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NURS 3560 > Week 4: COVID 19 and ARDS > Flashcards

Week 4: COVID 19 and ARDS Flashcards

1
Q

What is COVID

A

new infectious disease from the coronavirus family that causes acute respiratory distress and syndrome
most people experience mild to moderate symptoms without hospitalization
elderly and immunocompromised are more susceptible to infection and serious conditions
aerosol and droplet transmission
infectious period of 7-14 days
infection can be limiting for 80% of people

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2
Q

What is the Pathogen That Causes COVID

A

SARS-CoV-2

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3
Q

Long Term Effects of COVID

A

mostly unknown as pandemic is still ongoing, but can last form weeks to months of effects

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4
Q

Corona Viruses

A

subfamily of RNA viruses that often cause resp and GI infections that can range from limiting to mild symptoms to more severe
viral envelope with positive sense single stranded RNA genome in helical nucleocapsid

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5
Q

What is a Viral Envelope

A

lipid biolayer, membrane, envelope, spike and occasionally hemagglutinin esterase

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6
Q

What is the Spike Virus for COVID

A

membrane, envelope and spike proteins that are critical to viral effects
spike proteins has a receptor binding ability to bind to ACE-2 receptor
viral membrane fuses with cell membrane to release RNA host cell
fusion membrane is where fusion peptide is exposed after the spike is cleaved by proteases

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7
Q

Intracellular Viral Replication Cycle

A

expression of RNA and replication of full genome RNA and simultaneous transcription of protein
normally replicated RNA is packages in viral particles and undergo exocytosis and is then released

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8
Q

What are Variants

A

changed or mutated viruses that are common in coronaviruses

changes include transmissibility, virulence, vaccine efficacy and diagnostics

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9
Q

What are the COVID Variants

A

Alpha from the UK, Beta from South Africa, Gamma from Brazil, Delta from India and Omnicron from South Africa

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10
Q

Where is COVID Mostly Found

A

bronchoalveolar lavage fluid, sputum and saliva

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11
Q

Phases of COVID

A

Early Infection - 1-14 days can last but the average length is 5-6 days, peak viral load in 4 days and symptoms start on day 5
Pulmonary Phase - typically avoidable unless the disease progresses; SOB, difficulty breathing, and is typically 5 days post symptom onset with pneumonia and SOB on CXR. Requires hospitalization
Optional Hyperinflammatory Phase - 6% of cases progress to this where the pt is critically ill with sepsis, pneumonia, acute respiratory failure, renal failure and MOD (average LOS is 10 days)

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12
Q

Recovery of COVID

A

long term effects are largely unknown

lasts 2-8 weeks with fatigue, heart problems, activity intolerance, muscle weakness and lung damage

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13
Q

Importance of ACE-2 in COVID

A

receptor it binds to cause the effects of the virus that makes 1/2 of extracellular peptides like angiotensin II and COVID depends on the receptors to spread

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14
Q

COVID Effects on Kindey

A

mild proteinuria, hematuria, and increased creatine levels with COVID pt but COVID is not the main cause, secondary injury

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15
Q

COVID Effects on Liver

A

altered liver enzymes bit is more likely damage from treatment methods and hyperinflammatory than form COVID

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16
Q

COVID Effects on GI tract

A

causes diarrhea, nausea, vomiting, and abdominal pain but there is very little research on the links with COVID

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17
Q

COVID Effects on Cardiovascular System

A

promotes coagulation, heart disease and arrhythmias with severe to long term effects
COVID in shakey on whether or not it is the cause or if it is just an inflammatory response

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18
Q

COVID Effects on CNS System

A

linked to confusion, conjunctivitis (loss of taste), agitation, headache, and paranesthesia with the effects on taste reported form 5-96% of cases
link to COVID in unknown

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19
Q

COVID Effects on Immune System

A

increased production of proinflammatory cytokines, and interferons as a direct response to COVID particles
systematic hyperinflammatory response leads to cytokine storm or cytokine release syndrome, respiratory distress, disease progression, organ damage and death

20
Q

Cytokine Storm of Cytokine Release Syndrome

A

Characterized by fever and multi-organ failure where there is a systemic inflammatory state from an excess of cytokines in the body

21
Q

COVID Effects on Respiratory System

A

primary spot of infection is the upper resp track with a peak of COVID particles and site of exit in the body
lungs have more ACE-2 receptors and diffuse alveolar damage (DAD) and leads to ARDS
most common cause of death in COVID pt is respiratory failure

22
Q

DAD or Diffuse Alveolar Damage

A

structural change in alveoli where there is a fusion of alveoli from damage or disease
early stage of ARDS

23
Q

Acute Respiratory Failure or ARF

A

condition or complication of a disease of hypoxemic, no CO2 release, insufficient O2 to blood and hypercalcemia that is a major threat to the lungs
2 or more physiological mechanisms with imbalanced ventilation supply and demand

24
Q

S&S of ARF

A 
air hunger
decreased O2 Sat and HTN
Tachy
SOB
hyperpigmentation of cyanosis
impaired renal function
cyanosis
metabolic acidosis
GI alteration
25
Q

Classification of Hypoxemic

A

Pa O2 < or = to 60mmHg with O2 Sat < or = to 60%

26
Q

Classification of Hypercapnic

A

ventilation failure of PaCO2 >48mmHg with a pH of >7.35, with an imbalance arising from imbalance of supply and demand

27
Q

Causes of ARF

A 
V/Q mismatch
pneumonia
asthma
pain
atelectasis
pulmonary embolism
COPD
COVID
emphysema
cystic fibrosis
chronic bronchitis
28
Q

Effects of Hypoxemic Respiratory Failure

A

shunting (blood leaves heart without gas exchange) of anatomical (bypass lungs) or intrapulmonary (lungs no worky)
diffusion limitation - decrease in gas exchange across alveolar cap membrane b/c of thickened or destroyed membrane
alveolar hyperventilation

29
Q

Diagnostics of ARF

A 
The girls who get it, get it. And the girls who don't, don't
C-XR
ABG
ECG
V/Q Mismatch and lung scan
uranalysis
pulmonary artery collection
CBC/blood culture
30
Q

Tx of ARF

A 
Stabilize
increase O2 sat and levels
decreased CO2 levels
activity tolerance
decrease symptoms
effective coughing or augmentation coughing/clear secretions
resp therapy of O2 therapy to be >92% and 55-60mmHg humidification
airway suctioning
endotracheal closed tube suctioning
PPV
Bi-PAP
CPAP
hydrate or die-drate
31
Q

Drugs for ARF

A

Bronchodilators to reduce bronchospasms
corticosteroids to decrease airway inflammation and system inflammation
increase protein and nutrition status
benzothiazepines
IV antibiotics for tx of infection
diuretics’ and nitrates to decrease pulmonary congestion
meds to reduce anxiety and restlessness

32
Q

Complications of ARF

A 
CNS disease
restrictive lung disease
cheat wall dysfunction
neuro-muscular disease
brain damage
death
renal damage
33
Q

Acute Respiratory Distress Syndrome or ARDS

A

sudden and progressive form of ARF where alveolar-capillary membrane becomes damaged and more permeable by intravascular fluid

34
Q

Causes of ARDS

A 
COVID 
resp infections
sepsis
pneumonia
direct lung injury
35
Q

Phases of ARDS

A

Injury or Exudative Injury - 1-7 days after injury of guckiness and impaired gas exchange that can lead to interstitial and alveolar edema and atelectasis
Reparative or Proliferation - 1-2 weeks post injury with inflammation occurring that causes increased pulmonary vascular resistance and pulmonary HTN with hypoxemia worsening
Fibrotic - 2-3 weeks post injury with lung remodeling that causes worsening gas exchange due to scar tissue

36
Q

S&S of ARDS

A 
resp alkalosis
SOB
cough
restlessness
fine crackles
hypoxemia 
cyanosis
37
Q

Hallmark Signs of ARDS

A

hypoxemia, PaO2/FiO2 ration <200

C-XR showing bilateral interstitial/alveolar infiltrates

38
Q

Vaccinations

A

prophylactics treatment with either live attenuated, whole inactivated, protein subunit and virus like particle technology for mocking the virus and making the immune system recognize and make an inflammatory system response to the virus

39
Q

Pfizer and Moderna

A

we know the drill
lipid nanoparticle encapsulated mRNA coding mutated form of COVID
cannot get COVID from it

40
Q

AstraZeneca and J&J

A

the blood clot boi and the joke of a vax

viral vector to trigger spike protein formation for the body to identify and attack

41
Q

Noravax

A

lol not even approved in Canada it’s that big of a joke recombient nanoparticle tech with very little efficacy

42
Q

Antiviral

A

prevent replication of virus in body but not ridding the body of the virus, good in theory for treating viruses

43
Q

Bamlanivimab LY-CoV5555

A

antiviral 12 and older with mild to moderate COVID to neutralize IgG1 monoclonal antibody by blocking interaction with ACE-2 receptor

44
Q

Remdesivir

A

antiviral with reverse transcription inhibitor so the RNA is unable to replicate
only for 12 and older with pneumonia and O2 applied

45
Q

Immune System Enhancers

A

interferons, viral mimics, convalescent plasma from COVID pt, VIt D, and stem cell therapies to prevent severe disease but not real approval for COVID yet

46
Q

Pulmonary Supportive Agents

A

support with O2 therapy and mechanical ventilation that can be bovine lipid extract surfactant suspension and dornase alfa
indicated with cystic fibrosis to decrease mucous formation, improving lung function and to decrease surface tension of alveoli

47
Q

Cardiovascular System Regulators

A

trialed for COVID potential to increase lung function but aiding in increasing circulation in lungs to clean pulmonary inflammation
BB, ACE inhibitors and diuretics

NURS 3560 (4 decks)

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