4/1/2026
SBAR: Christopher Parrish
S: Christopher Parrish is an 18-year-old male with a history of cystic fibrosis who presented to
the ED overnight in respiratory distress and has just been transferred to the ward. The primary
focus of care is managing his increased work of breathing, facilitating airway clearance, and
monitoring for a potential pulmonary exacerbation. He is currently stable on 2 liters of oxygen
via nasal cannula.
B: The patient was diagnosed with cystic fibrosis as an infant and has a history of frequent
hospitalization for respiratory issues. Upon ED arrival, his oxygen saturation was 85%-87% on
room air. He reports a recent 10-day history of decreased appetite and difficulty clearing
secretions. He has no known allergies. Current orders include his regular high-protein diet with
supplements and his home regimen of an airway clearance vest used twice daily. He was
administered 650 mg of Acetaminophen at 0730 for an oral temperature of 37.8 °C.
A: The patient is AAOx4 and appears slightly pale with dry mucous membranes. Current vitals
show BP 124/80, HR 86 (Sinus Rhythm), RR 20, and Temp 37.8 °C. On 2L O2 via nasal
cannula, his SpO2 is 94%. Patient reports a 3/10 pain level localized to his chest and back; the
pain is described as tenderness that is provoked by coughing with no reported radiation.
Respiratory assessment reveals mild subcostal retractions, a loose productive cough, and crackles
auscultated in the lower lung bases. Clubbing is present in the nail beds, though no cyanosis is
noted. He is a fall risk due to fatigue and respiratory compromise.
R: I recommend performing a thorough respiratory assessment every 4 hours, including close
monitoring of sputum production. Ensure he remains in a high sitting position to optimize lung
expansion. Also, his airway clearance vest therapy should be scheduled and provide further
education on huff coughing and deep-breathing exercises. His nutritional intake should also be
monitored closely given his recent poor appetite and provide high-protein shakes with his
breakfast.
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