Page 1036 - Saunders Comprehensive Review For NCLEX-RN

5. Handheld percussors or a special vest device that
provides high-frequency chest wall oscillation may be
prescribed to help loosen secretions.
6. A positive expiratory pressure mask may be
prescribed; use of this mask forces secretion to the
upper airway for expectoration.
7. The child should be taught the forced expiratory
technique (huffing) to mobilize secretions for
expectoration.
8. Bronchodilator medication by aerosol may be
prescribed; the medication opens the bronchi for
easier expectoration (administered before chest
physiotherapy when the child has reactive airway
disease or is wheezing). Medications that decrease the
viscosity of mucus may also be prescribed.
9. A physical exercise program with the aim of
stimulating mucus expectoration and establishing an
effective breathing pattern should be instituted.
10. Aerosolized or IV antibiotics may be prescribed; IV
antibiotics may be administered at home through a
central venous access device.
11. Oxygen may be prescribed during acute episodes;
monitor closely for oxygen narcosis (signs include
nausea and vomiting, malaise, fatigue, numbness and
tingling of extremities, substernal distress), because a
child with cystic fibrosis may have chronic carbon
dioxide retention.
12. Lung transplantation may be an option.

H. Interventions: Gastrointestinal system

1. A child with cystic fibrosis requires a high-calorie,
high-protein, and well-balanced diet to meet energy
and growth needs; multivitamins and vitamins A, D,
E, and K are also administered; for those with severe
lung disease, energy requirements may be as high as
20% to 50% or more of the recommended daily
allowance.
2. Monitor weight and for failure to thrive.
3. Monitor stool patterns and for signs of intestinal
obstruction.
4. The goal of treatment for pancreatic insufficiency is to
replace pancreatic enzymes; pancreatic enzymes are
administered within 30 minutes of eating and
administered with all meals and all snacks (enzymes
should not be given if the child is NPO).
5. The amount of pancreatic enzymes administered
depends on the primary health care provider’s
(PHCP’s) preference and usually is adjusted to

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