Read the case study below and answer

Read the case study below and answer the following questions with references: What is the rationale for treating this patient with ceftriaxone and Decadron. Please provide explanation for each with references. Explain the rationale for discontinuing azithromycin and remdesivir. Please provide references for each. Case Study Mr. S is a 65 y/o male presenting from home with shortness of breath and lethargy. Girlfriend notes that he had an appointment at an outpatient pain management clinic today at noon and was told after that there were issues with his O2 levels and to keep a close eye on him. Following the appointment, patient was lethargic the remainder of the day and his O2 sat at home was 76% per his girlfriend. Not suspected to have taken any sedatives/opiate medications after procedure per girlfriend. Pt was given Narcan and put on Bipap upon admission to ED and initially responded well. His respiratory status then declined and was given another dose of Narcan with no improvement upon which pt. was intubated. In ED, spO2 is 55% with pCO2 >99. Hx of COPD, Afib, diastolic HF, CAD, HLD, HTN. He sees Dr. B for chronic pain and is currently taking Oxycodone and Gabapentin. Pt has pacemaker and history of cardioversion. Pt tested positive for COVID upon arrival to ED. Objective BP 81/55 (patient position: lying) | Pulse 69 | Temp 99.8 °F(Axillary) | Resp 15 | Wt. 117 kg | SpO2 100% |Ht 5’7| Notable labs: Chloride 98 WBC 16.7 k/uL Hgb 20.3 Hematocrit 69.2 Creatinine of 1.84 mg/dl BUN 26 PLT 126 CK Total 480 CK-MB 9.9 INR 1.51 proBNP 4253 Acute on chronic respiratory failure with hypoxia and hypercapnia (CMS/HCC)- (present on admission) Assessment & Plan Pt presenting to ED with AMS, lethargy, and hypoxia with O2 in 70’s at home In ED, spO2 is 55% with pCO2 >99. Given dose of Narcan and put on BiPap with vast improvement. However, respiratory status started to decline. Another dose of Narcan was given with no improvement. Pt was intubated, minimal settings. RASS of -2. ABG:7.49/43.3/98/33.5 1.2 (post hypercapnia metabolic alkalosis?) Urine tox cream positive for benzo and opioids COVID positive Resp cultures pending Blood cultures pending XR Chest: hypoinflation with bibasilar atelectasis vs. Infiltrates. Moderate venous congestive changes with interstitial edema, possible left sided pleural effusion CTAP: no PE, moderate pleural parenchyma consolidation in the right greater than the left lower lobes suspicious for atelectasis or pneumonia Etiology: Possibly secondary to COVID versus drug-induced versus heart failure exacerbation Plan: Continue full mechanical support and wean as able Try to wean propofol and perform SAT/SBT Continue ceftriaxone and Decadron Switch as needed duo nebs to scheduled Discontinue azithromycin and remdesivir Avoid volume overload due to risk for ARDS in setting of COVID SCIENCE HEALTH SCIENCE NURSING MEDICAL 145

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