Info

Drug Class

Dosage

Description

Rationale

Antibiotics

Varies with drug

Initial antibiotic: macrolides including erythromycin, azithromycin, roxithro-mycin and clarithyromycin.

Other antibiotics: Penicillin G for streptococcal pneumonia; nafcillin or oxacillin for staphylococcal pneumonia; aminoglycoside or a cephalosporin for klebsiella pneumonia; penicillin G or clindamycin for aspiration pneumonia Alternatives: amoxicillin and clavulanate (Augmentin); doxycycline; trimethoprim and sulfamethoxazole (Bactrim DS, Septra); levofloxacin (Levaquin)

Macrolides provide coverage for likely organisms in community-acquired bacterial pneumonia

Independent

Make sure the patient coughs and uses deep-breathing exercises at least every 2 hours. Encourage drinking 3 L of fluid daily, unless contraindicated, to help expectorate secretions. If the patient cannot cough up secretions, you may have to perform nasotracheal or orotracheal suction to maintain an open airway. Turn and position patients on bedrest to help keep the airway open and free of secretions. Elevate the head of the bed to at least 45 degrees to help the patient maintain an open airway, and find positions that ease breathing. Place the patient in an upright position with both arms well supported on pillows, or position the patient to lean forward and rest her or his arms on the overbed table.

Involve the patient in as much decision making as possible, and when possible, include the family in teaching situations. Explain all procedures, particularly intubation and suctioning. Teach the importance of adequate rest and the deep-breathing and coughing exercises that are designed to clear lung secretions.

Teach proper ways to dispose of secretions and proper hand-washing techniques to minimize the risk of spreading infection. Advise annual influenza vaccinations or avoidance of using antibiotics indiscriminately because such use creates a risk for upper airway colonization by antibiotic-resistant bacteria.

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