A client admitted with a lung abscess has developed an area of pulmonary tissue necrosis. Which is the BEST treatment to manage this complication? Adequate hydration and nutrition Oral antibiotics Surgical debridement Humidified oxygen
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Step 1: Lung abscess is a collection of pus in the lung tissue. Show more…
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The Case Three year-old Adam presented with a fever and frequent episodes of coughing. He had a history of recurrent pneumonia and sinus infections since he was six months-old, but appeared to be of normal physical and mental function. Adam's mother had brought him to the doctor's office for a fever that had started two days earlier. She had started him with liquid Tylenol and had hoped that his fever would go away, but Adam continued to have fever, poor appetite, and sporadic diarrhea. Adam was up-to-date on all vaccinations. When Adam's mother was questioned about her family history, she told the doctor that she was 36 years-old, and was healthy, while Adam's father was 42 years-old and had essential hypertension. Adam's sister was 10 years-old and in good health. Adam's maternal uncle had died as a child from an unknown infection. No one in the household smoked or used any nonprescription drugs. Household chemicals including cleaning agents and pesticides were stored in child-safe cabinets. They had no household pets. Adam's vital signs showed his blood pressure was 110/60 mmHg, his pulse 145 bpm, his respiratory rate 32-36 breaths per minute, his temperature 39 degrees Celsius, and his body mass index 14.0 kg/m². The doctor noticed a flushed face with a tinge of cyanosis on his lips. Palpitations, dyspnea, and mild rales and rhonchi were noticed throughout both lung fields during his physical examination. Adam was placed on oxygen via nasal cannula at 2 L/ min. After 5 minutes on oxygen, his oxygen saturation was obtained by a pulse oximetry and demonstrated 95% saturation. Suspecting a hereditary immune disease, the doctor sent Adam (on oxygen) and his mother to the hospital lab for blood work. The blood was drawn for normal electrolyte, hemoglobin, hematocrit, WBC count and differential profile, antibody levels as well as prothrombin time (PT) and partial prothrombin time (PTT). Adam's mother was instructed to continue giving Tylenol (160 mg/dose, not to exceed four doses/day) until Adam's lab results were read. The lab results revealed sodium concentrations of 135mEq/L, chloride 99mEq/L, potassium 4mEq/L, bicarbonate 22 mEq/L, blood urea nitrogen 15 mg/dL, creatinine 1.0 mg/dL, and glucose 90 mg/dL. Arterial blood gas values were PaCO₂ 36 mm Hg, PaO₂ 95 mm Hg, SaO₂ 97% and pH 7.44. His WBC counts were 4,500/mm³, platelets 140/ mm³, hematocrit of 34, and hemoglobin 2.0% 12 g/dL. WBC differential shows Neutrophils 45%, Lymphocytes 40%, Monocytes 4%, Eosinophils 2.0%, and Basophils 1%. His serum immunoglobulins showed IgM 350 mg/dL, IgG 100 mg/dL, IgA 0, and IgE 0. Adam's PT was 11 sec and PTT was 62 sec. The nurse contacted Adam's mother to let her know that the doctor had ordered a chest X-ray and bronchoscopy based on the lab results. A pediatric pulmonologist, who happened to be in the hospital, was consulted who performed a bronchoscopy in the ER. Pneumocystis jirovecii was quickly identified. A nasal swab displayed gram positive cocci in chains. The lung lavage confirmed P. jirovecii. Chest X-ray showed diffuse pneumonia. The doctor diagnosed Adam with hyper-IgM syndrome and admitted Adam for observation. Adam was treated with pentamidine nebulizer (300 mg) per protocol. Bactrim (40 mg/kg sulfamethoxazole and 8 mg/kg trimethoprim for 24 hours, given in two divided doses every 12 hours for 10 days) and immunoglobulin therapy (300 mg/kg of body weight every 3 to 4 weeks) was implemented. Blood work was to be repeated to follow immunoglobulin levels, blood cell counts, hemoglobin and hematocrit. Questions 1. List the abnormal findings, signs, and symptoms in this patient. Explain the cause(s)/mechanism(s) of each. 2. Explain the pathophysiology of hyper-IgM syndrome.
Adi S.
A farmer working on a piece of machinery gets his shirtsleeve caught in a moving piece of the equipment. His shirt is sliced, and a sharp blade covered in mud slices through his upper arm. He attempts to control the bleeding and immediately seeks medical attention. After 3 days, he develops a fever and his arm becomes extremely swollen and painful. Pulling back the bandages, he finds that the wound has become blackened and is leaking a bloody fluid. Microscopic analysis of the fluid reveals the presence of gram-positive bacilli. a. Discuss what condition the patient is suffering from and the likely causative agent of this infection. b. Explain how the patient contracted this pathogenic microbe, and what virulence factors contributed to the pathogenesis seen at the wound site. c. In addition to antibiotics, the physician prescribes hyperbaric therapy. Describe what this treatment involves and how it could be therapeutic to this patient.
A farmer working on a piece of machinery gets his shirtsleeve caught in a moving piece of the equipment. His shirt is sliced, and a sharp blade covered in mud slices through his upper arm. He attempts to control the bleeding and immediately seeks medical attention. After 3 days, he develops a fever and his arm becomes extremely swollen and painful. Pulling back the bandages, he finds that the wound has become blackened and is leaking bloody fluid. Microscopic analysis of the fluid reveals the presence of gram-positive bacilli.a. Discuss what condition the patient is suffering from and the likely causative agent of this infection.b. Explain how the patient contracted this pathogenic microbe and what virulence factors contributed to the pathogenesis seen at the wound site.c. In addition to antibiotics, the physician prescribes hyperbaric therapy. Describe what this treatment involves and how it could be therapeutic to this patient.
Keemin L.
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