Week 9 Discussion
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)
Patient health needs:
Aside from the continuation of the patient’s antibiotics as first priority, this patient will need assessment and treatment for nutrition since he is not tolerating a diet at this time. Malnutrition is associated with an increased risk of complications in hospitalized patients, and parenteral nutrition (PN) is used when oral or enteral feeding is not possible TPN should be considered if the patient cannot tolerate a diet (Comerlato, Stefani, Viana, & Viana, 2020). TPN is also considered high risk in a patient with an already known infection as TPN has high sugar content and infection feeds on sugar. The patient is also diabetic and blood sugars will need to be checked at least every 6 hours.
Another consideration is with the allergy to penicillin, the provider will cover this patient with Ceftriaxone and azithromycin until the patient’s sputum and blood cultures result. Cultures are important to be sure the patient’s specific infection is covered and treated effectively. Bloodcultures are one of the most important specimens managed by the clinical microbiology laboratory and are the primary and most sensitive method for diagnosing bloodstream infections (bacteremia, fungemia, and sepsis), in addition to influencing appropriate antimicrobial therapy (Snyder, 2015).
Depending on what the sputum and blood cultures result, the provider will likely start the patient on vancomycin. The patient will also be assessed by the nutrition team to determine if the patient is a candidate for TPN or is an NG/OG is appropriate. The provider should also consider pre-treating the patient with an antiemetic prior to meals or at least a nutrition supplement drink. Antiemetics to consider could be: Zofran, Granisetron, Dolasetron, Haldol, Phenergan, Reglan, ect (Rosenthal & Burchum, 2021).
Thorough education on the importance of nutrition and compliance with prescribed medications must be emphasized. The patient must be set up for success before discharge. The nurse and provider must be congruently to be sure that the patient understands the importance of their plan of care at home. This plan of care must include an adequate understanding of what nutritional needs need to be met at home, when to take his antibiotics and nausea medications, proper hand hygiene, and ways to prevent community-acquired infections. The patient must also be educated on the importance of following up with a primary care provider to ensure the patient is in compliance with his home care plan.
Comerlato, P. H., Stefani, J., Viana, M. V., & Viana, L. V. (2020). Infectious complications associated with parenteral nutrition in intensive care unit and non-intensive care unit patients. Brazilian Journal of Infectious Diseases, 24(2), 137–143. https://doi-org.ezp.waldenulibrary.org/10.1016/j.bjid.2020.02.002
Rosenthal, L. D. & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Snyder, J. W. (2015). Blood Cultures: the Importance of Meeting Pre-Analytical Requirements in Reducing Contamination, Optimizing Sensitivity of Detection, and Clinical Relevance. Clinical Microbiology Newsletter, 37(7), 53–57. https://doi-org.ezp.waldenulibrary.org/10.1016/j.c…
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