Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

The health needs for the patient include nutritional needs, hydration status, and the length of IV antibiotic treatment. First, the patient is not tolerating the diet as manifested by nausea and vomiting. Further investigations are required to establish if nausea and vomiting are due to medications’ side effects or a different condition. Secondly, the patient is vomiting and hence it is necessary to keep him well hydrated because hydration will loosen up secretions and ease his breathing through coughing and airway clearance (El-Sharkawy, Sahota & Lobo, 2016). It is important to strictly measure intake and output to prevent dehydration. Regarding the length of the IV antibiotic medication, it is recommended that patients with CAP should be administered with empiric antibiotics for 5-7 days. by the 5^th and 7^th day, the patient should be reevaluated before stopping the antibiotic and extend the treatment if the patient is clinically unstable, febrile, and requires supplemental oxygen. The patient needs to continue with the current antibiotic up to the 7^th day (McMullan et al., 2016). The home medications, especially the COPD medications need to be reconciled to prevent a COPD exacerbation, which is associated with increased mortality risk. Sliding-scale insulin needs to be used to treat hypertension for the patient as it is more effective during hospitalization through frequent administration of short-acting insulin (Carter et al., 2021). The patient needs to be encouraged to use an incentive spirometer to assist him to practice taking deep breaths, which helps open airways, prevent mucus and fluid build-up in the lung, and ease breathing. This will reduce the demand for supplemental oxygen (Eltorai et al., 2018).

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On education, the patient needs to be educated to always take metoclopramide before meals to prevent vomiting and nausea and to improve both nutrition and hydration status. The patient will be taught how to use an incentive spirometer and its importance. Moreover, the patient has COPD and is an older adult and thus he is at high risk of CAP (Dhar et al., 2020). He will thus be educated to get a pneumonia vaccine before being discharged to reduce the risk of pneumonia in the future.

References

Carter, P., Eshelbrenner, T., Kirk, L., Fisk, M., & Rodrigues, C. (2021). Readmission Outcomes of Sliding Scale Insulin Compared to Basal-Bolus Insulin Prescribed at Discharge in an Insulin-Naive Patient Population. Journal of pharmacy practice, 34(5), 780-785.

Dhar, R., Ghoshal, A. G., Guleria, R., Sharma, S., Kulkarni, T., Swarnakar, R., Samaria, J. K., Chaudhary, S., Gaur, S. N., Christoph犀利士
er, D. J., Singh, V., Abraham, G., Sarkar, A., Mukhopadhyay, A., Panda, J., Swaminathan, S., Nene, A., Krishnan, S., Shahi, P. K., Sarangdhar, N., … Koul, P. A. (2020). Clinical practice guidelines 2019: Indian consensus-based recommendations on pneumococcal vaccination for adults. Lung India: official organ of Indian Chest Society, 37(Supplement), S19–S29. https://doi.org/10.4103/lungindia.lungindia_272_20

El-Sharkawy, A. M., Sahota, O., & Lobo, D. N. (2016). Acute and chronic effects of hydration status on health. Nutrition reviews, 73(suppl_2), 97-109.

Eltorai, A. E., Szabo, A. L., Antoci, V., Ventetuolo, C. E., Elias, J. A., Daniels, A. H., & Hess, D. R. (2018). Clinical effectiveness of incentive spirometry for the prevention of postoperative pulmonary complications. Respiratory care, 63(3), 347-352.

McMullan, B. J., Andresen, D., Blyth, C. C., Avent, M. L., Bowen, A. C., Britton, P. N., … & Bryant, P. A. (2016). Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children: systematic review and guidelines. The Lancet Infectious Diseases, 16(8), e139-e152.

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This week we will be looking at hormones, infections and hematologic diseases.  You will have a Discussion, however, this one is a little different.  You will need to post your initial discussion by Day 3 as normal, but you will respond to 2 colleagues in Week 10.  Please use the following scenario for your discussion:

 

HH is a 68 yo M who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days. His PMH is significant for COPD, HTN, hyperlipidemia, and diabetes. He remains on empiric antibiotics, which include ceftriaxone 1 g IV qday (day 3) and azithromycin 500 mg IV qday (day 3). Since admission, his clinical status has improved, with decreased oxygen requirements. He is not tolerating a diet at this time with complaints of nausea and vomiting.

Ht: 5’8” Wt: 89 kg

Allergies: Penicillin (rash)

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DISCUSSION INSTRUCTIONS:

Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

As an advanced practice nurse, you will likely experience patient encounters with complex comorbidities. For example, consider a female patient who is pregnant who also presents with hypertension, diabetes, and has a recent tuberculosis infection. How might the underlying pathophysiology of these conditions affect the pharmacotherapeutics you might recommend to help address your patient’s health needs? What education strategies might you recommend for ensuring positive patient health outcomes?

For this Discussion, you will be assigned a patient case study and will consider how to address the patient’s current drug therapy plans. You will then suggest recommendations on how to revise these drug therapy plans to ensure effective, safe, and quality patient care for positive patient health outcomes.

Photo Credit: Getty Images

To Prepare

• Review the Resources for this module and reflect on the different health needs and body systems presented.
• Your Instructor will assign you a complex case study to focus on for this Discussion.
• Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected.

By Day 3 of Week 9

Post a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.

You will respond to your colleagues’ posts in Week 10.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
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