NURS 6521 Week 9 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders Example 2 Case Study 1

NURS 6521 Week 9 Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders Example 2

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)

Community-Acquired Pneumonia Case Study

Community-acquired pneumonia (CAP) is a subtype not acquired in a hospital or clinical setting. It may be caused by bacteria, viruses, and fungi, especially in immunocompromised patients. Despite the availability of a wide range of antibiotics and other treatment options, pneumonia remains a highly infectious disease with high morbidity and mortality. Therapeutic regimens need to be well developed and tailored towards specific patient needs and thorough patient education extended to the patients.

HH, a 68-year-old male, is admitted to the hospital and diagnosed with community-acquired pneumonia. His  PMH is significant for COPD, HTN, hyperlipidemia, and diabetes. He is on empiric antibiotics, including ceftriaxone 1 g IV day (day 3) and azithromycin 500 mg IV day (day 3). His clinical status has improved since admission; however, he complains of nausea and vomiting and is not tolerating a diet. He is allergic to penicillin.

Treatment Regimen

Various treatment options exist for the management of CAP. However, fluoroquinolone monotherapy is preferred due to its relative safety, efficacy, and reduced association with antimicrobial resistance. Fluoroquinolones (levofloxacin and moxifloxacin) inhibit bacterial DNA synthesis by inhibiting the topoisomerase enzyme function. They are generally safe and well-tolerated and are considered the first-line option for patients with comorbidities (Karampela, 2020).

Fluoroquinolones have excellent oral bioavailability with extensive tissue penetration and have an elimination half-life of six to 12 hours, thus allowing once-daily dosing and ensuring compliance. They undergo extensive hepatic metabolism and renal excretion, thus being recommended for use in patients with normal hepatic and renal function. They have fewer adverse effects than other antibiotics, including nausea, vomiting, and photosensitivity, with the rare occurrence of tendinitis (Rosenthal, 2021). Blood glucose levels should be closely monitored as fluoroquinolones have a hypoglycemic effect.

Patient Education Strategy

The teach-back method is a useful strategy for promoting patient education. The care provider may explain to the patient the need to minimize physical contact with friends and family and maintain proper hygiene by regular handwashing or using alcohol-based sanitizers. They may also be taught to practice pursed-lip and diaphragmatic breathing to control dyspnea (Liu, 2019). The care provider then asks the patient to reiterate this information in their own words to assess their level of understanding.

The goal of treatment is to reduce the global disease burden by disease prevention, curbing antimicrobial resistance, and ensuring patient safety. Physicians need to optimize treatment regimens by tailoring them towards specific patient needs, depending on their age and comorbidities.

References

Karampela, I., & Dalamaga, M. (2020). Could respiratory fluoroquinolones, levofloxacin, and moxifloxacin prove to be beneficial as an adjunct treatment in COVID-19? Archives of Medical Research, 51(7), 741–742. https://doi.org/10.1016/j.arcmed.2020.06.004

Liu, S., Tong, X., Ma, Y., Wang, D., Huang, J., Zhang, L., Wu, M., Wang, L., Liu, T., & Fan, H. (2019, April 17). Respiratory fluoroquinolones monotherapy vs. β-lactams with or without macrolides for hospitalized community-acquired pneumonia patients: A meta-analysis. Frontiers in Pharmacology, 10. https://doi.org/10.3389/fphar.2019.00489