Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

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Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

However, for this patient, after confirming the diagnosis of CAP and Streptococcus Pneumoniae as the causative cause, I would reconsider changing his drug regimen of azithromycin. Azithromycin is a macrolide that falls under the same class as erythromycin that has been indicated as resistant. A perfect and more specific alternative would be starting him on Levaquin IV or vancomycin in place of azithromycin (Wunderink & Waterer, 2017). Levaquin is a quinolone antibiotic. After the client meets the clinical criteria of discharge for CAP, I would discharge him on oral levofloxacin 500mg PO daily for 7-14 days to finish the course of medication. Since the findings of the sputum culture revealed resistance of Streptococcus pneumoniae to macrolides and tetracycline’s, levofloxacin is a perfect alternative for broader coverage to clear the infection and prevent re-infection.Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

Your post was very comprehensive especially on the discussion regarding patient education and additional management plans that you would implement for this patient to promote a stable hemodynamic status and vital signs within the normal range. Patients with suspected CAP must be started on empiric therapy before an actual diagnosis of CAP is made (Rosenthal & Burchum, 2021). However, for this patient, after confirming the diagnosis of CAP and Streptococcus Pneumoniae as the causative cause, I would reconsider changing his drug regimen of azithromycin. Azithromycin is a macrolide that falls under the same class as erythromycin that has been indicated as resistant.Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay. A perfect and more specific alternative would be starting him on Levaquin IV or vancomycin in place of azithromycin (Wunderink & Waterer, 2017). Levaquin is a quinolone antibiotic. After the client meets the clinical criteria of discharge for CAP, I would discharge him on oral levofloxacin 500mg PO daily for 7-14 days to finish the course of medication. Since the findings of the sputum culture revealed resistance of Streptococcus pneumoniae to macrolides and tetracycline’s, levofloxacin is a perfect alternative for broader coverage to clear the infection and prevent re-infection.Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

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.Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

You are required to participate in the discussion a total of three days between weeks 9 and 10. Response postings should be substantial, at least 7 sentences, and add new information to the forum. BE SURE TO DISCUSS BOTH CASES. Provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples. Use and cite at least two sources for each response post. No discussion posts will count for credit once week 10 has ended.Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

morganelkins

Wk 9 Main discussion- Case study 1

COLLAPSE

Top of Form

HH is being treated for community acquired pneumonia x3 days and is taking antibiotics. He is a diabetic as well as a COPD patient, also HLD and HTN. His needs at this time are 1) Antibiotics (tx of pneumonia) 2) monitoring of blood glucose levels (pt is diabetic not tolerating diet.) 3) medication for N & V. 4) Continue monitoring labs 5) Continuous IV fluids (d/t increased BUN levels, meaning possible dehydration from nausea and vomiting.)Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

First, I would continue his antibiotic treatment,ascetriaxone and azthromycin IV are improving the patient’s condition as evidenced by his decreasing fever, decreasing HR, decreasing B/P, decreasing RR, and increasing patient oxygen saturation from only being able to maintain O2 level at 90% with 4L O2 to on day three having an O2 of 92% on RA. The decreasing of the vitals is bringing them back into normal intervals. This is known as an empiric therapy, which is used when a patient has a severe infection, we are able to start a broad spectrum agent (ceftriaxone) initially, and then after the identity and sensitivity of the infecting organism are determined, we are abe to use a more selective antibiotic (azithromycin) {Rosenthal & Burchum, 2021}. My next area of concern is my patients blood glucose level.Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay. Many different things can affect the level of his glucose (i.e. does he have scheduled breathing treatments/steroids, he isn’t eating which could lower it, and is he taking his medication the way its prescribed, does he change the dosage based on his glucose readings, what is a normal glucose reading for him, etc.) With this patient being nauseated and unable to eat its imperative that we monitor his glucose levels to make sure they are not causing him hypoglycemia. On the other end of the spectrum if there are breathing treatments or steroids involved in his plan of care we need to be monitoring to make sure his blood glucose levels are not extremely high. Increases or spikes in blood glucose are common in diabetic patients that are on a steroid regimen (Austin, 2010).Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay. It is also import that the patient is being treated for his nausea and vomiting, as well as making sure that this is not an adverse effect of other medications (i.e. is he only getting sick when he is given his IV antibiotics or is it around the clock?). We need to be medicating this patient with an anti-emetic, such as zofran, in order to help the patient be able to hydrate orally, as well as get his diet back to normal. Zofran is more widely used in practice today then phenergan, but phenergan is still available if patient does not have subsiding nausea and vomiting with the zofran. Zofran can be given orally or IV. Since this patient is unable to keep things down it is best to give the zofran IV. Next, it is imperative to give IV fluids as the patient BUN was 30 on day one but dropped to 18 by day three. Normal BUN range is 5-20 (Hosten,1990). While the patient’s BUN is back in normal range it is still a little on the higher side and could increase with the patient not tolerating PO and the N&V. However, with the patient being a COPD patient we need to watch for fluid overload and not give too much fluid so I would start him on a 50 mL/hr dose of normal saline just to help the patient with hydration, but stop this at the first sign of fluid overload or once the nausea and vomiting is relieved and the patient is able to drink and eat, as well as keep it down. Something else that could be considered with the fluids if is the patients blood glucose is hanging on the lower side we may need to initiate d5 1/2NS so that the patient is taking in glucose as well as the fluds. Yet again it would be at a low initiation rate, with close monitoring for fluid overload and close monitoring of glucose level. We would also need to continue to monitor patient vital signs and laboratory results daily and treat accordingly. Lastly, we should also do a repeat chest x-ray in order to see if the pneumonia is resolving, is unchanged, or is getting worse. Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

As for patient education we can discuss checking his oxygen level by having a home pulse oximeter, which can usually be covered by insurance, patient should be informed that level should not be below 88% and not higher than 92%. Another education point would be watching for fluid overload, such as monitoring his weight, watching for edema, or increased shortness of breath. He should be informed that if he notices significant weight gain in a day, such as 3 pounds or more, or develops eema, or feels short of breath he should be seen as soon as possible. We could re-discuss his diabetes regimen with him, like when he takes his sugar and how often, if he is on insulin reiterating to rotate sites of injection, when he should skip a dose or if he should, what happens if the dosage becomes not enough, etc. Also, I could discuss with the patient the importance of taking medicaiton as prescribed, especially the antibiotic regimen that will be changed to PO from IV before discharge. It is important for the patient to know that just because he feels better he should not stop taking the medicine before the end of the regimen, as the body can build up resistance to the medication causing it not to work in the future. Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

Corbin Vickery

68 year-old male with CAP

COLLAPSE

Top of Form

The patient in this case study is a 68-year-old male diagnosis with community acquired pneumonia (CAP). The patient has a history of COPD, HTN, hyperlipidemia, and diabetes. The patient was admitted to the hospital febrile, tachycardic, tachypneic, and on 4LNC to achieve an O2 saturation of 90%. The patient was started on rocephin, and azithromycin prior to the sputum culture result. Once the culture came back it showed gram positive cocci streptococcus pneumoniae whcih was resistant to tetracycline and macrolide antibiotics. Rocephin is a third generation cephalosporin and can still be utilized in this case with low incidence of reaction although there is slight similarity to penicillin (Pandey et al, 2020).Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay. One problem with the antibiotic regimen is the azithromycin. Azithromycin and erythromycin are in the same drug class and the bacteria is resistant to erythromycin. Azithromycin should be stopped, and vancomycin or levaquin should be started, In this case since the culture is finished and we know that levaquin will be used orally for outpatient treatment, I would prescribe levaquin IV in hospital in replacement of azithromycin so that the patient will continue levofloxacin after discharge.Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

After three days of antibiotic treatment the patients vital signs have improved. Patient still has a fever of 100.9 but the heart rate is normal and the respiratory rate is normal and the patient has been titrated off of O2 and is 92% on room air. (This is all prior to administration of new antibiotic levaquin). Acccording to Dr. Feiz and colleagues if a patient is responding to therapy within the first 2-3 days of IV antibiotic treatment for CAP, the patient needs at least 5 days of treatment and if all criteria is met can be discharged home on oral antibiotics. Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

Other criteria that must be met for this patient to be discharged is being afebrile for 48-72 hours before discharge is considered. As this patient is 100.9 fever still, his 48 hour clock has not begun yet. Also, the patient needs to be back to normal O2 saturation prior to CAP diagnosis. It is understood that the patient has COPD, however the patients normal O2 saturation and activity level is not known. The patient also needs to be back to baseline or not hypoxic or dyspneic on exertion before discharging home to self care (Feiz et al, 2016).

Once all of the criteria has been met, the patient is afebrile for 48 to 72 hours, all vital signs are baseline or within normal limits, Then the patient can be discharged home on oral antibiotic regimen. The patient in this case has received rocephin, azithromycin and levaquin IV inpatient. The patient can only take the levaquin orally for outpatient treatment as the bacteria is resistant to macrolides. Rocephin is IV and IM formulation. There is an oral vancomycin but the bioavailability and absorption is terrible and is only recommended to be use for infection of the bowels (c-diff) (Petal et al, 2020). The medication recommended for oral treatment of CAP is a fluoroquinolone such as Levofloxacin. This medication will be given at 500mg a day for 7-14 days rather than 750mg a day for 5 days. This reasoning is because the sputum culture showed resistance to tetracycline and macrolides. This will give a longer coverage to increase the likelihood of clearing the infection (FDA, 2020).Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

I would educate the patient on the significance of taking the oral levofloxacin until it is gone. I would also remind him that he has multiple comorbidities and to keep an eye on blood sugar as well as respiratory status. Use breathing treatments as necessary and inhalers as necessary as this pneumonia compromises his respiratory status even more. Teach the patient of signs of infection to look for and be aware that this is not an illness to play with especially with the other comorbidities and to come back to the hospital for any worsening symptoms. Getting up and moving and not staying sedentary is a huge help in clearing illness such as CAP.Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

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.Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

Photo Credit: Getty Images

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.Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

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.Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

SEE BELOW ANNOUNCEMENT AND EXPLANATION FROM THE PROFESSOR

Discussion: Women and Men’s Health, Infectious Disease, and Hematologic Disorders

To Prepare

Select a complex case study to focus on for this discussion (below).
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.Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.
You will pick 1 case to discuss for your initial post during week 9. Then complete 2 response posts during week 10; be sure to discuss both cases.

By Day 3

Post a description of your patient’s health needs from the patient case study you selected. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including specific medications. 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 must make at least a reference to course materials and two outside sources in your initial posting (at least 3 sources for initial posts). You will respond to your colleagues’ posts in Week 10.

Case Overview

This case study involves a 46-year-old weighing 230lb with a family history of breast cancer. She is up to date on annual mammograms, has a history of hypertension with complaints of hot flushing, genitourinary symptoms, and night sweats. This patient had felt well until one month ago when she presented for an annual gynecological exam to discuss her symptoms. About 5 years ago, she did a pap smear and has a history of ASCUS. However, other pap smears have been normal. Her home medications include HCTZ 25mg qd and Norvasc 10mg qd. Today, her BP is 150/90. She has regular menstrual cycles and her LMP was one month ago.Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

Patient Healthcare Needs

The sex and age of the patient presented in this case study suggest that she is undergoing menopause. Therefore, the symptoms are menopausal. Menopause usually starts between 40-60 years of age in 95% of women although genetics also have a significant role in determining the onset (Huether & McCance, 2017). There are major changes that occur in specific body systems during menopause. The most significant changes occur in the uterus, skeletal system, breasts, urogenital tract, and cardiac systems. Breast changes include the death of cells and remodeling of breast tissues, increased connective tissue, and fatty deposits, decreased firmness and breast size.Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

In the urogenital tract, the vaginal epithelium and urethra also undergo the following degenerative changes; changes in the vaginal pH balance, increased vaginal irritation, decreased vaginal lubrication, shrinking of the cervix, decreased muscle tone in the pelvic area which increases the likelihood of urinary incontinence, urgency, and UTIs (Huether & McCance, 2017). During menopause, the levels of estrogen decrease causing vasomotor symptoms experienced by women menopause. Vasomotor symptoms usually present as dizziness, palpitations, headaches, sweating, and hot flashes due to dilatation of peripheral blood vessels (Huether & McCance, 2017). Menopausal symptoms tend to interfere with a person’s ADL (Activities of Daily Life) and are a major reason patients seek care to get relief. Therefore, it is also likely that this patient wanted relief of her menopausal symptoms.Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

Recommended Treatment Regimen

Current evidence recommends hormone therapy as an intervention to relieve genitourinary and vasomotor symptoms during menopause. However, hormonal replacement therapy (HRT) has cardiovascular-related risks. It is for this reason that Rosenthal & Burchum (2018) recommend that, before initiating HRT, a NP should assess the benefits versus risks of HRT for a patient and list the contraindications of when not to prescribe HRT. HRT is contraindicated in patients with a history of cardiovascular disease, MI, DVT, breast cancer, PE, and those with per vaginal bleeding history whose cause is unknown. Despite recent subsequent normal pap smears, the patient in this case study has a history of ASCUS, a family history of breast cancer that increases her risk of breast cancer, a possible CHD, and hypertension. Therefore, she is considered a high risk for HRT. This should prompt the NP to consider other alternatives. Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

For high-risk patients, Stubbs et al (2017) recommend SSRI and SNRI antidepressants to relieve menopausal vasomotor symptoms. The most preferable first-line SSRI to prescribe in this case would be escitalopram 10–20 mg/day, since it can be tolerated well orally, and has less severe adverse effects. For the patient’s genitourinary symptoms, I would prefer short-term topical estrogen since when compared to oral estrogen HRT in patients considered high risk for HRT; it has very minimal effects on the levels of blood estrogen thus safer.Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

Patient Education Strategy

The best education strategy is individualized education which begins with identifying potential gaps in the patients’ knowledge about her menopause, hypertension, the need to adhere to medications, and making lifestyle modifications. I will also include instructions on how to use topical estrogen and oral escitalopram and the side effects to expect. Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

Week 9 Discussion-Women’s and Men’s Health, Infectious Disease Essay.

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