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Pneumonia

  • Admission orders

    • Admit: Floor
    • Diagnosis: Community-Acquired Pneumonia in an Immunocompetent adult
    • Condition: Stable
    • Vital Signs: Routine
    • Allergies:
    • Nursing: O2 via NC to keep sat > 92
    • Diet: Regular
    • Activity: Activity as Tolerated
    • Labs:
      • Prior to antibiotics: Blood cultures x 2, sputum stain and culture
      • CBC with diff, Chem
      • Legionella urine antigen if suspected
      • ABG if sat < 91 on RA or respiratory distress
      • CXR (PA and lateral)
    • IV: D5 1/2 NS at 100 mL/h
    • Special:
    • Medications:
      • Empiric coverage (covers legionella)
        • ASAP after collecting culture
        • Ceftriaxone 1 g IV q 24 hours
        • Azithromycin 500 mg IV q 24 hours
      • Transition to PO when afebrile for 16 hours, vitals stable and sx improving
      • Alternative antibiotics
        • Moxifloxacin 400 mg or levofloxacin 500-700 mg IV/PO q 24 h
      • Anaerobic coverage
        • Ampicillin/sulbactam 1.5 g IV q 6 hours
        • if penicillin allergy
          • Clindamycin 600 mg IV q 8 h and levofloxacin 500 mg IV/PO q 25 h
          • or Moxifloxacin 400 mg IV/PO q 24 h
      • Pseudomonas coverage
        • Piperacillin/tazobactam, imipenem, meropenem, cefepime
        • plus Azithromycin or a respiratory fluoroquinolone
      • MRSA coverage add Vancomycin
      • Acetaminophen 650 mg PO q 6 hours prn pain or fever
      • Oxycodone 5-10 mg PO q 6 hours prn pleuritic chest pain not relieved by acetaminophen
      • Heparin 5000 units SQ q 8 hours
  • Discharge

    • criteria:
      • vitals stable (HR < 100, SBP > 90, RR < 24, O2 sat > 90, temp < 37.8 C) for at least 24 h
      • no AMS
      • tolerating PO
      • safe d/c location

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