Presents a 68-year-old male admitted to the medical ward three (3) days ago with community-acquired pneumonia. The patient was started on ceftriaxone 1g iv qday and Azithromycin 500mg iv qday on admission with so much improvement clinically evidenced by decreased oxygen requirements. The patient has a history of COPD, HTN, hyperlipidemia, and diabetes. The patient is allergic to penicillin and is currently unable to hold down food or water due to nausea and vomiting.
Community-Acquired Pneumonia (CAP)
Community-acquired pneumonia (CAP) is an acute infection of the lung parenchyma which is acquired outside of the hospital (in the community) (Ramirez, 2022). It is the leading cause of morbidity and mortality worldwide (Eticha&Gemechu,2021). The goal of treatment is to eliminate the infection and prevent complications (File, 2020). It is vital to prescribe appropriate antibiotics to treat CAP to prevent an antibiotic resistance crisis. Ceftriaxone and azithromycin are effective and the most common combination to treat CAP (Eticha&Gemechu,2021). The patient was started on Ceftriaxone and Azithromycin on admission for three days. The decreased oxygen requirement indicates improvement with the current antibiotic treatment. It is, therefore, recommended to continue the current antibiotic therapy for seven days (Jaffar et al.,2019).
The patients needs and treatment Regimen
The patient complains of nausea and vomiting and cannot tolerate his meals. Nausea and vomiting can be the side effect of antibiotic therapy. It is essential to improve the nutritional status of the patient. Monitoring the patients electrolytes daily is essential, especially the potassium, sodium, magnesium, and phosphate, and replacing them if necessary. Metoclopramide and Zofran are the most common medicines used as pro-motility agents to reduce nausea and vomiting. It is appropriate to start the patient on Reglan (Metoclopramide) 10mg IV TID thirty (30) minutes before meals to prevent nausea and vomiting and thus help the patient keep down his food (Hauser et al., 2022). Hydration is also important since the patient does not tolerate diet and is likely unable to tolerate fluids. IVF D5 1/2NS can be started at 75 ml/hr. Using the patients weight. It is vital to start the patient on his current home medications to address his COPD, hypertension, hyperlipidemia, and diabetes. It is essential to continue them to prevent further complications like exacerbation of COPD and HTN.
To address the patients diabetes, sliding-scale insulin should be ordered to prevent hypoglycemic episodes since the patient is currently not tolerating oral intake. This patient will also benefit from using an incentive spirometer. An incentive spirometer helps to increase lung capacity and inspiratory volume, thus, expanding the lungs and helping the patient breathe better. It decreases the patients need for supplemental oxygen (Eltorai et al., 2018). It is also essential to monitor the patients vital signs every four (4) hours. The patient has a history of hypertension, and metoclopramide increases blood pressure and may cause headaches, dizziness, or blurred vision (Hauser et al., 2022). The care providers must maintain the patients oxygen saturation at 90% and above, which is an okay level for a patient with COPD.
Education Strategy
Educate the patient on the importance of compliance with antibiotic therapy and completing the treatment course. Educate the patient to take the antiemetic drug before meals so he can tolerate his meals, as good nutrition is also essential for his recovery. Educate the patient on using an incentive spirometer, coughing, and deep breathing. Educate the patient to eat a healthy diet and drink more fluids as tolerated and the potential side effects and report such promptly. Also, this patient needs to take the pneumonia vaccine every five years as he has a history of COPD to prevent further pneumonia and complications (Eltoria et al., 2018). The patient must also practice handwashing, limit face-to-face contact, and always cover his mouth when sneezing or coughing to prevent transmission and reinfection (File, 2020). He must keep up with all his appointments and seek medical attention promptly when he gets ill.
