Treatment of community-acquired pneumonia in adults who require hospitalization Response

Hello, I agree that addressing nausea and vomiting is the primary health need of the patient. Resolving nausea will enable the client to take a balanced diet with all food nutrients, facilitating quick recovery and enhancing the management of his chronic illnesses, particularly diabetes. According to Forouhi et al. (2018), a balanced diet is essential in controlling or reversing diabetes mellitus. Thus, the client should be prescribed medications for controlling nausea and vomiting. The second healthcare need for this patient involves considering his previous diagnosis when developing treating plan. His medical history indicates that the client was diagnosed with COPD, HTN, and DM. Thus, the client’s treatment plan should include medications for managing his comorbidities to provide the patient with holistic care.

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Furthermore, I concur that the client’s treatment regimen should include combination therapy, anti-pneumococcal beta-lactam, plus a macrolide. Additionally, it would be advisable to continue with the client’s current dosage, ceftriaxone 1g IV daily and azithromycin 500mg IV daily, due to their effectiveness in treating bacterial infections, including CAP. Additionally, being antibiotics, the current therapy should be taken for a minimum of five days (Metlay et al., 2019). I also agree with you that the patient should be educated on how to reduce the risk of contracting CAP to minimize the likelihood of contracting CAP in the future. Additionally, the client should be educated about the importance of adhering to the prescribing medication. Adhering to the prescribed medicine and dosage enhances the effectiveness of the prescribed medication in treating presented symptoms. Lastly, I agree the teach-back method is an effective intervention that should be applied during patient education. It allows the educator to assess the trainee’s understanding of concepts taught during patient education.

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References

Forouhi, N. G., Misra, A., Mohan, V., Taylor, R., & Yancy, W. (2018). Dietary and nutritional approaches for prevention and management of type 2 diabetes. Bmj, 361. Doi: https://doi.org/10.1136/bmj.k2234

Metlay, J., Waterer, G., Long, A., Anzueto, A., Brozek, J., Crothers, K., Cooley, L., Dean, N., Fine, M., Flanders, S., Griffin, M., Metersky, M., Musher, D., Restrepo, M., & Whitney, C. (2019). Diagnosis and Treatment of Adults with Community-acquired Pneumonia. American Journal of Respiratory and Critical Care Medicine, 200(7).

The primary health need of the patient at this time is to control the new onset of nausea and vomiting and to recover from CAP. In order to do this the patient will be prescribed medication to control the nausea and vomiting. The patient will continue to receive the antibiotics for the treatment of CAP. The patient needs to understand the importance of continuing the home medications that they were taking. This patient has COPD, HTN, DM, and hyperlipidemia. All of these comorbidities require daily medications that should be resumed as quickly as possible. Additionally, patients should be provided with emotional support. The provider should provide a judgement free environment and allow ample time for the patient to express concerns or worries they may have. Treatment Regimen According to File (2021), combination therapy of an antipneumococcal beta-lactam plus a macrolide is recommended. With this information, I would continue ceftriaxone 1g IV daily as well as azithromycin 500mg IV daily. Metlay et al. (2019) recommends that antibiotics should be administered for a minimum of 5 days. The provider can switch the patient from IV to PO route if the patient achieves clinical stability. In the case study provided the patient is still experiencing nausea and vomiting. I would continue the IV antibiotics but add on an antiemetic. Zofran is one form of antiemetic that can be given IV push to help relieve the nausea and vomiting that can sometimes be associated with antibiotics. The patient should be placed on a clear liquid diet and slowly advanced to a diabetic diet as they continue to tolerate the food. Due to the patient having a history of diabetes, they should be placed on sliding scale insulin ACHS. This ensures that their blood sugar is being checked often so that hypoglycemia can be monitored since the patient is not eating. This also allows the nurse to give insulin to maintain a therapeutic glucose level if the patient’s blood sugar becomes elevated. Individuals may experience blood sugar elevation with sickness or stress (Rosenthal & Burchum, 2021). The patient should resume home blood pressure and cholesterol medications as soon as they can tolerate oral intake. This patient will continue their daily inhalers for the management of COPD. Some patients with COPD and hypertension are prescribed calcium channel blockers. Calcium channel blockers have been shown to assist in bronchodilation (Weinberger, 2022). Restarting this medication could help the patient breathe easier. Additionally, all individuals with COPD should receive the Pneumococcal vaccination. This vaccination reduces exacerbations and community-acquired pneumonia in COPD patients (Ferguson & Make, 2021). The patient can be prescribed a PRN IV anti-hypertensive medications such as hydralazine since they are not tolerating oral intake. This will ensure the patient’s blood pressure remains under control. Patient Education “The comorbidity that places patients at highest risk for community-acquired pneumonia hospitalization is chronic obstructive pulmonary disease (Ramirez, 2022).” The patient should be provided education on ways to reduce the risk of contracting CAP. One way of providing patient education is to utilize the teach back method. The teach back method is where the patient is presented with education and they have to retell the instructions to the healthcare provider. This will allow the provider to ensure the patient understands the material being taught.

Ferguson, G., & Make, B. (2021). Stable COPD: Overview of management. UpToDate. Retrieved July 27, 2022, from https://www.uptodate.com/contents/stable-copd-overview-of-management?search=COPD+management&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=3

File, T. (2021). Treatment of community-acquired pneumonia in adults who require hospitalization. UpToDate. Retrieved July 27, 2022, from https://www.uptodate.com/contents/treatment-of-community-acquired-pneumonia-in-adults-who-require-hospitalization?search=CAP+treatment&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H2573069467

Ramirez, J. (2022). Overview of community-acquired pneumonia in adults. UpToDate. Retrieved July 27, 2022, from https://www.uptodate.com/contents/overview-of-community-acquired-pneumonia-in-adults?search=overview+CAP&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.

Weinberger, S. (2022). UpToDate. Retrieved July 27, 2022, from https://www.uptodate.com/contents/treatment-of-hypertension-in-asthma-and-copd?search=COPD+and+CCB&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=
please use them as refrencess