Group 2B Natal, Neri, Nosidal, Ore

A pulmonary
Histoplasmosis case
 CASE
A 33-year-old white female presents after admission to the general medical/surgical hospital ward with a chief complaint
of shortness of breath on exertion. She reports that she was seen for similar symptoms previously at her primary care
physician’s office six months ago. At that time, she was diagnosed with acute bronchitis and treated with bronchodilators,
empiric antibiotics, and a short course oral steroid taper. This management did not improve her symptoms, and she has
gradually worsened over six months. She reports a 20-pound intentional weight loss over the past year. She denies
camping, spelunking, or hunting activities. She denies any sick contacts. A brief review of systems is negative for fever,
night sweats, palpitations, chest pain, nausea, vomiting, diarrhea, constipation, abdominal pain, neural sensation
changes, muscular changes, and increased bruising or bleeding. She admits a cough, shortness of breath, and shortness
of breath on exertion.
 
Social History: Her tobacco use is 33 pack-years; however, she quit smoking shortly prior to the onset of symptoms, six
months ago. She denies alcohol and illicit drug use. She is married, in a monogamous relationship, and has three children
aged 15 months to 5 years. She is employed in a cookie bakery. She has two pet doves. She traveled to Mexico for a one-
week vacation, one year ago.
I.Demographic
Profile
 I. Demographic Profile
Name: Patient X
Address: N/A
Age: 33 years old Birthdate: N/A
Gender: Female
Religion: Roman Catholic
Occupation: Employed in a cookie bakery
Marital Status: Married
Chief Complaints: Shortness of breath on exertion
Date of Admission: October 22, 2020
Room & Bed No: 406 - D
Attending / Admitting Physician: N/A
Admitting / Final Diagnosis: Based on the bronchoscopy findings, a diagnosis of
acute pulmonary histoplasmosis in an immunocompetent patient was made.
II. Past Health History
III. Present Health
History
 II. Past Health History
The patient has a history of Hypertension and a past surgical history in which
Cholecystectomy is performed.

III. Present Health History

The patient has a chief complaint of shortness of breath on exertion. She reports that
she was seen for similar symptoms previously at her primary care physician’s office
six months ago. At that time, she was diagnosed with acute bronchitis and treated
with bronchodilators, empiric antibiotics, and a short course oral steroid taper. This
management did not improve her symptoms, and she has gradually worsened over
six months. She reports a 20-pound intentional weight loss over the past year. She
denies camping, spelunking, or hunting activities. She denies any sick contacts. A
brief review of systems is negative for fever, night sweats, palpitations, chest pain,
nausea, vomiting, diarrhea, constipation, abdominal pain, neural sensation changes,
muscular changes, and increased bruising or bleeding. She admits a cough, shortness
IV. Family History
 IV. Family History
According to the client’s family health history, she is married in a monogamous
relationship, and has three children aged 15 months to 5 years. Further data
regarding medical history from the family wasn’t available.
 V. Gordon’s
Assessment with
Analysis
(only findings with deviation are presented and
based solely from the data case )
 a. Health Perception - Health Management
Pattern
She does not regularly go for check-up and had vices with cigarette smoking stating that
she was able to consume Tobacco since her 33-pack per year. However, these routines
and lifestyles were changed before the onset of symptoms manifested and received
medications in response to the disease such as bronchodilators (Lisinopril), empiric
antibiotics, and a short course oral steroid taper.

Interpretation & Analysis: Deviation from normal. The actions people take to
understand their health state, maintain an optimal state of health, prevent illness and
injury, and reach their maximum physical and mental potential. (Kozier and Erb’s,
Fundamentals of Nursing, 2012).
 j. Activity and Exercise Pattern

She reports a 20-pound intentional weight loss over the past year. However, she stated
she has not done any outdoor activities such as camping, spelunking, or hunting
activities.

Interpretation & Analysis: Normal. The behaviors of people in activity and exercise are
paying attention to signs of illness. Exercising may also prevent affecting existing
disease and staying fit is staying health (Kozier and Erb’s, Fundamentals of Nursing,
2012).
VI. Physical
Assessment
 A. General Survey
Assessment Method Normal Findings Actual Findings Analysis & Interpretation
Listen for Understandable, The client stops Deviation
quantity, quality, moderate pace, talking between Rapid or slow pace;
and organization exhibits thought mid-sentences overly loud or soft;
of speech. association. because of uses generalizations;
respiratory distress. lacks association,
difficulty in producing
words or sounds.

(Kozier and Erb’s,

Fundamentals of
Nursing, 2012)
 Posterior Thorax
Assessment Method Normal Findings Actual Findings Analysis & Interpretation
Observe use for The client does The client uses Deviation
accessory not use accessory muscle Expiration may require the use of
muscles. accessory to assist breathing. accessory muscles. The expiratory
reserve volume significantly
(trapezius/ increases
shoulder) because of the increased amount
of
air remaining in the lungs at the
end
of a normal breath

(Kozier and Erb’s, Fundamentals of

Nursing, 2012)
 Anterior Thorax
Assessment Method Normal Findings Actual Findings Analysis & Interpretation
Observe quality Respirations Presence of diffuse Deviation
and pattern of are relaxed, rales, mild Increased or decreased intensity;
respiration effortless and wheezing. The varying intensity with different
beats; increased intensity at aortic
quiet. Rhythm client is area; increased intensity at
and normal tachypneic. pulmonic area; sharp-sounding
depth at a rate ejection clicks; S3 in older adults;
of 15 per S4 may be a sign of hypertension
minutes.
Tachypnea and (Kozier and Erb’s, Fundamentals of
Nursing, 2012)
bradypnea may
be normal in
some clients.
 Anterior Thorax
Assessment Method Normal Findings Actual Findings Analysis & Interpretation
Observe for use Use of The client is using Deviation
of accessory accessory accessory muscles Expiration may require the use of
muscles. muscles because of accessory muscles. The expiratory
reserve volume significantly
(sternomastoid difficulty in increases because of the increased
and rectus breathing amount of air remaining in the
abdominis) is lungs at the end of a normal
not seen with breath.
normal
respiratory (Kozier and Erb’s, Fundamentals of
Nursing, 2012)
effort.
VII. Laboratory
Or
Diagnostic Exam
Date Laboratory/ Normal Values Actual Results Clinical Interpretation & Analysis (with
Done Diagnostic reference)
Examination

n.d. CBC Test WBCs - 5,000- CBC Test revealed Pancytopenia is a disorder where there are too
10,000/mm3 pancytopenia with a few red blood cells, white blood cells , and
RBCs - 4.2-5.4 platelet count of platelets in a person's body. Pancytopenia
Hgb - 12-16g/dl 74,000 per mm3; begins with a bone marrow problem. Blood cells
HCT - 37%-47% hemoglobin, 8.3 g are made in this spongy tissue inside the bones .
Plt count - 150,000- per and mild This bone marrow damage can result from
400,000/mm3 transaminase illnesses and exposure to some drugs and
elevation, AST 90 and chemicals.
ALT 112.  
Reference: Healthline Medically reviewed by
Suzanne Falck, M.D., FACP — Written by
Stephanie Watson — Updated on September 18,
2018
Date Laboratory/ Normal Values Actual Results Clinical Interpretation & Analysis (with reference)
Done Diagnostic
Examination

n.d. Blood Normal- Negative for Normally, the blood has no bacteria or fungus in it.
Culture Test NEGATIVE (No bacterial growth and A blood culture is a test to identify germs that can
Bacteria found in gram staining cause an infection in a blood sample (such as
blood) bacteria or a fungus). Other severe diseases, such
Abnormal) as those affecting the lungs, liver, bowel,
  gallbladder, or heart valves, most commonly occur
Abnormal- with a blood infection. When the immune system
POSITIVE is weak, a blood infection can also develop. Infants
(Bacteria were and older people, and diseases (such as cancer or
identified in AIDS) or medications (such as corticosteroids or
blood) chemotherapy) that affect how well the body can
combat infections (immunity) can cause this to
happen.
 
Reference: E. Gregory Thompson, MD - Internal
Medicine & Adam Husney, MD - Family Medicine
& Martin J. Gabica, MD - Family Medicine
University of Michigan Medicine, 2019
Date Laboratory/ Normal Values Actual Results Clinical Interpretation & Analysis (with reference)
Done Diagnostic
Examination

n.d. Diagnostic No signs of any Bronchoalveolar Bronchoalveolar lavage or BAL is a minimally

bronchoscopy foreign materials, lavage returned with invasive procedure involving the instillation
of the lungs blockages, of a fluid that was into a subsegment of the lung of sterile
with unusual cells of cloudy and muddy in normal saline, accompanied by the
bronchoalveo fluids in the appearance. There
lar lavage bronchi. was no bleeding. instillation suction and collection for
examination. The insertion of a flexible
bronchoscope into a sub-segment of the lung
usually enables this operation.
 
Reference: Patel PH, Antoine M, Ullah S.
Bronchoalveolar Lavage. [Updated 2020 Aug
27]. In: StatPearls [Internet]. Treasure Island
(FL): StatPearls Publishing; 2020 Jan-.
Available from:
https://www.ncbi.nlm.nih.gov/books/NBK43
0762
Date Laboratory/ Normal Values Actual Results Clinical Interpretation & Analysis (with reference)
Done Diagnostic
Examination

n.d. Cytology Negative for Cytology showed Histoplasmosis is a mycotic infection of the
Intraepithelial Histoplasma Histoplasma capsulatum dimorphic fungus.
Lesions or capsulatum Typically, the pathogens are contained within
Malignancy the cells (macrophages). In
(NILM)
immunocompetent people, this organism
mainly impacts the lungs and disseminated
forms are seen in immunocompromised
situations.
 
Reference: Role of fine-needle aspiration
cytology in diagnosis of disseminated
histoplasmosis in an immunocompetent
patient: A case report
J Cytol. 2016 Jul-Sep; 33(3): 163–165.
doi: 10.4103/0970-9371.177145
VIII. Drug Analysis
 Drug Indication Contraindication Mechanism of Side Effect/ Nursing Responsibilities
Action Adverse effect
Lisinopril ➢HTN Contraindicated in Causes decreased CNS: dizziness, When using drug in acute
  patients with production of headache, MI, give patient the
Therapeutic ➢Adjunctive hypertensive to angiotensin II and fatigue, appropriate and standard
class: treatment ACE inhibitors and suppression of paresthesia recommended treatment,
Antihypertens (with diuretics in those with a RAAS. CV: orthostatic such as thrombolytics,
ives and cardiac history of hypotension, aspirin, and beta blockers.
  glycosides) angioedema hypotension,  
Pharmacologi related to previous chest pain. -Monitor BP frequently. If
c class: ACE ➢Hemodyna treatment with EENT: nasal drug doesn’t adequately
inhibitors mically stable ACE inhibitor. congestion control BP, diuretics may be
  patients   GI:diarrhea, added.
Oral solution: within 24 -Use cautiously in nausea, dyspepsia  
1mg/mL hours of acute patients with GU: impaired -Monitor WBC with
Tablets: MI to improve impaired renal renal function, differential counts before
2.5mg, 5mg, survival function; adjust impotence. therapy, every 2 weeks for
10mg, 20mg, dosage Metabolic: the first 3 months of
30mg, 40mg   hyperkalemia therapy, and periodically
thereafter.

Respiratory:
dyspnea; dry,
persistent,tickling,
nonproductive
cough.
 Drug Indication Contraindication Mechanism of Side Effect/ Nursing Responsibilities
Action Adverse effect

Lisinopril -Use cautiously in Respiratory:

  patients at risk for dyspnea; dry,
Therapeutic hyperkalemia or persistent,tickling,
class: hypotension and nonproductive
Antihypertens in those with cough.
ives aortic stenosis or Skin: rash.
  hypertrophic Other:
Pharmacologi cardiomyopathy.   angioedema
c class: ACE
inhibitors
 
Oral solution:
1mg/mL
Tablets:
2.5mg, 5mg,
10mg, 20mg,
30mg, 40mg
 Drug Indication Contraindication Mechanism of Side Effect/ Nursing Responsibilities
Action Adverse effect
Itraconazole ➢Pulmonary and -Use cautiously in Interferes with CNS: headache, -Perform baseline LFTs and
  extrapulmonary patients at risk fungal cell-wall fever, dizziness, monitor results
Therapeutic blastomycosis, for hyperkalemia synthesis by somnolence, periodically. In patients
class: nonmeningeal or hypotension inhibiting fatigue, malaise, with baseline hepatic
Antifungal histoplasmosis and in those with ergosterol asthenia, pain, impairment, give drug only
  ➢Aspergillosis aortic stenosis or formation and tremor, abnormal if the patient's condition is
Pharmacolog ➢Onychomycosis hypertrophic increasing cell- dreams, anxiety, life threatening. If liver
ic class: of the fingernail cardiomyopathy.   wall depression dysfunction occurs during
Synthetic ➢Oropharyngeal permeability, CV: HF, HTN, therapy, notify prescriber
triazoles candidiasis leading to edema, immediately.
  ➢Oropharyngeal osmotic orthostatic  
Capsules: candidiasis in instability. hypotension -Monitor patient for
100mg patients EENT: rhinitis, hearing loss
Oral unresponsive to sinusitis,  
solution: fluconazole pharyngitis -Oral solution isn’t
10mg/mL tablets GI: nausea, interchangeable with other
Tablets: ➢Esophageal vomiting, forms.
200mg candidiasis diarrhea,
abdominal pain,
 Drug Indication Contraindication Mechanism of Side Effect/ Nursing Responsibilities
Action Adverse effect
Itraconazole GI (cont.):
  anorexia,
Therapeutic dyspepsia,
class: flatulence,
Antifungal increased appetite,
  constipation,
Pharmacolog gastritis,
ic class: gastroenteritis,
Synthetic ulcerative
triazoles stomatitis,
  gingivitis.
Capsules: GU: albuminuria
100mg Hematologic:
Oral neutropenia
solution: Hepatic:
10mg/mL hepatotoxicity,
Tablets: liver failure,
200mg impaired hepatic
function
 Drug Indication Contraindication Mechanism of Side Effect/ Adverse Nursing Responsibilities
Action effect
Itraconazole Metabolic:
  hypokalemia,
Therapeutic hypertriglyceridemia
class: Musculoskeletal:
Antifungal myalgia
  Respiratory:
Pharmacolog pulmonary edema,
ic class: URI.
Synthetic Skin: rash, pruritus.
triazoles Other: decreased
  libido, injury, herpes
Capsules: zoster,
100mg hypersensitivity
Oral reactions (urticaria,
solution: angioedema,
10mg/mL Stevens-Johnson
Tablets: syndrome)
200mg
 Drug Indication Contraindication Mechanism of Side Effect/ Nursing Responsibilities
Action Adverse effect
Amphotericin B ➢Invasive -Contraindicated Amphotericin’s CNS: fever, -Hydrate before infusion to
  fungal in patients pharmacodynami headache, pain reduce risk of
Therapeutic class: infections, hypersensitive c properties CV: cardiac nephrotoxicity.
Antifungals including to amphotericin provide oxidative arrest, chest -Monitor creatinine and
  Aspergillus B or its damage to the pain, HTN, electrolyte levels
Pharmacologic and Candida components. cells through hypotension (especially magnesium and
class: species, in Anaphylaxis can binding to GI: GI potassium), LFT values and
Polyene antibiotics patient's occur if a patient ergosterol in the hemorrhage, CBC during therapy.
  refractory to develops severe cell membrane of abdominal -Acute infusion reactions,
IV solution: or intolerant respiratory the fungi and pain, diarrhea, including fever and chills,
100 mg/20-mL vial of distress, then forming ion nausea, may occur 1 to 2 hours
  conventional discontinues channels to vomiting after start of infusion and
Dosage: amphotericin infusion and release the GU: are more common with the
5 mg/kg daily I.V. as B therapy treatment protons and Renal failure first few doses. Infusion
a single infusion appropriately monovalent Hematologic: has rarely been associated
given at a rate of without cation of the leukopenia, with arrhythmias,
2.5 mg/kg/hour restarting the infection cells (Al thrombocytop hypotension, and shock.
drug. Balushi et. al, enia, anemia
2018).
 Drug Indication Contraindication Mechanism Side Effect/ Nursing Responsibilities
of Action Adverse effect
Amphotericin B -Use cautiously Hepatic: -Inform patients that
  in patients with hyperbilirubinem fever,chills, nausea, and
Therapeutic class: renal ia vomiting may develop during
Antifungals impairment. Metabolic: infusion , but that these
  Adjust dosage hypokalemia symptoms usually subside with
Pharmacologic based on the Respiratory: subsequent doses.
class: patient's overall respiratory -Instruct patients to report any
Polyene antibiotics condition. Renal failure,dyspnea, redness or pain at the infusion
  toxicity is more respiratory site.
IV solution: common at disorder -Teach patients to recognize
100 mg/20-mL vial higher dosages. Skin: rash and report to prescriber signs
  Other: multiple and symptoms of acute
Dosage: organ failure, hypersensitivity, such as
5 mg/kg daily I.V. as chills, sepsis, respiratory distress.
a single infusion infection -Warn patients that therapy
given at a rate of may take several months.
2.5 mg/kg/hour -Tell Patient to expect frequent
laboratory testing to monitor
kidney and liver function.
 Drug Indication Contraindication Mechanism Side Effect/ Nursing Responsibilities
of Action Adverse effect
Methylpredniso ➢Severe -Methylprednisolone Not clearly CNS: euphoria, -Medrol may contain
lone inflammati contraindications defined. insomnia, tartrazine. Watch for allergic
  on or include patients with Decreases psychotic reaction in patients with
Therapeutic immunosu documented inflammation behavior, sensitivity to aspirin.
class: ppression hypersensitivity to , mainly by psuedotumor -most adverse reaction to
Corticosteroids the drug or stabilizing cerebri, vertigo, corticosteroids are dose-or
  components, leukocyte headache, duration- dependent.
Pharmacologic systemic fungal lysosomal depression, -Monitor patient’s weight, BP,
class: infection, intrathecal membranes; personality electrolyte level, and sleep
Glucocorticoster administration, live suppresses changes, patterns. Euphoria may initially
oids or attenuated virus immune parasthesia, interfere with sleep, but
  vaccine, idiopathic response; seizures, malaise, patients typically adjust to
Oral solution: thrombocytopenia stimulates emotional therapy in 1 to 3 weeks.
1mg/mL purpura, or in bone instability. - Monitor patients for
Tablets: 2mg, premature infants. marrow; and CV: arrhytmias, cushingoid effects.
4mg, 8mg, influences HF, -Measure growth and
16mg, 32mg, protein, fat, cardiomyopathy, development periodically in
and HTN, children during high-dose or
carbohydrate bradycardia, prolonged treatment.
metabolism. tachycardia,
- -Watch for depression or
Methylprednisolone, psychotic episodes
like all other CV (cont.): -Diabetic patients may need
glucocorticoids, must syncope, increased insulin
be used with great myocardial -Taper off dosage after long-
 Drug Indicati Contraindication Mechanism Side Effect/ Adverse effect Nursing
on of Action Responsibilities
Methylprednis -Methylprednisolone, CV (cont.): syncope, myocardial -Watch for
olone like all other rupture after MI, edema, depression or
  glucocorticoids, must thrombophlebitis, psychotic episodes
Therapeutic be used with great thromboembolism, cardiac arrest, -Diabetic patients
class: caution in patients circulatory collapse after rapid use may need
Corticosteroids with peptic ulcer, of large I.V. dose. increased insulin
  heart disease or EENT: cataracts, glaucoma, IOP, -Taper off dosage
Pharmacologic hypertension with exophathalmoses. after long-term
class: heart failure, certain GI:peptic ulceration, GI irritation, therapy.
Glucocorticost infectious illnesses increased appetite, pancreatitis,
eroids such as varicella and nausea, vomiting.
  tuberculosis, GU: menstrual irregularities.
Oral solution: psychoses, diabetes, Musculoskeletal: growth
1mg/mL osteoporosis, or suppression in children, muscle
Tablets: 2mg, glaucoma. weakness, osteoporosis, tendon
4mg, 8mg, rupture, aseptic necrosis.
16mg, 32mg, Skin: hirsutism, delayed wound
healing, acne, skin eruptions,
cutaneous and subcutaneous
atrophy.

Other: crushingoid state,

susceptibility to infections, acute
adrenal insufficiency after
 Drug Indicati Contraindication Mechanism Side Effect/ Adverse effect Nursing
on of Action Responsibilities
Methylprednis Other: crushingoid state,
olone susceptibility to infections, acute
  adrenal insufficiency after
Therapeutic increased stress or abrupt
class: withdrawal after long term
Corticosteroids therapy, hypersensitivity reactions.
 
Pharmacologic
class:
Glucocorticost
eroids
 
Oral solution:
1mg/mL
Tablets: 2mg,
4mg, 8mg,
16mg, 32mg,
IX. Prioritization
 1st: Ineffective airway clearance related to Histoplasmosis infection as
evidenced by presence of interstitial infiltrate in chest x-ray, adventitious
breath sounds of wheezes, difficulty verbalizing due to respiratory
distress, and alteration in respiratory rate.

Under the Maslow’s Hierarchy, ineffective airway clearance is under the

physiologic needs which demands for being the top priority problem
because the infection characterize as major cause of developing
pneumonitis infiltrates in the lungs, hence leading to airway obstruction. It
is efficient to tend immediate management on the primary source of the
pulmonary disease to prevent worsening of symptoms and result in further
destruction to other organs of the body congruent to the physiologic
function towards the cardiovascular system. Reference: Porth & Matfin
Pathophysiology: Concepts of Altered Health States, 8th Edition
 2nd: Ineffective breathing pattern related to pulmonary lung disease
secondary to acute bronchitis as evidenced by dyspnea with cough,
tachypnea with the use of accessory muscles and increase in respiratory
rate.
According to Maslow’s hierarchy, the problem identified also classifies
under the physiologic needs which qualifies as a top priority nursing
problem to manage. However, the including manifestation caused by
ineffective breathing pattern is primarily caused by the infection to the
lungs, wherein immediate intervention must be done to treat the infection
by clearing airway obstruction in order to further alleviate or reduce the
occurence of the client’s shortness of breath and other respiratory cues.
Reference: Treas & Wilkinson. Basic Nursing: Concepts, Skills, & Reasoning
(2018)
3rd: Deficient knowledge related to insufficient information as evidenced
by exposure to predisposing factors of Histoplasmosis (bird pet and travel
record from the endemic country)

This problem classifies under the safety and security needs according to
Maslow’s Hierarchy, which focus on the knowledge promotion regarding
the predisposing factors and symptoms of Histoplasmosis infection. The
need for implementing interventions in accordance to the diagnosis imply
efficient measures for the client to adapt alteration on her behavioural
actions towards her health condition, and not limited on obtaining
knowledge.
Reference: Rankin, Stalling & London. Patient Education in Health and
Illness (2012)
4th: Risk for bleeding related to disseminated intravascular coagulopathy;
pancytopenia and impaired liver function; mild elevated transaminase.

This risk for bleeding classifies under the safety and security needs in
Maslow’s hierarchy. Sign and symptoms does not necessarily manifest any
excess bleeding yet, thus characterizing it as a prevention management to
ensure absence of complication. Related factors involved present bleeding
possibilities to occur due to increased vulnerability to excess bleeding
because of the lack of platelet count were affected by bone marrow
damaged from the infection, as well as produce impair liver function as an
integrated system during blood circulation.
Reference: Doenges, Moorhouse, & Murr. Nurse’s Pocket Guide: Diagnoses,
Prioritized Interventions, and Rationales. 14th edition
IX. Ecologic
Model
 A. Hypothesis
Epidemiological Triad
In the pathogenesis of
Histoplasmosis
capsulatum infection, the
greater the harboring
factors present for the
suitable environmental
condition, the higher
possibility of fungi
contamination in the
environment to penetrate
the disease airborne
process to the susceptible
host
Predisposing Factors: A. Agent
a. Nutritive (Carbohydrates, Vitamins, Fat, Proteins, Mineral,
Water)
- Bird and Bat guano with Fatty acid composition of yeast cells
b. Chemical (Pollutants, Pesticides, Cosmetics)
- Fungal spores contaminant on the soil
c. Physical
- Dust from fungal spores formed in the environment
d. Infectious agent
- Fungi: Histoplasmosis
e. Mechanical
- N/A
f. Psychosocial
- N/A
Predisposing Factors: B. HOST
a. Genetic
- HLA (Human Leukocyte Antigen) gene B22
b. Age
- Middle aged adults and Older adults with a median age of
50-years-old
c. Sex/Gender
- Men (in Mexico)
d. Ethnic/Race
- Blu and Thai Dum groups (in Thailand)
e. Intercurrent infection
- HIV (human immunodeficiency virus)
- AIDS (acquired immunodeficiency syndrome)
- Pulmonary related-infection
Predisposing Factors: B. HOST
f. Human behaviour
- Environmental hygiene inside the pet cage and aviaries.
g. Religion
k. Social class membership
- N/A
- N/A
h. Family size
l. Resistance
- N/A
- N/A
i. Occupation
- Ornithologist (Studies birds), Cave tourist guide
- Game-cock handlers, Farmer
- Labor occupation that exert activities in mines
- Maintenance worker in the birds or bat area
- Food seller of Bat (predominant in the Southeast Asia)
j. Personality type
- N/A
Predisposing Factors: C.Environment
1. Physical
a. Geography:
- Mexico (Juxtlahuaca and Olinala, State of Guerrero)
- Central America (Ohio and Mississippi River valleys)
- South America ((Brazil, French Guiana, Perù and Venezuela)
- Africa (Congo, Tanzania-, and South Africa’s Guateng and
Limpopo provinces)
- Southeast Asia (Malaysia, Thailand, Indonesia, Philippines,
China)
b. Temperature/ humidity d. Weather /climate
- 37 degree Celsius - Humid Weather
c. Geology e. Air quality
- N/A - N/A
f. Noise
- N/A
Predisposing Factors: C.Environment
2. Biologic
a. Human population
density:
- United States of
America : 3.4 cases per
100,000 population
b. Fauna (animal life):
- Bird and bat guano
c. Flora (plant life):
- N/A
3. Socio-economic
a. urban overcrowding
– N/A
b.Workplaces contain the
agent:
- Zoo park or Aviaries
(A large living space of birds
where they freely fly)
- Cave tourist spots
- Poultry Farms
c. Income – N/A
d. social disruptions
- Preexisting endemic
recorded countries (In Mexico
& Central America)
e. Availability of health
services– N/A
f. Culture
- Thai culture
g. tensions & pressures
- N/A
Lever Model
 V. Analysis
This risk for bleeding classifies under the safety and security needs in
Maslow’s hierarchy. Sign and symptoms does not necessarily manifest any
excess bleeding yet, thus characterizing it as a prevention management to
ensure absence of complication. Related factors involved present bleeding
possibilities to occur due to increased vulnerability to excess bleeding
because of the lack of platelet count were affected by bone marrow
damaged from the infection, as well as produce impair liver function as an
integrated system during blood circulation.
Reference: Doenges, Moorhouse, & Murr. Nurse’s Pocket Guide: Diagnoses,
Prioritized Interventions, and Rationales. 14th edition
 VI. Conclusion and Recommendation

This risk for bleeding classifies under the safety and security needs in
Maslow’s hierarchy. Sign and symptoms does not necessarily manifest any
excess bleeding yet, thus characterizing it as a prevention management to
ensure absence of complication. Related factors involved present bleeding
possibilities to occur due to increased vulnerability to excess bleeding
because of the lack of platelet count were affected by bone marrow
damaged from the infection, as well as produce impair liver function as an
integrated system during blood circulation.
Reference: Doenges, Moorhouse, & Murr. Nurse’s Pocket Guide: Diagnoses,
Prioritized Interventions, and Rationales. 14th edition
 Contribution to Nursing Practice

This study contributes a

lot with the enhancement This can be a guide to a
of nursing knowledge better application of
about Pulmonary nursing skills and
Histoplasmosis knowledge to provide the
considering that this is a best health care service
disease that may cause an possible.
outbreak
 Anatomy and Physiology

When spores produced by the Histoplasmosis mycelial form become airborne, they are inhaled and
deposited in alveoli. The spores germinate into the yeast form of this dimorphic fungus at normal
body temperature (37 ° C [98.6 ° F]) and are ingested by pulmonary macrophages. The yeasts become
parasitic, multiply within these cells, and move to the lymph nodes of the hilar and mediastinal,
where they gain access to the blood circulation that spreads them to different organs. The organism is
consumed and sequestered by macrophages through the reticuloendothelial system
 Overview of Disease

20% of healthy
Endemic individuals can be affected Life-threatening
illness

The spectrum of this disease varies from asymptomatic infection to serious

disseminated disease. Most people with normal immunity who acquire
histoplasmosis have an asymptomatic or clinically insignificant infection and a
solitary pulmonary nodule is the most common chest radiograph abnormality.
Cavitation is uncommon, but adenopathy (particularly hilar and mediastinal) is
frequently seen.
XII. Discharge
Plan
 Medicine
• Advise significant others of the client and client herself to
have the medications taken that are prescribed by the
health care provider regularly with the right dosage, time,
and frequency.

• Provide adequate instruction regarding the medication

such as its importance, purpose to help stabilize the
condition of the client as long as possible. Including its side
and adverse effects so that if it occurs immediately consult
with a medical professional.
 Exercise
• Demonstrate and promote proper
breathing exercise for relaxation and
avoid difficulty in breathing.

• Instruct the client to avoid heavy

activities until advised by the doctor to
prevent worsening or triggering
symptoms.
 Treatment
• Advise the client to have a bed rest but still
do stretching for better blood circulation to
lower the risks of different diseases.

• Encourage the client to have adequate

vitamins, if needed, take supplements such
as vitamins with vitamin C to help improve
the immune system.
Health Education
• Keep proper hygiene by hand washing and taking a
bath every day. Including a clean environment to
prevent viruses and bacteria that can cause different
diseases which may also affect existing diseases.

• Instruct the client to stay away from areas that has a

growing fungus such as caves, farms, and places with
old woods like attics. Wear a mask that covers your
mouth and nose to prevent inhalation of fungal
bacteria.
Out-patient follow up
●Encourage the client to continue regular follow-up check-
ups to maintain a healthy lifestyle and ensure proper
management and treatment.

●Advise to seek immediate medical attention if any

adverse effects occur when taking medications and
unexpected or sudden feeling that need to be checked by a
medical professional. If symptoms get worse and does not
get any better
 Diet
• Encourage the client to eat healthy food
such as vegetables, fruits, and meat that
are rich in nutrients, vitamins,
carbohydrates, and proteins that will
help boost the immune system. Also,
avoid unhealthy foods that can trigger
or affect existing diseases.

• Advise the client to increase fluid intake

with at least 3 liters per day.
 Spirituality
• Provide the client with a safe environment and
support from significant others will help attain
positive spiritual health. Relaxation can help the
client meditate such as doing yoga.

• Prayer and meditation should be done more than once daily to maintain
good spirituality, considering the client is Roman Catholic.