reply for discussion
Reply to this discussion and provide recommendations for alternative drug treatments to address the patientâ€™s pathophysiology. Be specific and provide examples.
HH is a 68 yo M who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days. His PMH is significant for COPD, HTN, hyperlipidemia, and diabetes. He remains on empiric antibiotics, which include ceftriaxone 1 g IV qday (day 3) and azithromycin 500 mg IV daily (day 3). Since admission, his clinical status has improved, with decreased oxygen requirements.
Ht: 5’8″ Wt: 89 kg
Allergies: Penicillin (rash)
Pneumonia is an infection of the lung or pulmonary parenchyma by definition. Unfortunately, community-acquired pneumonia (CAP) is a prevalent illness often misdiagnosed and improperly managed. Although it often manifests as a very minor condition, it remains a significant source of morbidity and death. It is estimated that about 5 million instances of pneumonia occur annually in the United States, with over 1 million hospitalizations and 60,000 fatalities (Mandell L. A.2015). Depending on the host pathogen, the severity of the sickness might range from moderate to lethal. The average patient has a high body temperature and heart rate, as well as chills, cough, and shortness of breath. Chest discomfort may result from coughing or pleuritic involvement. As in the case of HH, a 68-year-old man, up to 20% of CAP patients may develop gastrointestinal symptoms such as nausea, vomiting, or diarrhea.
Streptococcus pneumoniae, Mycoplasma pneumoniae, and Hemophilus influenzae are the common bacterial infections that may cause CAP. pneumoniae and Viral Respiratory Infections (Marrie T, 2014). In the case of HH, there is no known pathogen information; however, according to the case study, he is on the third day of empiric antibiotic treatment with Ceftriaxone 1 g IV/q day and Zithromax 500 mg/IV/q day, which is improving his respiratory condition, as evidenced by decreased oxygen requirements.
Patients with a confirmed or suspected illness, but for whom the culprit organism(s) or germs have not been identified often get empiric antibiotic treatment. (Empiric Antibiotic Selection – Infectious Disease and Antimicrobial Agents, not long ago)
Current Medical Demands
Respiration and oxygenation. Community-acquired pneumonia (CAP) is present in Mr. HH, a risk factor, who has a history of COPD. His blood pressure requires stabilization and management. Due to nausea and vomiting, his diabetes mellitus should be managed along with water and nourishment.
Mr. HH has a history of COPD and CAP. Comorbidities such as chronic obstructive pulmonary disease (COPD), asthma, and heart failure are risk factors for CAP. Variable CAP symptoms include productive cough, dyspnea, pleuritic discomfort, and abnormal vital signs. The infection causes the air sacs (alveoli) of the lungs to become inflamed and to fill with fluid or pus, resulting in shortness of breath and low oxygen saturation. Oxygen saturation levels should be maintained above 90 percent but not so high as to impair respiratory drive in COPD patients. (Mandell L. A. (2015).
Treatment Regimen and Pharmacotherapeutics
Inhaled corticosteroids (ICS) are essential for lowering the frequency of exacerbations associated with chronic obstructive pulmonary disease (COPD). (Crim et al.,2009) Inhaled corticosteroids (ICS) are anti-inflammatory drugs routinely recommended as respiratory therapy for the majority of people with Chronic Obstructive Pulmonary Disease (COPD), while Long-Acting Beta 2 agonists are Bronchodilators often used to treat COPD and pneumonia ( Sibila et al., 2015)
I will continue ceftriaxone 1 g IV QD and azithromycin 500 mg IV QD. Ceftriaxone is a parenteral cephalosporin of the third generation with a long elimination half-life that facilitates once-daily delivery. It is effective against Streptococcus pneumonia, staphylococci sensitive to methicillin, and Haemophilus influenza. In addition, Ceftriaxone has a significant position in treating invasive pneumococcal infections, either alone or as part of a combination regimen, due to its potent action against S. pneumoniae ( Lamb et al., 2015). When the source of the disease is identified, IV antibiotics may be discontinued and replaced with oral antibiotics, such as broad-spectrum Azithromycin. Need cultural and sensitivity report.
Check vital signs every four hours. Continue taking home blood pressure meds as indicated. Amlodipine) Norvasc 10 mg daily may be recommended for the treatment of hypertension.
Monitor glucose levels before meals and before bed. In diabetics, illness and steroid usage may destabilize blood glucose levels. Therefore, I will continue diabetes meds at home. In addition, since the patient cannot tolerate a P.O. diet at this time, the patient’s risk for unstable blood sugars is enhanced.
Maintain D51/2 NS Intravenous Fluids daily at 25-30 cc/kg. Since the patient’s nausea and vomiting are likely due to the IV antibiotics, I would prescribe 8 mg of Zofran every 8 hours as required for nausea and vomiting.
Patients’ education is an integral component of any therapy strategy. Included in a plan’s components are coughing and deep breathing. Signs and symptoms to report to the nurse, as well as education on the medicine’s harmful side effects. Since the patient is taking inhaled corticosteroids, I believe it is essential to address his persistent sensitivity to respiratory infection. Finally, as the patient will be discharged with oral antibiotics, teaching about their correct usage and administration must be performed.