NURS 6521 Wk 9 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

NURS 6521 Wk 9 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

NURS 6521 Wk 9 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

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

The case study addresses HH, who is 68 years old male. The patient has been diagnosed with community-acquired pneumonia. His PMH is significant to diabetes, COPD, hyperlipidemia, and HTN. The patient is

on ceftriaxone 1 g IV qday and azithromycin 500 mg IV qday. 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 and has lost some weight. The patient is also presenting with an allergic reaction to penicillin. This paper examines a patient who is present with COPD, diabetes, and hyperlipidemia and is receiving antibiotics although he is allergic to them.

The patient in the scenario has community-acquired pneumonia, improving oxygen demands on day three of ceftriaxone 1 gram daily and azithromycin 500gm intravenous daily. It is important to obtain sputum cultures when treating pneumonia before starting antibiotic therapy (Quinton et al., 2018). The scenario does not list any lab results, and therefore, the infective agent is unknown. Common bacteria that cause CAP are Streptococcus pneumoniae, mycoplasma ssp., Hemophilus influenzae, and staphylococcus aureus (Ding et al., 2018). This patient has an allergic reaction to the penicillin family, evidenced by his skin rash. Patients with a history of penicillin allergy should never receive them again (Rosenthal & Burchum, 2021).

NURS 6521 Wk 9 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Similar medications with no incidences of allergic reactions are sulfonamides, trimethoprim, and erythromycin. Patients with allergic reactions to penicillin can receive third or fourth-generation cephalosporin or carbapenems such as Tetracyclines (doxycycline), quinolones (ciprofloxacin), macrolides (gentamycin), and glycopeptides (vancomycin) (Rosenthal & Burchum, 2021). These are all unrelated to penicillins and are safe to use in patients with penicillin allergies.

The patient has a chronic obstructive pulmonary disease (COPD). COPD can be exacerbated by respiratory tract infections and may require antibiotic therapy, bronchodilators, glucocorticoids, and supplemental oxygen (Amin et al., 2021). The scenario did not indicate any bronchodilators nor glucocorticoids being administered. Depending on the patient’s dynamics, some of these medications need to be considered.

The patient is currently showing signs of improvement. However, the patient is also experiencing stomach discomfort, nausea, and vomiting, likely due to antibiotic therapy. I will keep the patient on antibiotics since they are necessary for his treatment. However, I will add an antiemetic such as ondansetron (Zofran) intravenous 4 mg for every six hours to control the symptoms.

I will also change the type of antibiotic he is currently on since the patient’s status is improving. I should consider changing the current therapy to include trimethoprim (sulfamethoxazole), the drug of choice for Hemophilus influenzae, gram-negative bacilli, in upper respiratory infections (Rosenthal & Burchum, 2021). Staphylococcus aureus is gram-positive cocci that can be penicillinase-producing or methicillin-resistant; in this case, the first drug of choice is vancomycin (daptomycin) (Ding et al., 2018).

Alternative drugs for treating Streptococcus pneumoniae are azithromycin, levofloxacin, meropenem, imipenem, and trimethoprim/sulfamethoxazole. Mycoplasma pneumoniae is a mycoplasma bacteria that one of the first choice antibiotics is azithromycin (Rosenthal & Burchum, 2021). The fourth-generation cephalosporin has a narrow pseudomonas aeruginosa (Rosenthal & Burchum, 2021). Cefepime is a fourth-generation cephalosporin with the highest activity against gram-negative bacteria (Rosenthal & Burchum, 2021). According to Metlay et al. (2019), appropriate antibiotic combination therapy for community-acquired pneumonia might include ceftriaxone, cefotaxime, ceftaroline, ertapenem, or ampicillin-sulbactam with azithromycin, clarithromycin, clarithromycin XL or Doxycycline.

Based on this scenario, my treatment plan would be to stop the ceftriaxone first and then start cefepime. I will keep the route of administration unchanged since IV antibiotics are preferred because of the high mortality associated with community-acquired pneumonia and the unmeasurable absorption of antibiotics in the GI tract (Metlay et al., 2019). Adding to the fact that the patient is not currently showing hemodynamic stability or functional normal gastrointestinal tract that would tolerate PO medications.

As the patient proceeds with therapy, it is essential to ensure the administration of a bronchodilator and antibiotic together. Fluoroquinolones help inhibit the two enzymes involved in the synthesis of DNA (Pham et al., 2019). The bronchodilator makes breathing easier by relaxing the muscles in the lungs and widening the airways (Pham et al., 2019).

The patient needs to know his symptoms, what to expect during admission, stay period, and discharge. Most patients admitted with CAP have at least one lingering symptom of pneumonia for 6 weeks post-discharge, such as cough, fatigue, or difficulty breathing (Metlay et al., 2019). I would also educate the patient on preventive measures such as pneumococcal influenza vaccines, especially recommended for adults older than 65 years old (Rosenthal & Burchum, 2021). My education plan will also include taking daily Zinc and Vitamin C and smoke cessation, if applicable; it is also important that a patient diet is considered, which helps manage the patient’s diabetic condition. Therefore, a balanced diet and regular exercise help in managing the condition. These measures will help improve patient outcomes, reduce reinfection, and prevent future hospitalization.

References

Amin, A. N., Cornelison, S., Woods, J. A., & Hanania, N. A. (2021). Managing hospitalized patients with a COPD exacerbation: the role of hospitalists and the multidisciplinary team. Postgraduate Medicine, (just-accepted). https://www.tandfonline.com/doi/abs/10.1080/00325481.2021.2018257

Ding, W., Zhou, Y., Qu, Q., Cui, W., God’spower, B. O., Liu, Y., … & Li, Y. (2018). Azithromycin inhibits biofilm formation by Staphylococcus xylosus and affects histidine biosynthesis pathway. Frontiers in Pharmacology, 9, 740. https://www.frontiersin.org/articles/10.3389/fphar.2018.00740/full

Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., … & Whitney, C. G. (2019). Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. American Journal of Respiratory and Critical Care Medicine, 200(7), e45-e67. https://www.atsjournals.org/doi/abs/10.1164/rccm.201908-1581st

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NURS 6521 Wk 9 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
NURS 6521 Wk 9 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

Pham, T. D., Ziora, Z. M., & Blaskovich, M. A. (2019). Quinolone antibiotics. Medchemcomm, 10(10), 1719-1739. https://pubs.rsc.org/en/content/articlehtml/2019/md/c9md00120d

Quinton, L. J., Walkey, A. J., & Mizgerd, J. P. (2018). Integrative physiology of pneumonia. Physiological Reviews, 98(3), 1417-1464. https://journals.physiology.org/doi/abs/10.1152/physrev.00032.2017

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants. Elsevier.

WK 9 Main Post
COLLAPSE

Comorbidities increase complexity of healthcare.  The purpose of this discussion is to consider how to address pharmacotherapeutics for comorbidities within a case study via examination of health needs, recommended treatment, and patient education strategies.  As advance nurse students navigate the case study, their ability to increase the quality of pharmacotherapeutic treatment for cases with comorbidities improve.

Health Needs

The patient in the case study health needs consist of a chief complain of community acquired pneumonia (CAP) with a past medical history of chronic obstructive pulmonary disease (COPD), hypertension (HTN), hyperlipidemia (HLD), and diabetes (DM).  The combination or individualized diseases potentially causes and/or exacerbate pneumonia (Gavrilova, Bontsevich, Vovk, & Balabanova, 2020).  The patient’s past medical history effects the development of the pneumonia and the pharmacotherapeutics effects the development of the pneumonia as well as the other diseases.  For example, the current medication list is necessary to know and consider.  Drug therapy for COPD typically long term that consist of long acting beta 2 agonist and corticosteroids via inhalation (Rogliani, Ora, Puxeddu, Matera, & Cazzola, 2017).  In this case scenario, the comorbid disease and its drug therapy aid in the development of pneumonia via decrease lung functionality from chronic obstruction and decreased immunity from long term steroid usage.  Hypertension drug therapy may consist of angiotensin-converting enzyme inhibitors that has a side effect of persistent cough (Yılmaz, 2019).  The patient may have the cough, may be use to the cough, but the cough may exacerbate the pneumonia.  For HDL, statin drug therapy is typical and may decrease inflammation of the lungs (Dashti‐Khavidaki & Khalili, 2020).  Continuation of the statins may help alleviate some pneumonia symptoms via anti-inflammatory properties. As for DM, uncontrolled diabetes causes white blood cells to decrease fight of infection; DM patients are more susceptible to develop diseases (Huang, Lim, & Pranata, 2020).  Compromised immune systems presents again through a different comorbid disease.  The consideration of all diseases in this case is vital to the quality of the patient’s pharmacotherapeutic care.

Recommended Treatment

The recommended treatment for the patient is empiric antibiotics, which include ceftriaxone 1g IV qday (day 3) and azithromycin 500 mg IV qday (day 3).   The patient is allergic to penicillin in the case study.  The prescribed ceftriaxone and allergen, penicillin are both cephalosporin (Khan, Banerji, Bernstein, Bilgicer, Blumenthal, Castells, … & Phillips, 2019).  Consideration of a different antibiotic class is necessary because the patient may have an allergic reaction to ceftriaxone. Levoflaxin is an established innovative quinolone and is secondary usage on the Empirical guidelines (Kolditz & Ewig, 2017). This medication is a considerable replacement drug therapy for ceftriaxone.  Macrolides are a different class antibiotic and treats community acquired pneumonia (Horita, Otsuka, Haranaga, Namkoong, Miki, Miyashita, … & Kaneko, 2016).  Therefore, the use of azithromycin should be safe because it’s a macrolide.  The recommended drug therapy for this patient potentiates significant safety risk.

Patient Education Strategy

One patient’s education strategy that is important is the comorbidity effect of COPD with CAP.  Each winter, COPD patients acquire community pneumonia and the correlation highlights causes (Williams, Coombs, Johnson, Josephs, Rigge, Staples, … & Wilkinson, 2017).  Strategic educational planning consists of writing down these causes to make sure the patient is aware of the causes and how to take preventive measures.  Education of causes and preventive measures decreases the risk of COPD patients acquiring community pneumonia.

Summary

In summation, development of comorbidity healthcare is challenging.  Examination of a comorbidity case study allows the advance student nurses to practice and understand how critical the knowledge and consideration is to pharmacotherapeutic development.  In the midst of improving abilities to increase the quality of pharmacotherapy for comorbid case studies, the advance nurse students are able to advance comorbid pharmacotherapy.

 

References

Ahmadikia, K., Hashemi, S. J., Khodavaisy, S., Getso, M. I., Alijani, N., Badali, H., … & Rezaie, S. (2021). The double‐edged sword of systemic corticosteroid therapy in viral pneumonia: A case report and comparative review of influenza‐associated mucormycosis versus COVID‐19 associated mucormycosis. Mycoses, 64(8), 798-808.

Chang, S. P., Lee, H. Z., Lai, C. C., & Tang, H. J. (2019). The efficacy and safety of nemonoxacin compared with levofloxacin in the treatment of community-acquired pneumonia: a systemic review and meta-analysis of randomized controlled trials. Infection and Drug Resistance, 12, 433.

Dashti‐Khavidaki, S., & Khalili, H. (2020). Considerations for statin therapy in patients with COVID‐19. Pharmacotherapy, 40(5), 484.

Gavrilova, A. A., Bontsevich, R. A., Vovk, Y. R., & Balabanova, A. A. (2020). Modern approaches to pharmacotherapy of Community-Acquired Pneumonia. Research Results in Pharmacology, 6, 77.

Horita, N., Otsuka, T., Haranaga, S., Namkoong, H., Miki, M., Miyashita, N., … & Kaneko, T. (2016). Beta‐lactam plus macrolides or beta‐lactam alone for community‐acquired pneumonia: A systematic review and meta‐analysis. Respirology, 21(7), 1193-1200.

Huang, I., Lim, M. A., & Pranata, R. (2020). Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia–a systematic review, meta-analysis, and meta-regression. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 14(4), 395-403.

Khan, D. A., Banerji, A., Bernstein, J. A., Bilgicer, B., Blumenthal, K., Castells, M., … & Phillips, E. (2019). Cephalosporin allergy: current understanding and future challenges. The Journal of Allergy and Clinical Immunology: In Practice, 7(7), 2105-2114.

Kolditz, M., & Ewig, S. (2017). Community-acquired pneumonia in adults. Deutsches Ärzteblatt International, 114(49), 838.

Rogliani, P., Ora, J., Puxeddu, E., Matera, M. G., & Cazzola, M. (2017). Adherence to COPD treatment: myth and reality. Respiratory medicine, 129, 117-123.

Williams, N. P., Coombs, N. A., Johnson, M. J., Josephs, L. K., Rigge, L. A., Staples, K. J., … & Wilkinson, T. M. (2017). Seasonality, risk factors and burden of community-acquired pneumonia in COPD patients: a population database study using linked health care records. International journal of chronic obstructive pulmonary disease, 12, 313.

Yılmaz, İ. (2019). Angiotensin-converting enzyme inhibitors induce cough. Turkish thoracic journal, 20(1), 36..

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