Examine the x-ray of a patient diagnosed with pneumonia due to infection with Mu

Question

Examine the x-ray of a patient diagnosed with pneumonia due to infection with Mucor. Refer to the "Module 4 DQ Chest Xray" resource in order to complete the following questions.

Critical Thinking Questions

1. 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. Discussion Question Resource: Chest X-Ray 2.

2. 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.

Discussion Question Resource: Laboratory Blood Test Results

Laboratory Blood Test Results and Arterial Blood Gases Na 141 meq/L Mg 1.7 mg/dL pH 7.50 K 4.5 meq/L PO4 2.9 mg/dL PaO2 59 mm Hg on room air Cl 105 meq/L Glu, fasting 138 mg/dL PaCO2 25 mm Hg HCO3 29 meq/L Hb 13.7 g/dL BUN 16 mg/dL Hct 39.4% Cr 0.9 mg/dL WBC 15,200/mm³ Ca 8.7 mg/dL Lymphocytes 10%

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.

Explanation / Answer

Part 1: Mucor/Mucormycosis(Also known as Zygomycosis) is a fungal infection produced by a group of moulds called mucormycetes.This disease is often characterized by hyphae(filamentous structure of fungus) growing in and around the blood vessels.This disease can be life –threatening if the individual is diabetic or immunocompromised (means with low immunity).

This disease generally affects the sinuses, lungs and central nervous system.These fungal spores grow in lungs, sinuses eyes and disperse to Central Nervous System.

Main Risk Factors of disease are:

1.Diabetes

2.Organ Transplantation(eg Kidney, Liver Transplant)

3.Low WBC count(Neutropenia)

4.Cancer

Pathophysiologic Progression into Pneumonia:

Fungal pneumonia is common in the individuals with chronic diseases or weakened immune systems(HIV positive patients), and in people who have inhaled large doses of the organisms. Once the spores reach the alveoli of the lungs, fluid accumulation occurs. The organisms reproduce in the serous fluid thus infection spreads in the lungs. This infection damage the individual by their overwhelming growth and interference with lung function

Medical and Nursing Interventions:

Enhance the respiratory status of the patient by initiating and maintaining the supplemental oxygen with high oxygen pressure as ordered by the Doctor

Antifungal Therapy(Amphotericin B) should be started and Bronchodilators should be administered to maintain the airway patency

2.Part

Based on the ABG values the patient is experiencing respiratory alkalosis, this happens when CO2 and O2 levels in the blood are not balanced. Respiratory alkalosis occurs with hyperventilation. The lungs are unable to compensate when there is a respiratory problem. Infection such as pneumonia or sepsis may cause hyperventilation. The pathophysiology involves increased CO2 excretion from hyperventilation.

Part 3.Medications and medical treatment

Medications:

Amphotericin B therapy should be initiated immediately and can be carried for up to 4 to 6 weeks.It will help to deal with the fungal organism

Bronchodilators(doxophylline) helps to maintain patent airway

Medical Treatment:

Surgical removal of the fungus is usually recommended after initiation of medication therapy.

Maintain the blood glucose level by placing on Insulin sliding scale.Normal glucose levels helps in boosting up the immunity

Administer IV Fluids to the patient.Fluids will help in mobilization of the accumulated secretions

Continue supplemental oxygen with high oxygen pressure.High oxygen pressure increases the ability of neutrophils to kill the fungal organism

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