Infection Case Study
RR is 48-year-old Hispanic woman who comes to see you at the V. A. homeless clinic. The major complaint is a six-day history of worsening cough, productive of green sputum. There have been fever and chills with complaints of pain in the right mid-back with deep breathing or coughing. Further history reveals a history of tobacco use of one pack of cigarettes a day for 30 years. There is an incontainent health history as a result of Post-Traumatic Stress Disorder (PTSD) and homelessness. On examination, the skin is warm and clammy, pale; RR appears to not feel well; the temperature is 100.5° F; respiratory rate is 24 breaths per minute; pulse is 98 beats per minute; blood pressure is 120/75 mm Hg; and saturation of oxygen is 96 percent on room air by pulse oximetry.
Auscultation of the lungs reveals rales in the right lower-posterior lung field. The remainder of the examination is within normal limits.
- What organism(s) do you most suspect and why?
- What antibiotic would you recommend to treat RR with and why?
- What is the mechanism of action of this antibiotic? Provide rationale
- Do you have any counseling points for RR?
POST # 1 AYME
Based on the subjective findings as well as the physical examination findings, pneumonia features as the primary diagnosis for this patient. The symptoms exhibited by this patient are consistent with those associated with pneumonia that could be categorized as community-acquired pneumonia (CAP) since it occurred outside a healthcare facility, possibly due to bacterial infections. As such, Streptococcus pneumonia features as the most suspect organism since it is responsible for most cases of bacterial pneumonia and is associated with symptoms that are similar to those exhibited by this patient including, chills, sputum production, and chills (Lanks, Musani & Hsia, 2019). The other organisms that could be suspected include; Mycoplasma pneumonia as well as Haemophilus influenza since they are among the other causes of CAP.
Antibiotics are typically the main medications that are used in the treatment of bacterial pneumonia. According to Metlay et al. (2019), the first-line antibiotics that are used in the treatment of this disease include; macrolides like clarithromycin and azithromycin, doxycycline as well as fluoroquinolones like levofloxacin. The antibiotic that would be recommended to treat this patient is azithromycin. Macrolides like azithromycin are considered as the best antibiotics used in the initial treatment of CAP associated with bacterial infections (Woo & Robinson, 2020). This antibiotic offers the best coverage for various organisms associated with community-acquired pneumonia (Metlay et al., 2019). For instance, this antibiotic offers effective coverage for Legionella, gram-positive as well as mycoplasma organisms (Kruger & Prathapan, 2020).
Azithromycin is categorized as a macrolide-type antibiotic, and its mechanism of action involves inhibiting bacterial growth that helps in the treatment of various bacterial infections (Kruger & Prathapan, 2020). Inhibiting the multiplication of bacteria helps in killing them hence the effective treatment of this infection (Kruger & Prathapan, 2020).
Patient counseling is one of the essential aspects that help in enhancing the adherence of patients to their treatment leading to the achievement of optimal outcomes. Thus, it is necessary to offer the appropriate counseling to this patient to enhance her health outcomes. Patient counseling, in this case, would focus on various aspects related to pneumonia that include; the risk factors, causes, associated complications as well as the prevention of this disease. For instance, the patient would be counseled on the prevention of this disease that includes; the maintenance of proper hygiene, consuming healthy foods, getting sufficient sleep, and smoking cessation (Froes, Pereira & Póvoa, 2019). Smoking is one of the main risk factors associated with this disease and exposure of the patient to cigarette smoke may lead to worsening of her symptoms hence the need for counseling on smoking cessation (Froes, Pereira & Póvoa, 2019). The patient will be counseled on the treatment of this disease and the lifestyle remedies that could assist in quick recovery and minimize the risk of developing the associated complications such as staying hydrated and getting sufficient rest (Froes, Pereira & Póvoa, 2019). For instance, the patient would be counseled on the appropriate use of the provided medication that includes; the correct dose and the need to adhere to her medication regimen. Medication non-adherence might lead to the recurrence of pneumonia. Thus, it would be imperative to counsel her on the need for completing the course of her medications, especially the antibiotic, since it would help in the effective treatment of this infection, thereby preventing the recurrence of this disease. Patient counseling would also include; the interactions as well as the possible side effects associated with the provided medications. Overall, providing the appropriate counseling would help in enhancing the patient’s adherence to her treatment plan, thereby improving her clinical outcome.
References
Froes, F., Pereira, J. G., & Póvoa, P. (2019). Outpatient management of community-acquired pneumonia. Current opinion in pulmonary medicine, 25(3), 249-256.
Kruger, D., & Prathapan, P. (2020). Azithromycin: The first broad-spectrum therapeutic. Journal of translational autoimmunity, 100062.
Lanks, C. W., Musani, A. I., & Hsia, D. W. (2019). Community-acquired pneumonia and hospital-acquired pneumonia. Medical Clinics, 103(3), 487-501.
Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., … & Griffin, M. R. (2019). Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. American journal of respiratory and critical care medicine, 200(7), e45-e67.
Woo, T. M., & Robinson, M. V. (2020). Pharmacotherapeutics for advanced practice nurse prescribers (5th ed.). Philadelphia, PA: F.A. Davis Company.
