respond

Apa format and respond to two peers with at least 2 references each

Peer 1

This discussion post will focus on a 68-year-old, overweight male who is admitted with community acquired pneumonia. His PMH includes COPD, HTN, hyperlipidemia, and diabetes and he has an allergy to Penicillin. He is currently on day three of IV ceftriaxone 1 g qday and azithromycin 500 mg qday. Since admission, his clinical status has improved, with decreased oxygen requirements but is not tolerating food and complains of nausea and vomiting.

          In patients who require hospitalization but not admission to an intensive care unit, the most frequently isolated pathogens for CAP are Streptococcus pneumoniae, respiratory viruses (eg, influenza, parainfluenza, respiratory syncytial virus, rhinovirus, severe acute respiratory syndrome coronavirus 2, and, less often, Mycoplasma pneumoniae, Haemophilus influenzae, and Legionella spp. However, the causative organism is not identified in the majority of patients, so broad-spectrum antibiotics are the first choice (Treatment of Community-acquired Pneumonia in Adults Who Require Hospitalization, 2022).

          Gastrointestinal side effects such as nausea and vomiting are the most common side effects of macrolide antibiotics, such as azithromycin. Unfortunately, macrolide antibiotics can prolong QT intervals, as can most antiemetics (Rosenthal & Burchum, 2021). Glucocorticoids, particularly dexamethasone, has well-established antiemetic properties (Antiemetics and QT Prolongation – Clinical Correlations, 2021). My suggestion would be to start the patient on 5-10 mg of dexamethasone IV twice a day to help prevent nausea and hope that with the lessened nausea, he will be able to tolerate some foods. I would also recommend the patient be on continuous IV fluids until tolerating diet consistently and goes 24 hours without vomiting.

Peer 2

he patient in question is a 68-year-old male admitted to the hospital for community-acquired pneumonia. His health needs would be improved oxygenation: improved nutrition, treatment of nausea and vomiting, and improvement of overall symptoms. One must also consider that a patient with a significant history of COPD has decreased lung immunity. Patients with COPD are additionally at an increased risk of Pseudomonas aeruginosa and Methicillin-Resistant Staphylococcus Aureus. Therefore, when these patients are being treated for pneumonia before sputum culture, they should be given antibiotics covering gram-negative bacilli (Cavallazzi & Ramirez, 2020).

Many people with diabetes have the additional problem of impaired lung function due to microangiopathy. Patients with diabetes are also at a higher risk for developing pneumonia due to their neutrophil dysfunction. They are additionally at a higher risk for infection due to disturbed cytokine production due to accumulated levels of hyperglycemia and oxidative stress. Many studies have shown decreased pneumonia severity in patients given metformin during hospitalization. A recent has shown that metformin can limit hyperglycemia-induced staph aureus growth in the airways (Au et al., 2021). In patients with diabetes mellitus, the most common infections can be S Pneumonia, Legionella, and H influenza. A recent study has shown an increased incidence of Klebsiella and pneumococcal pneumonia. Recommendations for diabetic patients are a combination of amoxicillin/Clavulanic acid, Cephalosporin/ macrolide /doxycycline, or monotherapy with respiratory fluoroquinolone. Subsequently, patients should be given at least one dose of PPSV23 vaccine after treatment (Nagendra et al., 2022).

 

Explain the treatment regimen you would recommend for treating your patient, including the pharmacotherapeutics you would recommend.

The first portion of the treatment that I recommend is to gather a sputum sample to ensure that you are treating the correct bacteria for your patient. Additionally, I would perform a nasopharyngeal swab to get a proper diagnosis of any respiratory viral infections so that they could be adequately treated. Changing the antibiotic treatment without the appropriate guidance from sputum or respiratory panels would be difficult. Most studies suggest that antimicrobial coverage should be the first line of treatment for all community-acquired pneumonia pathogens until appropriate susceptibility can be diagnosed. This should include quick fluid and electrolyte restoration, thromboembolic prevention, the management of hypoxia, and early ambulation. Given the patient's COPD history, coverage for S pneumonia, atypical bacterial pathogens, and pseudomonas should begin immediately. Therefore, treatment is recommended for patients with chronic lung disease and diabetes mellitus to start a regimen of beta-lactam and a macrolide. However, with the patient's sensitivity to penicillin, it would be recommended that he be changed to a monotherapy fluoroquinolone. A regimen of Levofloxacin 750mg IV q 24 hrs x 5 days. This would require baseline creatine to determine if there is any underlying renal impairment. This also requires periodic blood glucose monitoring, which would be done since the patient is in a hospital setting. Patients should also not be given medication within the prolonged QT interval; therefore, a baseline EKG should be obtained. Fluoroquinolones can be a great alternative because side effects are generally mild and metabolism is mentally hepatic (Baer, 2022)

Explain a patient education strategy you recommend for assisting your patient with managing their health needs.

Levofloxacin education should begin with the most significant adverse reactions the patient should be aware of. The drug possesses a black box warning for tendonitis and inflammation. Therefore, the patient should notify their physician immediately if they begin to have tendonitis-type symptoms. The patient should not start any treatment that involves corticosteroids during concurrent usage. They should inform the physician immediately if they develop severe skin reactions or dark-colored urine. Ultimately condensing patients' medication regimen to one medication may assist the patient with their symptoms. However, Levofloxacin can additionally cause diarrhea; therefore, if it does not improve, another regimen will begin. The patient should notify the physician immediately of any symptoms of hypoglycemia or dizziness. Levofloxacin can cause sensitivity to sunlight; therefore, exposure to the sun must be brief, and sunblock must be applied if prolonged exposure is necessary (Rosenthal DNP ACNP, Laura et al., 2020).