Drug Treatments Discussion
This is an informative post. I agree that it is important to know the precise bacteria causing CAP for the patient. As Giuliano et al (2019) explain, obtaining cultures prior to antibiotic administration helps to identify the exact microorganism and hence allows possible de-escalation through proper treatment. If cultures are obtained after the initiation of antibiotics, there may be a reduction in the blood-culture yield, and this can lengthen the period of hospital stay for the patient and increase healthcare costs (Giuliano et al., 2019). I also agree that nausea and vomiting are side effects of the medications as these are common side effects with antibiotics. I would like to add that even if the use of broad-spectrum antibiotics to treat pneumonia is a common practice, it is important to identify the exact disease-causing microorganism to prevent resistance because improper use of antibiotics is associated with antibiotic resistance costs (Giuliano et al., 2019).
Regarding the vomiting for the patient, I would add that the patient needs to be well hydrated due to the vomiting and to ease his breathing (El-Sharkawy, Sahota & Lobo, 2016). The intake and output need to be monitored strictly to prevent any possible dehydration. For the patient education, apart from the deep breathing exercises and taking adequate fluids, the patient needs to be taught how to use the incentive spirometer. It is also important to teach the patient to avoid smoke and any allergen as this might trigger a COPD exacerbation (Dhar et al., 2020). The patient will be educated to always ensure the pneumonia vaccine is up-to-date as he is at high risk of contracting pneumonia because he is an older adult with COPD (Dhar et al., 2020).
Dhar, R., Ghoshal, A. G., Guleria, R., Sharma, S., Kulkarni, T., Swarnakar, R., Samaria, J. K., Chaudhary, S., Gaur, S. N., Christopher, 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.
Giuliano, C., Patel, C. R., & Kale-Pradhan, P. B. (2019). A Guide to Bacterial Culture Identification and Results Interpretation. P & T: a peer-reviewed journal for formulary management, 44(4), 192–200.
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.
A patient admitted to the hospital with community acquired pneumonia that has a history of HTN, DM, hyperlipidemia and COPD needs close monitoring of their respiratory status and their blood sugar. Patients with COPD that develop pneumonia are at an increased risk of complications. Each respiratory infection changes the baseline of the patient’s COPD. When DM patients get infections the stress on the body increases the patients blood sugars. The patient will likely require IV steroids due to the infection with the history of COPD. The IV steroids will increase their blood sugar, potentially creating more problems.
As the clinician caring for a patient with pneumonia, it is important to know the exact bacteria that caused the community-acquired pneumonia. Obtaining the blood culture samples that should have been collected prior to the start of the antibiotic is important in letting the clinician know what antibiotic to use. The patient has required less oxygen since admission but is continued on two antibiotics, one of which is a broad-spectrum antibiotic that are like Penicillin’s, and the azithromycin is another broad-spectrum antibiotic to treat gram- positive and gram-negative bacteria (McMullan & Mostaghim, 2015). It is not abnormal to start a patient on dual antibiotics until the exact bacteria is known to reduce the risk of developing resistant bacteria, but due to the patient’s history of a PCN allergy the use of ceftriaxone should be avoided (Rosenthal & Rosenjack Burchum, 2021). The nausea and vomiting could be a form of a reaction to the antibiotic. Due to Azithromycin potential interactions with other medications, such as statins, cardiac medications, and any medications that prolong the QT the clinician needs to be aware of the medications the patient currently takes (Azithromycin, 2021). Azithromycin is the most appropriate medication choice for an atypical or community acquired pneumonia.
The patient has been having issue with nausea and vomiting that could be due to the infection, the antibiotics, and possible diabetic related issues. Gathering the information needed to determine the reason for the nausea and vomiting are important. In the meantime, treating the patient with an antiemetic such as Zofran is necessary for the comfort of the patient. Start the patient on a clear liquid diet while closely monitoring their blood sugar.
There are several teaching opportunities the clinician should focus on with the patient, such as deep breathing exercises and close control of their diabetes. Deep breathing exercises are important to help move any mucous that has collected from the pneumonia. It is important for the patient to drink more liquids if they are not on a fluid restriction to help cough up the mucous. The patient’s blood sugars will likely be increased due to the likelihood of the patient being placed on IV steroids, so closer monitoring is essential to prevent any complications.
There are several antibiotics available to treat patients for infections. The clinician can use resources available to decide on the appropriate antibiotic while waiting on the blood culture results. Several clinicians use dual antibiotics for empiric treatment to prevent bacteria from developing resistance, but it is necessary to give the appropriate antibiotic when it is known the susceptibility of the bacteria.
Azithromycin. (2021). Prescriber’s Digital Reference. Retrieved October 27, 2021, from https://www.pdr.net/drug-summary/Zithromax-250-mg-and-500-mg-Tablets-and-Oral-Suspension-azithromycin-1012
McMullan, B., & Mostaghim, M. (2015). Prescribing azithromycin. Australian Prescriber, 38(3). Retrieved October 27, 2021, from https://doi.org/ncbi.nlm.nih.gov>pmc
Rosenthal, L., & Rosenjack Burchum, J. (2021). Pharmacotherapeutics for Advanced practice nurses and physician assistants (2nd ed.). Elsevier.
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