Community-Acquired Pneumonia Essay Assignment Paper
Community-Acquired Pneumonia Essay Assignment Paper
Read this 2 different responses and respond note they were assigned a different patient case study, please provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples. RESPOND WITH 6-8 SENTENCES EACH AND 2 REFRENCES WITHIN 5YRS Post 1 for John Mc Community-acquired pneumonia (CAP) is contracted outside the healthcare facility and the most frequent pathogens identified are Streptococcus pneumoniae, Haemophilus influenzae, atypical bacteria such as Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella species, and viruses like influenza and rhinoviruses. Signs and symptoms consist of fever, cough, productive sputum, chest pain, dyspnea, tachypnea, and tachycardia. It is diagnosed by clinical presentation and chest x-ray and treated by empirically selected antibiotics. Prognosis is positive in healthy, younger patients but can be fatal in older and more ill populations depending on the pathogens involved (Reckziegel et al., 2020). The patient in the scenario is suffering from moderate risk CAP along with hypertension, hyperlipidemia, and diabetes. The treatment currently being used is empirical antibody therapy since the causative organism for the condition is not been yet identified. Empiric antimicrobial therapy is directed against an anticipated and likely cause of infectious disease. Community-Acquired Pneumonia Essay Paper. This form of therapy is employed when antimicrobials are given to a person before the identification of a particular bacterium or fungus initiating the infection has been discovered but ideally the treatment should be tailored to a specific microorganism. For the identification of the causative organism, sputum gram stain, urinary antigen test and RT-PCR (Corona virus) are to be performed. Urinary antigen test help to identify the best specific antibiotic that can be used to treat the condition (Blaschke, 2011). The patient is diagnosed with diabetes and the organism responsible for CAP could likely be a bacterium specifically Klebsiella pneumonia which is a gram-negative which is an encapsulated, non-motile bacterium found in the environment and connected with pneumonia in patients with chronic alcohol use disorder or poorly controlled diabetes mellitus. However, with the rare occurrence of Klebsiella pneumonia in the community,
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CAP treatment should follow standard guidelines for antibiotic therapy. Once infection with Klebsiella pneumonia is either suspected or confirmed, antibiotic treatment should be tailored to local antibiotic sensitivities. Current regimens for community-acquired Klebsiella pneumonia include a 14-day treatment with either a third or fourth generation cephalosporin as monotherapy or a respiratory quinolone as monotherapy or either of the previous regimes in conjunction with an aminoglycoside (Ashurst & Dawson, 2020). Recommendations for imagining in CAP would consist of chest x-ray in conjunction with patient history and physical exam. A PA and Lat x-ray should be routinely performed as well. If the chest x-ray accuracy is low due to obese or immunosuppressed patients, a chest CT may be performed and is indicated in suspected fungal infections as well as identifying lung abscesses and loculated pleural effusion (Corrêa et al., 2018). Antibiotic treatment for patients admitted to the ward would benefit from monotherapy with respiratory fluoroquinolone such as levofloxacin or combination therapy with a β-lactam and a macrolide has been guideline recommended for the treatment of ward patients with CAP because these regimens provide good coverage and produce good results in infections caused by S. pneumoniae, M. pneumoniae, C. pneumoniae, H. influenzae, or Legionella (Corrêa et al., 2018). Respiratory fluoroquinolones provide wide microbiological coverage, have a convenient dosing schedule, and have the ability to switch from parenteral to oral therapy. The patient has been identified to have a penicillin-allergy so an IV transition to an oral antibiotic like a azithromycin 500 mg PO once daily for 7-10 days should be considered (Ashurst & Dawson, 2020). During the course of an infection, an appropriate balance between activation of the immune response and control of inflammation is critical to combating an infection without neighboring tissue damage. Adjuvant treatment with corticosteroids can improve the course of patients treated for CAP when combined with antibiotics as well as utilized for the patient’s treatment for COPD. Corticosteroid result in good tolerance without increasing the incidence of adverse effects, except for some cases hyperglycemia (Corrêa et al., 2018). Corticosteroids such as prednisone can cause hyperglycemia and blood sugar levels will need to be monitored. NPH insulin administered at the time of steroid administration and dosed according to dose of administered steroid (e.g., 0.1 unit/kg NPH insulin for each 10 mg Prednisone equivalent of administered glucocorticoid to maximum dose of 0.4 units/kg for doses ≥ 40 mg) has been demonstrated as being effective in maintaining glycemic control (Khowaja et al., 2018). The patient in the scenario clinical status is improving with decreased oxygen demands but not tolerating dietary intake with complaints of nausea and vomiting.
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The most common adverse reactions from cephalosporins such as Rocephine are nausea, vomiting, lack of appetite, and abdominal pain (Bui & Preuss, 2020).Community-Acquired Pneumonia Essay Paper. In addition, as with other macrolides, azithromycin has gastrointestinal adverse effects as well such as nausea and diarrhea, are commonly reported. All macrolides exhibit dose-dependent activation of intestinal-motilin receptors, which stimulate gastric motility (Sandman & Iqbal, 2020). The gut microbiome (environment where microorganisms live) allows the digestive system working and assists the immune system to protect against viral infection. When antibiotics, such as the ones in the scenario, disturb the bacterial balance, patients may suffer side effects, such as nausea, vomiting, or diarrhea. This can be addressed by consuming prebiotic and probiotic supplements during and after a course of antibiotic therapy and dietary intake should consist of yogurt, bananas and foods with garlic and onion to promote a stable gut microbiome balance. Depending on which chemoreceptor trigger zone for emesis has been activated, antiemetics such as Zofran 4mg IV Q 6hrs PRN or Phenergan 12.5mg IV Q 4-6hrs PRN (potential sedative side effects) for breakthrough nausea may be administered as well. The patient should be on Q4 hr vital signs with 4L of supplementary oxygen and continuous pulse oximetry. Pneumococcal and influenza vaccines should be administered upon discharge. Continue with IV antibiotic therapy of Rocephin 1 GM IV qday and azithromycin 500mg IV q day for 7-10 days and transition to azithromycin 500mg PO once daily for 7-10 days when clinically stable. Prescribing prednisone 50mg PO once daily for 7 days as combination therapy with antibiotics to aid in blocking several arms of the inflammatory cascade identified with pneumonia may be beneficial with impeding any COPD exacerbation as well (Blum et al., 2014). The patient should continue home medication and doses for HTN, hyperlipidemia, and diabetes. Monitoring of blood glucose should be initiated with frequency depending on how well controlled the disease is and while on corticosteroid for hyperglycemia. If controlled with insulin, employing a sliding scale insulin regimen can be initiated by either long-acting insulin (glargine/detemir or NPH), once or twice a day with short acting insulin (aspart, glulisine, lispro, Regular) before meals and at bedtime, long-acting insulin (glargine/detemir or NPH), given once a day, or regular and NPH, given twice a day. Nausea and vomiting should be remedied by reestablishing gut microbe balance by introducing prebiotics and probiotics such as yogurt and lactobacillus. Zofran 4mg IV Q6 hrs and Phenergan 12.5mg IV Q4-6 hrs PRN for break through nausea. Patient education should consist of IV and oral antibiotic treatment and side effects primarily the symptoms the patient is currently experiencing and rationale of using prebiotics, probiotics, and antiemetics prescribed. If applicable, the patient should be educated on steroid treatment with potential hyperglycemia associated with the drug and frequency of blood glucose monitoring and insulin medication therapy. The patient may also benefit from diabetic education regarding diet and exercise to maintain diabetes control as well as hypertension and hyperlipidemia management. Community-Acquired Pneumonia Essay Paper. Increasing vitamin C and zinc in dietary intake may also help to improve current condition with CAP (Shehzad et al., 2015). References Ashurst JV, Dawson A.
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