WOMEN’S AND MEN’S HEALTH, INFECTIOUS DISEASE, AND HEMATOLOGIC DISORDERS
As an advanced practice nurse, you will likely experience patient encounters with complex comorbidities. For example, consider a female patient who is pregnant who also presents with hypertension, diabetes, and has a recent tuberculosis infection. How might the underlying pathophysiology of these conditions affect the pharmacotherapeutics you might recommend to help address your patient’s health needs? What education strategies might you recommend for ensuring positive patient health outcomes?
For this Discussion, you will be assigned a patient case study and will consider how to address the patient’s current drug therapy plans. You will then suggest recommendations on how to revise these drug therapy plans to ensure effective, safe, and quality patient care for positive patient health outcomes.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
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.Links to an external site.
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.
You will respond to your colleagues’ posts in Week 10.
clicking on Post Reply!
BY DAY 6 OF WEEK 10
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.
TuesdayJan 24 at 4:31pm
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)
Discussion
Community-acquired pneumonia remains the single most common cause of death from infectious diseases in the elderly population. Adults aged over 65 years are a rapidly expanding cohort with growth rates more than twice that of younger populations with an expected 20% of the world’s population reaching elderly status by 2050, the burden of CAP will be even more significant in the coming years. Moreover, the annual incidence of CAP in elderly patients is estimated to be 25–44 cases per 1000 persons (Stupak et al., 2009). In the above case study patient is an elderly 68yrs old who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days with his PMH is significant for COPD, HTN, hyperlipidemia, and diabetes who 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 however he is not tolerating a diet at this time with complaints of nausea and vomiting. Therefore, the following treatment and health needs are important.
Patient’s Health needs
Treatment and need for longer hospitalization stay with longer IV ABX treatment
Mr. HH is 68ys old elderly patient and he is at risk of infection for a longer period. To prevent the spread of infection, he might need more than 7days of IV ABX treatment even though he is improving. Moreover, he is not tolerating the diet currently and complains of nausea and vomiting. Therefore, he may require a longer hospitalization stay with a longer duration of parenteral IV ABX therapy before switching to an oral antibiotic along with antiemetic medication. The oral course of ABX can be started once his nausea/vomiting stop and able to tolerate the diet. Moreover, Pharmacists should evaluate medication choices, check for allergies and interactions, and educate patients about side effects and the importance of compliance.
Need for treatment of his co-morbidities
Mr. HH has other significant co-morbidities like COPD, HTN, hyperlipidemia, and diabetes and should be treated with a bronchodilator and steroids for COPD, anti-hypertensive for HTN, Statin and Cholesterol for hyperlipidemia and Metformin or insulin for diabetes along with treatment of community-acquired pneumonia.
Need for hydration and nutritional diet
Particular attention should also be paid to nutritional status, fluid administration, functional status, and comorbidity stabilizing therapy in this group of frail patients (Simonetti et al., 2014).
Mr. HH is an elderly patient and risk of malnutrition since he is not tolerating his diet and complain of nausea and vomiting. Continuous iv fluids should be given for hydration and a nutritionist Consult should be done and parenteral nutrition should be started according to the needs of the patient.
Need for financial support
The patient’s financial status for treatment should be assessed by the case manager. If a Patient has Medicare or Medicaid, it will be covered by insurance but if the patient does not have insurance or financial support then the hospital should provide financial support via a charity fund or a discount should be given if possible.
Need for physical and psychological support
Physical support should be given by providing physical and occupational therapy to increase the activity of daily living, breathing exercises, and self-care. Help patient to maintain hygiene throughout the hospital stay. Similarly, emotional support should be provided by allowing him to express his feeling and allowing family time for emotional support that prevents depression.
Recommended Treatment
In the presence of comorbid illness (chronic heart disease excluding hypertension; chronic lung disease – COPD and asthma; chronic liver disease; chronic alcohol use disorder; diabetes mellitus; smoking; splenectomy; HIV or other immunosuppression), a respiratory fluoroquinolone (high-dose levofloxacin, moxifloxacin, gemifloxacin) or a combination of oral beta-lactam (high dose amoxicillin or amoxicillin-clavulanate, cefuroxime, cefpodoxime) and macrolide is recommended (Regunath & Oba, 2022).
For patients with a CURB 65 score of greater than or equal to 2, inpatient management is recommended. A respiratory fluoroquinolone monotherapy or combination therapy with beta-lactam (cefotaxime, ceftriaxone, ampicillin-sulbactam, or ertapenem) and macrolide are recommended options for nonintensive care settings (Regunath & Oba, 2022).
The pneumonia severity index score can be used to assess the severity and need for more hospitalization in patients with community-acquired pneumonia
Diagnostic tests like chest X-ray, CT, or MRI can be done to identify infiltration or effusion
A complete blood count with differentials, serum electrolytes, and renal and liver function tests are indicated for confirming evidence of inflammation and assessing severity.
A chest x-ray will be needed to identify an infiltrate or effusion, which, if present, will improve diagnostic accuracy.
Blood and sputum cultures should be collected, preferably before the institution of antimicrobial therapy, but without delay in treatment.
Urine for Legionella and pneumococcal antigens must be considered as they aid in diagnosis when cultures are negative.
Influenza testing is recommended during the winter season. If available, testing for respiratory viruses on nasopharyngeal swabs by molecular methods can be considered. CURB 65 (confusion, urea greater than or equal to 20 mg/dL, respiratory rate greater than or equal to 30/min, blood pressure systolic less than 90 mmHg or diastolic less than 60 mmHg),
Pneumonia Severity Index (PSI) are tools for severity assessment to determine the treatment setting, such as outpatient versus inpatient, but accuracy is limited when used alone or in the absence of effective clinical judgment.
Serology for tularemia, endemic mycoses, or psittacican be sent in the presence of epidemiologic clues
Education Strategy
The interpersonal level communication helps to use the community volunteer to alert the surrounding people about health hygiene, the impact of community-acquired pneumonia, treatment, antibiotic therapy, diagnosis, tests, and other health care services. Which can be conveyed even by conducting small-group educational programs. Moreover, elderly patients like HH should be provided education on the following topic:
The following education strategy for the Community-acquired Pneumonia
Staying compliance with medication helps in full recovery
Vaccination
All adults 65 years and older and those considered at risk for pneumonia must receive the pneumococcal vaccination. There are two vaccines available: PPSV 23 and PCV 13.
For all unvaccinated adults 65 years or older, first vaccinate with PCV 13, followed by PPSV 23 at least a year later for immune-competent patients and at least eight weeks or more apart for patients who are immune-compromised or asplenic.
Influenza vaccination is recommended for all adult patients at risk for complications from influenza. Inactivated flu shots (trivalent or quadrivalent, egg-based or recombinant) are usually recommended for adults.
Cessation of smoking: – Smoking is injurious to health and will damage the lungs by deteriorating their health condition. Educate patient on smoking cessation therapy and offer therapy like nicotine treatment
Hand Hygiene and mask
Proper hand hygiene and the use of a face mask while traveling in crowded places helps to prevent the transmission of disease and encouraged to wash hand with soap water or hand sanitizer
Diet and exercise: – Eating a well balanced diet like protein-rich food, and green leafy vegetables help to increase the immune system and prevent infection as well as malnutrition. Breathing exercise helps to improve respiration
Follow up with PCP to monitor the health status
Reference
Regunath H, Oba Y. Community-Acquired Pneumonia. [Updated 2022 Nov 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430749/
Stupka, J. E., Mortensen, E. M., Anzueto, A., & Restrepo, M. I. (2009). Community-acquired pneumonia in elderly patients. Aging health, 5(6), 763–774. https://doi.org/10.2217/ahe.09.74Links to an external site.
Simonetti, A. F., Viasus, D., Garcia-Vidal, C., & Carratalà, J. (2014). Management of community-acquired pneumonia in older adults. Therapeutic advances in infectious disease, 2(1), 3–16. https://doi.org/10.1177/2049936113518041
ThursdayJan 26 at 5:02am
Hello Sarala! This is a detailed and outstanding post about the case study.
Indeed, community-acquired pneumonia remains the single most common cause of death from infectious diseases in the elderly population. Regarding the treatment, it is essential to determine the appropriate treatment option after conducting respiratory cultures and blood work to establish the agent that causes the current infections (Rothberg, 2022). This information will help in determining the precise antibiotic that should be given to the patient. When using IV antibiotics, it is important to administer them for five to seven days and reassess the patient to determine their efficacy before discontinuing them to avoid the development of resistance to certain antibiotics. The patient is not tolerating diet appropriately. As such, he needs nutrition therapy and IV hydration until vomiting and nausea are eliminated to avert electrolyte imbalance and dehydration during the existence of the reported symptoms. As you have correctly mentioned, it is important to ensure patient education is conducted by an interprofessional team to achieve optimum patient health outcomes (Munro et al., 2021).
References
Munro, S. C., Baker, D., Giuliano, K. K., Sullivan, S. C., Haber, J., Jones, B. E., … & Klompas, M. (2021). Nonventilator hospital-acquired pneumonia: a call to action: recommendations from the National Organization to Prevent Hospital-Acquired Pneumonia (NOHAP) among nonventilated patients. Infection Control & Hospital Epidemiology, 42(8), 991-996. https://doi.org/10.1017/ice.2021.239
Rothberg, M. B. (2022). Community-Acquired Pneumonia. Annals of Internal Medicine, 175(4), ITC49-ITC64. https://doi.org/10.7326/AITC202204190
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