Main discussion - Week 9
COLLAPSE
Case Study 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 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)
Health Needs
Nutrition status. The patient is not tolerating diet, related to nausea (N) and vomiting (V). It is unclear in
the case scenario when the patient first complained of N and V. It is less likely to be caused by CAP (Baer,
2019). It can be a side effect of the antibiotics (Rxlist, 2018), or related to a condition undiscovered by
the provider yet. Further physical examination and a KUB are necessary to determine if the N and V are a
side effect of the medications or caused by a different condition.
Hydration status of the patient. The patient has been having N and V. It is essential to maintain the
patient well hydrated during recovery time because hydration loosens up the secretion, which makes it
easier for the patient to breathe by coughing and clearing up their airway (Ausmed, 2017). Strict intake
and output measurement are essential to prevent dehydration.
Length of IV antibiotic therapy. The Infectious Diseases Society of America (IDSA) recommends treating
CAP patients who are hospitalized with five to seven days of empiric antibiotics (File, 2020). IDSA
recommends to re-evaluate patients by the fifth to the seventh day before stopping the antibiotic,
extend the therapy needed if the patient is febrile, needs supplemental oxygen (unless required for a
preexisted condition), and patient clinically unstable (HR>100, RR>24, and SBP<90) (File, 2020).
Treatment Regimen
COLLAPSE
Case Study 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 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)
Health Needs
Nutrition status. The patient is not tolerating diet, related to nausea (N) and vomiting (V). It is unclear in
the case scenario when the patient first complained of N and V. It is less likely to be caused by CAP (Baer,
2019). It can be a side effect of the antibiotics (Rxlist, 2018), or related to a condition undiscovered by
the provider yet. Further physical examination and a KUB are necessary to determine if the N and V are a
side effect of the medications or caused by a different condition.
Hydration status of the patient. The patient has been having N and V. It is essential to maintain the
patient well hydrated during recovery time because hydration loosens up the secretion, which makes it
easier for the patient to breathe by coughing and clearing up their airway (Ausmed, 2017). Strict intake
and output measurement are essential to prevent dehydration.
Length of IV antibiotic therapy. The Infectious Diseases Society of America (IDSA) recommends treating
CAP patients who are hospitalized with five to seven days of empiric antibiotics (File, 2020). IDSA
recommends to re-evaluate patients by the fifth to the seventh day before stopping the antibiotic,
extend the therapy needed if the patient is febrile, needs supplemental oxygen (unless required for a
preexisted condition), and patient clinically unstable (HR>100, RR>24, and SBP<90) (File, 2020).
Treatment Regimen
