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.

Colleagues’ responses

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.

 Case study

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)

David

Individuals with comorbidities can present with challenges when trying to manage the many medical symptoms when their health begins to deteriorate. For patient HH, who has PMH of COPD, HTN, hyperlipidemia, and diabetes is now having to manage newly acquired pneumonia. Comorbidities contribute decisively to the risk of dying from pneumonia in the hospital, regardless of their type or origin (Hespanhol & Bárbara, 2020) His medical needs will require hospitalization for monitoring of respiratory distress given the diagnoses of pneumonia and history of COPD. Provide optimal care to minimize stress on the respiratory system allowing for rest and recovery with supplemental oxygen.

To combat the infection, the patient is to finish out the prescribed empiric antibiotic regiment of Ceftriaxone and Azithromycin that is specific to the patient who is allergic to Penicillin that can take up to 10 days. Initial treatment of Community-acquired pneumonia (CAP) is usually empirical, because the microbial etiology cannot be predicted on the basis of clinical presentation (Wongsurakiat & Chitwarakorn, 2019). With the patient showing improvement and deceased oxygen requirement there will be a time to switch the patient from IV antibiotic therapy to antibiotics to be given orally. Continued monitoring of other heath related factors will be addressed and provided with care as needed. As needed medication can prescribed such as Zofran IV to combat the nausea and vomiting that perhaps is related to the current antibiotic regiment. Due to the antibiotics having disrupted the gut balance, a probiotic can be prescribed to help restore the guts normal PH balance and prevent for episodes of nausea and vomiting.

Educational needs will be provided during stay in the hospital and upon discharge with educational materials to help patient better understand heath related illness and management of health. Given the history of COPD and the likeliness of continued development of health-related issues due to compromised health, its imperative that the patient is understanding of medication regiment set for discharge and the need for follow up by primary health care provider. Medication non-adherence is a complex process determined by many modifiable and unmodifiable determinants which can be categorized into five dimensions (socio-economic, patient-related, therapy-related, condition-related, and health system–related) (González-Bueno et al, 2022). Resources for outpatient services, connection with social services and other social concerns to be addressed to help manage both physiological and psychological health needs.

GE

Infections and Hematologic Systems

The patient’s health needs are particular and include a need for antibiotics, IV fluids, and pain relief. Mr. HH is also at risk for complications from his underlying medical conditions, so close monitoring is warranted. He needs to be as comfortable as possible and have as little pain as possible. The patient also needs to be able to eat and drink without difficulty. In addition, Mr. HH needs to be able to take his antibiotics without vomiting (Jacobs, 2017). Lastly, he needs to be able to urinate without difficulty. According to Gallagher et al. (2016), the best treatment regimen for Mr. HH would be a ceftriaxone and azithromycin combination. This regimen is effective in treating community-acquired pneumonia. The patient should also be given IV fluids and pain relief. The IV fluids will help to keep the patient hydrated, and the pain relief will help to manage any discomfort the patient may be experiencing (Gallagher et al., 2016). The patient should be closely monitored for any complications from his underlying medical conditions.

Prabhu et al. (2016) found that patients with community-acquired pneumonia (CAP) often require significant lifestyle changes to improve their prognosis. A patient education strategy that could be recommended for Mr. HH is creating a personalized plan of care that considers their Previous Medical History (PMH). For example, Prabhu et al. (2016) explain that a CAP patient with HTN and hyperlipidemia may need to change their diet and exercise regimen, while a patient with COPD may require lifestyle modifications such as increased rest and reduced smoking. Many resources are available to help patients understand and follow their personalized PMH care plan, such as patient education leaflets or books.