Question

Use the image in "Discussion Question Resource: Chest X-Ray" to answer the following Critical Thinking Questions.

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

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.

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.

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.

Answer 1

Explain what Mucor is and how a patient is likely to become infected with Mucor.

Mucor is mucormycosis also called as zygomycosis before.It is an infrequent , but serious fungal infection caused by group of molds called mycomycetes.It is present all over the environment , commonly in soil with association of decaying organic matter like leaves,compost piles and rotten wood .A low immune individual is at most risk for acquiring these types of fungal infections.These spores may enter the individual via sinuses or lungs through inhalation from air in the environment. The infection sometimes may affect brain also.It can affect the skin after the fungus enters the skin through any trauma, cuts, laceration and burns.The fungi can produces enter body via lungs, sinuses, skin and in unusual circumstances has an ability to enter the central nervous system. Mucormycosis is not transmittable and does not spread from individual to individual (Center for Disease Control and Prevention, 2015). Mucormycosis is a rare infection. The infection is more frequent amongst individuals with diminished immune systems, but it can happen (unusual) in individuals who are otherwise healthy. Risk factors for acquiring mucormycosis include (CDC, 2015)poorly managed diabetes,skin trauma and in diseases leading to weakened immune system in individuals like cancer, AIDS, viral hepatitis , myeloma ,etc and Organ transplanted patients .

Describe the pathophysiologic progression of the infection into pneumonia and at least two medical/nursing interventions that would be helpful in treating the patient.

Fungal pneumonia is most common in people with chronic health problems and diminished immune systems, and in people who have inhaled large doses of the organisms. Once the organisms reach the alveoli, an outpouring of fluid accumulates. The organisms mutiplies in the serous fluid and the infection is spread. It damages the host by their overwhelming growth and interfere with functions carried out by lungs.(Mayo2016)

Nursing interventions are

• Provide supplemental oxygen to help patient to breathe with ease.
• Administer bronchodilators and antifungal medications to decrease the extent of infection.

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.

• Fasting glucose: 138mg/dL, high. This may indicate diabetes or response to stress or infection. High glucose levels weaken the immune system, and raises the chance of infection. Normal range: 70-100 mg/dL.
• WBC: 15,200/mm3, elevated. This may indicate the body’s defense system in fighting infection or recognition of any organism. Normal range: 4,500-11,000/mm3
• Lymphocytes: 10%, low. Normal range: 20-40%. Low lymphocyte counts may be low due to a weakened immune system and inability to prevent infection

Respiratory alkalosis is noted.May be due to hyperventilation there is imbalance in oxygen and carbon dioxide.Pneumonia results in fluid accumulation in lungs leading to inadequate exchange of gases leading to less oxygen in body .

• HCO3: 29 meq/L, baseline normal. Normal range: 22-28 meq/L,pH: 7.50, high-alkalotic. Normal range: 7.35-7.45,PaO2: 59 mmHg on RA, significantly low. Normal range: 75-100 mmHg. Patient is hypoxic related to inadequate lung function related to pneumonia,PaCO2: 25 mmHg, low. Normal range: 38-42 mmHg CO2 is controlled by the lungs . Because CO2 forms carbonic acid when dissolved in the blood, low levels indicate alkalosis.

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.

• Lipid amphotericin B- has proven efficacy in the treatment of mucormycosis.(emedicine.medscape)
• Isavuconazole (Cresemba) is a novel triazole antifungal agent that was approved for the treatment of mucormycosis in March 2015.The drug has excellent oral bioavailability not reliant on food intake or gastric pH and is also available in an intravenous formulation.

These both drugs are helpful in supressing the mutiplication of organisms.

• Bronchodilators- promote airway patency and and gas exchange (Gulanick & Myers, 2011)
• Analgesics – Enhance cough effort by decreasing discomfort (Gulanick & Myers, 2011)

.Debridement of necrotic tissue in combination with medical therapy is mandatory for patient survival.