Case Story

Adherence

Theresa is a bright, active 17-year-old and a model patient.  Her cystic fibrosis hasn’t slowed her down one bit.  She makes high grades in school, is involved in student council and yearbook, and loves to play volleyball on the all-girls team.

Theresa comes from a well-educated family.  Her mom is a pharmacist at the local pharmacy and her dad teaches biology at the high school in the neighboring town.  Since both her parents work, Theresa manages her own daily treatment regimen.  She and her parents have done a wonderful job at treatment, and Theresa hasn't been in the hospital for any problems in 10 years—a great record for a young person with cystic fibrosis.  Her parents and the Cystic Fibrosis Center team feel that Theresa does an excellent job adhering to medications and this shows what a responsible young woman Theresa is.

Theresa's treatments are certainly no walk in the park.  She has daily respiratory therapy to help keep her lungs clear, and she takes loads of medications, including inhaled medications for her lungs, a hi-potency multivitamin/mineral supplement with extra vitamins A, E, D and K, enzymes to aid digestion, pills that help reduce stomach acid and enhance enzyme action, and two medications to keep her bowel movements regular. She also takes three eight-ounce cans of a nutritional supplement to maintain her weight. She takes several courses of antibiotics throughout the year.

Theresa has come to clinic for an unscheduled visit complaining about an irritating, shallow cough.  She decided not to mention the constipation she has had for the last two weeks.  Little does she know that she will be admitted to the hospital for concerns that she had no idea were important.

Things to consider about this case

There are several issues to consider about this case. You will explore these issues more fully in the learning activities.

• The effect of Theresa's daily schedule on her adherence.
• Theresa's level of responsibility for her care given her developmental status.
• How her relationship with the Cystic Fibrosis Center team affects her adherence.