Question: I am a nurse, don't flame me please

  1. SIL and DD went on vacation about a month ago. Went to Biloxi, MS, New Orleans and on to Tampa Bay to vs. inlaws. They came home on a Tuesday night, and he c/o sore throat. Got progressively more ill. I listened to his lungs on Friday and told him to go to the dr. He did and was hospitalized overnight with pneumonia in RLL. Gave him IV Rocephin and Zithromax in hospital. D/C'd on po Levaquin. Stayed home from work two weekends in a row.
    This past weekend was to be his first back. Ran out of ABT on Tues or Wed, starting c/o feeling bad again, but thought might be allergies on account of crazy weather, season change, etc. Went to work Sat, worked 12 hours (in a walmart warehouse, dusty, warm, not real good for someone getting over a resp. illness). That night ran fever of 102. Got up, went to work Sunday, made it four hours, DD had to take him home. Ran fever high 102's all day and night. Fever Broke, but would come back.
    Went to doc yesterday, sent for CXR and labs. Called him as soon as he got home and told him to go check back into hospital.

    I asked him what his white count was, he said they told him it was normal, and was the last time he was in. They are xraying him for lungs, gb and liver today, CT scan actually.
    My question is do you think he could have picked up some funky disease in New Orleans or Florida that little country docs in BFE Inidiana have no clue about and needs to go somewhere to a place where the docs might have a higher knowledge base?
    He has fever, cough, pain on rt side and back.
    Just wonder if I'm just being a paranoid, meddling MIL or if anyone besides me thinks this is a possibility.
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  2. 23 Comments

  3. by   baseline
    Well, I don't think he picked up anything funky here in Fla necessarily. He was treated following recommended protocols foe pneumonia. RUL ....how old is he? Sounds like asp. pneumonia, but without cx results, hard to say. Wait for the results of the CT scan.
  4. by   deespoohbear
    Originally posted by KaroSnowQueen
    .
    My question is do you think he could have picked up some funky disease in New Orleans or Florida that little country docs in BFE Inidiana have no clue about and needs to go somewhere to a place where the docs might have a higher knowledge base?
    As someone who lives in Indiana, I take offense to this reference of our state. Maybe you ought to reconsider rephrasing that part of your post.....
  5. by   wv_nurse 2003
    Sounds like a resistent pneumonia, maybe Legionaires--but I agree, wait for the CT, sounds as if the treatment was normal protocol
  6. by   KaroSnowQueen
    Dee, I live in Indiana too. But he is in a tiny rural hospital. I live two blocks from it and wouldn't go there if I were dying, have been there before and have seen and heard many many many many many many many sad stories of malpractice come out of there. Wasn't knocking Indiana.
    Baseline, I doubt it's aspiration, he's 23 and has all of his faculties. Always been perfectly healthy until now. Just wondering if he picked something up down there, a strange germ or thing that wouldn't necessarily be seen up here.
    He said he and another guy were racing each other up a set of stairs in an outdoor parking garage, he was breathing hard and that evening is when he started feeling bad. I think this was in New Orleans. That's what made me start on that particular train of thought.
    And also as for the comment about the hospital he's in, they've put him back on the exact same ABT he was on before. Shouldn't they try something else if that didn't kill it to begin with, wouldn't the germs have resistance to it now??? Or am I just crazy, It's always a possibility.
  7. by   BMS4
    Well, being from Louisiana and having lived in Florida as well, I know there are pollens that you may not find else where. I'm sure every climate has it's own set of flora and fauna. Also, you need to consider that NOLA is below sea level and is an old moldy city. He may very well have inhaled something that is foreign to him. Good luck and let us know how he is doing.
  8. by   K O'Malley
    I wonder if he could have SARS? It seems to be popping up around the world. Did he fly recently? I would have him transferred to a larger facility.
  9. by   baseline
    Reason I asked about asp pne, is its occurance in the RUL. Although it is rare in younger people, there is nothing like a few toddies (been there myself on vacation!) to aid in aspiration. But I still think you need to wait for the CT results. It may well be a reisitent pne, as wv_nurse suggested, eg Legionaires and or mycoplasma (less likely).

    My experience is that younger people with pne do not recover as well as the older patients for some reason. No studies backing me up here!!

    He should be okay on the same abx, unless he con't with fever.
  10. by   jemb
    Hope he is doing better. I can understand why you are concerned.

    Did sputum cultures grow anything? That could have some bearing on which abx were used (or should be used).

    A "normal" WBC doesn't sound right for his s/s, either. Does he have a copy of his lab results?

    My suggestion would be to request transfer of care to another physician, who can admit him to a different hospital if need be.
    Definitely sounds like something is being missed, regardless of where he got it.
  11. by   SmilingBluEyes
    I have nothing to advise over what I see here. I just hope he gets well soon. Post us as to how he is doing ok? NO FLAME here.
  12. by   passing thru
    I think there are small rural hospitals in ALL states where the locals say "I wouldn't take my dog there !" and "don't take me there if I'm sick, I'll never get out alive !"
    I know there's a few in my state and I have heard family members make similar remarks in their respective states.
    So, personally, I don't see it as a criticism.
    Back to the focus of the thread. Sounds interesting. I do think his white count is up with the high fever. At any rate, the white count-lymphs, monos, etc. are going to be out of whack somewhere.
    In my hospital, if you ask, the nurse will go out to the copier, or fax machine and make you a copy of the lab results...if the patient asks.
    Fungal pulmonary illnesses are difficult to treat and cure. Usually, what happens is, it is a bug we are living with. The patient goes on vacation, wears himself down, exhausted, stressed, and the bug thats been there for a year or two overcomes the host.
    Usually it is that simple, especially for vacationers.
    Keep us informed. I am curious to hear what it is and how he is doing.
    Nope, you are not meddling. Concerned. When a family member is ill, the more eyes and ears the better I think. (The Greek Family Syndrome)...The ill person needs all the help he can get.
  13. by   nurseT
    I'm sorry to hear about the illness of your family member. I would make sure he sees a pulmonologist since it's looking resistant to the normal Tx. I often find pts have no clue what their labs are. When your sick and the doc is telling you whats going on it's easy to get results confused, esp a layperson.
  14. by   MandyInMS
    Originally posted by jemb
    Hope he is doing better. I can understand why you are concerned.

    Did sputum cultures grow anything? That could have some bearing on which abx were used (or should be used).

    A "normal" WBC doesn't sound right for his s/s, either. Does he have a copy of his lab results?

    My suggestion would be to request transfer of care to another physician, who can admit him to a different hospital if need be.
    Definitely sounds like something is being missed, regardless of where he got it.
    I wondered about the sputum cultures as well

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