Pneumonia implies a lung infection. It is community-acquired if it is contracted by an individual independent of the healthcare system (Rider & Frazee, 2018). Patients with comorbidities such as COPD, diabetes, hypertension, and hyperlipidemia are prone to recurrent community-acquired pneumonia attacks, especially if the comorbidities are not well controlled (Niu et al., 2021). The evaluation and treatment of these patients present a challenge.
The current discussion will focus on the patient’s needs, treatment regimen, and education based on a case study of HH, a 68-year-old male admitted to the medical ward with community-acquired pneumonia on empiric treatment for the past three days. His past medical history is significant for hypertension, hyperlipidemia, diabetes, and COPD. He is allergic to penicillin and currently not tolerating diet due to nausea and vomiting.
Patient Health Needs
HH shows gradual improvement since admission, evidenced by a decrease in oxygen requirements. However, he requires regular monitoring of his vital signs, particularly his blood pressure, respiratory rate, saturation, and temperature (Rider & Frazee, 2018). Likewise, he has several comorbidities. Random blood sugar levels, lipid levels, and blood pressure levels are required to establish the level of control. Similarly, his nutritional and hydration status must be addressed.
For instance, he requires antiemetic, parenteral nutrition, and intravenous fluids. The patient is on ceftriaxone, a cephalosporin, and azithromycin, a macrolide, for empiric treatment of the infection (Niu et al., 2021). Consequently, he requires a reassessment and tailoring of antibiotics based on culture and microscopy findings. Finally, hospitalized patients are prone to stress ulcers. A proton pump inhibitor such as omeprazole may be initiated.
Empirical treatment with ceftriaxone and azithromycin for 5 to 7 days is recommended by the infectious disease society of America (IDSA) for inpatient treatment of non-severe community-acquired pneumonia in patients with comorbidities (Cavallazzi & Ramirez, 2020). Ceftriaxone is a cephalosporin that binds to bacterial cell walls, causing death. Adverse effects include seizure, pseudomembranous colitis, bleeding, anaphylaxis, and pain at the IM site (Rosenthal & Burchum, 2020).
Azithromycin is a macrolide that inhibits protein synthesis at the 50S ribosomal subunit. Its adverse effects include seizures, toxic epidermal necrolysis, leukopenia, and hepatotoxicity (Rosenthal & Burchum, 2020). Structural dissimilarity warrants the use of cephalosporins in patients allergic to penicillin due to the low incidence of cross reactivity. Monotherapy with a respiratory fluoroquinolone such as levofloxacin may be used as an alternative, particularly if the patient has an immediate penicillin allergy (Sucher et al., 2020).
Additionally, the treatment regimen for HH should contain a statin, antihypertensive, antidiabetic, and fluids to control hyperlipidemia, hypertension, diabetes, and dehydration, respectively. Finally, the COPD treatment should be tailored to Global Initiative for chronic lung disease (GOLD) groups.
Patient education forms a critical component of patient treatment. HH should be instructed on the central role of lifestyle modifications such as exercise, weight reduction, diet, smoking, and alcohol cessation in the effective management of his comorbidities (Niu et al., 2021).
Similarly, he should be enlightened extensively on his comorbidities, the importance of compliance to treatment, and the need for lifetime treatment and regular follow-up. His history of COPD necessitates that he should be advised on the role of vaccinations and avoidance of environmental precipitants in preventing exacerbation (Niu et al., 2021).
In addition, he should be taught self-management skills such as self-monitoring of blood pressure and blood glucose. Lastly, HH is likely to be a candidate for polypharmacy. He should therefore be instructed on adverse effects, potential drug-drug interactions, and when to consult a healthcare provider.
Cavallazzi, R., & Ramirez, J. (2020). Community-acquired pneumonia in chronic obstructive pulmonary disease. Current Opinion in Infectious Diseases, 33(2), 173–181. https://doi.org/10.1097/QCO.0000000000000639
Niu, Y., Xing, Y., Li, J., Shui, W., Gu, Y., Zhang, C., & Du, H. (2021). Effect of community-acquired pneumonia on acute exacerbation of the chronic obstructive pulmonary disease. COPD Journal of Chronic Obstructive Pulmonary Disease, 18(4), 417–424. https://doi.org/10.1080/15412555.2021.1950664
Rider, A. C., & Frazee, B. W. (2018). Community-acquired pneumonia. Emergency Medicine Clinics of North America, 36(4), 665–683. https://doi.org/10.1016/j.emc.2018.07.001
Rosenthal, L., & Burchum, J. (2020). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.). Saunders.
Sucher, A., BCIDP Professor of Pharmacy Practice Shannon Knutsen, PharmD Associate Professor of Pharmacy Practice Charles Falor, & PharmD Candidate 2021 Regis University School of Pharmacy Denver. (2020, April 17). Updated clinical practice guidelines for community-acquired pneumonia. Uspharmacist.com. https://www.uspharmacist.com/article/updated-clinical-practice-guidelines-for-communityacquired-pneumonia
Community-Acquired Pneumonia Assignment Description
My topic is community-acquired pneumonia Synthesize Course content from Weeks 1-5 according to the following sections: Introduction: Analysis of the communicable disease (causes, symptoms, mode of transmission, complications, treatment) to include demographic breakdown that includes age, gender, race, or other at-risk indicators (da ta per demographics should include mortality, morbidity, incidence, and prevalence). Determinants of Health: Define, identify and synthesize the determinants of health as related to the development of the infection. Utilize HP2020. Epidemiological Triad: Identify and describe all elements of the epidemiological triad: Host factors, agent factors (presence or absence), and environmental factors. Utilize the demographic breakdown to further describe the triad. Role of the NP: Succinctly define the role of the nurse practitioner according to a national nurse practitioner organization ( National Board of Nursing or AANP, for example) and synthesize the role to theâ€¯management of infectious diseases (surveillance, primary/secondary/tertiary interventions, reporting, data collecting, data analysis, and follow-up). This includes integrating a model of practice that supports the implementation of an evidence-based practice.â€¯ Refer to your course textbook for models of practice examples. use this text book also Concepts and Competencies for Advanced Practice Edition: 3rd Authors: Ann L. Curley, PhD, RN use this book as a reference and please answer every topic from the direction thoroughly