21.Wk10Response1

CHIP/CHI

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.

(Both responses I send will be the same case)

Introduction

Pneumonia is inflammation of the lung parenchyma. Streptococcus pneumoniae is the most common bacterial cause of community-acquired pneumonia (CAP) in older adults. Other common causes of CAP include Haemophilus influenza, mycoplasma spp., staphylococcus aureus (Rosenthal & Burcham, 2018). Haemophilus influenza is usually the cause of pneumonia in patients with COPD (Cilloniz, Rodriguez-Hurtado & Torres, 2018). Older adults are particularly susceptible to pneumonia due to a compromised immune system and age-related anatomic and physiologic changes that make the lungs more vulnerable to infection. Treatment for CAP in older adults involves the use of antibiotics or antivirals. It is essential to avoid indiscriminate use of antibiotics as it increases the risk of resistant bacterial strains. According to Rosenthal et al. (2018), important considerations when prescribing antibiotic therapy are identifying the infecting organism, drug sensitivity of the infecting organism, and host factors (e.g., site of infection, age, renal and hepatic function, allergies, comorbidities etc). The purpose of this discussion is to explain the recommended treatment regimen for CAP and to provide a patient education strategy to help manage the disease process.

Case Study

HH is a 68-year-old male who has been admitted to the medical ward with community-acquired pneumonia for the past three days. His past medical history (PMH) is significant for COPD, HTN, hyperlipidemia (HLD), and diabetes. He remains on empiric antibiotics, which include ceftriaxone 1g IV daily (day 3) and azithromycin 500 mg IV daily (day 3). Since admission, his clinical status has improved, with decreased oxygen requirements. However, he is not tolerating a diet at this time with complaints of nausea and vomiting. He is allergic to penicillin drugs. Ht: 5’8” Wt: 89kg.

Drug Recommendations

The severity of CAP determines what medications to prescribe. According to Rosenthal et al. (2018), it is recommended to start empirical antibiotic therapy when the causative agent is unknown. Since HH has comorbidities and required hospitalization, recommended treatment involves the use of levofloxacin monotherapy (for PCN allergies), a second-generation (e.g., cefuroxime), or a third-generation (ceftriaxone) cephalosporin together with a (macrolide) clarithromycin, for a wide coverage of atypical pneumonia (Cilloniz et al., 2018). Therefore, I would recommend leaving the patient on the initiated antibiotic therapy since there’s an unknown etiology based on the given information, and the patient is responding to treatment. While in-patient, I would include Ondansetron (Zofran) 4mg IVP every eight hours as needed for nausea and vomiting (N/V). However, because Zofran and azithromycin can cause prolonged QT intervals, I would also put the patient on metoclopramide (Reglan) 10mg IM every six hours PRN for N/V as it does not have any drug-drug interactions with the current medications (Drugs.com, 2020). Since the patient is responding well to therapy, I would reassess the need to switch to oral antibiotics when the patient is stable and can tolerate a diet.

Patient Education

It is imperative to educate the patient to continue on oral antibiotics for the entire course as prescribed even after symptoms subside before completion of the medication regimen; this is to prevent recurrent infections. Educate on the importance of good hygiene and receiving influenza and pneumococcal vaccines for prevention. Once discharged, emphasize the importance of seeking medical attention if new or worsening symptoms arise, such as shortness of breath, fever, chills, and or chest pains. Otherwise, I would suggest the patient schedule a follow-up visit within one week.

Conclusion

The treatment goal for CAP is selecting the most appropriate antibiotic therapy to destroy the causative agent. However, there are many factors associated with selecting the proper regimen for treatment. As an advanced practice nurse (APN), there must be an understanding as to which would be the best option for treatment after thorough health history and assessments are completed.

References

Cillóniz, C., Rodríguez-Hurtado, D., & Torres, A. (2018). Characteristics and Management of Community-Acquired Pneumonia in the Era of Global Aging. Medical sciences (Basel, Switzerland), 6(2), 35. https://doi.org/10.3390/medsci6020035

Drugs.com. (2020). Interactions between your medications. Received from https://www.drugs.com/interactions-check.php?drug_list=300-0,1752-1120

Gordon, K., Stevens, R., Westley, B., & Bulkow, L. (2018). Impact of an antimicrobial stewardship program on outcomes in patients with community-acquired pneumonia admitted to a tertiary community hospital. American Journal of Health-System Pharmacy, 75, S42–S50. https://doi-org.ezp.waldenulibrary.org/10.2146/ajhp170360

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier