Respond to this discussion . Add some facts with at least 2 citations APA Format Discussion: Community-Acquired Pneumonia                                                                                                               Case  Study HH is a 68-yr 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 q day (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, complaining of nausea and vomiting. Ht: 5'8" Wt: 89 kg Allergies: Penicillin (rash). Diagnosis: Community-Acquired Pneumonia (CAP) CAP is the term used to describe an acute infection of the lungs that develops outside the hospital setting by an immune-competent individual who has not been recently hospitalized (Shoar & Musher, 2020). Adults with CAP typically present with cough, fever, sputum production or shortness of breath, oxygen desaturation, confusion, leukocytosis or leukopenia, and pleuritic chest pain, along with the presence of an acute infiltrate on the chest radiograph (Shoar & Musher, 2020). Antibiotic suggested for CAP's empiric treatment is based on agents useful against CAP's major treatable bacterial causes. The bacterial pathogens responsible for CAP include Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Legionella species, and Moraxella catarrhalis (Metlay et al., 2019). The patient is on right treatment, his clinical status has improved, with decreased oxygen requirement. Recommended treatment plan for patients with comorbidities such as alcoholism, COPD, post influenza, asplenia, diabetes mellitus, lung/liver/renal diseases include: Combination of a beta-lactam (ceftriaxone 1 g IV q24h or cefotaxime 1 g IV q8h or ceftaroline 600 mg IV q12h) plus azithromycin 500 mg IV q24h (Donovan, 2019). The therapy duration is a minimum of 5 days. The patient needs to be afebrile for 48-72 hours, controlled blood pressure, adequate oral intake, and room air oxygen saturation of greater than 90% and treatment duration can be extended if symptoms are not recovered in some cases (Donovan, 2019).              In this case, the patient symptoms are improving, his oxygen requirement is decreased, but he is not tolerating a diet at this time, complaining of nausea and vomiting. The patient received antibiotics for three days, so antibiotics need to be continued. With appropriate antibiotic therapy, some improvement in the patient's clinical course is usually seen within 48 to 72 hours (File, 2020).                                                                                      Health Needs and Treatment Regimen The patient is not tolerating diet and complaining of nausea and vom.

1. Respond to this discussion . Add some facts with at least 2
citations APA Format
Discussion: Community-Acquired Pneumonia
Case Study
HH is a 68-yr 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 q
day (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, complaining of nausea and vomiting. Ht: 5'8"
Wt: 89 kg Allergies: Penicillin (rash).
Diagnosis: Community-Acquired Pneumonia (CAP)
CAP is the term used to describe an acute infection of the lungs
that develops outside the hospital setting by an immune-
competent
individual who has not been recently hospitalized (Shoar &
Musher, 2020). Adults with CAP typically present with cough,
fever, sputum production or

2. shortness of breath, oxygen desaturation, confusion,
leukocytosis or leukopenia, and pleuritic chest pain, along with
the presence of an acute
infiltrate on the chest radiograph (Shoar & Musher, 2020).
Antibiotic suggested for CAP's empiric treatment is based on
agents useful against CAP's major treatable bacterial causes.
The bacterial
pathogens responsible for CAP include Streptococcus
pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae,
Haemophilus
influenzae, Staphylococcus aureus, Legionella species, and
Moraxella catarrhalis (Metlay et al., 2019).
The patient is on right treatment, his clinical status has
improved, with decreased oxygen requirement. Recommended
treatment plan for
patients with comorbidities such as alcoholism, COPD, post
influenza, asplenia, diabetes mellitus, lung/liver/renal diseases
include: Combination
of a beta-lactam (ceftriaxone 1 g IV q24h or cefotaxime 1 g IV
q8h or ceftaroline 600 mg IV q12h) plus azithromycin 500 mg
IV q24h (Donovan, 2019).
The therapy duration is a minimum of 5 days. The patient needs
to be afebrile for 48-72 hours, controlled blood pressure,
adequate oral intake, and
room air oxygen saturation of greater than 90% and treatment
duration can be extended if symptoms are not recovered in some
cases (Donovan,

3. 2019).
In this case, the patient symptoms are improving, his
oxygen requirement is decreased, but he is not tolerating a diet
at this time,
complaining of nausea and vomiting. The patient received
antibiotics for three days, so antibiotics need to be continued.
With appropriate antibiotic
therapy, some improvement in the patient's clinical course is
usually seen within 48 to 72 hours (File, 2020).
Health
Needs and Treatment Regimen
The patient is not tolerating diet and complaining of nausea and
vomiting. Gastrointestinal (GI) manifestations such as nausea,
vomiting,
and diarrhea are considered possibly due to adverse drug
(antibiotics) effects (Lin et al., 2009). Changing the antibiotic
can help patients to avoid
these side effects. Levofloxacin 750 mg IV or PO q24h is a
recommended dose to treat CAP patients (Donovan, 2019).
Levofloxacin possesses greater bioavailability and a
longer serum half-life that allows for rapid step-down from
intravenous administration
to oral therapy, minimizing unnecessary hospitalization, which
may decrease costs and improve patient quality of life (Lynch
III et al., 2006). Several

4. randomized clinical trials to evaluate levofloxacin to treat CAP
demonstrate that levofloxacin is effective and safe for CAP
treatment, displaying
relatively mild adverse effects. Levofloxacin has much to offer
in terms of bacterial eradication (Lynch III et al., 2006). The
other studies also
concluded that monotherapy with oral levofloxacin is as
effective as treatment with Ceftriaxone plus, Azithromycin
combination in patients with CAP
who required hospitalization (Izadi et al., 2019).
Probiotics can be added to the treatment plan.
Probiotics replenish the natural GI flora with nonpathogenic
organisms. Few studies found
probiotics to be useful for preventing and treating antibiotic-
associated diarrhea related to antibiotic treatment (Rodgers et
al., 2013).
An antiemetic medication such as ondansetron can be added. It
is a selective 5-HT3 serotonin-receptor antagonist and acts on
central and
peripheral areas to prevent and treat nausea and vomiting
(Griddine & Bush, 2020).
As the patient is diabetic, his blood sugar needs to monitor
carefully because of sickness, nausea, and vomiting. Sliding
scale insulin (SSI) is
recommended. Both hyperglycemia and hypoglycemia in
hospitalized patients result in adverse outcomes, including
increased infection rates,

5. longer hospital length of stay, and even death. The use of oral
antidiabetic treatments during hospitalization is generally not
recommended because
of their safety and efficacy and their significant risk of
hypoglycemia and contraindications (Marín-Peñalver et al.,
2016).
Patient Education for
the management of Their Health Needs
The patient needs to be educated and encouraged to use an
incentive spirometer (IS). Incentive spirometry is commonly
used to break up
fluid that builds up in the lungs in people with pneumonia. IS
helps to open the airways and help manage COPD symptoms
(Yetman, 2020).
The patient needs to be educated about importance of the
pneumococcal conjugate vaccine (PCV) and influenza vaccines.
As per International Journal of Chronic Obstructive Pulmonary
Disease study, these vaccines decrease the risk of exacerbations
in patients with
chronic obstructive pulmonary disease (COPD) (Ely, 2018).
Patients over 65 years of age are more susceptible to
community-acquired pneumonia
(CAP), and COPD patients are 20 times more prone to develop
CAP (Ely, 2018). The Community-Acquired Pneumonia
Immunization Trial in Adults
(CAPITA) provided evidence of the benefits of vaccinating with

6. PCV13, which protects against 13 pneumococcal bacteria types
(Ely, 2018).
At the time of discharge, the patient needs to be
educated to continue his home medications and finish the
prescription of antibiotics if
prescribed, even if he starts to feel better. Taking the entire
course of antibiotics is one way to prevent recurring and more
severe infections and
combat antibiotic resistance (Rosenthal & Burchum, 2020).
Conclusion
Community-acquired pneumonia (CAP) is one of the
most common acute infections requiring hospital admission.
Age is a dominant risk
factor, with CAP's incidence increasing markedly in patients
who are over 65 years of age. Aging increases the mucosal cell
surface protein
expression that bacteria can adhere to, enabling potential
pathogens to avoid normal clearance mechanisms better. There
is evidence that age
directly affects innate and adaptive immunity, a process called
immunosenescence, which weakens lung immunity to invading
microbes (Brown,
2012). Few behavior changes like quitting smoking and alcohol
abuse and administering the vaccine can prevent or decrease
CAP's severity.

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