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as the patient's clinical status has improved, with decreased oxygen requirements since his admission and patient is not tolerating a diet at this time with complaints of nausea and vomiting,

the above mentioned conditions such as nausea and vomiting are just the adverse effects of the antibiotics which are used and these are almost same in all patients.

ADR's of ceftriaxone:

· nausea

· vomiting

· upset stomach

· dizziness

· headache

due to his stomach upset he is not tolerating his diet at this time.

ADR's of  azithromycin:

· nausea

· vomiting

· abdominal pain

these ADRs are not life threatening .

· Health needs of the patient:

1. The nurse should control the patient's vomiting

2. The nurse should ask the physician to change the medication of the patient.

3. The patient needs to reduce his cholesterol

· Aztreonam with azithromycin is the correct pharmacotherapeutic choice. When the vomiting and nausea subsides, the nurse should shift the patient to oral therapy.

· The nurse will assess the educational needs of the patient. She will educate the patient based on his health education and will ask the patient to teach her back. She will ask him to regularly check the patient portal of the EHR (electronic health record) software system of the hospital.

Explanation:

· The patient is suffering from community-acquired pneumonia (CAP). He has several comorbidities, such as COPD (chronic obstructive pulmonary disease), diabetes, hyperlipidemia, and hypertension (HTN). CAP worsens the COPD situation in patients. Even without COPD, CAP is one of the leading mortality causes in America. The condition of the patient has worsened already hence, he was hospitalized and put on empiric antibiotic treatment. He is getting the treatment of emergency care consisting of a beta-lactam (ceftriaxone) and a macrolide (azithromycin) treatment. He has shown improvement however, he is vomiting. Following are the recommendations based on his health needs:

1. The patient has shown improvement after the treatment from antibiotics. His health improved within the recommended period of 3 days. Now, the nurse should shift the patient to oral antibiotic therapy to discharge him. However, the patient is not tolerating any food. To shift the patient to oral antibiotic therapy, the nurse should take steps to stop the vomiting of the patient.

2. The patient is allergic to penicillin. The diagnostic symptom of penicillin allergy is rashes that are present on the patient. Vomiting and nausea are the anaphylactic reactions of penicillin allergy. Anaphylactic reactions are severe allergic reactions to the exposure to the allergen. It is a group of reactions that end in system failure. It can be fatal. Hence, the nurse should ask the physician to stop the administration of beta-lactam (ceftriaxone) immediately.

3. The patient's health history includes HTN and hyperlipidemia. Hyperlipidemia will exacerbate the HTN status of the patient. Hyperlipidemia is the excess of cholesterol in the body. Patients should lower the level of cholesterol.

· The correct therapeutic regimen for the patient would be aztreonam with azithromycin. A beta-lactam and macrolide antibiotic treatment are recommended for emergency patients. However, the patient has a penicillin allergy. Hence, the physician should substitute the beta-lactam antibiotic named ceftriaxone with aztreonam. Aztreonam belongs to the carbapenem class of antibiotics. The patient has shown improvement in CAP condition. Hence, the nurse should shift the patient to oral therapy after vomiting subsides. American thoracic society (ATS) has recommended macrolide monotherapy as oral therapy for CAP treatment. Azithromycin is a good agent. This regimen is

· For the effective treatment and prevention of rehospitalization, good patient education is a must. For effective patient education, the nurse should assess the patient's knowledge about his disease and should provide education based on the patient's requirements. After providing information to the patient, the nurse should ask the patient to teach her back in his own words. It will help the nurse to assess how the patient has comprehended the information. It is observed that patients tend to forget the information provided by the nurse. Hence, the nurse should ask the patient to regularly check the patient portal of the hospital HER where all the information will be available. To assess patient knowledge, the nurse should ask specific questions to the patient, such as does he know about penicillin allergy? Does he know the effect of diabetes and HTN on CAP? What does he like to eat during lunch and dinner? Does he take his medications regularly?

References:

Lin, S. H., Perng, D. W., Chen, C. P., Chai, W. H., Yeh, C. S., Kor, C. T., Cheng, S. L., Chen, J. J., & Lin, C. H. (2016). Increased risk of community-acquired pneumonia in COPD patients with comorbid cardiovascular disease. International journal of chronic obstructive pulmonary disease, 11, 3051-3058. https://doi.org/10.2147/COPD.S115137

4 Patient Education Strategies that Drive Patient Activation. (2020). Retrieved 28 July 2020, from https://patientengagementhit.com/news/4-patient-education-strategies-that-drive-patient-activation

Community-Acquired Pneumonia (CAP): Practice Essentials, Overview, Etiology of Community-Acquired Pneumonia. (2020). Retrieved 28 July 2020, from https://emedicine.medscape.com/article/234240-overview#a17

What is the proper duration of antibiotic treatment in adults hospitalized with community-acquired pneumonia?. (2020). Retrieved 28 July 2020, from https://www.the-hospitalist.org/hospitalist/article/124075/antimicrobial-resistant-infections/what-proper-duration-antibiotic

Penicillin allergy - Symptoms and causes. (2020). Retrieved 28 July 2020, from https://www.mayoclinic.org/diseases-conditions/penicillin-allergy/symptoms-causes/syc-20376222