Re:Topic 4 Mandatory Discussion Question
Mucor is a mold that can be found in plants, soil, manure, vegetables and decaying fruits (Mold & Bacteria Consulting Laboratories, n.d.). There are around 50 known species worldwide. Mucor is a fungus that can grow in high temperature environments and many of the Mucor species are not able to infect humans but there are some that can (Mold & Bacteria Consulting Laboratories, n.d.). People can develop pneumonia when fungal spores are inhaled (Medscape, n.d.). Most often fungal pneumonia occurs in immunocompromised hosts (Medscape, n.d.). This could be diabetes, burns, AIDS and intravenous drug users Mucormycosis cause infarction of the affected tissues. Fungus causes necrosis and can spread locally (Medscape, n.d.). This fungal pneumonia can be life threatening and symptoms include fever, chest pain, dyspnea, hypoxia, hemoptysis, and cough (Medscape, n.d).
Two nursing interventions:
Teach and assist patient with proper deep-breathing exercises. Demonstrate proper splinting of chest and effective coughing while in upright position. Encourage him to do so often. (Deep breathing exercises maximize expansion of the lungs and smaller airways. Coughing is a reflex and a natural self-cleaning mechanism to maintain patent airways. Splinting reduces chest discomfort and an upright position can promote deeper and more forceful cough efforts) (Medscape. (n.d.).
Observe for deterioration in condition, noting hypotension, copious amounts of bloody sputum, pallor, cyanosis, change in LOC, severe dyspnea, and restlessness. (Shock and pulmonary edema are two of the most common causes of death inpneumonia and require immediate medical intervention.) (Medscape. (n.d.).
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.
NR= normal range BLUE = low, RED = elevated
Na 141 meq/L (NR 135-145)
Mg 1.7 mg/dL (NR 1.3-2.1)
pH 7.50 (NR 7.35-7.45)
Ca 8.7 mg/dL (NR 9-10.5)
K 4.5 meq/L (NR 3.5-5)
PO4 2.9 mg/dL (NR 3-4)
PaO2 59 mm Hg on room air (NR 80-100)
Lymphocytes10% (NR 20-40%)
Cl 105 meq/L (NR 98-106)
Glu, fasting 138 mg/dL (NR <110)
PaCO2 25 mm Hg (NR 35-45)
WBC 15,200/mm³ (NR 5,000-10,000)
HCO329 meq/L (NR 22-26)
Hb 13.7 g/dL (NR 12-18)
Cr 0.9 mg/dL (NR 0.5-1.2)
Hct 39.4% (NR 37-52%)
BUN 16 mg/dL (NR 10-20)
The glucose could be elevated due to diabetes that is not being treated or undiagnosed. The ABG values show that the patient is partly compensated metabolic alkalosis. This is a condition where the pH of the tissue is elevated above normal range, and this happens when there is a decrease in hydrogen ion concentration that leads to increased bicarbonate levels (Mold & Bacteria Consulting Laboratories, n.d.). This would be due to the mucar infiltrating in the lungs and affecting the airway and breathing patterns (Mold & Bacteria Consulting Laboratories, n.d.).
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.
Medications that can be used to treat would include antifungals, oxygen, and over the counter medications to prevent fever. Some of the medications that could be used would include:
Amphotericin B-it has been proven effective in the treatment of mucormycosis. It is used to treat fungal infections; this medication is used for serious fungal infections not minor infections (Medscape, n.d.)
Posaconazole- is used for the treatment of fungal infections, especially when they have weaker immune systems to start with (Medscape, n.d.).
Isavuconazole- a new extended spectrum triazole with activity against yeasts, molds, and dimorphic fungi. It is used for the treatment of invasive aspergillosis and mucormycosis (Medscape, n.d.).
Medscape. (n.d.). Overview of Fungal Pneumonia. Retrieved from http://emedicine.medscape.com/article/300341-overview
Mold & Bacteria Consulting Laboratories. (n.d.). Mucur. Retrieved from https://www.moldbacteria.com/mold/mucor.htm