NURS 6512 Case study 1: HH is a 68 yo M who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days.
An undergrad physiology professor of mine once said “Many people say men and women are the same, but there is a Vas Deferens between us”
Students with last names beginning with A-M please do case study 1: 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)
Week 9. Mr. HH’s Case Study
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CASE STUDY
HH is a 68-year-old M who has been admitted to the medical ward with community-acquired Pneumonia for the past three days. His PMH is significant for COPD, HTN, hyperlipidemia, and diabetes. He remains on empiric antibiotics, including ceftriaxone 1 g IV qday (day 3), and Azithromycin 500 mg IV q day (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)
According to the presented case study, Mr. HH, a 68-year-old male, has been diagnosed with community-acquired Pneumonia. The Centers for Disease Control and Prevention (CDC) (2020) defines Pneumonia as a lung infection that can cause mild to severe ailments to people of all ages. Prina, Ranzani & Torres (2015) states that the clinical presentation of community-acquired Pneumonia is the acute symptoms and immediate signs of lower respiratory infection. The most exhibited symptoms being new-onset chest pain, cough, dyspnea, fever, etc. (Prina, Ranzani & Torres, 2015).
Patient’s health needs
Patient HH needs a complete assessment/triage to fully obtain a timeline on when his symptoms and other occurrences led to hospitalization. Need a complete set of vital signs and bedside finger stick to proceed with a plan of care. Pt needs O2 saturation monitoring, needs IV hydration, and nutrition.
HH’s cause of nausea and vomiting is unknown as it is not a symptom of community-acquired Pneumonia (CAP) (Prina, Ranzani & Torres, 2015). Resolution of nausea and vomiting will improve the patient’s dietary status and prevent possible hypoglycemia, as the patient has diabetes. HH presented with other medical problems like COPD, Hypertension, Hyperlipidemia, and Diabetes and has been on antibiotics for three days since hospital admission.
Treatment Regime
It is essential to mention that this patient was placed on a broad-spectrum antibiotic regime, Azithromycin, a treatment plan utilized when the causative agent, either bacteria or fungus, is unknown (Rosenthal & Burchum 2021). HH needs blood work and respiratory cultures to determine the agent causing his current infection so that the specific antibiotic can be initiated, bearing in mind that he is allergic to Penicillin. The patient is also on Ceftriaxone for three days as part of his treatment plan. Rosenthal & Burchum (2021) states that Ceftriaxone is utilized to treat all various types of common bacterial infection and critical ones like Meningitis, E. coli, and Pneumonia. Therefore, the IV antibiotics need to be continued for five to seven days and patient re-evaluated for their effectiveness before discontinuation to avoid developing patient resistance to a specific antibiotic (Metlay et al., 2019).
Due to not tolerating diet well, patient HH needs IV hydration and nutrition therapy until nausea and vomiting is resolved to avoid dehydration and electrolyte imbalance from an unknown period of said symptoms.
I would recommend placing the patient on D51/2 NS to maintain adequate hydration, provide nutrients, balance electrolytes, and maintain blood sugar level and frequent Accu- checks.
It is also worthy to note that the patient’s respiratory treatment is improving and respiratory medications utilized were not listed. The first-line medication for COPD exacerbation / respiratory treatment and management are Anti-inflammatory and B2 agonists. Rosenthal & Burchum (2021) opined that these medications work by minimizing bronchial hyperreactivity, thereby eliminating respiratory inflammation and decreasing the production of mucus in the respiratory tract.
Patient Education
The patient should be educated on the need to monitor his oxygen level closely and weaned off accordingly if he is not oxygen dependent at home. The patient will be educated on the importance of living a more active lifestyle, using an Incentive spirometer for lung expansion, to inhibit mucus plug and pneumonia reinfection. The patient will be educated on the need to closely monitor his blood pressure to maintain his baseline. Patient dietary plan and medication compliance need to be reviewed with the patient to manage hyperlipidemia adequately. It is crucial for education and follow-up to be continually provided to the patient to understand that HTN, HLD, and DM place him at an alarming risk for stroke.
References
Centers for Disease Control and Prevention (2020). Pneumonia an infection of the lungs. Cdc.gov Retrieved from
Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Crothers, K., Cooley, L. A., Dean, C. N., Fine, M. J., Flanders, S. A., Griffin, M. R., Metersky, M. L., Musher, D. M., Restrepo, M. I. & Whitney, C. G. (2019). Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Disease Society of America. Infectious Disease Society of America Retrieved from
Prina, E. Ranzani, O. T., Torres, A. (2015). Community acquired Pneumonia. The lancent Journal. Retrieved from
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, M.O: Elsevier.
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Last names beginning with N-Z please do case study 2: A 46-year-old, 230lb woman with a family history of breast cancer. She is up to date on yearly mammograms. She has a history of HTN. She complains of hot flushing, night sweats, and genitourinary symptoms. She had felt well until 1 month ago and she presented to her gynecologist for her annual gyn examination and to discuss her symptoms. She has a history of ASCUS about 5 years ago on her pap, other than that, Pap smears have been normal. Home medications are Norvasc 10mg qd and HCTZ 25mg qd. Her BP today is 150/90. She has regular monthly menstrual cycles. Her LMP was 1 month ago.
Discussion: Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
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.
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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.
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.
You will respond to your colleagues’ posts in Week 10.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Submission and Grading Information
Grading Criteria
Post by Day 3 of Week 9 and Respond by Day 6 of Week 10
What’s Coming Up in Week 10?
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Next week, you will continue working on your Discussion assigned in Week 9, as you examine the types of drugs used to treat infections and disorders of the hematologic system.
Next Week
