D027 CCM1 Phase3 3c Patient Tx Plan
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Western Governors University *
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D027
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Medicine
Date
Feb 20, 2024
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docx
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2
Uploaded by MasterHornetMaster659
3c Patient Focused Treatment Plan
Treating pneumonia without a significant medical history is very easy as there are antibiotics that bacteria are susceptible to. Treatment changes when people who have co-
morbidities like Dr. Douglas who has Hypertension and Chronic Kidney Disease (CKD) Stage II are
placed at greater risk of mortality from a pneumonia diagnosis. In a large, prospective, population-based cohort, Zekavat (2021) showed that prevalent hypertension is a risk factor for incident pneumonia, lower respiratory infections, ARDS or respiratory failure, and many other respiratory diseases. Each 5 mm Hg increase in systolic blood pressure was associated with a significant increased risk for incident pneumonia. The study by Zekavat (2021) discovered that hypertensive stimuli promote dysregulation of the adaptive immune response and that blood pressure elevations may result in pulmonary function alterations predisposing to the development of pneumonia.
Patients with chronic kidney disease showed lower median survival time during their time at hospital (Vidal & Santos, 2017). This finding alone translates to mean that patients with chronic kidney disease have a survival rate less than 50% than those without a chronic kidney disease and a pneumonia diagnosis. Chronic kidney disease compromises the host's ability to fight, especially affecting the cell-mediated immune system (Pant et al. 2021). Medication that fights the pneumonia infection must still be safe given the predisposing ailments of the patient, in this case, Dr. Douglas and her hypertension and chronic kidney disease. Combination therapy in this case was Amoxicillin/Clavulanate 875/125mg PO BID and Doxycycline 100mg PO BID. The 2019 Official Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America noted that patients with chronic renal disease are more susceptible to treatment resistance and poor outcomes. These patients respond better to combination therapy (Metlay, 2019).
References Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozel, J., Crothers, K., Cooley, L. A.,Dean, N. C., Fine, M. J., Flanders, S. A., Griffin, M.R., Metersky, M. L., Musher, D. M.,Restreo, M.
I., & Whitney, C. G. (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. e45-67. https://doi.org/10.1164/rccm.201908-1581ST
Pant, A., Prasai, A., Rauniyar, A. K., Adhikary, L., Basnet, K., & Khadka, T. (2021). Pneumonia in Patients with Chronic Kidney Disease Admitted to Nephrology Department of a Tertiary Care Center: A Descriptive Cross-sectional Study. JNMA; journal of the Nepal Medical Association, 59(242), 1000–1003. https://doi.org/10.31729/jnma.7074
Vidal, A., & Santos, L. (2017). Comorbidities impact on the prognosis of severe acute community-acquired pneumonia. Porto biomedical journal, 2(6), 265–272. https://doi.org/10.1016/j.pbj.2017.04.009
Zekavat, S. M., Honigberg, M., Pirruccello, J. P., Kohli, P., Karlson, E. W., Newton-Cheh, C., Zhao, H., & Natarajan, P. (2021). Elevated Blood Pressure Increases Pneumonia Risk: Epidemiological Association and Mendelian Randomization in the UK Biobank. Med (New York, N.Y.), 2(2), 137–148.e4. https://doi.org/10.1016/j.medj.2020.11.001
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