Histoplasmosis Case Management and Patient Interaction

Patient Overview

• Patient Demographics: 44-year-old male
• Symptoms: Fever, chills, substernal pain
• Condition: Suspected histoplasmosis based on exposure

Initial Assessment

• Patient Alertness: Alert and oriented
• Room Setup: In a regular room with peripheral IV
• Vital Signs:
  • Pulse: 106 bpm, regular
  • Blood Pressure: 138/60 mmHg
  • Temperature: 38.4°C
  • Respiration: 24 breaths/min, slightly labored

Physical Exam Findings

• Breath Sounds: Decreased, particularly at the bases, with crackles on inspiration
• Cough: Nonproductive, occasional
• Chest X-ray: Shows diffuse patchy, breakable density with possible consolidation in the left lower lobe, with a setting of 91%

Occupational History

• Work Environment: Patient works outdoors around chickens
• Protective Measures: No mask worn despite recommendations

Patient Interaction & Care Plan

• IV Cannula Application: Discussed comfort and addressed patient's needs during the process
• Instructions to Patient: Encouraged to cough and communicated steps clearly

Diagnostic and Treatment Plan

• Medications: Prescribing amphotericin B for suspected histoplasmosis
• Diagnostic Tests:
  • Fungal culture to confirm histoplasmosis
  • Fungal stain
  • Serology test for histoplasmosis
  • Diagnostic Pulmonary Function Tests (PFTs) for suspected restrictive disorder

Patient Education

• Mask Wearing: Instructed on importance of N95 mask when working around potential spores (e.g., chickens)
• Medication Adherence: Importance of completing antifungal treatment to prevent resistance
• Disease Management:
  • Potential for pulmonary rehabilitation
  • Techniques for managing activities of daily living with the diagnosis
  • Deep breathing exercises and proper coughing techniques to prevent atelectasis
  • Use of Incentive Spirometry (IS) 10 times per hour to improve lung function
  • Emphasis on maintaining a healthy diet as part of overall health management

Conclusion

• Follow-Up: Ensured all educational points were communicated effectively to the patient to support their treatment and recovery from histoplasmosis.