• Cancer
• Organ transplant
• Neutropenia (low white blood cells)
• Skin trauma (cuts, scrapes, punctures, or burns)

Pathophysiologic Progression of the Infection into Pneumonia (Mayo Clinic, 2016):

Fungal pneumonia is most common in people with chronic health problems or weakened 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 reproduce in the serous fluid and the infection is spread. This infection damage the host by their overwhelming growth and interference with lung function

Medical/Nursing Interventions (Gulanick & Myers, 2011):

• Initiating and maintaining supplemental O2 as prescribed to enhance respiratory status.
• Administer drugs (bronchodilators) that promote airway patency and and gas exchange.

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.

• Fasting glucose: 138mg/dL, high. This may indicate diabetes or response to stress or infection. High glucose levels debilitate the immune system, and raise the chance of infection. Normal range: 70-100 mg/dL.
• WBC: 15,200/mm3, elevated. This may indicate an immune disorder or the body’s defense system in fighting infection or recognition of an unfamiliar 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.

Based on the ABG values the patient is experiencing respiratory alkalosis, this happens when CO2 an 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. Pathophysiology involves increased CO2 excretion from hyperventilation.

• 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. May be related to inadequate lung function related to pneumonia.
• PaCO2: 25 mmHg, low. Normal range: 38-42 mmHg CO2 is controlled by the lungs and is thus considered the respiratory element of the ABG. Because CO2 forms carbonic acid when dissolved in the blood, low levels indicate alkalosis.

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.

Medication Treatment

• Lipid amphotericin B- This antifungal is used to combat the mucormycosis agent (CDC, 2015).
• Bronchodilators- promote airway patency and and gas exchange (Gulanick & Myers, 2011).
• Analgesics – Enhance cough effort by decreasing discomfort (Gulanick & Myers, 2011).

Medical Treatment

• Hardline surgical debridement of necrotic tissue vital in mucormycosis, specifically if limited to lungs. Lack of timely and hardline therapy, mucormycosis is nearly always deadly (Mayo Clinic, 2015).
• Provide supplemental IV fluids. Fluids are needed to replenish losses and aid in mobilization of secretions (Gulanick & Myers, 2011).
• Correct hyperglycemia and place on insulin sliding scale. By achieving normal blood glucose levels the patient is able to resist further infection and attain compromised immune defense.
• Continue oxygen administration device as ordered. Supplemental oxygen therapy sustains O2 saturation of 90% or higher to offer for sufficient oxygenation (Gulanick & Myers, 2011).

Answers

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