Admission Orders Sample Paper A 68-year-old female is brought to the hospital from the acute rehabilitation facility. She complains of shortness of breath and a productive cough.

Admission Orders Sample Paper

A 68-year-old female is brought to the hospital from the acute rehabilitation facility. She complains of shortness of breath and a productive cough. The symptoms have been there for the past one week. The patient was started on ciprofloxacin three days, but her condition has just worsened. The patient is hypertensive and has a history of hypothyroidism. She recently underwent knee replacement surgery about two weeks ago. She is currently on lisinopril, ciprofloxacin and rivaroxaban. She is presently experiencing fever, chills, productive cough with green purulent sputum, and worsening shortness of breath. On examination, her vitals are recorded as T 102.6, HR 92, RR 22, and BP 128/82. Oxygen saturation is recorded as 96% on four liters of oxygen. A chest X-ray done indicates consolidation in the right lower lobe. The patient’s CBC and CMP are within the normal range. This essay aims to write down admission orders for this patient.

Treatment of the patient.

I would immediately discontinue the ciprofloxacin and initiate piperacillin/tazobactam, 5g IV every six hours, tobramycin, 5mg/kg IV every 24 hours, and vancomycin, 15mg/kg every 12 hours. The patient meets the criteria for hospital-acquired pneumonia (HAP). This is because of her surgery two weeks prior and her inpatient admission at the rehabilitation facility. A chest X-ray done shows a consolidated right lower lobe. This further increases the risk of a diagnosis of pneumonia. It is important to commence a three-drug combination for broad-spectrum coverage until a culture and sensitivity report of the patient’s sputum is available to begin de-escalation of antibiotics. This is because the patient is at risk of drug-resistant bacteria and MRSA.

In 2007, the Infectious Diseases Society of America and the American Thoracic Society guidelines defined treatment based on the population at risk of infection with antibiotic-resistant pathogens. The current recommendations established in 2016 propose using narrower spectrum antibiotics in instances where it is possible. The recommended drugs for use in institutions where MRSA incidence is below 20%, and there is prior IV antibiotic use within 90 days are piperacillin/tobramycin, cefepime, levofloxacin, imipenem, and meropenem (Martin-Loeches et al., 2018).

In instances where the MRSA rate is more than 20%, and there is a great risk of antibiotic-resistant micro-organisms, the following drugs are recommended. A beta lactam/lactamase inhibitor such as piperacillin or tazobactam is recommended, an aminoglycoside such as amikacin, tobramycin, and finally, either linezolid or vancomycin are recommended in such instances. Although this indiscriminate use of antibiotics is a major predisposing factor for antibiotic resistance, it is recommended to commence treatment with these broad-spectrum drugs and later narrow down depending on the response to treatment and results obtained from further tests, such as culture and antibiotic susceptibility.

Adjustments to make.

Adjustments to make include the discontinuation of tobramycin and vancomycin. The patient should be continued on piperacillin/tazobactam. The sensitivity report obtained indicates that the bacteria cultured from the patient’s sputum and blood is sensitive to piperacillin/tazobactam. Continuation of piperacillin/tazobactam and discontinuation of the other antibiotics provide good coverage for the patient’s condition. A full ten-day course is indicated.

As indicated earlier, the use of broad-spectrum drugs increases the risk of antibiotic resistance. It is important to narrow down these antibiotics as soon as the results recommend it. In this case, results obtained from sputum and blood culture show that the causative agent is susceptible to piperacillin/tazobactam. It is therefore advisable to discontinue the other antibiotics. Piperacillin/tazobactam is sold under the brand name Zosyn and is administered via the intravenous route. It is very effective against gram-negative organisms, including pseudomonas aeruginosa, gram-positive organisms, and anaerobic organisms (Huang et al., 2022). It is effective in managing gastrointestinal infections, skin infections, uterine infections, and pneumonia. Discontinuing the other medications is vital in minimizing the risk of antibiotic resistance.

Care Management.

As the patient’s condition is improving, she requests that the IV be removed and that she be discharged. It is crucial to place a peripherally inserted central catheter and carry out an assessment to determine whether discharging her or transferring her back to t