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Jamella Miller 1 posts
Re:Topic 4 Mandatory Discussion Question

Mucor is a mold that can be found in plants, soil, manure, vegetables and decaying fruits (Mold & Bacteria Consulting Laboratories, n.d.). There are around 50 known species worldwide. Mucor is a fungus that can grow in high temperature environments and many of the Mucor species are not able to infect humans but there are some that can (Mold & Bacteria Consulting Laboratories, n.d.). People can develop pneumonia when fungal spores are inhaled (Medscape, n.d.). Most often fungal pneumonia occurs in immunocompromised hosts (Medscape, n.d.). This could be diabetes, burns, AIDS and intravenous drug users Mucormycosis cause infarction of the affected tissues. Fungus causes necrosis and can spread locally (Medscape, n.d.). This fungal pneumonia can be life threatening and symptoms include fever, chest pain, dyspnea, hypoxia, hemoptysis, and cough (Medscape, n.d).

Two nursing interventions:

Teach and assist patient with proper deep-breathing exercises. Demonstrate proper splinting of chest and effective coughing while in upright position. Encourage him to do so often. (Deep breathing exercises maximize expansion of the lungs and smaller airways. Coughing is a reflex and a natural self-cleaning mechanism to maintain patent airways. Splinting reduces chest discomfort and an upright position can promote deeper and more forceful cough efforts) (Medscape. (n.d.).
Observe for deterioration in condition, noting hypotension, copious amounts of bloody sputum, pallor, cyanosis, change in LOC, severe dyspnea, and restlessness. (Shock and pulmonary edema are two of the most common causes of death inpneumonia and require immediate medical intervention.) (Medscape. (n.d.).
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.

NR= normal range BLUE = low, RED = elevated

Na 141 meq/L (NR 135-145)

Mg 1.7 mg/dL (NR 1.3-2.1)

pH 7.50 (NR 7.35-7.45)

Ca 8.7 mg/dL (NR 9-10.5)

K 4.5 meq/L (NR 3.5-5)

PO4 2.9 mg/dL (NR 3-4)

PaO2 59 mm Hg on room air (NR 80-100)

Lymphocytes10% (NR 20-40%)

Cl 105 meq/L (NR 98-106)

Glu, fasting 138 mg/dL (NR <110)

PaCO2 25 mm Hg (NR 35-45)

WBC 15,200/mm³ (NR 5,000-10,000)

HCO329 meq/L (NR 22-26)

Hb 13.7 g/dL (NR 12-18)

Cr 0.9 mg/dL (NR 0.5-1.2)

Hct 39.4% (NR 37-52%)

BUN 16 mg/dL (NR 10-20)

The glucose could be elevated due to diabetes that is not being treated or undiagnosed. The ABG values show that the patient is partly compensated metabolic alkalosis. This is a condition where the pH of the tissue is elevated above normal range, and this happens when there is a decrease in hydrogen ion concentration that leads to increased bicarbonate levels (Mold & Bacteria Consulting Laboratories, n.d.). This would be due to the mucar infiltrating in the lungs and affecting the airway and breathing patterns (Mold & Bacteria Consulting Laboratories, n.d.).

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.

Medications that can be used to treat would include antifungals, oxygen, and over the counter medications to prevent fever. Some of the medications that could be used would include:

Amphotericin B-it has been proven effective in the treatment of mucormycosis. It is used to treat fungal infections; this medication is used for serious fungal infections not minor infections (Medscape, n.d.)
Posaconazole- is used for the treatment of fungal infections, especially when they have weaker immune systems to start with (Medscape, n.d.).
Isavuconazole- a new extended spectrum triazole with activity against yeasts, molds, and dimorphic fungi. It is used for the treatment of invasive aspergillosis and mucormycosis (Medscape, n.d.).

Medscape. (n.d.). Overview of Fungal Pneumonia. Retrieved from http://emedicine.medscape.com/article/300341-overview

Mold & Bacteria Consulting Laboratories. (n.d.). Mucur. Retrieved from https://www.moldbacteria.com/mold/mucor.htm


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Re:Topic 4 Mandatory Discussion Question
Mucor is a fungus. It can be found in the house on bread and bread like products. It can also be in the heating and air ducts and soiled carpets. Outside it can be found in soil, hay and manure. Especially in leaves, compost and rotten wood piles. It can sometimes be in stored seeds. It can be inhaled or ingested. It affects the respiratory system. It can lead to a brain infection, paralysis, pneumonia, seizures, even death. It can also affect the digestive tract as well. The colonies if the fungus is fast growing and spread quickly. Because we are all probably exposed at times to these conditions, it is most likely for patients with weakened immune systems have a high chance to become affected. There is a lot of complications from fungal pneumonia.

The disease dissemination to other areas, like the brain, heart, eyes, adrenals, meninges, kidneys, spleen, liver and skin is one complication. Another is that the blood vessel invasion, leading to hemoptysis, pulmonary infraction, myocardial infarction, cerebral septic emboli, cerebral infarction, or even blindness. People can experience bronchopleural fistulas, chronic pulmonary symptoms, histoplasmosis, and pericarditis (Web MD, 2017). As a nurse, it is important to watch for effective airways clearance and breathing pattern, Provide oxygen if necessary. It is important to watch for fluid deficit and encourage fluids, watching for fluid overload. As a nurse always be aware of any pain and treat as needed. Give ordered antibiotics as prescribed by the doctor. It is always important to help maintain adequate nutrition.

The laboratory tests are all within normal limits except the following. The glucose fasting was 138 which is higher than the normal range. This may indicate that the patient may have diabetes. The WBC are elevated suggesting infection or inflammation. The ph is elevated meaning the blood is alkaline, low levels of concentrated carbon dioxide. The lymphocytes are low, meaning the body’s ability to fight infection is low. The PaO2 is low and this means low oxygen saturation in the blood. The PaCO2 is also low, this means low carbon dioxide in the blood. The HCO3 is high, meaning the bicarbonate which helps determine body’s ph. These all point to respiratory alkalosis. The numbers represent an infection or inflammation. The patient has a disturbance in the acid and base exchange from alveolar hyperventilation. This decreases carbon dioxide and increases the bicarbonate which increases the ph which is the bases for respiratory alkalosis.

Treatment would include antibiotics to get rid of infection. Cough medication to give your lungs a rest and allow them to clear. Pain relief because you need to have pain under control so that you can rest. Possible steroids to reduce inflammation. The doctor would order intravenous antifungal medications and consider having surgical debridement. This involves cutting away all infected tissue. By doing the surgery it prevents infection from spreading. These antibiotics of choice are:

amphotericin B (given through an IV)- Concerns of nephrotoxity. Must monitor renal functions closely, as well as electrolytes
Posaconazole- (given through an IV or orally)- triazole antibiotic and can be used as the step down antibotic from amphotericin B.
isavuconazole (given through an IV or orally)- wide spectrum triazole fungal antibiotic
Centers for Disease Control and Prevention.(2015). Fungal Diseases. Retrieved August 19, 2017, from https://www.cdc.gov/fungal/diseases/mucormycosis/treatment.html

Medscape. (2017). Mucormycosis (Zygomycosis). Retrieved August 19, 2017, from

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