What are they measuring? What does improvement look like according to that measurement? What kind of information and data is needed to effectively employ that measurement?
September 12, 2018Describe the problem of obesity in the United States and discuss the role of the built environment in exacerbating such problem.
September 12, 2018Explain what Mucor is and how a patient is likely to become infected with Mucor. Describe the pathophysiologic progression of the infection into pneumonia and at least two medical/nursing interventions that would be helpful in treating the patient
Mucor
Explain what Mucor is and how a patient is likely to become infected with Mucor. Describe the pathophysiologic progression of the infection into pneumonia and at least two medical/nursing interventions that would be helpful in treating the patient
Mucor is “a fungi of the order Mucorales and class Zygomycetes” (Maheen et al, 2014). It causes a disease called mucormycosis, a mold infection which could be life threatening and has to be treated emergently. “Mucormycosis is not common but can be frequent in immunocompromised patients (neutropenic, diabetic ketoacidosis) (NIH, 2016). Mucor is a fungus living in the soil. Humans can get infected through soil or inhaling it in the air. When a person inhales Mucor spores she or he can become infected with it. If a patient has weak immune system this fungus starts to grow in the lungs causing pneumonia. Symptoms might include cough, shortness of breath and fever. Early detection is crucial as this fungus can disseminate quickly (Maheen, 2014).
Two interventions:
- Amphotericin B is he most often drug of choice to treat this fungus infection
- Monitor patient’s respiratory status (respiratory treatments as needed, oxygen as needed, monitor vital signs for hypoxia and deterioration).
- . Examine the laboratory blood test results and arterial blood gases provided in “Discussion Question Resource: Laboratory Blood Test Results.” What laboratory values are considered abnormal? Explain each abnormality and discuss the probable causes from a pathophysiologic perspective.
Laboratory Blood Test Results and Arterial Blood Gases
| Na 141 meq/L WNL | Mg 1.7 mg/dL WNL | pH 7.50 H |
| K 4.5 meq/L WNL | PO4 2.9 mg/dL L | PaO2 59 mm Hg on room air L |
| Cl 105 meq/L WNL | Glu, fasting 138 mg/dL H | PaCO2 25 mm Hg L |
| HCO3 29 meq/L H | Hb 13.7 g/dL WNL | |
| BUN 16 mg/dL WNL | Hct 39.4% WNL | |
| Cr 0.9 mg/dL WNL | WBC 15,200/mm³ H | |
| Ca 8.7 mg/dL L | Lymphocytes 10% L |
This patient’s laboratory values point to the infection. WBC’s are elevated meaning the body is trying to fight the infection. Lymphocytes are low which might be sign of compromised immune system. Fasting glucose is high which means patient’s body is not in the homeostatic state, most probably is high due to infection.
ABG’s are not WNL. They indicate patient’s respiratory system is compromised and are confirming pneumonia which is seen on the X-ray as well.
Breathing is compromised which reflects PaO2 (low oxygen saturation) and PaCO2 being low .
Patient’s respiratory rate is most probably elevated and breathing is not deep enough well. Oxygen exchange is not sufficient because of the infection therefore level of O2 and CO2 is not WNL. PH is high (alkaline) which leads to elevated bicarbonate levels as well.
3. What medications and medical treatments are likely to be prescribed by the attending physician on this case? List at least three medications and three treatments. Provide rationale for each of the medications and treatments you suggest.
- Recommended medications:
– Amphotericin B, posaconazole, isavuconazole. These medications are antifungals. (Centers for Disease Control [CDC], 2015).
– Steroids to decrease inflammation and improve breathing
– Cough medication, antipyretics and analgesics.
2.Treatments:
– possibly bronchoscopy or surgery . Mucor can cause tissue necrosis (CDC, 2015)
– breathing treatment and oxygen to increase gas exchange
– monitor ABG’s and vital signs closely to prevent deconditioning
References:
Centers for Disease Control and Prevention (CDC). (2015). Mucormycosis. Retrieved from https://www.cdc.gov/fungal/diseases/mucormycosis/treatment.htm
Maheen Z. Abidi, Nayantara Coelho-Prabhu, James Hargreaves, Tim Weiland, Irminne Van Dyken, Aaron Tande, Pritish K. Tosh, Randall C. Walker, and Nathan W. Cummins, “Mucormycosis in Patients with Inflammatory Bowel Disease: Case Series and Review of the Literature,” Case Reports in Medicine, vol. 2014, pp. 1–7, 2014. Mucor.
National Institute of Health. (2011). Mucormycosis Caused by unusual Mucormycotes, Non-Rhizopus, -Mucor, and Lichtheimia Species. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21482731/
Ziaee, A., Zia, M., Bayat, M., & Hashemi, J. (2016). Molecular Identification of Mucor and Lichtheimia Species in Pure Cultures of Zygomycetes. Jundishapur Journal of Microbiology, 9(4), e35237. http://doi.org/10.5812/jjm.35237. Mucor.