NURS 6521 Discussion Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
In this particular case study is a 60-year-old male admitted to the hospital for a . Patient’s past medical history consists of COPD hypertension, hyperlipidemia, and diabetes. In this particular case study patient was placed azithromycin 500 mg. THis is a macrolide drugs class. This type of antibiotic is a broad spectrum and can fight against many gram-positive bacteria. This medication is also known for causing liver toxicity. Some of the side effects of this medication can cause nausea, and vomiting. Patient was also placed on ceftriaxone 1 g. This is a type of beta-lactam class. These particular antibiotics inhibit bacteria by binding covalently to PB P in the cytoplasmic membrane. Many side effects of this medication can include diarrhea, nausea, rashes, and super infections. By combining both antibiotics will provide patient with a broad spectrum of coverage to inhibit further bacteria growth. We don’t know what type of bacteria is caught causing the pneumonia. Until bacterial cultures and sensitivities results come back from the laboratory value to see what type of bacteria and antibiotics will work for this particular patient. The patient is allergic to penicillin but is responding good to the antibiotic.He hasn’t had any hypersensitivity. If patient was to show hypersensitivity patient can also be given doxycycline or cephalosporins , which can also provide a great broad-spectrum coverage for pneumonia.
Struggling to meet your deadline ?
Get assistance on
NURS 6521 Discussion Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
done on time by medical experts. Don’t wait – ORDER NOW!
Patients has a history of COPD, patient’s oxygen saturations must be monitored on a continuous basis. And if needed, patient must be given supplemental oxygen. Patient also has high blood pressure so blood pressure must be monitored .The type of medication that I would prescribe would be angiotensin receptor blocker for example Losartan, and irbesartan. ARB are the first line of anti-hypertension medication to be prescribed to treat hypertension. This medication works by blocking receptors that act on hormone especially a T-1 receptors by blocking the action of angiotensin two and helps lower blood pressure. Some side effects may be vomiting, diarrhea, and dizziness. Patient also has hyperlipidemia.I would prescribe a statin medication to help lower cholesterol levels. Patient has diabetes. Patient requires monitoring of blood glucose levels even with pneumonia. I would prescribe Metformin and insulin since patient is not able to tolerate PO, I would prescribe insulin.
Also, since patient is not able to tolerate regular diet or anything PO. I would start IV fluids administer dextrose and an oral parenteral nutrition as needed for patient’s nutritional needs.
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 . 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?
Case Study
- HH is a 68-year-old male who has been admitted to the medical ward with community-acquired pneumonia (CAP) for the past 3 days.
- His past medical history PMH is significant for:
- Chronic obstructive pulmonary disease (COPD)
- Hypertension (HTN)
- Hyperlipidemia
- Diabetes.
- He remains on empiric antibiotics, which include:
- Ceftriaxone 1 g IV everyday (day 3)
- Azithromycin 500 mg IV everyday (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 (196 pounds)
- Allergies: Penicillin (delayed, rash)
Addressing Patient’s PMH
First, due to risk of bronchoconstriction resulting in chronic obstructive pulmonary disease (COPD) exacerbation, prescribing a thiazide diuretic or a potassium-sparing diuretic would be an appropriate first step in treating hypertension in the patient. For the same reason, beta-blockers should be used with caution and reserved for patients diagnosed with cardiovascular disease (Finks et at., 2020). Addressing hyperlipidemia, statins have been proven to be effective in preventing cardiac complications in patients also diagnosed with COPD (Lu et al., 2019). Lastly, metformin (biguanide) has been proven to be the best treatment option in treating diabetes for patients who have also been diagnosed with COPD (Zhu et al., 2019).
CAP
Community acquired pneumonia (CAP), can be classified as either viral or bacterial. Biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) have been demonstrated to be beneficial in differentiating between bacterial and viral CAP (Ito & Ishida, 2020). Along with good antibiotic stewardship, it is important to take into consideration comorbidities that may increase the risk of complications due to CAP. Aside from treating with antibiotics for bacterial suspected CAP, anti-infective medications such as antivirals have been studied and have NOT been proven to be successful in reducing symptoms of CAP unless the patient is also suspected to be infected with influenza (Metlay et at., 2019).
Antivirals in CAP
Oseltamivir is one such antiviral prescribed within 48 hours of the onset of influenza-like symptoms. This medication inhibits viral replication by impeding the enzyme neuraminidase preventing the new particles of the virus from budding off the cytoplasmic membrane of the host cells that have been infected by the virus. Oseltamivir is considered a prophylactic treatment for the prevention of influenza A and B to help alleviate the severity and duration of symptoms. This medication is typically well tolerated but can cause nausea, vomiting, and headache and is best taken with food. This medication should NOT be administered within two weeks of a live attenuated influenza vaccine (LAIV) as this may cause a decreased immune response to the vaccine. Oseltamivir is protein binding and is metabolized almost solely by the liver and excreted through the urine (Rosenthal & Burchum, 2021). As the patient is now three days out, this medication would not be proven to be beneficial.
Empiric Therapy for CAP
Empirical treatment of CAP is not always recommended in order to practice good antibiotic stewardship. However, because the patient is currently receiving oxygen supplementation in an inpatient setting, empirical treatment would be appropriate. Other beta-lactam antibiotics should be avoided in those with immediate-type allergic reactions because the patient is allergic to penicillin. Because the patient’s allergic reaction was delayed, cefadroxil (a third generation cyclosporin/beta-lactam antibiotic) has not been shown to increase the rate of allergic reaction and may be used as an alternative to penicillin in these patients if the culture is sensitive to this class. This medication is frequently used as an adjunct to azithromycin to help prevent more serious complications such as sepsis. It is also common for patients to experience nausea and vomiting as a result of antibiotic therapy. Ondansetron may be prescribed, and a probiotic may also be recommended. Careful monitoring of the patient is essential, and glucocorticoids such as prednisone may be considered at some point, with careful monitoring of blood pressure and blood glucose (Arumugham et at., 2021).
If the allergic reaction to penicillin was severe, other antibiotic classes could be prescribed as an emergency treatment. Fluoroquinolones like levofloxacin and tetracyclines like doxycycline have also been demonstrated to be effective and approved for the empirical treatment of CAP. Newer pleuromutilin (Lefamulin) medications have been shown to be highly effective as an empirical treatment for CAP and to be well tolerated in those with COPD. This medication prevents bacterial protein translation and the formation of peptide bonds. This medication can improve the efficacy of statins and is primarily eliminated in the gastrointestinal (GI) tract, so the main symptoms are GI-related (Russo, 2020).
References
Arumugham, V. B., Gujarathi, R., & Cascella, M. (2021). Third generation cephalosporins, In StatPearls. StatPearls Publishing. Retrieved from
Finks, S. W., Rumbak, M. J., & Self, T. H. (2020). Treating Hypertension in Chronic Obstructive Pulmonary Disease. New England Journal of Medicine, 382, 353-363. doi: 10.1056/NEJMra1805377.
Ito, A. & Ishida, T. (2020). Diagnostic markers for community-acquired pneumonia. Annals of Translational Medicine, 8(9), 609. doi: 10.21037/atm.2020.02.182
Lu, Y., Chang, R., Xinni, J. Y., Teng, Y., & Cheng, N. (2019). Effectiveness of long-term using statins in copd-a network meta-analysis. Respiratory Research, 20(17), n. p. Retrieved from
Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., Cooley, L. A., Dean, N. C., Fine, M. J., Flanders, S. A., Griffin, M. R., Metersky, M. L., Musher, D. M., Restrepo, M. I., & Whitney, C. G. (2019). Diagnosis and treatment of adults with community-acquired pneumonia. American Journal of Respiratory and Critical Care Medicine, 200(7), e45-e67. doi: 10.1164/rccm.201908-1581ST
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier
Russo, A., (2020). Spotlight on new antibiotics for the treatment of Pneumonia. Clinical Medicine Insights: Circulatory, Respiratory, and Pulmonary Medicine, 14, n. p. doi: 10.1177/1179548420982786
Zu, A., Teng, Y., Ge, D., Zhang, X., Hu, M., & Yao, X. (2019). Role of metformin in treatment of patients with chronic obstructive pulmonary disease. Journal of Thoracic Disease 11(10), 4371-4378. doi: 10.21037.jtd.2019.09.84
In one instance, a 68-year-old man was admitted and given the diagnosis of community-acquired pneumonia. The patient has been getting 500 mg of azithromycin (Zithromax) IV for the past three days, along with 1 g of ceftriaxone (Rocephin) daily. Past medical conditions for the patient include COPD, HTN, hyperlipidemia, and diabetes. Since being admitted, the patient’s condition has improved, and his or her oxygen needs have decreased. Patient currently complains of nausea and vomiting along with inability to accept his food.
Disease History
Community-acquired pneumonia (CAP) is regarded as a major factor in hospitalization, mortality, and high medical expenses. Depending on the severity of the condition, CAP can be treated either as an outpatient or an inpatient. The main causes of bacterial pneumonia worldwide are the causal organisms, S. pneumoniae and H. influenzae. The most frequent pathogens found in the United States were the human rhinovirus, the influenza virus, and Streptococcus pneumoniae (Regunath & Oba, 2020). Streptococcus pnuemoniae pneumonia, the most prevalent cause of death from CAP and responsible for 70% of all fatalities, is a common and potentially dangerous infection that is accompanied by morbidity and mortality. Even though the development of new medical technologies and the discovery of novel medications and therapies offers renewed hope, bacterimic pneumococcal pneumonia remains fatal and its treatment remains difficult in the twenty-first century. Ageing population, immune-compromised status, and the occurrence of comorbid illnesses are just a few of the reasons for this situation (Caballero and Rello, 2011).
Given his age, comorbidities, and treatment regimen, Mr. HH responded favorably to the combination of ceftriazone (Rocephin), a cephalosporin, and azithromycin (Zithromax), a macrolide. For the treatment of patients with severe CAP, combination antibiotic therapy performs better than monotherapy. Comparatively speaking, combination therapy performs better than monotherapy. It has been hypothesized that treating CAP patients who need to be hospitalized with an initial empirical combination therapy of a cephalosporin and a macrolide is related with a lower mortality rate and/or a shorter hospital stay than treatment with a cephalosporin alone (Caballero and Rello, 2011). The patient’s condition has improved over the previous three days that he has been receiving this combination medication, as shown by a decrease in oxygen needs and an improvement in clinical status.
Treatment Plans
I will maintain the patient on ceftriaxone (Rocephin) and azithromycin (Zithromax) because of how effectively the patient is responding to these medications. Depending on the disease’s severity, patients with community-acquired pneumonia are treated. Many pneumonia patients receiving hospital care are given both a macrolide and a cephalosporin drug (Metersky, et al, 2017). A respiratory fluoroquinolone or a combination of oral beta-lactam and macrolide is advised for patients with comorbidities (CHF excluding hypertension, chronic lung disease – COPD and asthma; chronic liver disease; chronic alcohol use disorder; diabetes mellitus; smoking; splenectomy; HIV or other immunosuppression). Monotherapy with a macrolide (such as erythromycin, azithromycin, or clarithromycin) or doxycycline is advised for outpatients. (2011) Cavallero and Rello The patient is a strong candidate for combination therapy due to his advanced age and the existence of comorbid conditions.
A third generation cephalosporin is ceftriaxone (Rocephin). Cephalosporins are B-lactam antibiotics that work similarly to penicillins in both structure and action. These medications are bactericidal, frequently B-lactamase resistant, and effective against a variety of infections. They are not very poisonous. Cephalosporins prevent the production of cell walls, which disrupts cell walls. This will cause bacterial lysis and death as a result. Cephalosporins are one of the safest classes of antibacterial medications and are typically well tolerated (Rosenthal & Burchum, 2020). Azithromycin (Zithromax), a broad-spectrum antibiotic of the macrolide class, on the other hand, prevents protein synthesis. Because they are large, they are referred to as macrolides. Erythromycin, the earliest member of the macrolide family, is the source of the more recent macrolides, azithromycin and clarithromycin. The most frequent side effects of taking medication with meals are gastrointestinal disturbances such epigastric discomfort, vomiting, nausea, and diarrhea (Rosenthal & Burchum, 2020). In one study by Hansen, et al. (2019), patients using macrolide antibiotics also experienced taste abnormalities more frequently.
Read Also:
Addressing Gastrointestinal Side Effects
Mr. HH’s inability to tolerate diet may be due to the nausea and vomiting he is experiencing as an adverse effect of taking macrolides. We can correct the nausea and vomiting by adding an anti-emetic as a PRN medication . In addition, we will put a high regard on him being diabetic so we will ensure that he is getting the right caloric intake – a referral to a dietitian is necessary. With the dietitian on board, we can work collaboratively in order to improve patients appetite, for instance asking the patient what are the foods that he likes to eat and from there, perform selective choices. Encourage meticulous oral care, a refreshed and clean buccal cavity can enhance one’s appetite.
Patient Education Strategy
It is a must for the primary care provider to provide patient education to their patients in order to achieve the desired outcome of treatment. Explaining the reason for tests, desired effect and adverse of effects of medication is important to ensure patient adherence and completing of therapy. Provide education pamphlets or materials for patient reference for them to understand their disease and how it may impact their current medical problems. If patient is internet savvy, we can suggest websites that particular to their current illness to enlighten them more with information. Educate about their pharmacotherapy regiment. Medication side effects are most of the time the cause of patient non – compliance in continuing their medications. This can frustrate the patient and may lead to stopping of the medication they are taking which can create avenue of problems. Educating the patients about their medications, the way it works, duration of therapy and their the side effects will help them a full understanding why its included in their therapy. Encourage the patient that they are in charge in their health as well.
References:
Caballero, J., & Rello, J. (2011). Combination antibiotic therapy for community-acquired pneumonia. Annals of intensive care, 1, 48.
Hansen MP, Scott AM, McCullough A, Thorning S, Aronson JK, Beller EM, Glasziou PP, Hoffmann TC, Clark J, Del Mar CB. Adverse events in people taking macrolide antibiotics versus placebo for any indication. Cochrane Database Syst Rev. 2019 Jan 18;1(1):CD011825. doi: 10.1002/14651858.CD011825.pub2. PMID: 30656650; PMCID: PMC6353052.
Metersky, M. L., Priya, A., Mortensen, E. M., & Lindenauer, P. K. (2017). Association Between the Order of Macrolide and Cephalosporin Treatment and Outcomes of Pneumonia. Open forum infectious diseases, 4(3), ofx141.
Rosenthal, Laura D., and Jacqueline Rosenjack Burchum. Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants. Elsevier, 2021.
Regunath H, Oba Y. Community-Acquired Pneumonia. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430749/
Weiss, K., & Tillotson, G. S. (2005). The controversy of combination vs monotherapy in the treatment of hospitalized community-acquired pneumonia*. Chest, 128(2), 940-6. Retrieved from https://ezp.waldenulibrary.org/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fscholarly-journals%2Fcontroversy-combination-vs-monotherapy-treatment%2Fdocview%2F200452640%2Fse-2%3Faccountid%3D14872
Week 9: Women’s and Men’s Health/Infections and Hematologic Systems, Part I
Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
The patient is a 68-year-old male admitted for community-acquired pneumonia. His PMH is significant for COPD, diabetes, HTN, and hyperlipidemia. The patient is placed on empiric antibiotics, which help achieve gradual improvement.
The needs of the patient include hydration and nutrition due to nausea and vomiting which make him unable to tolerate diet. Maintaining hydration and nutrition will help prevent dehydration and malnutrition in the patient. The patient should also be monitored for hypokalemia and hypoglycemia due to vomiting. The characteristics of his vomit should also be assessed to determine its etiology and intervention. To control the N&S, I would prescribe the patient Zofran 4 mg IV q 6 hrs. PRN (Rosenthal & Burchum, 2021). The patient’s vital signs (oxygen saturation, pulse rate, temperature, blood pressure, glucose levels, respiratory rate, etc.) will need to be constantly monitored. Hydration status will be monitored via urine output and labs for electrolyte imbalance. Fluid overload will be assessed by assessing lung crackles whose presence will indicate the need to stop fluid therapy (Covic et al., 2018). Keeping the patient hydrated will help loosen mucus and allow him to cough it out and clear his airways.
For nutrition, the patient will be started on clear fluids and slowly progress to a regular diet as tolerated. The nutritional status will be assessed by ordering serum protein panels. The patient will continue with the empiric antibiotic medications and be assessed on the last day of medication to determine whether they effectively treated the pneumonia or any need to change the pharmacological therapy.
Patient education will include CAP and how to protect self- from such infections (e.g. vaccinations, hydration, and nutrition status, and adherence to all medications prescribed for his current health conditions (Lanks et al., 2019). Education also includes self-care and disease management strategies (Madmoli et al., 2019). For instance, diet and nutrition for maintaining a healthy glycemic and BP status.
References
Covic, A., Siriopol, D., & Voroneanu, L. (2018). Use of lung ultrasound for the assessment of volume status in CKD. American Journal of Kidney Diseases, 71(3), 412-422.
Lanks, C. W., Musani, A. I., & Hsia, D. W. (2019). Community-acquired pneumonia and hospital-acquired pneumonia. Medical Clinics, 103(3), 487-501. doi:https://doi.org/10.1016/j.mcna.2018.12.008
Madmoli, M., Khodadadi, M., Ahmadi, F. P., & Niksefat, M. A. (2019). Systematic review on the impact of peer education on self-care behaviors of patients. International Journal of Health and Biological Sciences, 2(1), 1-5. https://doi.org/10.30750/ IJHBS.2.1.1
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
This patient is a 68-year-old male that has been diagnosed with community acquired pneumonia. He has been being treated the last three days with empiric antibiotics consisting of Rocephin 1g IV once a day and azithromycin 500mg IV once a day. This patient’s health needs consist of checking his oxygen saturation regularly. Since he has COPD his saturations might be on the lower side to begin with.
At this time the patient is not tolerating a diet and I would include an antiemetic into their pharmacotherapeutic regimen. The drug I would prescribe would be Ondansetron, which is a serotonin receptor antagonist used to prevent nausea and vomiting (Rosenthal and Burchum, 2021). This will help the patient be able to tolerate a diet and liquids while fighting pneumonia. Since pneumonia leads to fatigue and the bodies requirement for energy increases it is imperative to provide an increase in diet (Daruvuri, 2021). Consistent blood sugar monitoring is also a treatment regimen that should be included when monitoring this patient. With any infection patients with diabetes are at a higher risk of diabetic ketoacidosis (DKA). Infection is a metabolic stress, and it raises your blood sugar (Vann, 2016).
Overall health is important and while having pneumonia is difficult the patient should be educated on the importance of monitoring their oxygen levels at home due to the COPD while having community acquired pneumonia. With any infection diabetes can easily become unmanageable which would cause the patient to have to be readmitted to the hospital increasing their chance for more infections.
References
Daruvuri, S. (2021, December 13). Pneumonia Diet Chart: What To Eat, What Not To Eat. Mfine.
Rosenthal, L., & Burchum, J. (2021). Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants (2nd ed.). Elsevier.
Vann, M. (2016, March 9). 9 Dos and Don’ts of Managing Diabetes When You’re Sick. Everyday Health.
Struggling to meet your deadline ?
Get assistance on
NURS 6521 Discussion Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
done on time by medical experts. Don’t wait – ORDER NOW!