DQ#9F
To Prepare
· Review the Resources for this module and reflect on the different health needs and body systems presented.
· Review the complex Case Assigned by your Instructor for this Discussion.
· 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 3 of Week 9
1-Post a Brief Description of your patient’s health needs from the patient Case Study you assigned. Be Specific.
2-Then, Explain the Type of Treatment Regimen you would recommend for treating your patient, including the Choice or Pharmacotherapeutics you would recommend and Explain Why . Be sure to Justify your response.
3- Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be Specific and provide examples.
CASE STUDY#1
Patient Case Study 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 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)
Results
On admission Day 3 Urine Legionella antigen: Non-reactive
Urine Pneumococcal antigen: Non-reactive
CXR: Right lower lobe infiltrate
Blood cultures (2 sets): No growth to date x 3
days
Vitals
Temp (F) 102.7 100.9
BP 138/72 136/70
HR 124 88
RR 34 20
O2 Saturation 90% (4L O2) 92% (room air)
Na (mEq/L) 144 140
K (mEq/L) 4.6 4.3 Bronchial alveolar lavage (BAL) culture:
Gram-positive cocci in pairs, 34 WBCs, 3
epithelial cell
Heavy growth Streptococcus pneumoniae
Antibiotic MIC Interpretation
Penicillin 1 Susceptible
Ceftriaxone 0.25 Susceptible
Vancomycin 0.125 Susceptible
Erythromycin >16 Resistant
Levofloxacin ≤ 0.5 Susceptible
Tetracycline >16 Resistant
Cl (mEq/L) 103 105
HCO
3
(mEq/L) 34 30
BUN (mg/dL) 30 18
Cr (mg/dL) 1.2 1.1
Glucose (mg/dL) 180 143
WBC (x 10
3
cells/mm
3
)
18.2 14.6
Neut 86% 83%
Bands 10% 8%
Lymph 4% 6%
Mono 0% 1%
Eos 0% 1%
Baso 0% 1%