Path discussion 4 response

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Please read the peers discussions and respond to them APA format with reference

Discussion 1

Mucor is a type of fungi from the group of molds called mucorcycetes.
This type of mold is able to thrive in in various surroundings,
predominantly in decaying fruits and vegetables, soil, leaves, manure
and rotting wood (Centers for Disease Control and Prevention [CDC],
2015). Predominantly people who are in an immuno- compromised state
can develop this uncommon infection called mucomyosis by inhaling
mucor spores or by the spores entering through a break in the skin
(CDC, 2015).

Mucomyosis is an opportunistic infection. It affects the
immunocompromised whose own defense mechanisms are not working
properly. People at risk are usually in a neutropenic state and are
unable to kill the mucor fungus through phagocytosis. When the
immune-compromised patient inhales the fungal spores they are able to
reach and infect the lungs due to the lack of macrophages and the
process of phagocytosis. Evidence has shown that the phagocytic
process is a primary defense against mucomyosis (Spellberg, Edwards,
& Ibrahim, 2005). It would be helpful for the nurse to be
knowledgeable of the risk factors associated with mucomyosis and be
able to rapidly suspect a patient that presents with symptoms of
pneumonia. Rapid diagnosis and initiation of antifungal drug therapy
is key due to its rapid progression. Other medical/nursing
interventions would include collecting a sputum culture, bronchial
washing, CT scan and interventions that would treat the symptoms such
as supplemental oxygen, pain medication and administering antipyretics
for fever (CDC, 2015).

Abnormal lab values:

Fasting Glucose 138mg/dL. A fasting glucose above 126mg/dL on two
separate occasion indicates diabetes.

WBC= 15,200/mm. A white count >10,000 indicates infection. This
reflects the current infection with pneumonia from mucormyosis.

Lymphocytes =10%. Are produced in the bone marrow and differentiate
into B cells (responsible for production of antibodies) and T cells
(play a role in immunity). The immunocompromised are the people most
susceptible to mucormyosis.

pH =7.50 (7.35-7.45). A high level indicates alkalosis.

PaCO2= 25mm Hg (35-45). Is controlled by the lungs. A low value
indicates alkalosis.

HCO3= 29meq/L (22-26). Primarily controlled by the kidneys. High
levels indicate alkalosis.

PaO2 =59mm Hg on RA (80-100). A low level indicates hypoxemia. The
infection causes fluid and secretions to accumulate in the alveoli
where gas exchange happens.

A decreased PaCo2 and an increased pH level give you respiratory
alkalosis. The HCO3 should be normal or low if he is compensating, but
they are slightly elevated at 29. In the acute phase compensatory
mechanisms would bring HCO3 to normal or even low. So the patient is
now also developing metabolic alkalosis because it is passed the acute phase.

Three medications that are likely to be described in this case
are the antifungals:

Lipid preparations of amphotericin B are first line treatments due
to the cost and safety. They are able to be given in higher initial
doses without harming the kidneys (Crum-Cianflone, 2015).

Posaconazole is used in patients who cannot be treated with
amphotericin B. This drug is offered in oral form to follow up with
after IV amphotericin B (Crum-Cianflone, 2015).

Isavuconazole can also be taken orally after initial treatment with
amphotericin B. It is available in water soluble IV formula. In
general it is well tolerated with few side effects (Micelli &
Kauffman, 2015).

Three treatments that are likely to be prescribed are:

Surgery- Mucormysosis can spread very quickly through penetration
into the blood vessels causing tissue necrosis. This penetration in
the blood vessels also allows the fungus to easily be carried to other
organs. Surgical intervention can help to prevent spreading (Spellberg
et al., 2005).

Biopsy- tissue sampling is the only definitive way to diagnose due
to lack of serum and blood tests available (CDC, 2015)

Sputum or bronchiolar alveolar lavage- Cultures may be collected,
but may be negative in an infected person (Spellberg et al., 2005).

Reference

Crum-Cianflone, N. F. (2015). Mucormycosis medication. Retrieved
from http://emedicine.medscape.com/article/222551-medic…

Miceli, M. H., & Kauffman, C. A. (2015). Isavuconazole: a new
broad-spectrum triazole antifungal agent. Clinical Infectious
Diseases
, 61(10), 1558-1565. Retrieved from https://academic.oup.com/cid/article/61/10/1558/30…

Centers for Disease Control and Precention. (2015). Definition of
Mucormyosis. Retrieved from https://www.cdc.gov/fungal/diseases/mucormycosis/d…

Spellberg, B., Edwards, J., & Ibrahim, A. (2005). Novel
perspectives on mucormycosis: pathophysiology, presentation, and
management. Clinical microbiology reviews, 18(3),
556-569. Retrieved from http://cmr.asm.org/content/18/3/556.fu

Discussion 2

Mucor is type of mold/fungus that can infect
the respiratory passages of humans. Mucor normally infects
Immunocompromised patients such as those with Aids, uncontrolled
diabetes or patients taking immunosuppressant therapies (Taber’s,2017).

Immunocompromised patient inhales fungus spores from the
environment, raking up leaves as an example, the spores transport to
the lungs via the respiratory tract. The mold then penetrates the
blood vessels in the lungs causing infarcts to the lung tissue
resulting in necrotic lung tissue (Pulmonary Mucormycosis, sect 3,
para 5, 2012)

Monitor vital signs, particularly the 02
saturation level, to determine if supplimental 02 becomes necessary
for this patient. Feed patient high calorie diet to ensure energy is
available to increased metabolic activity.

Abnormal lab values: Ca+ is slightly low 8.7 (8.8-10.3)

Fasting glucose is elevated 138 (70-100) possibly diabetic,

check HA1C, possible immunocompromised

WBC’s elevated 15.2 (4-10) Infection, immunosuppression

Lymphocytes low 10% (25%-33%) AIDS, Cancer

Much of this patient’s abnormal lab values can point to an
imminocompromised state. Patient with Mucro are most often
imminocompromised as a normal immune system protects against this type
of Fungal pneumonia.

ABG: pH Alkalosis 7.50 (7.35-7.45)

Pa02 low 59mm HG on room air (75-100) Normal treatment for
respiratory alkalosis in to have patient rebreath C02 by breathing
into a bag however this patient has a low 02 level, I would be
inclined to use supplimental 02. I am not sure if this would be contraindicated.

PaC02 25 (35-45)

HC03 increased 29 (22-26) metobolic alkalosis

This patient is uncompenated respiratory alkalosis. The treatment
for respiratory alkalosis in to rebreathe C02, generally having the
patient breath into a paper bag. Supplemental 02 in the situation
would generally not be advisable, as it would exacerbate the
alkalosis, however this patient Pa02 in low on RA. I am not sure if 02
is contraindicated in this situation.

Medications: 1. Amphotericin B or Liposomal Amphotericin B
Anti-fungal to treat Murco infection. (Treatment for Mucormycosis,
Para, 1, 2015).

2. Pain medication such as Norco to decrease pain so patient is able
to expand lungs fully, and cough forcefully enough to mobilize secreations.

3. Guaifenesin Thin secretions to increase patient able expectorate mucus.

Treatments: 1. Diagnosis through biopsy is important to
get a definitive diagnosis.

2. Surgical removal of necrotic tissue is often necessary. 3.
Treatment of underlying immune deficiency. Strengthening immune
system will provide enhanced health going forward.

References:

Pulmonary Mucormycosis: An Emerging Infection Case Reports
in Polmonology Volume 2012, Article ID 120809, 3pages https://dx.doi.org/10.1155/2012/120809

Treatment for Mucormycosis (December 30, 2015) retrieved from https://www.cdc.gov/fungal/diseases/mucormycosis/t…

Taber’s Medical Dictionary. (2017). In D.
Venes (Ed.), Taber’s Cyclopedic Medical Dictionary
(23). [Unbound software platform]. Retrieved from Unbound Medicine
Nursing Central App

Vallerand, A. H., Sanoski, C. A., & Deglin, J. H. (2018).
Davis Drug Guide (15 ed.). [Unbound Mobile Platform].
Retrieved from Unbound Nursing Mobile App

Discussion 3

According
Centers for Disease Control and Prevention (2015), Thermotolerant
species such as Mucor (mold) indicus sometimes cause opportunistic
infections known as Mucormycosis, includes infections in mucous
membranes, nasal passages and sinuses, eyes, lungs, skin, and brain,
as well as renal and pulmonary infections and septic arthritis.
Mucor are present
throughout the environment, particularly in found in soil, plants,
manure, and decaying organic matter. There are about 50 species may
plague water-damaged or moist building materials which can trigger
allergies on exposed people. Mucormycosis mainly affects people with
weakened immune systems, diabetes, extensive burns, intravenous drug
users, and AIDS. It most commonly affects the sinuses or the lungs
after inhaling fungal spores from the air, or the skin after the
fungus enters the skin through a cut, scrape, burn, or other type of
skin trauma.

According to
Spellberg, Edwards, and Ibrahim (2005), both mononuclear and
polymorphonuclear phagocytes, the major host defense mechanism, kill
Mucorales by the generation of oxidative metabolites and the
cationic peptides defensins. Neutropenic patients, dysfunctional
phagocytes, hyperglycemia and acidosis are known to impair the
ability of phagocytes to move toward and kill the organisms.
Additionally, corticosteroid treatment affects the ability of mouse
bronchoalveolar macrophages to prevent germination of the spores in
vitro or after in vivo infection induced by intranasal inoculation.
people with weakened immune systems breathing in mucormycete spores
can cause an infection in the lungs or sinuses which can spread to
other parts of the body.

The nursing
interventions that would be helpful in treating the patient with
pneumonia: Elevate head of bed, have patient perform deep breathing
and coughing exercises, provide warm liquids to help mobilization
and expectoration of secretions. Assist and monitor effects of
nebulizer treatment and other respiratory physiotherapy, such as
incentive spirometer and percussion. Administer medications per order.

The abnormal lab values include
fasting Glu (138 mg/dL) indicating diabetes,
WBC (15,200/mm
3
) indicating
infection, PH (7.50), PaO2 (59mmHg), and PaCO2 (25mmHg) indicated
respiratory alkalosis, PH (7.50) and HCO3 (29meq/L) indicated
metabolic alkalosis, and Lymphocytes (10%) indicates that the patient is immunocompromised.

Amphotericin B,
posaconazole, and isavuconazole are active against most
mucormycetes. Lipid formulations of amphotericin B are often used as
first-line treatment (According to Centers for Disease Control and
Prevention, 2015, para 1). Amphotericin B is often utilized as
primary therapy for mucormycosis, while posaconazole is often used
in sequence after amphotericin B therapy or as primary therapy in
those patients unable to tolerate amphotericin B therapy.
isavuconazole is a viable alternative treatment option for patients
with mucormycosis who are not able to tolerate or fail amphotericin
B or posaconazole therapy(Wilson, et al. 2016, para.27). According
to Centers for Disease Control and Prevention (2015), treatment of
mucormycosis need to be fast and aggressive. Most patient will
require both surgical and medical treatments. Mucormycosis often
requires surgery to cut away the infected tissue because the patient
has suffered significant tissue damage that cannot be reversed.
Medication plays important role. Administration of Amphotericin B,
posaconazole, and isavuconazole because it is important for
improving outcomes for patients with mucormycosis pneumonia. Oxygen
therapy may apply if needed. treatment the underlying
immunocompromising condition to improve immune system for fighting
with the infection.

Reference:

Centers for
Disease Control and Prevention. (2015). Definition of Mucormycosis.
Retrieved from https://www.cdc.gov/fungal/diseases/mucormycosis/d…

Spellberg, B.,
Edwards, J., & Ibrahim, A. (2005). Novel Perspectives on
Mucormycosis: Pathophysiology, Presentation, and Management.
Clinical Microbiology Reviews, 18(3), 556–569. http://doi.org/10.1128/CMR.18.3.556-569.2005

Wilson, D. T.,
Dimondi, V. P., Johnson, S. W., Jones, T. M., & Drew, R. H.
(2016). Role of isavuconazole in the treatment of invasive fungal
infections. Therapeutics and Clinical Risk Management, 12,
1197–1206. http://doi.org/10.2147/TCRM.S90335

Mold & Bacteria Consulting Laboratories. (2018

Discussion 4

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.

Mucormycosis (previously known as zygomycosis) is a serious but rare
fungal infection caused by a group of molds called mucormycetes. These
molds live throughout the environment. Mucormycosis mainly affects
people with weakened immune systems and can occur in nearly any part
of the body. Similarly, pulmonary mucormycosis occurs after inhalation
of fungal sporangiospores. Mucormycosis agents being angioinvasive
cause infarction of the affected tissues. Fungus causes necrosis and
can invade tissue to spread locally or disseminate systemically. It
can present with mild to severe symptoms such as fever, cough, chest
pain, dyspnea, hypoxia, and hemoptysis. Pulmonary mucormycosis has a
predilection to invade the adjacent organs such as the pericardium,
chest wall, and mediastinum. Invasion of the large mediastinal vessels
can lead to massive hemoptysis, which could occasionally be fatal.

According to the case report in pulmonology (2018), “Diagnosis
can be particularly challenging in part because of its relative
rarity. On chest imaging, pulmonary mucormycosis may present with
focal consolidation, lung masses, pleural effusions, or multiple
nodules.” Direct histological examination of the tissue biopsy
remains the gold standard for diagnosis. Since in most cases it
affects the sinuses or the lungs after inhaling fungal spores from the
air, or the skin after the fungus enters the skin through a cut,
scrape, burn, or other type of skin trauma. If mucormycosis is
suspected, amphotericin B therapy should be immediately administered
due to the rapid spread and high mortality rate of the disease. Also,
some nursing interventions would help in the treatment of
mucormycosis. The interventions might include; frequent monitoring of
vital signs and pain, if the patient is not yet receiving hyperbaric
treatment, place them on oxygen; either nasal cannula or mask.

Explain each abnormality and discuss the probable causes from
a pathophysiologic perspective.

The abnormal laboratory values comprise: WBC- 15,200/mm3 (indicating
infection), PH of 7.50, PaO2 of 59mg, HCO3 of 29, and PaCO2
of 25 (indicated the body is alkaline but partially compensated
– through hyperventilation), and Lymphocytes 10% (patient is immunocompromised).

List at least three medications and three treatments. Provide
rationale for each of the medications and treatments you suggest.

Referring to Philip J McDonald (2017), “Effective management
requires a 3-pronged combination of medical and surgical modalities
along with correction of the predisposing underlying
condition(s).” Amphotericin B or its newer lipid
formulation—liposomal Amphotericin—B (L-AmB) along with
extensive surgical debridement to remove the necrotic tissue, remains
the mainstay of therapy. Despite aggressive treatment, invasive
mucormycosis carries a high mortality rate. The overall mortality in
those with pulmonary mucormycosis is high (76%) (Philip J McDonald,
2017). Thus it is important that clinicians maintain a high degree of
suspicion for pulmonary mucormycosis in case of immunocompromised
patients with nonresolving pneumonia. Early diagnosis and aggressive
treatment might reduce the mortality associated with this devastating
fungal infection. Below are listed medications and possible treatments:

1. Amphotericin B

Amphotericin B deoxycholate is a medication that can be used to
treat mucormycosis, particularly when other formulations prove too
costly, unlike other drugs, this medicine is readily available

2. Isavuconazole

Isavuconazole offers several advantages over other triazoles (ie,
posaconazole, voriconazole), apart from its wider spectrum of
antifungal activity. The drug has excellent oral bioavailability not
reliant on food intake or gastric pH and is also available in an
intravenous formulation, which does not contain the nephrotoxic
solubilizing agent cyclodextrin.

3. Surgical debridement of necrotic tissue is mandatory. Removes
necrotic tissue and prevents further spore growth.

References

Philip J McDonald (2017). Mucormycosis (Zygomycosis) Treatment
& Management. Retrieved from https://emedicine.medscape.com/article/222551-trea…

Muqeetadnan, M., Rahman, A., Amer, S., Nusrat, S., Hassan, S., &
Hashmi, S. (2012). Pulmonary mucormycosis: an emerging
infection. Case reports in pulmonology, 2012.

Lehrer, R. I., Howard, D. H., Sypherd, P. S., Edwards, J. E., Segal,
G. P., & Winston, D. J. (1980). Mucormycosis. Annals of
Internal Medicine
, 93(1_Part_1), 93-108.

The case report in pulmonology (2018). Case Report: Pulmonary
Mucormycosis: An Emerging Infection. Retrieved from https://www.hindawi.com/journals/cripu/2012/120809…

Discussion 5

Mucor is a fungus mold that is generally found in soil, plants,
fruits, and vegetables, as well as in food that is contaminated,
(Mucor, 2018). Some mucor species can grow in warm temperatures
causing infections to grow in humans known as zygomycosis, (Mucor,
2018). These types of zygomycosis infections can infect mucous
membranes, nasal and sinus passage ways, eyes, lungs, skin, and brain,
(Mucor, 2018). This fungus can enter the kidneys and lungs causing
severe renal and pulmonary infections and most susceptible those who
have a weakened immune system, (Mucor, 2018).

Pathophysiology

Mucormycosis also referred to as zygomycosis caused by the mucor
fungus can enter the body through the nasopharynx and inhaled into the
lungs multiplying rapidly resulting in to pulmonary mucormycosis,
(Osborn, Wraa, Watson, & Holleran, 2014, p. 698). This an
infection causes pulmonary obstruction and inflammation known as
pneumonia, (Osborn, Wraa, Watson, & Holleran, 2014, p. 740).

Medical/Nursing Interventions

As a nurse it is important to monitor the patient’s
oxygenation, (Osborn, Wraa, Watson, & Holleran, 2014, p. 742).
Vitals are important, especially respiratory rate and O2 saturation
levels because this will let the nurse if there is any decline or
change in the patients breathing and airway. Continuous assessment of
lung sounds or signs of cyanosis should be done, and ABGs to evaluate
and monitor the patients prognosis, (Osborn, Wraa, Watson, &
Holleran, 2014, p. 742). Other important intervention that should be
given to the patient to help in treating provide is supplemental
oxygen, medications, respiratory treatments, suction if needed, and
encourage and educate the patient on cough and deep breath exercise,
teach the use of an incentive spirometer, and encourage to spit up
mucus (Osborn, Wraa, Watson, & Holleran, 2014, p. 749).

Abnormal Laboratory Results

Fasting Glucose Level 138 mg/dL (normal range 70-100 mg/dL)

-A high level may indicate patient is could be diabetic, however can
also be an indication of infection in the body, (high Blood Sugar and
Diabetes, 2018).

White Blood Cell Count (WBC) Level 15,200 (normal range 4,500-11,000)

-A high WBC level may indicate infection or inflammation in the
body, (WBC Count, 2018).

Lymphocyte Level 10% (normal range 20-40%)

-A low lymphocyte level may indicate the patient is
immunosuppressed, (Everything You should Know About Lymphocytes, 2018).

PH level 7.5

Low PaO2 level of 59 (normal range 75-100 mmHg)

Low Paco2 of level 25 (38-42 mmHg)

Slightly high HCO3 level of 29 (normal range 22-28 mEq/L)

-All are arterial blood gas levels indicating the patient is
suffering from respiratory alkalosis that can be related to difficulty
breathing and the patient hyperventilating because he is breathing
rapidly and over breathing, (Respiratory Alkalosis, 2018).

Medications and Treatments

When treating fungal pneumonia the attending physician may order
medications like antifungals like Amphotericin B, posacanozole, and
isavicanozole drugs, and antipyretics to reduce fever. The physician
may recommend or consider surgery to remove what’s infected,
(CDC, 2018). The physician may also order oxygen therapy to help the
patients breathing.

Amphotericin B, posacanozole, and isavicanozole drugs are used to
treat fungal infections by slowing the growth of the organism or
killing it, (Osborn, Wraa, Watson, & Holleran, 2014, p.746). In
this case these antifungal medications would be appropriate to kill
and rid of the pneumonia infection of mucormycosis.

Antipyretics like Acetaminophen are used to treat high temperatures
(fevers) due to the infection. It is important to control to prevent
further symptoms.

The physician may also recommend the patient breathing into a paper
bag to control and normalize respiratory alkalosis. Breathing in to a
paper back can help normalize blood gas levels, and help control the
patients breathing by carbon dioxide, (Respiratory Alkalosis, 2018).

Difficulty breathing can cause the patient to panic and feel
anxiety, therefore the physician may also order medications to relieve
this anxious feeling. Medications that can be prescribed are
Benzodiazepines like alprazolam, diazepam, clonazepam, or lorazepam,
(Drugs to Treat Anxiety Disorder, 2018).

References

Centers for Disease Control. (2018). Treatment for Mucormycosis.
Retrieved from https://www.cdc.gov/fungal/diseases/mucormycosis/t…

Drugs to treat Anxiety Disorder. (2018). Health Line. Retrieved from https://www.healthline.com/health/anxiety-drugs

Everything You Should Know About Lymphocytes. (2018). Health Line.
Retrieved from https://www.healthline.com/health/lymphocytes#func…

High Blood sugar and Diabetes. (2018). WebMD. Retrieved from https://www.webmd.com/diabetes/guide/diabetes-hype…

Mucor. (2018). Mold and Bacteria Consulting Laboratories. Retrieved
from https://www.moldbacteria.com/mold/mucor.html

Osborn, K., Wraa, C., Watson, A., & Holleran, R. (2014).
Medical-surgical nursing preparation for practice second edition. New
Jersey, USA: Julie Levin Alexander.

Respiratory Alkalosis. (2018). Health Line. Retrieved from https://www.healthline.com/health/respiratory-alka…

WBC/White Blood Cell Count. 2018. Health Line. Retrieved from https://www.healthline.com/health/wbc-count

Discussion 6

Mucormycosis is an infectious disease that targets patients with
compromised immunity. Mucor is a type of fungus. It is able to survive
in the body by using iron chelators. Typically, health care
professionals treat patients with this illness using amphotericin, but
there are other options available. These drugs interrupt the
fungus’s metabolism, which limits growth. It is challenging to
diagnose people with this illness, but it is important for health care
professionals to be able to identify fungus as the cause of the
patient’s sickness. As a fungus, mucor produces spores. When
these spores are disrupted, they enter into the air and could
therefore be inhaled (Spellberg et al., 2006). These spores are
well-protected and can travel through the water, on people, and
through the air. This fungus could have a negative impact on the
brain, nervous system, and sinuses once it enters a host. Some
patients are at increased risk for this illness because their immune
system cannot fight against the fungus. These people tend to have
illnesses like AIDS, cancer, and diabetes. Individuals who have gotten
transplants might be impacted as well (Centers for Disease Control and
Prevention, 2017). When mucor is in the lungs, it’s called
pulmonary mucormycosis. When this occurs, the fungus is able to spread
quickly to the nervous, cardiovascular, and respiratory system. The
tissue near the bronchioles and alveoli become inflamed during an infection.

To provide aid to the patient, it would be necessary to closely
monitor the patient’s vital signs to prevent sepsis caused by
the fungus. During this process, it is necessary to address the
patient’s electrolyte imbalance, manage the patient’s
fever, and address hypoxemia (Spellberg et al., 2006). In addition,
oxygen should be offered and maintained to the patient. The oxygen
levels are low because the fungal infection is blocking the absorption
of oxygen in the lungs. The patient should be positioned to maximize
her breathing comfort. In addition, the room should be isolated to
reduce the risk that other’s will become infected. Respiratory
therapy is also needed.

This infection is deadly and therefore will require a series of
anti-fungal medications. Two options are Itraconazole and Posaconazole
(Spellberg et al., 2006). Combination therapy may be requested. It
would also be helpful to offer the patient medications that serve as
antiemetics, such as Zofran. It is common that patients become
nauseous or will vomit when taking the aforementioned anti-fungals, so
it is helpful to control this side effect of the medication to
increase the patient’s comfort. It is also helpful for the care
team to talk with the patient to discuss diet plans or therapies to
control blood sugar.

References

Centers for Disease Control and Prevention.
(2017). Mucormycosis. Retrieved from” http://www.cdc.gov/fungal/mucormycosis/definition….

Spellberg, B., Edwards, J., Ibrahim, A. (2006). Novel
perspectives on mucormycosis: pathophysiology, presentation, and
management. Clinical Microbiology Review, 18(3),556-69.

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