community-acquired pneumonia diagnosis
Hello, I agree that community-acquired pneumonia (CAP) is an infection acquired within the community and affects the lung. This condition is characterized by shortness of breath, heavy sputum, coughing, fever and chills, chest pain that worsens with coughing or breathing, dyspnea, or abdominal pain accompanied by nausea, diarrhea, or vomiting (Ticona et al., 2021). Additionally, individuals diagnosed with CAP might report difficulty breathing and chest and lung discomfort. However, these symptoms vary in individuals, with some portraying severe symptoms and others reporting mild symptoms. I also support that CAP is associated with various risk factors, including environmental contaminants, age, smoking, asthma, malnutrition, chronic bronchitis/chronic obstructive pulmonary disease, previous CAP, poor dental health, and functional impairment.
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Furthermore, I agree that antibiotics are the most recommended treatment for CAP. In particular, ceftriaxone plus azithromycin is the most common medication used in treating CAP due to its superior results. According to Ito et al. (2019), Ceftriaxone and Azithromycin improve symptoms within three days of treating patients diagnosed with CAP. Most CAP patients reduce oxygen requirement after being under this combined therapy for three days, indicating the effectiveness of this treatment regimen in treating CAP. Nonetheless, healthcare providers should assess the patient’s medical history, current medications, and known allergies before developing the plan of care to ensure that the proposed plan will have adverse effects on the client, such as adverse drug reactions or drug-to-drug interactions. In addition to medication interventions, treating patients with CAP includes non-pharmacological interventions, including a balanced diet and oxygen therapy for critically-ill patients.
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References
Ito, A., Ishida, T., Tachibana, H., Tokumasu, H., Yamazaki, A., & Washio, Y. (2019). Azithromycin combination therapy for community-acquired pneumonia: propensity score analysis. Scientific Reports, 9(1), 1-8. DOI: 10.1038/s41598-019-54922-4
Ticona, J. H., Zaccone, V. M., & McFarlane, I. M. (2021). Community-acquired pneumonia: A focused review. American journal of medical case reports, 9(1), 45. DOI: 10.12691/ajmcr-9-1-12.
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Community-acquired pneumonia (CAP)is an infection of the lung parenchyma acquired in the community (Eticha & Gemechu, 2021). The majority of patientswith community-acquired pneumonia do not seek treatment in hospitals. A number of community health risks are associated with this disease, including bacteria, environmental contaminants, and viruses that may cause difficulty in breathing, lung and chest, and discomfort.It is crucial to order appropriate antibiotics to treat CAP for mitigating antibiotics resistance crisis, and ceftriaxone plus azithromycin is the most common combination to treat CAP (Eticha&Gemechu,2021). In the scenario given, the patient has been on Ceftriaxone and Azithromycin for the last three days. It is recommended to continue the current antibiotic therapy for seven days (Jaffar et al.,2019) as the decreased oxygen requirement indicates the improvement with current antibiotic treatment. Treatment Regimen An assessment of patient HH is necessary in order to determine when his symptoms and other occurrences led to his hospitalization. To proceed with the plan of care, a complete assessment of his past medical/physical history and current medication regimens is necessary. The patient oxygen saturation should be monitored, nutrition should be provided, and intravenous hydration should be provided (Cook & Wulf, 2020). For instance the patient complains of nausea and vomiting and not tolerating diet. Nausea and vomiting can be the side effect of antibiotic therapy. It is essential to improve the nutritional status of the patient.Monitoring electrolytes, especially potassium, sodium, magnesium, and phosphate, and correct them if indicated. Ordering antinausea medication like Metoclopramide and Ondansetron can help improve the patient nausea and vomiting.Hydrating the patient if he is unable to tolerate oral intake with IV-fluid. For example Normal saline0.9% at the rate of 75 ml/hr. Total fluid volume per day [weight (kg) x 20 ml/kg/day] = 89 x 20= 1780 mlInfusion rate = total fluid volume per day ÷ 24 hour = 1780 ÷ 24= 74.1= 75 ml/hr (EBM Consult,n.d.) Since the patient has diabetes, the resolution of nausea and vomiting is critical to ensuring a healthy diet for the patient and preventing hypoglycemia. Additionally, HH presents with other medical conditions, such as hypertension, chronic obstructive pulmonary disease, hyperlipidemia which also should be monitored and treated as necessary to avoid further complications like COPD exacerbation. Also it is vital to put the patient on sliding scale to avoid diabetic crisis ( i.e hyperglycemia and hypoglycemia) Moreover, it is important to mention that this patient was placed on a broad-spectrum antibiotic regimen, Azithromycin, which is used when the cause of the infection is unknown, such as when bacteria or fungi are the culprits. In addition, a patient with a penicillin allergy will be prescribed Azithromycin and Ceftriaxone until the result of a sputum and blood culture can be determined (Izadi et al., 2018). The importance of cultures lies in ensuring that the patient’s unique infection is identified and treated as effectively as possible. There is improvement in the patient’s respiratory treatment, and there is no indication that respiratory medications are being used. For treating and managing COPD respiratory symptoms, anti-inflammatory medications and B2 agonists are the first-line medications (Tony & Abdelrahim, 2022). The mechanism of action of these medications is to minimize bronchial hyperreactivity, thus alleviating respiratory inflammation and reducing mucus discharge from the respiratory tract. Patient education/strategies When the patient is not oxygen dependent at home, he should be taught to monitor his oxygen level closely, as well as wean off the oxygen automatically if he is not oxygen dependent at home. A more active lifestyle will be explained to the patient, as well as the use of an incentive spirometer to expand the lungs in order to reduce mucus plugs and pneumonia reinfections (Martin et al., 2018). It will be explained to the patient that in order to maintain a baseline of blood pressure, he should closely monitor his blood pressure and adhering to his hypertensive medication(s) regimen. Managing hyperlipidemia effectively requires the patient to have an understanding of their dietary plan and their medication compliance. To make sure that the patient is aware that HTN and HLD place him at an alarming risk for stroke, it is imperative that he be educated and follow-up is provided constantly. Moreover, the patient will be made aware of the importance of attending follow-up appointments with a primary health care provider in order to ensure that he is adhering to his home treatment care plan. Importantly, this patient needs to take the pneumonia vaccine every five years as he has a history of COPD to prevent further pneumonia and complications (Masuda et al.,2021).
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Eticha EM, & Gemechu WD. (2021). Adherence to Guidelines for Assessment and Empiric
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Izadi, M., Dadsetan, B., Najafi, Z., Jafari, S., Mazaheri, E., Dadras, O., Heidari, H., SeyedAlinaghi, S., & Voltarelli, F. (2018). Levofloxacin versus ceftriaxone and azithromycin combination in the treatment of community-acquired pneumonia in hospitalized patients. Recent Patents on Anti-Infective Drug Discovery, 13(3), 228–239.
Jaffar A Al-Tawfiq, Hisham Momattin, & Kareem Hinedi. (2019). Empiric antibiotic therapy in
the treatment of community-acquired pneumonia in a general hospital in Saudi Arabia. Journal of
Global Infectious Diseases, 11(2), 69–72. https://doi[1]org.ezp.waldenulibrary.org/10.4103/jgid.jgid_84_18
Maintenance fluid calculator. EBM Consult. (n.d.). Retrieved July 26, 2022, from
https://www.ebmconsult.com/app/medical-calculators/maintenance-fluid-calculator
Martin, T. J., Patel, S. A., Tran, M., Eltorai, A. S., Daniels, A. H., & Eltorai, A. E. (2018). Patient factors associated with successful incentive spirometry. Rhode Island Medical Journal, 101(9), 14–18.
Tony, S. M., & Abdelrahim, M. E. (2022). Diseases of the Respiratory Tract: Asthma and Chronic Obstructive Pulmonary Disease. Journal of Clinical and Nursing Research, 6(3), 236–250.