Patient Care and Monitoring

1. Perform a thorough history of prescription, nonprescription, and alternative medications. Assess adherence to the prescribed regimen, including timing ofinhaled medications with respect to airway clearance therapies and timing of enzymes and insulin with regard to meals. Is the patient taking any medications not prescribed by the CF center team?

2. Is the patient on all appropriate maintenance medications? Are medications at the appropriate doses for weight and/or age? If the patient is admitted, are maintenance medications ordered?

3. Evaluate the medication regimen for drug interactions, adverse reactions, and allergies.

4. Assess pulmonary symptoms. Review the incidence and quality of cough, dyspnea, respiratory rate, sputum production, and fever. Are the patient's PFTs decreased? Is there an oxygen requirement?

5. Review culture and sensitivity history over the last 1 to 2 years. What antibiotics were used in the past, and did the patient appear to respond better to a particular regimen? Is the patient currently on antibiotics, and if so, are the symptoms improving? Recommend an appropriate antibiotic regimen based on culture and sensitivity data.

6. Review the pharmacokinetic history. Are there any possible changes in clearance since the last antibiotic course? Will the patient be discharged home on IV antibiotics? Can the IV regimen be simplified or made more convenient for home administration? Recommend appropriate doses based on the patient's clearance and an appropriate but convenient schedule.

7. Perform pharmacokinetic adjustments as necessary. Recommend a monitoring plan for the antibiotic course. Are any other laboratory tests necessary? Are signs of toxicity present?

8. Assess nutritional status. Is the patient gaining or maintaining weight according to age? Are any oral supplements or tube feedings being used?

9. Assess Gl symptoms. What is the quantity and quality of bowel movements? Does the patient have bloating, flatulence, or abdominal pain?

10. Assess quality-of-life measures such as physical, psychological, and social well-being.

11. Understand that CF therapy is complicated, and recommend regimens to ease the care burden if possible.

12. Educate the patient and family, stressing the importance of adherence to the regimen.

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