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

Nurses General Nursing

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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.

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

According the CDC, the SARS patients' white counts drop instead of increasing as they might with a bacterial infection.

It sounds like you're trying to talk yourself into telling him to see another physician--which I would definitely do at this point, and I'm not an RN.

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

Oh man that sounds exactly like the mycoplasma pneumonia I had. Even to the abx. Finished a course and 2 days later the sx returned. Lasted on and off 6 weeks.

Specializes in critical care, med/surg.

What about histoplasmosis? Could he have been exposed to some bird/rodent droppings in his warehouse job?

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

Was wondering about the cultures too. He may have a bug that's resistant to the abx that's he's been on and needs to be one something else.

Don't fall into the All American trap of looking for someone to blame. (That's not a flame).

Hope he gets well soon.

Specializes in Telemetry, Case Management.

CT scans all negative at this point. Still in hospital. Am getting ready to see DD right now at church, he encouraged her to go, so she is.

As far as all the suggestions, thanks so much you guys. Anybody else with any ideas, feel free to say so. As far as SARS, that's scary about the WBC dropping, but he hasn't flown anywhere, they drove from here to there on their trip.

Mycoplasma, (DD had that as a child, sick as a dog as I recall), histoplasmosis and SARS. I may pick the MD's brain tomorrow and will tell SIL if they suggest transferring, I would say NOW, this is a tiny little place, and if they really don't know, they have gotten better about transferring out, so I will push DD hard to do so, she wanted to take him to a big city hospital ER over the weekend but he refused.

This hospital's CT scanner wouldn't accomodate him, he weighs 275 and is 6 feet, he wouldn't fit, so had to send him 20 miles by ambulance (there goes an expense) to the next town for CT scan, and they made him wait from 9 am til 2pm after their pts and emergencies had been done, although presumably the doc had set it up as a scheduled thing. GRRRRRRRRRRRR!!

Will let you know when & if they find out anything.

SARS doesn't sound likely to me. Mycoplasma or some other atypical pne is more likely. Were any cx's take BEFORE the first round of abx? Keep us informed.

Karo,

Get him to Louisville. My brother lives in a perfectly lovely, yet tiny town in Southern Indiana but was repeatedly misdiagnosed and wound up on dialysis. He had a transplant at Jewish and is doing great. The facilities at U of L are probably better equipped to diagnose and treat the condition than the smaller outlying hospital. Best of luck to you.

Did they happen to culture his sputum before the antibiotics?

Specializes in Hospice, Critical Care.

Odd. I just had a 41-year-old patient who has NO medical history that just got back from Florida a month ago. Sick at home for 2 days; passed out, came to E.D. Had a pericardial effusion; did a pericardial window and he "smurfed" from the O.R. to the PACU and required intubation for 3 days. Bilateral infiltrates, cultures negative. Weird, eh? Even ventilated, his 02 sats were never higher than 95%. Non-smoker, clean medical hx except for GERD. Hmmmmm. Does make one wonder.

43-year-old patient several months ago with no medical history. Intubated for nearly 2 weeks with an atypical pneumonia. Never could pinpoint a cause but his wife did release the 19 pigeons that he kept!

Hope your hubby feels better soon. They may never really know what the culprit is; let's just get him better!

Originally posted by deespoohbear

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.....:rolleyes:

DITTO!!!!!!

Specializes in Telemetry, Case Management.

Update:

Released from hospital. Comedy of errors. Dear Lord. CT scan of lungs, gall bladder and liver negative. Did have fatty liver, doc asked if he was alcoholic. Kid hasn't drank more than ten beers in two years. Sheesh.

Did do sputum culture before ABT. Negative. Blood cultures negative. WBC normal. Fever if off of ABT, stays down if on ABT. Histoplasmosis negative. No upper respiratory symptoms. Has productive yellow cough. Feels like heck. No pneumonia shows on xray. Still feels bad and weak. Off work indefinitely per MD.

Sent him home on Avelox, one daily for 12 days and Zithromax, TWO pills daily for two weeks. Said frankly they have no idea what is wrong with him, and have no idea what to do for him, and did NOT refer him to any other doctor or hospital.

Found some good pulmonary docs in Louisville, she is calling their insurance today to see if they are covered on their plan.

If you read my original post, they called him at home after OP lab and CXR, told him to go to hospital. I asked him WHAT made them send him to hosptial, as they are now telling him all labs, and CXR WNL. Very strange.

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