Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for follow-up of Cystic Fibrosis-related bronchiectasis. Reports chronic productive cough with [mucoid/purulent] sputum, increased frequency of exacerbations, and baseline dyspnea on exertion. Denies hemoptysis, chest pain, or recent fever. Adherence to airway clearance techniques (ACT) and inhaled mucolytics noted as [consistent/suboptimal].
Clinical Examination Findings
General: Alert and oriented, appears [well/chronically] ill. Respiratory: Tachypneic at rest, use of accessory muscles noted. Auscultation reveals diffuse coarse crackles, expiratory wheezing, and rhonchi, predominantly in the [upper/lower] lobes. Clubbing of digits present. Cardiovascular: Regular rate and rhythm, no murmurs or peripheral edema.
Treatment Protocol
Plan: 1. Airway Clearance: Continue daily ACT (e.g., vest therapy/PEP mask). 2. Pharmacotherapy: Inhaled hypertonic saline [3%/7%] BID, Pulmozyme (dornase alfa) daily, and inhaled tobramycin [cycle/continuous]. 3. Nutrition: Continue pancreatic enzyme replacement therapy (PERT) and fat-soluble vitamin supplementation. 4. Monitoring: Sputum culture for Pseudomonas/MRSA, PFTs, and routine CBC/CMP.