Histoplasmosis Nursing Diagnosis Care Plan

Histoplasmosis is a lung disease caused by a fungus called Histoplasma capsulatum.

The fungus is common in Asia, central and eastern United States and southwestern Ontario, Canada.

Mild histoplasmosis may resolve on its own without any medical intervention.

If left untreated, severe histoplasmosis can progress and affect other organs in the body and can be fatal.

While histoplasmosis primarily affects the lungs, it can also be “disseminated” or extrapulmonary, which means that the infection can affect not only the lungs but also other parts of the body, including the oral cavity, liver, skin, adrenal glands, and the central nervous system.

People with weaker immune systems such as infants, elderly people, and immunocompromised patients can be gravely ill if they are infected with the fungus.

Signs and Symptoms of Histoplasmosis

Mild cases of Histoplasmosis may be asymptomatic.

Some people who are infected with the fungus may also have flu-like symptoms that resolve on their own.

However, severe to disseminated histoplasmosis begin within 3 to 17 days after exposure to the spores. Severe or disseminated histoplasmosis can manifest through the following pneumonia-like symptoms:

  • Fever
  • Cough – dry and non-productive
  • Shortness of breath
  • Fatigue
  • Chills
  • Headache
  • Chest pain
  • Myalgia or body aches
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Causes of Histoplasmosis

The disease is also known as “cave disease” because Histoplasma capsulatum can be found in the droppings of birds or bats, or on contaminated soil. The fungus can also be found in pigeon and chicken coops, parks, and old barns.

Infection with Histoplasma capsulatum is usually due to breathing in the spores that are airborne. When the soil is disturbed, the spores float in the air and can be inhaled by people. The fungus is not contagious; therefore the infected person cannot spread it to another via contact.

Complications of Histoplasmosis

  • Acute Respiratory Distress Syndrome. Severe histoplasmosis can cause lung damage by means of allowing the air sacs to be fluid-filled, compromising the air exchange and eventually reducing the oxygen level in the blood.
  • Adrenal Insufficiency. Adrenal glands are found on the top of the kidneys and are responsible in the production of hormones that help regulate the body metabolism, immune response, stress response, blood pressure, and other important functions for homeostasis. Histoplasma capsulatum can cause adrenal enlargement and necrosis, which affects the production of adrenal hormones.
  • Cardiac issues. In some cases, histoplasmosis can lead to the inflammation of the pericardium, the surrounding sac of the heart. Pericarditis can lead to cardiac tamponade and interference of the blood pumping ability of the heart.
  • Meningitis. Some patients with extrapulmonary histoplasmosis may develop meningitis, or the inflammation of the membranes that surround the brain and the spinal cord.

Diagnostic Tests for Histoplasmosis

  • Histoplasma skin test – injection of an allergen just below the skin surface and re-checking after 24 hours and 48 hours for any reaction
  • Sputum culture
  • Chest X-ray
  • Lung tissue biopsy

Treatment for Histoplasmosis

  • Symptomatic control. Mild histoplasmosis may present as a flu-like infection, and can be expected to resolve without any medical intervention. Rest to alleviate fatigue, deep breathing exercises to control breathing, and taking paracetamol or Tylenol to relieve fever and myalgia are some examples of symptomatic interventions for mild histoplasmosis.
  • Antifungals. Severe or disseminated histoplasmosis can be treated with prescription antifungal medication. The course of treatment can be from 3 to 12 months, depending on the severity of the disease, as well as the immunity status of the patient.

Nursing Diagnosis Care Plans for Histoplasmosis

Nursing Diagnosis: Ineffective Breathing Pattern related to Histoplasmosis as evidenced by shortness of breath, SpO2 level of 86%, and dry, non-productive cough

Desired Outcome: The patient will achieve effective breathing pattern as evidenced by respiratory rates between 12 to 20 breaths per minute, oxygen saturation above 96% on room air (88-92% if patient has COPD), and verbalize ease of breathing.

InterventionsRationale
Assess the patient’s vital signs and characteristics of respirations at least every 4 hours.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment.
Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within the target range of 88 to 92%.
Administer the prescribed medications (e.g. bronchodilators or combination inhalers / nebulizers) and antifungal medications.Bronchodilators: To dilate or relax the muscles on the airways.
Antifungal: To eradicate the causative agent Histoplasma capsulatum.
Elevate the head of the bed. Assist the patient to assume semi-Fowler’s position.Head elevation and semi-Fowler’s position help improve the expansion of the lungs, enabling the patient to breathe more effectively.

Nursing Diagnosis: Hyperthermia related to Histoplasmosis as evidenced by temperature of 38.5 degrees Celsius, rapid and shallow breathing, flushed skin, profuse sweating, and weak pulse.

Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.

InterventionsRationales
Assess the patient’s vital signs at least every 4 hoursTo assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs (e.g. Paracetamol or tylenol) administered.
Remove excessive clothing, blankets and linens. Adjust the room temperature.To regulate the temperature of the environment and make it more comfortable for the patient.
Administer the prescribed antifungal and anti-pyretic medications.Use the antifungal to treat the underlying infection, which is the underlying cause of the patient’s hyperthermia. Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.
Offer a tepid sponge bath.To facilitate the body in cooling down and to provide comfort.
Elevate the head of the bed.Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.

Other possible nursing diagnoses:

• Activity Intolerance related to Histoplasmosis as evidenced by fatigue and shortness of breath
• Alteration in comfort related to hyperthermia
• Pain related to the disease process

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