Posted: December 29th, 2022
Mucor is a rare mold from the fungi species which is found growing in moist areas of the environment such rotting fruits, vegetables or plants. Pulmonary Mucormycosis commonly affects those individuals who are immunocompromised due to cancer or had organ or stem-cell transplant (CDC,2015). The infection-mucormycosis is commonly acquired when one inhales the spores affecting the lungs and sinus tracks or enters the skin through a cut, scrape or trauma (CDC, 2015). Other ways mucormycosis can be acquired is during natural disasters such as floods or hurricanes where matter containing spores is transported into areas of contact with individuals who get affected or construction sites where the spores are in dust or contaminated filters or equipment in healthcare facilities can lead to nosocomial mucormycosis.
Pathophysiologic Progression: Mucormycosis progresses when the spores enter the systemic circulation and causes ischemia, infarction or tissue necrosis in the affected areas (Mohinda, et.al., 2014). When the fungus travels from the trachea to the lungs it causes pneumonia-like symptoms such as cough, fever, chills and dyspnea.
Nursing interventions: Because the infection can rapidly progress and spread into the vital organs of the body such as the heart and brain, it is vital that the nurse include critical interventions which would include: a) close monitoring of hemodynamics and communicating any subtle changes to the physician. B) maintain an accurate respiratory status assessment, continuous pulse oximetry and use of supplemental oxygen as well as incentive spirometry to prevent atelectasis. c) Administering the antifungal medications as ordered such as amphotericin B or Posaconazole.
Lab test results: An elevated WBC of 15.2 indicates infectious process in this because of the associated symptoms of productive cough otherwise in some cases could be due to inflammatory process in the body. The ABG is abnormal and interpreted as Respiratory Alkalosis; PaO2 is 59 which indicates hypoxia as the necrotic tissue cannot perfuse adequately.An elevated HCO3 of 29 and PH of 7.50 which indicates alkalosis and the low Pco2 of 25 indicates hyperventillation in attempt to increase oxygen.The blood glucose level is elevated in this case 138 which indicates diabetes.
Medications 1) The drug of choice because of it efficacy and safety is Amphotericin B: dose- 5mg/kg/day. 2 Amphotericin B deoxycholate (1.5mg/kg/day) of is also used and is cost effective but higher risk of causing nephrotoxicity. 3. Posaconazole is also a drug commonly used: dose- 800mg/day (dose divided in two) and recommended to be administered with high fat food or acidic beverage to improve absorption in the body (Crum-Cianflone, N., 2015).
Treatments:1) Surgical intervention such as pneumonectomy (removal of necrotic part of the lung) and debridement of infected tissue would be a way of eliminating the fungus and stop any spread. 2)Hyperbaric oxygen therapy can be used to treat mucormycosis by exposing the infected areas with high concentrations of oxygen to stop the growth of the mucor fungus and promote healing. 3)Transfusions of WBC and interferon- gamma treatments have been used although there is not enough research to support the effectiveness (Crum-Cianflone, N., 2015).
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