The Biologic Basis for Disease Assignment

Discussion Post Response:

Provide recommendations for alternative drug treatments to address the patient’s pathophysiology. Be specific and provide examples. NEED 2 REFERENCES

CASE STUDY:

A 68-year-old male has been admitted to the medical-surgical unit for community-acquired pneumonia for three days. The patient has a history of COPD, hypertension, hyperlipidemia, and diabetes. He is on day three of empiric antibiotics, ceftriaxone 1GM IV Daily and Azithromycin 500MG IV Daily. Clinical status has improved since admission, with decreased oxygen requirements. However, the patient cannot tolerate intake due to complaints of nausea and vomiting—penicillin allergy (rash). The Biologic Basis for Disease Assignment

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Microorganisms for community-acquired pneumonia are streptococcus pneumoniae, haemophilus influenzae, staphylococcus aureus, mycoplasma pneumoniae, chlamydia pneumoniae, moraxellacatarrhalis legionella pneumophila, Influenza, Rhinovirus, and Coronavirus (McCance & Huether, 2019). The goal in determining the appropriate treatment is ensuring that organisms are susceptible to antibiotic treatment; broad-spectrum antibiotics are often used for initial treatment in pneumonia until cultures identify a specific organism and reveal antibiotic sensitivities. The first step in managing pneumonia is establishing adequate ventilation and oxygenation (McCance & Huether, 2019); since the patient has decreased oxygen requirements, we will need to continue to monitor for respiratory discomfort, considering the history of COPD. However, PRN orders for Oxygen 2L via nasal cannula for respiratory discomfort will be necessary. This patient will also need an order for a spirometer, with instructions to utilize it at least every hour. Treatment will consist of antibiotics and supportive therapy to address symptoms the patient may experience, such as respiratory issues and nausea/vomiting. Recommendations for the treatment regimen for this patient are to continue with Azithromycin and Ceftriaxone, especially since treatment has been effective, as evidenced by improvement in clinical status. Both medications are effective alternatives for Penicillin allergy patients (Rosenthal & Burchum, 2019). Azithromycin classifies as a macrolide. This drug classification is preferred for respiratory infections such as pneumonia caused by mycobacterium (a community-acquired organism) and for patients with a penicillin allergy (Rosenthal & Burchum, 2019). Ceftriaxone classifies as a cephalosporin; it is a broad-spectrum antibiotic and categorized as a third-generation drug, making it highly effective against bacteria with good distribution; it is also considered a safe and well-tolerated drug (Rosenthal & Burchum, 2019). A short-term, tapered dose of IV steroid treatment is recommended for respiratory inflammation; studies show that administering steroids decreases mortality rates and decreases hospital length of stay (Nadler, 2020). Steroids induce hyperglycemia; one should take careful consideration regarding the patient’s history of diabetes, blood sugar checks should be monitored closely while on steroids if the protocol is not already in place for diabetic management, along with the implementation of a sliding scale for Humalog to maintain therapeutic blood sugar levels. Antibiotic therapy is likely the cause for this patient experiencing nausea and vomiting; recommendations for ondansetron (Zofran) IV 8MG Q8 hours as needed, preferably thirty minutes prior to the administration of IV antibiotics. Lastly, since the patient cannot tolerate intake and experiencing nausea/vomiting, recommendations for gentle hydration would benefit the patient, continuous normal saline at 50 ML/HR until the patient can tolerate meals. The Biologic Basis for Disease Assignment

Education recommendations for assisting the patient with the management of pneumonia diagnosis are as follows. Adequate hydration and good pulmonary hygiene, such as deep breathing and coughing, are essential for patients with pneumonia (McCance & Huether, 2019). Encourage the patient to drink plenty of fluids and practice deep breathing techniques; use of the spirometer should be at least every hour; if the patient is watching television, advise practicing on commercial breaks. Antibiotic therapy such as Cephalosporins can promote clostridioides difficile (c.diff) infection and instruct patients to monitor and report increased/abnormal frequency, consistency, and odor of stools (Rosenthal & Burchum). Also, educate this patient that steroids can cause hyperglycemia; it is essential to monitor intake and be sure not to contribute to elevated blood sugar levels through diet consumption.

References

McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The Biologic Basis for Disease in

Adults and Children (8^th ed.). St. Louis, MO: Mosby/Elsevier

Nadler, S. (2020). Evaluation and Treatment of Severe Community-Acquired Pneumonia in the

ICU. Critical Care Alert, 28(8). https://www.proquest.com/trade-journals/evaluation-Links to an external site.

treatment-severe-community-acquired/docview/2501269910/se-2

Rosenthal, L. D. & Burchum, J. R. (2021). Lehne’s Pharmacotherapeutics for Advanced  

             Practice Nurses and Physician Assistants (2^nd ed.) St. Louis, MO: Elsevier

CLASS RESOURCES:

• Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants(2nd ed.) St. Louis, MO: Elsevier.
  • Chapter 46, “Anticoagulant and Antiplatelet Drugs” (pp. 364–371)
  • Chapter 47, “Drugs for Deficiency Anemias” (pp. 389–396)
  • Chapter 50, “Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications” (pp. 425–436)
  • Chapter 51, “Birth Control” (pp. 437–446)
  • Chapter 52, “Androgens” (pp. 447–453) The Biologic Basis for Disease Assignment
  • Chapter 53, “Male Sexual Dysfunction and Benign Prostatic Hyperplasia” (pp. 454–466)
  • Chapter 70, “Basic Principles of Antimicrobial Therapy” (pp. 651–661)
  • Chapter 71, “Drugs That Weaken the Bacterial Cell Wall I: Penicillins” (pp. 662–668)
  • Chapter 75, “Sulfonamides Antibiotics and Trimethoprim” (pp. 688–694)
  • Chapter 76, “Drug Therapy of Urinary Tract Infections” (pp. 695–699)
  • Chapter 78, “Miscellaneous Antibacterial Drugs” (pp. 711–714)
  • Chapter 79, “Antifungal Agents” (pp. 715–722)
  • Chapter 80, “Antiviral Agents I: Drugs for Non-HIV Viral Infections” (pp. 723–743)
  • Chapter 82, “Drug Therapy of Sexually Transmitted Diseases” (pp. 763–770)
• Roberts, H., & Hickey, M. (2016). Managing the menopause: An updateLinks to an external site.. Maturitas, 86(2016), 53–58. https://doi.org/10.1016/j.maturitas.2016.01.007

This article provides an update on treatments on Vasomotor symptoms (VMS), genito-urinary syndrome of menopause (GSM), sleep disturbance, sexual dysfunction, and mood disturbance that are common during the menopause transition. The Biologic Basis for Disease Assignment