FOR THIS CASE STUDY BELOW, provide recommendations for alternative drug treatments to address the patient's pathophysiology. Be specific and provide examples. Include 4 references that are evidence-based research within 5 years. Hannah Prevatt Community Acquired Pneumonia COLLAPSE Women's and Men's Health, Infectious Disease, and Hematologic Disorders Community Acquired Pneumonia Pneumonia is a type of lung infection which can cause an individual to have difficulty breathing along with other symptoms (Cedars Sinai, 2021). In community-acquired pneumonia (CAP), an individual gets infected in a community setting (Cedars Sinai, 2021). CAP can result from infection with many types of germs, including bacteria, viruses, fungi, or parasites (Cedars Sinai, 2021). Symptoms from pneumonia can range from mild to severe, these include: Shortness of breath, coughing, heavy sputum, fever/ chills, chest pain which worsens during breathing/ coughing, and abdominal pain with nausea, vomiting, or diarrhea (Cedars Sinai, 2021). When a patient arrives with symptoms of CAP, the Provider must determine whether the patient meets criteria for an observation ward, medical floor, or an intensive care unit (File et al., 2020). Diagnostic screening should be performed; these include blood cultures, sputum cultures, COVID test, influenza test, and respiratory viral panel (File et al., 2020). However, initial empiric therapy is started until causative agent is identified (File et al., 2020). Intravenous antibiotics are recommended initially, however, once symptoms improve, the patient can be transitioned to oral antibiotic; the patient's response to treatment determines duration and course (File et al., 2020). However, recommended therapy states that a patient should be afebrile 48 to 72 hours, and have no more than one CAP sign of instability before discontinuing intravenous therapy (File et al., 2020). Once patient is deemed stable, the transition to oral antibiotics can be made; oral antibiotic treatment is recommended for a minimum of 5 days, to a maximum of 2 weeks; the patient can begin planned discharge after IV antibiotics are discontinued, oral medications can be continued at home (File et al., 2020). With regards to a cough, the patient should be informed that it may resolve anywhere from 8 days to 3 weeks (File et al., 2020). Hospital discharge is appropriate when the patient is clinically stable from pneumonia, can take oral medication, has no other active medical problems, and has a safe environment for continued care; patients do not need to be kept overnight for observation following the switch (File et al., 2020). Treatment Regimen In the case study presented, 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). For this specific patient, intravenous antibiotic therapy of Ceftizxone and Azithromycin should be continued; once cultures have resulted other appropriate antibiotics should be considered, with allergies of Penicillin to be kept in mind (File et al., 2020). The patient should also begin an antiemetic such as Zofran, Phenergan, Reglan, etc.; this can in hopes aid the patient in tolerating oral meal intake, thus to prep patient for initiation of oral antibiotic treatment once tolerating meal consumption, meal replacement therapy (Boost/ Ensure) should be considered as well (Athavale et al., 2020). Oxygen therapy should be continued but titrated down to wean patient off, monitoring of lung sounds should be done as well, consideration of patient history of COPD, extended oxygen therapy should be kept in mind (Mantero, 2017). Also, the patient's history of diabetes aids in glucose monitoring, this should be done at least every 6 hours, and also monitoring of blood pressure should be done as well, due to the patient's history of hypertension. Once patient is deemed stable: blood sugar within limits, blood pressure within limits, oxygen saturation within limits on home air, toleration of meals without use of antiemetic, initiation and tolerance of oral antibiotics, afebrile 48 to 72 hours, and metabolic panel within limits; patient can be deemed appropriate for discharge home (File et al., 2020). Patient Education Patient education is a must prior to discharge; patient should be encouraged to receive annual Influenza vaccinations as well as Pneumococcal vaccine (recommended in patients over age 65). Education regarding compliance with antibiotic regimen (continue full duration), expected length cough may persist, compliance with preexisting medications, monitoring of glucose and blood pressure daily, dietary/ nutritional requirements, scheduled follow up appointments with chest x-ray, education of how to aid in prevention of community acquired pneumonia (wash hands often, cover when sneezing/ coughing, disinfect surfaces, avoidance of individuals who are sick, vaccinations) (Anderson, 2021), also signs and symptoms of medication adverse affects or worsening symptoms of pneumonia should be conveyed; patient should then be instructed to contact provider immediately at that point. References Anderson, L. (2021, March 4). Community Acquired Pneumonia - What You Need to Know. Drugs.com. https://www.drugs.com/cg/community-acquired-pneumonia.html. Athavale, A., Athavale, T., & Roberts, D. M. (2020, April). Antiemetic drugs: what to prescribe and when. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186277/. Cedars Sinai. (2021). Community-Acquired Pneumonia in Adults. https://www.cedars-sinai.org/health-library/diseases-and-conditions/c/community-acquired-pneumonia-in-adults.html. File, T., Ramirez, J., & Bond, S. (2020). Treatment of community-acquired pneumonia in adults who require hospitalization. https://www.uptodate.com/contents/treatment-of-community-acquired-pneumonia-in-adults-who-require-hospitalization. Mantero, M., Tarsia, P., Gramegna, A., & Henchi, S. (2017, October 5). Antibiotic therapy, supportive treatment and management of immunomodulation-inflammation response in community acquired pneumonia: review of recommendations. Multidisciplinary Respiratory Medicine. https://mrmjournal.biomedcentral.com/articles/10.1186/s40248-017-0106-3. Read: Discussion: Alterations in Cellular Processes

ANSWER. PAPER DETAILS
Academic Level	Masters
Subject Area	Nursing
Paper Type	Discussion Response
Number of Pages	1 Page(s)/275 words
Sources	0
Format	APA
Spacing	Double Spacing

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