Posted: September 18th, 2022

HH is a 68 yo M who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days.

Colleague 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 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 with complaints of nausea and vomiting. Aging affects the body in several ways, more so related to decreased function and abilities of affected systems over time. The patient’s health needs include treatment primarily for his acute infection while taking into account his comorbidities. Aging causes normal alterations in pulmonary function without adverse events in healthy individuals; genetics, gender, and environmental agents factor into the development of abnormal alterations (Huether and McCance, 2019). Renal function and clearance are decreased in the older adult and must be taken into consideration when prescribing medications; along with considering renal and liver function, the prescriber must consider drug interactions. According to Miravitlles et. al. (2021), long-term use of inhaled corticosteroids in older adults with comorbidities can lead to the development of nonfatal pneumonia. For the treatment of the patient’s COPD, the severity of the patient’s symptoms would determine the therapy course; and an anti-inflammatory bronchodilator would be the first choice of initial control therapy. According to Rosenthal and Burchum (2019), when treating diabetes, the use of an ACE inhibitor such as lisinopril or an angiotensin II receptor blocker such as losartan along with a statin such as atorvastatin can reduce the risk of cardiovascular events and diabetic neuropathy. Metformin is the first line of treatment in type two diabetes (Rosenthal and Burchum, 2019). Until he can ingest the medications independently, the use of a nasogastric or orogastric tube can be used to deliver the medications; administering a proton pump inhibitor and antiemetic medication will aid in absorption unless underlying GI issues are involved. Post-discharge, prescribing aspirin 81mg orally daily as well will aid in cardiovascular prophylaxis. Once IV antibiotics therapy is completed, a 7-14 day course of oral antibiotics should be prescribed, a rescue inhaler, oral prednisone, and follow-up with PCP within one week of discharge.

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Colleague 1 HH is a 68-year-old M who has been confined to the medical ward for the previous three days with community-acquired pneumonia. His PMH is high for COPD, hypertension, hyperlipidemia, and diabetes. He is still receiving empiric antibiotics, including ceftriaxone 1 g IV q day (day 3) and azithromycin 500 mg IV q day (day 3). His clinical condition has improved since his hospitalization, and he now requires less oxygen. He is currently unable to tolerate a diet due to nausea and vomiting. Aging has a variety of effects on the body, the most noticeable of which is a decrease in the function and ability of affected systems over time. The patient’s health needs include treatment for his acute infection as well as consideration for his comorbidities. Normal changes occur as we age.

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