Isavuconazole Treatment For Mucormycosis Nursing Discussion Help

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Mucor is a mold found in soil, plants, manure, decaying fruits, or vegetables and also as a common contaminant of stored and processed foods in the kitchen. Mucor is also found in water damaged or moist building materials (Mold & Bacteria Laboratories). According to MBL, Mucor species that grow at high temperatures can cause infections to human beings. Mucor Indicus may cause opportunistic infections such as zygomycosis which is infection of the mucous membranes, nasal passages, eyes, lungs, skin and brain as well as renal and pulmonary infections and septic arthritis. Mucor infection affects people with weakened immune system and may infect any part of the body according to Centers for Disease and Prevention Control (CDC). It affects human beings through inhalation of fungal spores from the air or skin and after entering the body it causes infection especially if through inhalation leading to respiratory airway infection such as Pneumonia. In pneumonia, there is inflammation reaction in the alveoli and interstitium of the lung. This inflammation can result from three different sources such as, aspiration of oropharyngeal secretions which contain normal bacterial flora or gastric contents, or can be through inhalation of contaminants and also through contamination from the systemic circulation. Pneumonia may also result from inhalation of secretions from an infected person or from direct spread to the lungs due to trauma or surgery.

Medical interventions for pneumonia includes diagnostic process by a radiological chest x-ray to visualize the lungs and treating the patient with the appropriate antibiotic such as vancomycin or any broad spectrum intravenous antibiotic immediately a diagnosis is made. Nursing intervention that is very important is to check the airway and oxygenation of the patient by providing supplementary oxygen through a nasal cannula. Other nursing interventions in the acute phase is to provide comfort by placing the patient in an upright position in bed to assist in breathing and comfort. The chest x-ray provided in this finding shows a normal or more normal right lung tissues but the left lung shows opacities towards the left lower section and also more to the left margin of the lungs indicating possible pneumonia.

Examining the laboratory blood test results and arterial blood gases provided. Among the laboratory values that are considered abnormal are -White blood cell count of 15, 200/mm3, normal value range is 4,500-11, 000. The reason for the raise white blood cell count is because the white blood cells are responsible for body defense mechanism and the increase indicates infection and that is why there is high production of white blood cell count. The Lymphocytes which are part of the white blood cells are reduced (10%). The normal values are 20-40%, and the reason for the reduction is because they are destroyed by the process of infection. The Blood pH is raised 7.50 (normal levels are 7.35-7.45) and the reason for the elevated pH could be due to the toxins produced by the infection leading the blood to be more alkalotic as a way of the body mechanism responding to the changes. The Pa02 is 59 mmHg on room air which is diminished (normal is above 80 mmHg) and PaC02 is 25 mmHg which is low (normal is between 38-42 mmHg).This is because the gaseous exchange in the lungs and alveoli has been affected by the infection causing the patient not to have effective airway exchange. As the process of infection of the tissues of the body takes place, the person infected does not have adequate lung expansion and this also effects the gas exchanges through the blood system.

Three medications that are likely to be prescribed 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. 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. 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 (Jenks, 2018).

References

Copstead, L.C., & Banasik, J. L. (2012) Pathophysiology (5 th ed.). St. Louis, MO: Saunders Elsevier.

Center for Disease Prevention and Control (n.d). Pneumonia. Retrieved from http //www. cdc .gov/pneumonia