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    A 35-year-old man presented to the emergency department with a four-day history of cough, shortness of breath, fever, and chest pain. He was diagnosed with pneumonia in the right middle lobe based on chest x-ray and symptoms. He was treated with intravenous azithromycin in the hospital and discharged with a course of oral azithromycin to complete treatment over 4 days. Azithromycin works by inhibiting bacterial protein synthesis and is effective against common causes of pneumonia. The patient's symptoms, vital signs, and oxygen saturation were monitored during treatment.

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    A 35-year-old man presented to the emergency department with a four-day history of cough, shortness of breath, fever, and chest pain. He was diagnosed with pneumonia in the right middle lobe based on chest x-ray and symptoms. He was treated with intravenous azithromycin in the hospital and discharged with a course of oral azithromycin to complete treatment over 4 days. Azithromycin works by inhibiting bacterial protein synthesis and is effective against common causes of pneumonia. The patient's symptoms, vital signs, and oxygen saturation were monitored during treatment.

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    A 35-year-old man presented to the emergency department with a four-day history of cough, shortness of breath, fever, and chest pain. He was diagnosed with pneumonia in the right middle lobe based on chest x-ray and symptoms. He was treated with intravenous azithromycin in the hospital and discharged with a course of oral azithromycin to complete treatment over 4 days. Azithromycin works by inhibiting bacterial protein synthesis and is effective against common causes of pneumonia. The patient's symptoms, vital signs, and oxygen saturation were monitored during treatment.

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    57 views12 pages

    Your Big Idea

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    A 35-year-old man presented to the emergency department with a four-day history of cough, shortness of breath, fever, and chest pain. He was diagnosed with pneumonia in the right middle lobe based on chest x-ray and symptoms. He was treated with intravenous azithromycin in the hospital and discharged with a course of oral azithromycin to complete treatment over 4 days. Azithromycin works by inhibiting bacterial protein synthesis and is effective against common causes of pneumonia. The patient's symptoms, vital signs, and oxygen saturation were monitored during treatment.

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    of 12

    Scott’s Tots

    Pneumonia

    Victoria, Nashaly, Meagan, Jason, Cassi


    Case Synopsis
    Chief complaint: Patient presented to the ED with shortness of breath, cough and fever for four days

    History: 35 year old man who developed a harsh, productive cough four days prior to being seen
    by a physician.

    ● The sputum is thick and yellow


    ● He developed a fever, shaking, chills and malaise along with the cough
    ● One day ago he developed pain in his right chest that intensifies with inspiration
    ● Past history reveals that he had a chronic smoker's cough for "10 or 15 years" which he
    describes as being mild, non-productive and occurring most often in the early morning
    ● He smoked 2 packs of cigarettes per day for the past 50 years
    Case Synopsis
    Physical examination:
    ● Patient is underweight
    ● Continuous cough
    ● Sitting in a chair, he leans to his right side, holding his right chest with his left arm.
    ● Vital signs: blood pressure 152/90, apical heart rate 112/minute and regular, respiratory rate 24/minute and
    somewhat labored, temperature 102.6 F
    ● Auscultation reveals bilateral rhonchi and late inspiratory crackles (are heard)
    ● Clubbing of fingers

    LABORATORY:
    ● WBC 17,000/mm3; neutrophils 70%, bands 15%, lymphocytes 15%.

    COURSE OF ILLNESS:
    ● Chest x-ray revealed an acute pneumonia in the right middle lobe, the patient was treated with antibiotics
    ➔ Assessment Nursing Process ➔ Implementation
    ◆ shortness of breath, cough and
    fever, yellow sputum, abnormal ◆ Monitor rr, depth, and ease of
    breathing patterns, restlessness, respiration. Watch for use of
    accessory muscles and nasal
    clubbing of fingernails flaring

    ➔ Nursing Diagnosis ◆ Auscultate breath sounds


    every 1 to 2 hours. The
    ◆ Impaired gas exchange r/t to presence of crackles and
    pneumonia as evidenced by wheezes may alert the nurse
    abnormal breathing patterns and of airway obstruction, which
    may lead to or exacerbate
    clubbing of fingernails
    existing hypoxia.
    ➔ Planning ◆ Help the client deep breathe
    and perform controlled
    ◆ Client will demonstrate improved coughing.
    ventilation and adequate
    oxygenation as evidenced by ➔ Evaluation
    blood gas levels within normal
    parameters ◆ O2 sat is above 93%

    ◆ Clear lung sounds upon


    ◆ Maintain clear lung fields and
    auscultation
    remain free of signs of respiratory
    distress ◆ Fingernails no longer clubbing

    (Ackley, 2017).
    Therapy for Pneumonia
    ● Ensure that the patient is receiving adequate oxygen
    ○ Are they cyanotic?
    ○ Is there suction nearby to clear their airway?

    ● Treat with empirical antibiotics


    ○ Broad spectrum
    ○ Gram positive
    ○ What happens if the strain is resistant?

    ● Encourage the patient to use nonpharmacologic techniques


    as well!
    ○ Coughing
    ○ Deep breathing
    ○ Keep the patient well hydrated
    (McKance, K. L., 2014)
    (Parnham, et al., 2014)
    (Loeb, 2008)

    Medication used
    Zithromax (Azithromycin)
    ● Drug Class: Macrolide Antibacterial Antibiotic
    ● Azithromycin is indicated for respiratory, urogenital, dermal and other
    bacterial infections, and exerts immunomodulatory effects in chronic
    inflammatory disorders
    ● Long-term administration of azithromycin must be balanced against
    the potential for increased bacterial resistance.
    ● Treatment with azithromycin achieved a success rate (cure plus
    improvement) of 78% for the treatment of community-acquired
    pneumonia in a clinical study
    (Micromedex, 2018)

    Route: Intravenous, ophthalmic and oral

    Onset of Action: Azithromycin is rapidly absorbed after oral


    administration. Food does not interfere with absorption of
    tablet or suspension of azithromycin but of capsule is reduced.

    Peak plasma concentration: Occurs 2 to 3 hours after an oral


    dose and 1 to 2 hours after intravenous dosage.

    Elimination Half-life: An average terminal half-life of a single


    dose is 11 to 14 hours and 68 hours with multiple.

    Duration of Action: Up to 24 hours


    Duration of treatment
    ● The patient began treatment
    once the CXR confirmed the
    pneumonia diagnosis
    ● While in the hospital, they will
    receive 500 mg of IV Zithromax
    daily while in the hospital
    ● Just prior to discharge, give
    ONE dose of 500 mg oral
    Zithromax
    ● Discharge with a 4 day course of
    250 mg oral Zithromax

    (Ackley, 2017)
    (Vallerand, 2019).

    Drug action
    ● Inhibit protein synthesis at the level
    of the 50S bacterial ribosome
    ● Know effectiveness by monitoring
    vital signs, CBC - specifically WBC
    Tip
    count, and bacteria growth from
    Be cautious - may
    temporarily sputum samples
    increase other ● First dose can be given before
    values, such as receiving results of sputum bacteria
    PPT, BUN, and
    serum creatinine growth
    MAR
    Order Therapeutic Follow-up
    Azithromycin extended action Monitor patient’s O2 saturation
    release formula: 2g PO to ensure effective oxygen
    Reduction in the number perfusion.
    one time only
    of microorganisms
    causing the pneumonia. Monitor lung sounds for a
    ("Azithromycin Dosage reduction in crackles/ronchi.
    Guide with Precautions",
    2018) (Ackley,2017) (Ackley, 2017)
    Special considerations
    Side effects of azithromycin include: Diarrhea, nausea,
    abdominal pain, loose stools, and flatulence.

    Pregnancy category: B

    Can be administered orally or in injectable form.

    Taking the drug with food reduces both the rate and
    extent of GI absorption.

    (Ackley, 2017)
    References
    Ackley, B., & Ladwig, G. (2016). Nursing diagnosis handbook: An evidence-based guide
    to planning care (11th ed.). St. Louis: Mosby/Elsevier.

    Lilley, L.L., Collins, S.R, & Snyder, J.S. (2016). Pharmacology and the nursing process,
    8th Ed. St. Louis: Elsevier Mosby.

    Azithromycin Dosage Guide with Precautions. (2018, October 31). Retrieved from
    https://www.drugs.com/dosage/azithromycin.html#Usual_Adult_Dose_for_Pneumonia

    Loeb, M. (2008). Community-acquired pneumonia. BMJ Clinical Evidence, 2008(1503).


    Retrieved November 7, 2018, from
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907969/.

    McCance, K. L., & Huether, S. E. (2014). Pathophysiology: The biologic basis for disease
    in adults and children. St. Louis, MO: Mosby.

    Nuermberger, Eric L.,, Bishai, William R. Antibiotic Resistance in Streptococcus


    pneumoniae: What Does the Future Hold?, Clinical Infectious Diseases, Volume 38, Issue
    Supplement_4, 15 May 2004, Pages S363–S371, https://doi.org/10.1086/382696

    Vallerand, April Hazard, et al. Davis's Drug Guide for Nurses. F.A. Davis Company,
    2019.

    Parnham, M. J., Haber, V. E., Giamarellos-Bourboulis, E. J., Perletti, G., Verleden, G. M.,
    & Vos, R. (2014). Azithromycin: Mechanisms of action and their relevance for clinical
    applications. Pharmacology & Therapeutics, 143(2), 225-245.
    doi:10.1016/j.pharmthera.2014.03.003

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