Community Acquired Pneumonia: Intro Community-acquired pneumonia (CAP) is a common group of infectious diseases that are responsible for significant global health and economic burden. CAP affects approximately 5.5/1000 people annually, and is a leading cause of hospital admissions, morbidity, and mortality in developed countries (especially for older people). Among all patients with CAP, those aged 65 or older account for about one-third, but they account for more than half of all health costs due to this disease. COPD is one of the most common comorbidities in patients with CAP, characterized by persistent respiratory symptoms.  COPD was the third-most common cause of death in 2008, and the morbidity from COPD is projected to increase by 2020 (Liu, Han, & Liu, 2018). Brief Summary of Client Case             Client HH is a 68 year-old male admitted with a diagnosis of community-acquired pneumonia for the past 3 days. This client’s medical HX includes COPD, HTN, hyperlipidemia, and diabetes. Mr. HH is on day three of two empiric antibiotics (ceftriaxone 1 g IV daily and azithromycin 500 mg IV daily). The client’s clinical status has improved since admission, with decreased oxygen requirements. However, he is not tolerating anything PO at this time and complains of nausea and vomiting. The client’s height is 5’8” and he weighs 89 kg. The only known drug allergy is PCN which results in a rash. Analysis  The client in this scenario is responding well to the current antibiotic therapy, as evidence by a drop in WBC count from 18.2 upon admission to 14.6 currently (normal range is between 5.0 and 10). It is also pleasing that the client’s O2 saturation is now 92% on room air alone, compared to 90% while requiring 4L of supplemental oxygen upon admission. Overall, the client’s lab results are not significantly concerning. Neutrophil (normal range 40-60%) and band (normal range 0.0-03%) percentages are slightly elevated as expected given the infectious process (NIH, 2020). Aside from an elevated WBC count that is trending down, a marginally elevated blood glucose, and a HCO3 elevated eight points above the normal limit, the other lab results are within the normal ranges of a healthy adult male (Farinde, 2019). The issues of concern in this client case are the client’s inability to tolerate a diet due to nausea and vomiting, elevated temperature, and continuing antibiotics to treat the pneumonia. Treatment Considerations  According to Donovan (2019), the client’s empiric antibiotic regime is consistent with what is recommended by the Infectious Diseases Society of America (IDSA). Initial empiric antimicrobial treatment should be initiated until laboratory results can be obtained to guide more specific therapy. Also, a 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 is consistent with IDSA guidelines for a client with comorbidities such as COPD and diab.

1. Community Acquired Pneumonia: Intro
Community-acquired pneumonia (CAP) is a common group of
infectious diseases that are responsible for significant global
health and economic burden. CAP affects approximately
5.5/1000 people annually, and is a leading cause of hospital
admissions, morbidity, and mortality in developed countries
(especially for older people). Among all patients with CAP,
those aged 65 or older account for about one-third, but they
account for more than half of all health costs due to this
disease. COPD is one of the most common comorbidities in
patients with CAP, characterized by persistent respiratory
symptoms. COPD was the third-most common cause of death in
2008, and the morbidity from COPD is projected to increase by
2020 (Liu, Han, & Liu, 2018).
Brief Summary of Client Case
Client HH is a 68 year-old male admitted with a
diagnosis of community-acquired pneumonia for the past 3
days. This client’s medical HX includes COPD, HTN,
hyperlipidemia, and diabetes. Mr. HH is on day three of two
empiric antibiotics (ceftriaxone 1 g IV daily and azithromycin
500 mg IV daily). The client’s clinical status has improved
since admission, with decreased oxygen requirements. However,
he is not tolerating anything PO at this time and complains of
nausea and vomiting. The client’s height is 5’8” and he weighs
89 kg. The only known drug allergy is PCN which results in a
rash.
Analysis
The client in this scenario is responding well to the current

2. antibiotic therapy, as evidence by a drop in WBC count from
18.2 upon admission to 14.6 currently (normal range is between
5.0 and 10). It is also pleasing that the client’s O2 saturation is
now 92% on room air alone, compared to 90% while requiring
4L of supplemental oxygen upon admission. Overall, the
client’s lab results are not significantly concerning. Neutrophil
(normal range 40-60%) and band (normal range 0.0-03%)
percentages are slightly elevated as expected given the
infectious process (NIH, 2020). Aside from an elevated WBC
count that is trending down, a marginally elevated blood
glucose, and a HCO3 elevated eight points above the normal
limit, the other lab results are within the normal ranges of a
healthy adult male (Farinde, 2019). The issues of concern in
this client case are the client’s inability to tolerate a diet due to
nausea and vomiting, elevated temperature, and continuing
antibiotics to treat the pneumonia.
Treatment Considerations
According to Donovan (2019), the client’s empiric antibiotic
regime is consistent with what is recommended by the
Infectious Diseases Society of America (IDSA). Initial empiric
antimicrobial treatment should be initiated until laboratory
results can be obtained to guide more specific therapy. Also, a
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 is consistent with IDSA
guidelines for a client with comorbidities such as COPD and
diabetes. This therapy should be continued for minimum of 5
days, the client should be afebrile for 48-72 hours, have a stable
blood pressure, an adequate oral intake, and have a room air
oxygen saturation of greater than 90%; longer treatment
duration may be required in some cases (Donovan, 2019). In
addition to these criteria, the client’s temperature should be
below 100.9º F before switching to oral antibiotics. Zofran or
another antiemetic medication will be considered if the client is

3. still unable to tolerate meals at the 5 day mark. However, we
expect that the nausea will resolve as the antibiotics work to
treat the lung infection. If this client meets all criteria and
maintains it for 24 hours, the antibiotic therapy will be switched
from IV to oral (Kaysin & Viera, 2016). According to the
National Clinical Guideline Centre (2019), inpatient stay
remains appropriate for patients with pneumonia only as long as
hospital care is delivering management that cannot safely be
delivered at home. Thus, once the client is able to tolerate oral
antibiotics and his temperature drops below 100.9, discharge
should be considered. Ultimately, the client would be
discharged and sent home with a course of oral antibiotics.
Since the client has a PCN allergy, the client would be started
on an oral fluoroquinolone. According to Noreddin and Elkhatib
(2010), the efficacy and tolerability of levofloxacin 500mg
daily for 10 days in patients with CAP are well established.
The client in this case has COPD, which is an important
comorbidity to consider. Furthermore, COPD increases the risk
of developing CAP, which is thought to be associated with a
poorer prognosis. Therefore, the association between CAP and
COPD is important for providers to pay close attention to.
Patients with COPD are more often older, male, and more likely
to suffer from respiratory failure, severe pneumonia, or
comorbidities. However, COPD is a common and important
predisposing comorbidity in patients who develop CAP, and
often intensifies the clinical symptoms of patients with CAP.
While it may complicate treatment, it generally does not tend to
affect prognosis (Liu, Han, & Liu, 2018).
Possible Patient Education Strategy
An appropriate patent education strategy for this client would
be for the disease management nurse to meet with this client
prior to discharge and provide the client with handouts as well
as conduct an educational session on community acquired

4. pneumonia. The information disseminated should include an
explanation of what pneumonia is, how it’s diagnosed, and how
it is treated. Tips to facilitate a quicker recovery should also be
discussed. These pointers include: getting plenty of rest, deep
breathing exercises, hand washing, coughing/sneezing etiquette,
drinking plenty of water, and eating a balanced diet. Strategies
to avoid developing pneumonia should also be included, such
as; getting a flu vaccine, avoiding smoking, properly managing
preexisting respiratory conditions (e.g., asthma or COPD),
receiving a pneumonia vaccine, and staying active
(Nursing2020, 2010).
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