Colleague 1
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 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. Aging affects the body in several ways, more so related to decreased function and abilities of affected systems over time. The patient’s health needs include treatment primarily for his acute infection while taking into account his comorbidities. Aging causes normal alterations in pulmonary function without adverse events in healthy individuals; genetics, gender, and environmental agents factor into the development of abnormal alterations (Huether and McCance, 2019). Renal function and clearance are decreased in the older adult and must be taken into consideration when prescribing medications; along with considering renal and liver function, the prescriber must consider drug interactions. According to Miravitlles et. al. (2021), long-term use of inhaled corticosteroids in older adults with comorbidities can lead to the development of nonfatal pneumonia. For the treatment of the patient’s COPD, the severity of the patient’s symptoms would determine the therapy course; and an anti-inflammatory bronchodilator would be the first choice of initial control therapy. According to Rosenthal and Burchum (2019), when treating diabetes, the use of an ACE inhibitor such as lisinopril or an angiotensin II receptor blocker such as losartan along with a statin such as atorvastatin can reduce the risk of cardiovascular events and diabetic neuropathy. Metformin is the first line of treatment in type two diabetes (Rosenthal and Burchum, 2019). Until he can ingest the medications independently, the use of a nasogastric or orogastric tube can be used to deliver the medications; administering a proton pump inhibitor and antiemetic medication will aid in absorption unless underlying GI issues are involved. Post-discharge, prescribing aspirin 81mg orally daily as well will aid in cardiovascular prophylaxis. Once IV antibiotics therapy is completed, a 7-14 day course of oral antibiotics should be prescribed, a rescue inhaler, oral prednisone, and follow-up with PCP within one week of discharge.
Colleague 2
Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
HH has COPD, a chronic progressive and persistent disease that restricts airflow. COPD and pneumonia are often co-morbidities. Pneumonia is the leading cause of hospitalization for COPD and is associated with poor outcomes. Hospital mortality from COPD with community-acquired pneumonia is found to be as high as 12.2% (Bordon et al., 2020). Pulse oximetry in HH improved slightly from 90 to 93 after three days of antibiotic treatment. For most patients, the goal is usually 96%. Combination therapy for COPD may improve the prognosis. Systemic corticosteroids (oral and intravenous) are the gold standard for the treatment of acute exacerbations of chronic obstructive pulmonary disease (Lunenfeld et al., 2015). The value of corticosteroids may be helpful in patients with severe elevations in COPD. However, a comparison of systemic corticosteroids for pneumonia shows conflicting results, while others show no benefit due to increased side effects, especially hyperglycemia
Studies confirm that the combination of a constant dose of inhaled corticosteroids and a long-acting beta-2 agonist (LABA) can significantly reduce the risk of COPD exacerbations in community-acquired pneumonia without systemic abuse. For the treatment of COPD, there are two standard dose inhalation combinations of LABA and ICS, butazone / formoderol (Symbicard) and fluticasone / salmeterol (Seritide). Both combinations have been shown to reduce aggravation and improve quality of life
Patient Needs
In this case, the patient had community-acquired pneumonia (CAP) and hypertension, hyperlipidemia, and diabetes. Since the cause cannot be identified, the patient will receive standard antibody therapy. Pneumonia can occur in two ways: in a hospital or the community. Inpatient pneumonia develops in patients in hospitals, while the other one may be acquired by the community. CAP can be caused by many pathogens, including Streptococcus pneumoniae, Mycobacterium tuberculosis, Haemophilus influenzae, Nocardia, Staphylococcus aureus, and influenza viruses.
Patient Treatment Plan
To use a particular antibiotic, one of the clients must know the cause of their condition. Second, the patient had nutritional problems with nausea and vomiting. Therefore, the patient should be careful when treating specific CAP-causing medicines and eliminating the symptoms of nausea and vomiting (Rosenthal & Burchum, 2020). For further care and treatment, the pathogen must be identified and specific medications given. Because the patient has diabetes, it can be caused by bacteria, especially Klebsiella pneumoniae; thus, specific antibiotics must be used to treat CAP. However, treatment must be individually adjusted to target the causative microorganisms. The causative agents should be identified before planning specific antibiotic therapy (Lunenfeld et al., 2015). Urine antigen assays, sputum Gram staining, and PCR can be used to determine the pathogen. Urine antigen tests can help identify the most appropriate antibiotic to check for the condition. Therefore, until a specific causative agent is identified for the proposed appropriate treatment regimen.
Patient Education Strategies
First, the patient must be well prepared to prevent the disease from spreading. The client’s education strategy involves understanding the risks of spreading the disease (Bordon et al., 2020). Second, if a client has a smoking problem, they should be informed that smoking worsens their condition, and they should quit (Rosenthal & Burchum, 2020). As the patient has diabetes, the importance of diabetes control, regular exercise, and proper nutrition should be taught. Finally, the patient should be encouraged to follow a diet rich in zinc and vitamin C to improve his health.
Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
As an advanced practice nurse, you will likely experience patient encounters with complex comorbidities. For example, consider a female patient who is pregnant who also presents with hypertension, diabetes, and has a recent tuberculosis infection. How might the underlying pathophysiology of these conditions affect the pharmacotherapeutics you might recommend to help address your patient’s health needs? What education strategies might you recommend for ensuring positive patient health outcomes?
For this Discussion, you will be assigned a patient case study and will consider how to address the patient’s current drug therapy plans. You will then suggest recommendations on how to revise these drug therapy plans to ensure effective, safe, and quality patient care for positive patient health outcomes.
To Prepare
Review the Resources for this module and reflect on the different health needs and body systems presented.
Your Instructor will assign you a complex case study to focus on for this Discussion.
CASE STUDY
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 qday (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.
Ht: 5’8” Wt: 89 kg
Allergies: Penicillin (rash)
Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected.
By Day 6 of Week 10
Read a selection of your colleagues’ responses from Week 9 and respond to at least two of your colleagues on two different days 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.
