Posted: October 9th, 2022

Patients Education and Health Needs Discussion

Patients Education and Health Needs Discussion

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 qday (day 3) and azithromycin 500 mg IV qday (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.

Ht: 5’8” Wt: 89 kg

Allergies: Penicillin (rash)

Patient health needs:

Aside from the continuation of the patient’s antibiotics as first priority, this patient will need assessment and treatment for nutrition since he is not tolerating a diet at this time. Malnutrition is associated with an increased risk of complications in hospitalized patients, and parenteral nutrition (PN) is used when oral or enteral feeding is not possible TPN should be considered if the patient cannot tolerate a diet (Comerlato, Stefani, Viana, & Viana, 2020). TPN is also considered high risk in a patient with an already known infection as TPN has high sugar content and infection feeds on sugar. The patient is also diabetic and blood sugars will need to be checked at least every 6 hours.

Another consideration is with the allergy to penicillin, the provider will cover this patient with Ceftriaxone and azithromycin until the patient’s sputum and blood cultures result. Cultures are important to be sure the patient’s specific infection is covered and treated effectively. Bloodcultures are one of the most important specimens managed by the clinical microbiology laboratory and are the primary and most sensitive method for diagnosing bloodstream infections (bacteremia, fungemia, and sepsis), in addition to influencing appropriate antimicrobial therapy (Snyder, 2015).

Depending on what the sputum and blood cultures result, the provider will likely start the patient on vancomycin. The patient will also be assessed by the nutrition team to determine if the patient is a candidate for TPN or is an NG/OG is appropriate. The provider should also consider pre-treating the patient with an antiemetic prior to meals or at least a nutrition supplement drink. Antiemetics to consider could be: Zofran, Granisetron, Dolasetron, Haldol, Phenergan, Reglan, ect (Rosenthal & Burchum, 2021).

Patient Education:

Thorough education on the importance of nutrition and compliance with prescribed medications must be emphasized. The patient must be set up for success before discharge. The nurse and provider must be congruently to be sure that the patient understands the importance of their plan of care at home. This plan of care must include an adequate understanding of what nutritional needs need to be met at home, when to take his antibiotics and nausea medications, proper hand hygiene, and ways to prevent community-acquired infections. The patient must also be educated on the importance of following up with a primary care provider to ensure the patient is in compliance with his home care plan.

References:

Comerlato, P. H., Stefani, J., Viana, M. V., & Viana, L. V. (2020). Infectious complications associated with parenteral nutrition in intensive care unit and non-intensive care unit patients. Brazilian Journal of Infectious Diseases, 24(2), 137–143. https://doi-org.ezp.waldenulibrary.org/10.1016/j.bjid.2020.02.002

Rosenthal, L. D. & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician Helpants (2nd ed.) St. Louis, MO: Elsevier.

Snyder, J. W. (2015). Blood Cultures: the Importance of Meeting Pre-Analytical Requirements in Reducing Contamination, Optimizing Sensitivity of Detection, and Clinical Relevance. Clinical Microbiology Newsletter, 37(7), 53–57. https://doi-org.ezp.waldenulibrary.org/10.1016/j.c…
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Patients’ Education and Health Needs are discussed during this session.

HH is a 68-year-old man who has been admitted to the medical ward for the past three days due to community-acquired pneumonia (CAP). His PMH is significant for chronic obstructive pulmonary disease (COPD), hypertension, hyperlipidemia, and diabetes. Efficacious antibiotics, including ceftriaxone 1 g IV qday (day 3) and azithromycin 500 mg IV qday (day 3), are still being administered (day 3). Since his admission, his clinical condition has improved, and his oxygen requirements have decreased. Due to complaints of nausea and vomiting, he is not currently able to tolerate any kind of diet.

Height: 5’8″; weight: 89 kg

Penicillin is a common allergen (rash)

Patient health requirements:

Other than continuing to administer antibiotics to the patient, which is the first priority, this patient will require nutritional assessment and treatment because he is currently unable to tolerate any type of diet. Parenteral nutrition (PN) is administered to hospitalized patients when oral or enteral feeding is not possible. Malnutrition is associated with an increased risk of complications in hospitalized patients. If a patient is unable to tolerate a diet, TPN should be considered as an option (Comerlato, Stefani, Viana, & Viana, 2020). TPN is also considered a high-risk treatment option in patients who have a known infection because TPN contains a high sugar content, and infection thrives on sugar. Due to the fact that the patient is diabetic, blood sugar levels will need to be checked at least every 6 hours.

Also, because of the patient’s allergy to penicillin, the provider will treat him or her with Ceftriaxone and azithromycin until the results of his or her sputum and blood cultures are known. It is critical to obtain cultures in order to ensure that the patient’s specific infection is covered and treated effectively. Among the most important specimens managed by the clinical microbiology laboratory, bloodcultures are the primary and most sensitive method for diagnosing bloodstream infections (bacteremia, fungemia, and sepsis), in addition to having an impact on appropriate antimicrobial therapy (Snyder, 2015).

Depending on the results of the sputum and blood cultures, the provider will most likely begin treating the patient with vancomycin. The patient will also be evaluated by the nutrition team to determine whether or not the patient is a candidate for TPN or whether or not an NG/OG is necessary. It is also recommended that the patient be treated with an antiemetic prior to meals, or at the very least given a nutrition supplement drink. Antiemetics to consider include: Zofran, Granisetron, Dolasetron, Haldol, Phenergan, Reglan, and other similar medications, among others (Rosenthal & Burchum, 2021).

Patient Education & Counseling:

It is essential to provide comprehensive education on the importance of proper nutrition and adherence to prescribed medications. Before being discharged, the patient must be given the best chance of success. Patients must be aware of the importance of their plan of care at home, and the nurse and provider must work together to ensure that this is understood by the patient. These considerations include a clear understanding of what nutritional needs must be met at home, when to take his antibiotics and nausea medications, how to maintain proper hand hygiene, and how to prevent community-acquired infections. A primary care provider should be notified whenever a patient is not complying with his or her home care plan, and the patient should be educated on the importance of following up with them.

References:

Comerlato, P. H., Stefani, J., Viana, M. V., and Viana, L. V. Comerlato, P. H., Stefani, J., Viana, M. V., and Viana, L. V. (2020). Infectious complications associated with parenteral nutrition in patients admitted to the intensive care unit and those admitted to the non-intensive care unit. The Brazilian Journal of Infectious Diseases, volume 24, number 2, pages 137–143. https://doi-org.ezp.waldenulibrary.org/10.1016/j.bjid.2020.02.002

Rosenthal, L. D., and Burchum, J. R. (in press) (2021). Pharmacotherapeutics for advanced practice nurses and physician Helpants by Lehne & Associates (2nd ed.) Elsevier Science Publishers, St. Louis, MO.

Snyder, J. W., et al (2015). It is critical to meet pre-analytical requirements in order to reduce contamination, optimize sensitivity of detection, and ensure clinical relevance when performing blood cultures. Clinical Microbiology Newsletter, vol. 37, no. 7, pp. 53–57, 2007. https://doi-org.ezp.waldenulibrary.org/10.1016/j.c…

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