The nurse would identify which nursing diagnoses as appropriate for a 10-year-old patient just diagnosed with cystic fibrosis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply

Question

1. Ineffective Airway Clearance
2. Anticipatory Grieving
3. Imbalanced Nutrition: Less than Body Requirements
4. Mobility, Altered
5. Infection, Risk for

Answer 1

1,2,3,5
Rationale 1: Ineffective Airway Clearance is related to the thickened mucus production of the respiratory tract that makes it difficult to expectorate.
Rationale 2: The life span and lifestyle of a patient with cystic fibrosis are limited. The child may grieve for losses at his or her own level—for example the loss of the ability to play with other children.
Rationale 3: Due to the pancreatic enzyme deficiency and impaired digestion, nutrition is altered even with medication to improve the process. If the patient does not comply with the medical regimen, death from respiratory failure and nutrition deficit is likely.
Rationale 4: The patient may experience decreased oxygenation, which would result in Fatigue or Activity Intolerance as nursing diagnoses. There is no indication that mobility is altered.
Rationale 5: The patient with CF has chronic pulmonary disease and is at risk for infection.