C - COVID19

Question 1

What is COVID19 and what is it caused by?

Answer 1

● COVID-19 is a highly contagious disease that predominantly affects the respiratory tract.
○ disease is caused by the SARS-CoV-2 virus, which is a type of human coronavirus

Question 2

Transmission of COVID-19? (3)

Answer 2

• most often spread from person to person through respiratory droplets and aerosolised particles
• infected individual talks, sneezes, or coughs -> droplets can then land on another person’s eyes, nose, or mouth, and ultimately reach the respiratory tract
• Less frequently, the virus is transmitted indirectly when an individual touches a contaminated surface and then, prior to washing their hands, they touch their eyes, nose, or mouth

Question 3

Risk factors of COVID-19? (5)

Answer 3

● not fully vaccinated
● not wearing a well-fitted mask
● frequenting enclosed spaces without adequate ventilation
● going to large gatherings
● close contact with infected individuals, who are most likely to spread the virus 2 to 3 days before symptom onset until about 10 days after symptom onset

Question 4

Pathology of COVID-19?

Answer 4

● SARS-CoV-2 virus usually invades the nasal epithelial cells first, and then migrates through the respiratory tract to the alveoli.
● Virus binds to a protein called angiotensin-converting enzyme-2 or ACE2 for short, which is found mainly on the alveolar epithelial cells, but also sometimes in other respiratory tract cells, as well as the intestine, heart, blood vessels, kidneys, and bladder.
● Viral invasion damages the alveoli, as well as any other tissue infected.
● In response to this, the immune system launches an inflammatory response.

Question 4

Signs and Symptoms of COVID-19?

Answer 4

• Depends on severity of alveolar damage
• Can be asymptomatic or develop symptoms 2 - 14 days after exposure

Commonly
- fever, chills, fatigue, myalgia, headaches, a new loss of taste or smell, sore throat, cough, and dyspnea, as well as nausea, vomiting, diarrhoea, or abdominal pain

Less commonly
○ clients may present with conjunctivitis, skin rashes, and confusion or delirium

Severe cases
- acute respiratory distress syndrome
- cardiovascular or thromboembolic events
- Sepsis
- acute kidney injury

Clients at higher risk of developing severe complications:
- over age 65,
- chronic conditions such as chronic lung disease, cancer, diabetes mellitus, and clients who are overweight, pregnant, or immunocompromised, current & former smokers

Question 5

Diagnosis of COVID19?

Answer 5

Begins with history considering
● Possible exposure
● s/s
● Physical assessment

Viral tests to confirm diagnosis
● nucleic acid amplification tests like RT-PCR, which can detect viral RNA
● antigen testing, which can detect viral antigens like the S protein
Clients may receive tests from a healthcare provider or perform self-tests using an at-home testing kit

Laboratory tests may show normal or decreased white blood cells, and increased LDH, CRP, CK, AST, ALT, and D-dimer; while severe cases may show abnormal coagulation tests like an increased PT and INR

• chest X-rays or CT scans can be performed to assess disease severity or complications
• clients who previously had known or suspected COVID-19 may get serologic tests to detect antibodies against SARS-CoV-2

Question 6

Treatment

Answer 6

● no cure for COVID-19, so treatment involves supportive therapy to reduce the symptoms
- rest and hydration, as well as medications like analgesics, antipyretics, and antihistamines

● Mild cases → treated at home

● Moderate cases → may warrant
hospitalisation for close monitoring + supplemental oxygen

● Severe cases → require hospitalisation, supplemental oxygen as needed, medications like glucocorticoids, remdesivir, and thromboprophylaxis, as well as management of complications

● Most effective way to prevent → vaccination

Question 7

NURSING CARE FOR COVID19 patients?

Answer 7

1. Priority goals of your nursing care: improve respiration and oxygenation
   - prevent and manage systemic complications
   - prevent the spread of the disease
2. Assess respiratory status, breath sounds, and oxygen saturation.
   - Keep SpO2 92-96% by administering high-flow oxygen via nasal cannula, as ordered.
   - If they develop SOB and SpO2 is consistently < 92% -> report to HCP & implement the prescribed interventions, including non-invasive positive-pressure ventilation and prone positioning
3. Closely monitor vital signs, SpO2, and arterial blood gases, or ABGs;
   - report the development of severe acidosis and worsening hypoxemia
   - prepare for intubation and mechanical ventilation.
   - Administer glucocorticoids and antiviral medications as ordered.
4. monitor for signs and symptoms of cardiovascular and haematological complications of COVID-19
   - Review their baseline diagnostic tests, such as ECG, BNP and troponin levels, and report ECG changes, or a rise in BNP and troponin, which could indicate myocardial injury
   - keep a close eye on their coagulation studies, including platelets, FIB, TT, PT, aPTT, and D-dimer
5. promptly report indications of disseminated intravascular coagulation, including thrombocytopenia, increased D-dimer, increased fibrin degradation products, and prolonged PT
6. Provide supportive care and administer blood products as ordered
   - report if you notice signs of unusual clotting, such as microvascular thrombosis of the toes, sometimes called COVID toes, which can manifest as swelling and a pinkish or reddish discoloration, as well as a purple hue in skin of colour
7. report any
   - clotting of intravascular catheters
   - signs of deep vein thrombosis: warmth, swelling, and reddened or darkened skin around a painful area in a lower extremity
   - clinical manifestations of pulmonary embolism like anxiety, a sudden onset of dyspnea, chest pain
   - signs and symptoms of stroke: facial drooping, difficulty speaking, or a sudden and severe headache, dizziness, and confusion
8. Implement ordered thromboprophylaxis interventions, including administering low molecular weight heparin and applying either antiembolic stockings or an intermittent sequential pressure device to your client’s lower extremities

9.. monitor your client’s intake and output, and assess for signs of acute kidney injury, including decreased urine output, increased BUN and creatinine, electrolyte imbalances, and mental status changes

○ Report your assessment findings and be prepared to assist with renal replacement therapy, if indicated

○ keep a close eye on your client’s vital signs and laboratory test results, and report if your client develops signs of sepsis, such as a temperature of 100.4 F, or 38 C, or above; tachycardia; and hypotension

○ report increased urine specific gravity, increased or decreased WBC count, increased lactate and liver enzymes like ALT, AST, GGT; and the development of metabolic acidosis. Be prepared to initiate fluid resuscitation and vasopressors as ordered

Measures to prevent transmission of COVID-19
- isolation, and implement contact and droplet precautions.
- use PPE: N95 respirator, face shield or goggles, gown, gloves, and shoe covers.
○ Use dedicated equipment for each client in your unit, and avoid unnecessary exposure by clustering your nursing interventions, thereby decreasing the number of times you need to enter your client’s room.
○ wear gloves whenever disinfecting contaminated surfaces or equipment