Mrs. Deer is a 72-year-old female who presents to your office complaining of right upper quadrant pain that has been increasing in intensity over the past 2 days. She would have come sooner, but she lacked transportation and waited until her son could drive her. She states that she has not been sleeping very much because of the pain. She has been nauseous and vomited a couple of times two days ago but has only been drinking fluids. She states that she has not been around anyone else that had an upset stomach. She recalls prior to the onset of pain she had been at a church supper that included meats, refried beans, and many desserts which she sampled. She described the fried pies that she brought to the supper and ate the extras that afternoon. Vital Signs: BP 130/80, HR 85, RR 20, Temp 99.0°F. Discuss the following: 1) What additional subjective data are you seeking to include past medical history, social, and relevant family history? 2) What additional objective data will you be assessing for? 3) What are the differential diagnoses that you are considering? 4) What laboratory tests will help you rule out some of the differential diagnoses? 5) What radiological examinations or additional diagnostic studies would you order? 6) What treatment and specific information about the prescription that you will give this patient? 7) What are the potential complications from the treatment ordered? 8) What additional laboratory tests might you consider ordering? 9) What additional patient teaching may be needed? 10) Will you be looking for a consult?

Initial Post The first client you see in your clinical rotation has cystic fibrosis. As you engage this client and his family, you ask how they were diagnosed with this problem. The client doesn’t want to talk about it, and the family said that the physician took care of this a long time ago. Now you are curious and look up the testing process for genetic health problems. Describe methods of testing to diagnose cystic fibrosis. Discuss who may perform these tests and when. Describe what you believe will be the psychological needs of the client and family. Justify your thoughts based on facts about cystic fibrosis. Response Posts Response Post 1: After reviewing the posts from your colleagues, comment on the timing of testing to support the family’s desire to plan for care and services. Response Post 2: Describe possible resources that the family may access to provide additional information and support the psychological needs of the client and family. Response 1 There’s many different methods of testing for Cystic Fibrosis (CF) some of which are done as a child others can be done at any age. Sweat and genetic testing are the two most commonly used, each providing their own specific results. A sweat test can be done with someone of any age but it is mainly done to babies. Babies are usually between 2 to 6 weeks ago. A health care provider will put pilocarpine, a medicine that causes sweating, on a small area of the forearm. Then an electrode on this area. This current makes the medicine seep into the skin; the patient may feel little tingling or warmth. After removing the electrode, the sweat is collected. Sweat will be collected for 30 minutes and then sent to a lab. (Medline plus, 2021) Genetic test is a bit different from sweat testing because the test is done chest x-ray, and skin cells. In the skin as well as some organs there is protein called CFTR( Cystic Fibrosis transmembrane conductance regulator) that is responsible for regulating salt movement in and out the cell but with CF the protein is defective and chloride movement cannot take place. The abnormal levels of the CFTR and action, which is what labs are at times looking for. The needs of the patient from an outside point of view would be facts and data showing what’s going to happen, how are people handling the illness, and what support groups are out there for them. At the start they might feel that it’s but during the information session they most likely change their mind. Most of the time people only hear the scary and big bad of what’s going to happen, not the other side of things their loved one will still be able to do. Response 2 Cystic Fibrosis is a genetic disorder that affects the lungs and the pancreas. Cystic fibrosis is diagnosed by utilizing a newborn screening, clinical evaluation, genetic testing, lung function tests such as ABGs, PFTs, or chest X-rays. ( Story, 2020). A newborn screening became mandatory in 2009 in all 50 states. If immunoreactive trypsinogen (IRT) is elevated then a sweat test is recommended (Janeczko, 2016). The sweat test measures the amount of chloride and is done between 2-4 weeks of age(Janeczko,2016). Prenatal and Genetic testing is recommended if there is a positive family history of cystic fibrosis. Diagnostic kits have to be approved by the FDA and are done at 64 laboratories in the US (Janeczko,2016). The psychological needs of the client and family begin with education on the disease. Understanding the what, how, and why will help the family and client know what is happening in the body. Joining support groups is another helpful way to assist the client and family. This diagnosis can feel like a death sentence to families and many do not know how to cope properly. Having others around to talk to about appointments, hospitalizations, medical devices, and just having that emotional support could assist the family with being supportive to the client. Learning about nutrition is another valuable tool. Making sure the client eats and feels supported during this time can extend the life expectancy. To help increase the psychological needs education, therapy, support groups, and classes will be the best direction to go. References Janeczko, D. (2016). Cystic Fibrosis: Basics, Testing, Treatment. Journal of Continuing Education Topics & Issues, 18(2), 50–57. Story, L. (2020). Pathophysiology: A Practical Approach (4th Edition). Jones & Bartlett Learning. https://ambassadored.vitalsource.com/books/9781284...