Case studyRespiratory conditions

Hospitalized for management of cystic fibrosis

Every order in this case maps onto a mechanism of the disease. Reading them that way turns a list of tasks into an explanation of why he is losing weight.

Editorial process

Last reviewed · August 25, 2026

Written by

Maren Caldwell

MSN, RN, CNE

Medical-surgical nursing, pharmacology and NCLEX preparation

Reviewed by

Dr. Tessa Redmond

DNP, RN, CNE

Evidence-based practice and clinical education

On this page

Interpret the task
Assignment instructions
Deliverables
Proposed outline
Research plan
Reference shortlist
Final review

Each order maps onto a mechanism

The order set is the teaching material here, because every line connects to a mechanism of the disease. Pancrelipase with meals and at the start of the night feed is enzyme replacement for exocrine pancreatic insufficiency, and the timing matters because the enzyme has to be present with the food rather than before or after it. The high-fat, high-calorie, high-protein diet with overnight supplemental feeding reflects an energy requirement well above normal, driven by the work of breathing and chronic infection, combined with malabsorption, which is why a thirteen-pound loss is a clinical emergency in this patient rather than a lifestyle observation. Daily weights and intake and output are the measure that tells you whether the plan is working, which is why they are ordered daily rather than weekly. Reading the orders this way also gives the answer a structure the case itself supplies. The list of orders is not administrative detail; it is the case's explanation of itself.

Note the discrepancy in the record itself: the narrative describes an eighteen-year-old and the SBAR says nineteen. That is worth flagging rather than silently choosing one, because identifying a data conflict in a handover is a real clinical skill and a marker will recognise it. The other thread the case supplies is developmental. He is at college, his mother noticed the deterioration on a visit, and adolescence to young adulthood is the period when adherence to a demanding regimen most commonly falls away as responsibility shifts from parent to patient. That gives the assessment a direction: ask about enzyme dosing at college, missed doses, meal patterns and cost, since the weight loss may be a regimen problem rather than a disease progression problem, and those lead to different plans. Infection control also belongs in the answer, because cystic fibrosis has specific isolation requirements to prevent cross-infection between patients.

Likely learning objectives

Connect each order to the mechanism it addresses.
Explain the energy deficit as intake, absorption and expenditure together.
Flag a data conflict in a handover rather than resolving it silently.
Assess adherence during the transition to self-management.

Assignment instructions

Read the full question

Review every instruction before using the planning guidance that follows.

Christopher Parrish is an 18-year-old adolescent male who is hospitalized for management of cystic fibrosis with weakness and weight loss. He reports fatigue, and he has had a recent 6 kg (13.2 lb) weight loss. He was diagnosed with cystic fibrosis as an infant and has had multiple hospitalizations for respiratory and nutritional support. A nasogastric (NG) tube has been placed for feedings. Medications: · Pancrelipase supplement 5 capsules PO QID with meals and at start of nightly tube feeding · Multivitamin 2 tabs PO daily · Potassium chloride 40 mEq PO daily Orders: · Vital signs every 4 hours · Daily intake and output, and weight · Chest X-ray: AP and lateral tomorrow morning · Insert nasogastric tube · Nutrition consult · Diet: High-fat, high-calorie, high-protein regular diet, supplement with high-protein snacks in between meals · Promote tube feedings (1.5 kcal/mL) in nasogastric tube; administer 720 kcal over 8 hours at night (infuse via pump from 2200-0600) SBAR: S: Christopher Parrish is an 19-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-French, 42-inch feeding tube was placed in his right nare about an hour ago, and x-ray just called and confirmed placement in the stomach. The pump is in his room. He is up to the bathroom prn; otherwise bed rest. B: 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 he registered at the local college and moved to live in a dormitory, one month ago. Chris’s mom was here earlier, but she is a single parent and has two younger boys, so she had to go home. A: Christopher is awake and alert. His heart rate and rhythm are regular at 85 bpm. Breath sounds are fine with a respiratory rate at 18/min and his SpO2 saturation is 98% on room air. 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 skin turgor is > 3 seconds and his mucous membranes are dry. His belly is flat and nontender. Bowel sounds are normoactive. Chris is noted to have a persistent productive cough, and his sputum is noted to be thick and yellow in color. Chris tends to get short of breath with any strenuous activity. He was noted to become short of breath, with an increase in RR to 26 bpm, after walking in the hallway for about 10 minutes. His potassium level this morning was low at 3.2 mEq/L. R: Christopher is due for vital signs and assessment. The tube feeding just arrived, and you will need to start it on the pump. He needs 720 kilocalories over 8 hours overnight. His regular diet is high calorie, high fat, but he wasn’t too hungry this evening; just had a bit of his chocolate shake. You will need to give his pancreatic enzymes orally before you start the tube feeding. You should also assess his diet and reinforce patient education on nutrition.

What the case requires

01An assessment of Christopher's presentation, history and current status.
02An account of the medication regimen including pancrelipase, multivitamin and potassium chloride.
03The rationale for the ordered diet and nasogastric feeding schedule.
04Interpretation of the ordered monitoring, including daily weight and intake and output.
05Nursing priorities arising from the SBAR handover.
06Patient education appropriate to an adolescent moving into self-management.