Read a selection of your colleagues’ responses and respond to at least two of yo

Read a selection of your colleagues’ responses and respond to at least two of your colleagues who were assigned a different patient case study, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples. -Use at least 2 current scholarly sources in each reply, and a minimum of 200 words/per reply is needed. -APA format is required
Case Study HH is a 68 yo Male who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days. His Past Medical History is significant for COPD, HTN, hyperlipidemia, and diabetes. He remains on empiric antibiotics, which include ceftriaxone 1 g IV Q day (day 3) and azithromycin 500 mg IV Q day (day 3). Since admission, his clinical status has improved, with decreased oxygen requirements. He is not tolerating a diet at this time with complaints of nausea and vomiting.
Height: 5’8” Weight: 89 kg
Allergies: Penicillin (rash). 1) Post 1 by Laur Mcclur: Patient’s Health Needs
His nutrition needs to be addressed since he cannot tolerate food or fluids. The patient’s status is improving but the patient is currently experiencing nausea and vomiting which should be addressed with prescribing Zofran 8mg every 8 hours. When the patient is able to tolerate fluids and food this will help his overall clinical status. If oral intake cannot be sustained then he may need to be placed on IV fluids. The patient is diabetic and has hyperlipidemia. His blood sugars need to be monitored closely for hypoglycemia since he is not taking in fluid/food. His diet plan should include a heart healthy/diabetic diet while in the hospital.Since he has COPD monitoring his pulse ox throughout the hospital stay is important. If the Sa02 is less than 90 it must be corrected and may need supplemental oxygen or measure arterial blood gases.
Recommendation of Treatment for Patient
I would recommend the patient to provide a good quality sputum culture. To identify the specific organisms. The pathogens causing CAP can be classified as two types “1) Typical agents such as Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, Group A Streptococci, anaerobes, and gram-negative organisms and (2) Atypical agents such as Legionella, Mycoplasma, Chlamydia pneumoniae, and C. Psittaci” (Rider & Frazee, 2019).Community acquired pneumonia (CAP) include empiric antibiotics such as This will help to determine if he is on the right course of antibiotics to target the bacteria identified. He is currently on empirical antibiotic therapy which is indicated for community acquired pneumonia in which the causative agent has not been identified. I would recommend obtaining a sputum gram stain the causative agent can be identified and specific antibiotic can be ordered. “Sputum Gram stain test is sensitive and highly specific for identifying the main causative pathogens in adult patients with CAP” (Del Rio-Pertuz et al., 2019). Blood cultures can take up to 10 days for results.
The patient is currently taking ceftriaxone 1 g IV qday (day 3) and azithromycin 500 mg IV qday (day 3), if he is unable to tolerate the side effects he can be switched to levofloxacin 750mg IV QD. He may also be switched to oral antibiotics for the rest of his treatment. “Of 378,041 CAP patients, 21,784 (6%) were switched early. Patients were most frequently switched to fluoroquinolones. Patients switched early had fewer days on IV antibiotics, shorter duration of inpatient antibiotic treatment, shorter LOS, and lower hospitalization cost” (Deshpande et al., 2023). The duration for therapy for most pneumonias is around 5-7 days. I would also recommend prescribing Zofran 8mg every 8 hours orally disintegrating film to help with the nausea and vomiting. Zofran will help the patient tolerate food and fluids better if he is not so nauseous and vomiting. Once the patient is able to tolerate food and fluid this will also help improve his overall clinical status.
Patient Education Recommendation
Patient education should include signs and symptoms of community acquired pneumonia. I would discuss the importance of disease prevention through vaccines such as the (PCV15, PCV20) which the CDC recommends for adults 65 years or older with certain medical conditions or risk factors. He has COPD, Hypertension so the vaccine would be indicated. I would also discuss the flu vaccine at this time as getting vaccinated for the flu can help lessen pneumonia symptoms. “In meta-analyses, influenza vaccine significantly reduces pneumonia- and influenza-related hospitalizations, with a vaccine effectiveness of 25–53%”(Heo et al., 2018). I would reinforce diabetic education that focuses on diet and food choices that will help keep blood sugars from spiking. Providing education and answering any questions regarding his other conditions is also important. The patient should be counseled on any medications that he is prescribed while in the hospital or being discharged on. It is important for him to know the dosages, indications, potential side effects, time of day to take medications and what to do if he misses a dose.
References
Del Rio-Pertuz, G., Gutiérrez, J. F., Triana, A. J., Molinares, J. L., Robledo-Solano, A. B., Meza, J. L., Ariza-Bolívar, O. M., Acosta-Reyes, J., Garavito, A., Viasus, D., & Carratalà, J. (2019). Usefulness of sputum gram stain for etiologic diagnosis in community-acquired pneumonia: A systematic review and meta-analysis. BMC Infectious Diseases, 19(1). https://doi.org/10.1186/s12879-019-4048-6
Deshpande, A., Klompas, M., Guo, N., Imrey, P. B., Pallotta, A. M., Higgins, T., Haessler, S., Zilberberg, M. D., Lindenauer, P. K., & Rothberg, M. B. (2023). Intravenous to oral antibiotic switch therapy among patients hospitalized with community-acquired pneumonia. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciad196
Heo, J. Y., Song, J. Y., Noh, J. Y., Choi, M. J., Yoon, J. G., Lee, S. N., Cheong, H. J., & Kim, W. J. (2018). Effects of influenza immunization on pneumonia in the elderly. Human Vaccines & Immunotherapeutics, 14(3), 744–749. https://doi.org/10.1080/21645515.2017.1405200
Rider, A. C., & Frazee, B. W. (2019+). Community-acquired pneumonia. Emergency Medicine Clinics of North America, 36(4), 665–683. https://doi.org/10.1016/j.emc.2018.07.001 2) Post 2 by Gudel Marlat: As an advanced practice nurse who has as a priority to provide safety and quality of care for the patient, utilizing evidenced-based literature is of vital importance; thus, implementing evidenced-based research and strategies, informed decision-making to achieve patient well-being and health restoration. The patient has pneumonia: which he is being treated for and is the main problem affecting him. Pneumonia is an infection response to a bacteria pathogen in the lungs that reached the alveoli, causing an inflammatory response. The body’s defense mechanism to the infection, fluid production, or aspiration into the lungs causes the alveoli to fill with fluid or pus, this alters proper gas exchange, and the host defenses are overwhelmed by microorganism virulence or by the inoculum size. The mode of entry of microorganisms is nasal carriers, sinusitis, oropharynx, gastric, or tracheal colonization, and hematogenous spread. (Jain V, Vashisht R, and Yilmaz G. 2022). The evidenced-based research and strategies Our patient has been diagnosed with Pneumonia for the last 3 days; and is currently being treated with empiric antibiotics, which include ceftriaxone 1 g IV every day for the last 3 days as well as azithromycin 500 mg IV daily for the last 3 days since admission. Ceftriaxone (Rocephin) is a third-generation cephalosporin, that is recommended for gonorrhea treatment antibiotics that is used to treat bacterial infections in many different parts of the body by killing the bacteria and preventing its growth. Ceftriaxone is also given before certain types of surgery to prevent infections. As a member of the ß-lactam antibiotics, it has a crucial role in treating STIs. (Major S. 2019). The patient is also being treated with Azithromycin (Zithromax, Z-pack), which is a macrolide antibiotic class of medications called macrolide antibiotics. Azithromycin works in the body by stopping the growth of bacteria; and is recommended in the treatment of certain bacterial infections, such as pneumonia, bronchitis, sexually transmitted diseases (STD), and infections of the ears, lungs, sinuses, skin, throat, and reproductive organs. Azithromycin also is used to treat or prevent disseminated Mycobacterium-avium complex (MAC) infection. This type of lung infection often affects people with human immunodeficiency virus (HIV). ( Heidary M. et.al. 2022).
The patient’s clinical status has shown improvement with this antibiotic treatment and has had a decrease in oxygen therapy requirements. The patient however is not tolerating a diet at this time with complaints of nausea and vomiting. The co-administration of ceftriaxone and azithromycin together does not result in any clinically significant interactions and is been proven by research that it is a well-tolerated combination. In fact, a research study by Patel found that the combination therapy with azithromycin and ceftriaxone is a potent antibacterial agent combination that has the potential to improve survival in critically ill patients with bacterial infection; thus, reducing systemic inflammation and provides survival benefits in poly-microbial sepsis. (Patel A, Joseph J, Periasamy H, Mokale S. 2018). Our patient also has other health commodities such as COPD, Diabetes, Hypertension, and hyperlipidemia. One very important part of patient care is reviewing the patient’s current medication treatments, vitamins and mineral intake, and the effects of this new diagnosis of pneumonia on the patient’s health status; providing teaching and instructions on the plan of care to follow. Patients will have increased breathing complications as COPD will be impacted by the pneumonia complications of the lungs and air exchange. The infection in the body and the antibiotic treatments will also affect the patients’ blood sugar results as it will increase blood sugar levels; blood sugar monitoring, diet, and diabetic regimen compliance are key to diabetic well-being. The patient will have blood pressure and heart rate fluctuations; it is important to follow a heart-healthy diet with no concentrated sweets, a low-salt diet, and a low-cholesterol diet. Healthy nutrition and fluid intake is very important for our patient, especially before taking the antibiotic treatment to avoid nausea, vomiting, and stomach upset due to the possible side effects of antibiotic treatment.
Male patients over 65 can have many health complications such as prostate problems as the prostate gland is part of the male reproductive system can become enlarged and place pressure on the bladder and affecting the penis and encircling the tube through which urine passes from the bladder and cause pain and difficulty in urinating. Other adult male problems such as erectile difficulties, hormonal changes, depression, obesity, and social lifestyle should be discussed during teaching and instruction sessions. A PSA would be recommended. One in five men dies from heart disease before the age of 75; therefore, recommendations for heart-healthy lifestyle changes, daily exercise, and semi-annual physical exams are important.
In conclusion, our patient HH is a 68 years old male that is admitted to the medical ward with community-acquired pneumonia; treated with ceftriaxone and azithromycin antibiotics. The plan of care is to implement evidenced-based research and strategies, and informed decision-making to achieve patient well-being and health restoration. The patient has pneumonia: which he is being treated for and is the main problem affecting him. The treatment of the patient as a whole; thus, includes history, physical, current treatments, and recommendations to restore the patient’s heath.
References:
Heidary M, Ebrahimi Samangani A, Kargari A, Kiani Nejad A, Yashmi I, Motahar M, Taki E, Khoshnood S. (2022). Mechanism of action, resistance, synergism, and clinical implications of azithromycin. J Clin Lab Anal. 2022 Jun;36(6):e24427. doi: 10.1002/jcla.24427. Epub 2022 Apr 21. PMID: 35447019; PMCID: PMC9169196. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9169196/#:~:text=Azithromycin%20mechanism%20of%20action%20including,a%20wide%20range%20of%20microorganismsLinks to an external site..
Jain V, Vashisht R, and Yilmaz G.(2022). Pneumonia Pathology. 2022 Aug 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/books/NBK526116/Links to an external site.
Major S. (2019). Trial identifies new drug combination for treatment resistant gonorrhea. BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2046
Patel A, Joseph J, Periasamy H, Mokale S. (2018). Azithromycin in Combination with Ceftriaxone Reduces Systemic Inflammation and Provides Survival Benefit in a Murine Model of Polymicrobial Sepsis. Antimicrob Agents Chemother. 2018 Aug 27;62(9):e00752-18. doi: 10.1128/AAC.00752-18. PMID: 29967025; PMCID: PMC6125560. https://pubmed.ncbi.nlm.nih.gov/29967025/Links to an external site. Required Readings
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 372–388)
Chapter 47, “Drugs for Deficiency Anemias” (pp. 389–396)
Chapter 50, “Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications” (pp. 425–436)
Chapter 51, “Birth Control” (pp. 437–446)
Chapter 52, “Androgens” (pp. 447–453)
Chapter 53, “Male Sexual Dysfunction and Benign Prostatic Hyperplasia” (pp. 454–466)
Chapter 70, “Basic Principles of Antimicrobial Therapy” (pp. 651–661)
Chapter 71, “Drugs That Weaken the Bacterial Cell Wall I: Penicillins” (pp. 662–668)
Chapter 75, “Sulfonamides Antibiotics and Trimethoprim” (pp. 688–694)
Chapter 76, “Drug Therapy of Urinary Tract Infections” (pp. 695–699)
Chapter 78, “Miscellaneous Antibacterial Drugs” (pp. 711–714)
Chapter 79, “Antifungal Agents” (pp. 715–722)
Chapter 80, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 723–743)
Chapter 82, “Drug Therapy of Sexually Transmitted Diseases” (pp. 763–770)
Roberts, H., & Hickey, M. (2016). Managing the menopause: An updateLinks to an external site.. Maturitas, 86(2016), 53–58. https://doi.org/10.1016/j.maturitas.2016.01.007Thi… article provides an update on treatments on Vasomotor symptoms (VMS), genito-urinary syndrome of menopause (GSM), sleep disturbance, sexual dysfunction, and mood disturbance that are common during the menopause transition.
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Required Media
Pharmacology and the Immunological Disorders: Improvements in Medication and Drug Administrations
Nurse Manager, Bette Nunn discusses how technology has improved the practice of administering drugs and created new and improved drug therapies. The importance of using technology as well as a patient’s knowledge of their own drug history is also discussed.Time Estimate: 8 minutes