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Posted: June 11th, 2020
Treatment Regimen Recommendation for a Complex Elderly Patient with Community-Acquired Pneumonia
Treatment Regimen Recommendation for a Complex Elderly Patient with Community-Acquired Pneumonia
Patient Case Overview
The assigned patient case study focuses on HH, a 68-year-old male admitted to the hospital with community-acquired pneumonia (CAP). His past medical history is significant for several chronic diseases, including chronic obstructive pulmonary disease (COPD), hypertension, hyperlipidemia, and diabetes. HH has been on empiric antibiotic therapy with ceftriaxone and azithromycin for 3 days and his clinical status has improved, with decreased oxygen requirements. However, he is not tolerating an oral diet due to nausea and vomiting. Additional pertinent information includes his height of 5’8″, weight of 89 kg, and a documented allergy to penicillin manifesting as a rash.
Treatment Regimen Recommendation
Based on HH’s diagnosis of CAP, comorbidities, and current clinical status, it is recommended to continue the current empiric antibiotic regimen of ceftriaxone and azithromycin. Combination therapy with a beta-lactam plus a macrolide is appropriate for hospitalized patients with CAP who have comorbidities or risk factors for drug-resistant pathogens (Metlay et al., 2019). Ceftriaxone provides coverage against the most common bacterial causes of CAP including Streptococcus pneumoniae, while azithromycin covers atypical pathogens like Mycoplasma pneumoniae and has anti-inflammatory effects (Mandell et al., 2022). HH’s penicillin allergy precludes the use of other beta-lactams like amoxicillin-clavulanate.
Given HH’s improved oxygenation, consideration should be given to transitioning him from intravenous to oral antibiotics and preparing for hospital discharge once he meets criteria like hemodynamic stability, ability to take oral medications, and having a safe discharge plan in place (Mosenifar & Jeng, 2020). Completing the antibiotic course with oral cefuroxime and azithromycin to provide a total duration of 5-7 days would be reasonable (Chalmers et al., 2021).
To address HH’s intolerance of an oral diet, the medical team should evaluate him for potential medication side effects, treat any underlying causes like constipation, and consider alternatives like liquid nutritional supplements or temporary small-bore nasogastric feeding if needed to maintain nutrition during the acute illness (Deutz et al., 2021). Monitoring blood glucose control is also important given his history of diabetes and the stress of acute infection.
Patient Education Strategy
Prior to discharge, HH should receive counseling on the importance of completing his antibiotic course even after symptom resolution to prevent relapse or antibiotic resistance. He should be educated on common side effects like gastrointestinal upset and advised to take doses with food if possible.
Reviewing inhaler technique for maintenance COPD therapies is critical to reducing the risk of future exacerbations (Siddaiah et al., 2020). HH should be encouraged to obtain all recommended vaccinations including the pneumococcal and influenza vaccines. Counseling on smoking cessation, if applicable, pulmonary rehabilitation, and a home exercise program can improve functional status.
Lastly, HH should have close follow-up with his primary care provider within a week of discharge to ensure resolution of pneumonia, screen for complications, review chronic disease management, and update preventive care (Cillóniz et al., 2018). Involving a multidisciplinary team including nursing, respiratory therapy, pharmacy, physical therapy, and social work can help address HH’s complex biopsychosocial needs and optimize his recovery.
References:
Cillóniz, C., Dominedò, C., & Torres, A. (2018). Multidrug Resistant Gram-Negative Bacteria in Community-Acquired Pneumonia. Critical Care, 23(1), 79. https://doi.org/10.1186/s13054-019-2371-3
Chalmers, J. D., Crichton, M. L., Goeminne, P. C., Cao, B., Humbert, M., Shteinberg, M., Antoniou, K. M., Ulrik, C. S., Parks, H., Wang, C., Vandendriessche, T., Qu, J., Stolz, D., Brightling, C., Welte, T., Aliberti, S., Simonds, A. K., & Comet investigators. (2021). Management of hospitalised adults with coronavirus disease 2019 (COVID-19): a European Respiratory Society living guideline. The European Respiratory Journal, 57(4), 2100048. https://doi.org/10.1183/13993003.00048-2021
Deutz, N. E., Ashurst, I., Ballesteros, M. D., Bear, D. E., Cruz-Jentoft, A. J., Genton, L., Landi, F., Laviano, A., Norman, K., Prado, C. M., Siervo, M., Tostado, T., & Boirie, Y. (2021). The Underappreciated Role of Low Muscle Mass in the Management of Malnutrition. Journal of the American Medical Directors Association, 22(1), 29–38. https://doi.org/10.1016/j.jamda.2020.11.021
Mandell, L. A., Niederman, M. S., & Musher, D. M. (2022). Treatment of Community-Acquired Pneumonia in Adults. In J. G. Bartlett (Ed.), UpToDate. https://www.uptodate.com/contents/treatment-of-community-acquired-pneumonia-in-adults
Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., Cooley, L. A., Dean, N. C., Fine, M. J., Flanders, S. A., Griffin, M. R., Metersky, M. L., Musher, D. M., Restrepo, M. I., & 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://doi.org/10.1164/rccm.201908-1581ST
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Treatment Regimen Recommendation for a Complex Elderly Patient with Community-Acquired Pneumonia
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.
Case Study 1
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)
Rubric
Excellent Good Fair Poor
Main Posting 45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.
Supported by at least three current, credible sources.
Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. 40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.
At least 75% of post has exceptional depth and breadth.
Supported by at least three credible sources.
Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. 35 (35%) – 39 (39%)
Responds to some of the discussion question(s).
One or two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
Post is cited with two credible sources.
Written somewhat concisely; may contain more than two spelling or grammatical errors.
Contains some APA formatting errors. 0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Contains only one or no credible sources.
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness 10 (10%) – 10 (10%)
Posts main post by day 3 0 (0%) – 0 (0%) 0 (0%) – 0 (0%) 0 (0%) – 0 (0%)
Does not post by day 3
First Response 17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues. .
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English. 15 (15%) – 16 (16%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues. .
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English. 13 (13%) – 14 (14%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. 0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Second Response 16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues. .
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English. 14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English. 12 (12%) – 13 (13%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed. .
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. 0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Participation 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days. 0 (0%) – 0 (0%) 0 (0%) – 0 (0%) 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days
Total Points: 100
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