Each item outlined below must be reviewed at least once on an annual basis. To achieve this goal, a portion of the education program should be reviewed at each quarterly visit.  Older of presentation will vary with clinical needs of patient.
A. Nutrition/GI (taught by MD/RD/RN)
1. Review enzyme usage -- Dosage, relation to meals, signs and symptoms of too few or too many enzymes
2; Review fat-soluble vitamin supplementation, food sources for vitamins, minerals, and water miscible supplement, dosage
3. Dietary education (RD)
a) High protein, high caloric food choices
b) Provide written menus
c) Nutritional supplements with written guidelines
d) Referrals for supplemental funding for food (WIG, etc)
e) Anticipatory guidance for managing periods of increased
caloric needs such as sports, illness puberty
f) Anticipatory guidance for behavior issues surrounding eating
4. Review nutritional management (enzymes and food choices) at school or work
5. Review potential gastrointestinal problems -- Constipation, obstipation, rectal prolapse*, abdominal pain, CI bleeding, including warning signs and plan for care should these problems occur
6. Review dosage(s) of other gastrointestinal medication such as ursodeoxycholic acid, H,-blockers, antacids. Discussion of potential side effects and interactions with other medications
* Pediatric population
B. Respiratory(taught by RN/RT/PT/MD)
Lower Respiratory
1. Review signs and symptoms of a pulmonary exacerbation
a) When to call the CF Care Center versus primary care physician
b) When to initiate further treatments such as chest physiotherapy,
nebulizer therapy, etc
2. Review postural drainage and percussion, including written or video instruction
3. Initial training and subsequent review of other airway clearance techniques for effective clearance of secretions, including Flutter, PEP, autogenic drainage, ACBT, or vest
4. Review of proper cough techniques for effective expectoration and clearance of secretions
5. Training and review -- Proper use and maintenance of nebulizers  for aerosol therapies, including preparation of medication, breathing techniques, cleaning, drying, and monitoring for malfunctioning equipment
6. Training and review - Proper usage of metered dose inhalers and spacers, in eluding inhalation techniques and monitoring for empty canister(s)
7. Review of exercise programs
8. Review of dosage(s) and timing of all medications, including antibiotics, bronchodilators, corticosteroids, ibuprofen, theophylline, cromolyn, rhDNase, other mucolytic agents. Discussions regarding potential side effects and interactions between medications
9. Review risks of exposure to cigarette smoke and other environmental toxins
Upper Respiratory/Sinuses
1. Review signs and symptoms of sinusitis and when to call clinic
2. Review proper use of nasal sprays and corticosteroids, decongestants, etc
3. Review any over-the-counter medications -- Potential side effects and
interactions with prescribed therapy
1. Endocrine -- Diabetes education for new onset diabetes (minimum 120 minutes)
2. Genetics -- All patients/families should be offered complete genetics counseling by a genetics counselor (minimum 90 to 120 minutes) with periodic updates, and genetic mutation analysis
3. Fertility -- Adolescents and young adults need education and counseling regarding issues of infertility (males especially), contraception, and sexually transmitted diseases including HIV

Introduction to Outpatient Care | Preventive and Maintenance Care  | Physical Examination  | Interventions: Medications And Supplements | Patient Education | Functional Psychosocial | Case Management | CF Preventive and Maintenance Care (1)
Patient Home Worksheet | CF Preventive and Maintenance Care (2)
Patient Home Worksheet | CF Preventive and Maintenance Care (3)
Patient Home Worksheet

To contact us: landon@rain.org
Phone: 805-289-3333 Fax 805-289-3310