Infection Case Study
RR’s case is complicated with a six-day history of worsening cough, productive green sputum, fever, chills, pain in the right mid-back with deep breathing or coughing, warm and clammy skin, paleness, respiratory rate of 24 breaths per minute, pulse of 98 beats per minute, blood pressure is 120/75 mm Hg, and oxygen saturation of 96 percent on room air. These symptoms and clinical findings are consistent with pneumonia. Pneumonia is one of the top five conditions for hospital admission through the emergency department, second in pediatric admissions, and third in patients older than 45 years, and the eighth leading cause of death in the United States (Woo and Robinson, 2020).
The suspected organism for RR’s condition is streptococcus pneumonia because it is the most common cause of bacterial pneumonia (Medline Plus, 2015). Streptococcus pneumonia is identified in 60-75% of adults with bacterial pneumonia (Woo and Robinson, 2020). The recommended antibiotic for treatment for RR’s condition is a macrolide antibiotic. Examples of macrolide antibiotics used to treat pneumonia includes azithromycin, clarithromycin, erythromycin, and doxycycline (Woo and Robinson, 2020). The antibiotic that is recommended is erythromycin because RR does not have any pre-existing health conditions and no risk factors for drug-resistant streptococcus pneumonia, and it is the least expensive of the antibiotics discussed, with a cost of approximately $17 for a 7-10 day course of treatment (Woo and Robinson, 2020). Erythromycin is a bacteriostatic antibiotic that prevents further growth of bacteria rather than destroying it by inhibiting protein synthesis. It binds to the 23S ribosomal RNA molecule in the 50S subunit of the bacterial ribosome causing a blockage in the exiting of the peptide chain that is growing (Farzan et al., 2020).
The counseling points for RR would include the importance of faking all antibiotics as prescribed and completing the full prescription, even when she starts to feel better. She should also follow-up with her healthcare provider if she is not feeling better, afebrile in 2-4 days or worsening of symptoms, improved respiratory status, hydration, and activity tolerance (Woo and Robinson, 2020). RR should also be informed of the expected length of treatment, drug interactions, importance of hydration, adverse reactions to erythromycin, smoking cessation, and rest. Erythromycin will be prescribed orally because RR is being treated on an outpatient basis. During treatment, she should avoid alcohol, take the antibiotic on an empty stomach about one hour before or two hours after meals, take with a full glass of water, and avoid taking with grapefruit juice (Farzam et al., 2020). The common adverse effects of erythromycin are nausea, vomiting, diarrhea, abdominal pain, QT prolongation, rash, reversible deafness, and rare adverse effects includes Stevens-Johnson syndrome, toxic epidermal necrolysis, cholestasis, and avoidance of drugs metabolized by the P450 system because it will cause an increased concentration and the risk of toxicity (Farzam et al., 2020). Due to RR’s current social situation of being homeless, she would need assistance from social services in order to obtain the prescription for treatment of her condition.
References
Farzam, K., Nessel, T., and Quick, J. (2020). Erythromycin. StatPearls. Treasure Island, FL: StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK532249
Medline Plus. (2015). Pneumonia. Retrieved from https://www.medlineplus.gov/pneumonia.html
Woo, T. and Robinson, M. (2020). Pharmacotherapeutics for Advanced Practice Nurse Prescribers (5th ed.). Philadelphia, PA: F.A. Davis.
