03.06 Coronavirus (COVID-19) Nursing Care and General Information

Overview

**Disclaimer – The content produced for this lesson is referenced to the World Health Organization and the Centers for Disease Control and is current as of April 10, 2020 Please refer to the following links for the most up-to-date information:

• World Health Organization (WHO)
• Centers for Disease Control and Prevention (CDC)

COVID-19, or coronavirus, is a respiratory illness caused by the virus SARS-CoV2, which causes flu-like respiratory symptoms such as coughing, fever, or sore throat. Severe cases can lead to pneumonia, sepsis, and in rare cases, death.

Nursing Points

General

1. Virology
   1. Virus name – SARS-CoV2 (severe acute respiratory syndrome coronavirus 2)
   2. Disease name – COVID-19 (named by the World Health Organization)
2. Epidemiology
   1. Began in Wuhan, China in December 2019
   2. Within 2 months, a global pandemic threat was raised to a very “high level.”
   3. World Health Organization declares COVID-19 a pandemic
   4. April 9, 2020
      1. Worldwide
         1. Infections – 1.5 million confirmed cases
         2. Deaths – 89,733
      2. United States
         1. Infections – 431,000
         2. Deaths – 14,700
3. Transmission
   1. Person-to-person
      1. Airborne spread
         1. Some spread by droplet
         2. Use an N95 mask for protection
      2. Social distancing (greater than 6 feet distance from another person) encouraged
         1. Also shelter-in-place enacted in many different areas
4. Difference between COVID-19 and Influenza
   1. Many people who transmit influenza are asymptomatic
   2. COVID-19 causes much more severe disease than seasonal influenza
      1. Many people have built up a resistance through immunity against the seasonal flu
      2. COVID-19 is a new disease to which no one has immunity
         1. Means higher susceptibility of infection
         2. Higher likelihood of illness
5. At-Risk Patient Populations
   1. Elderly patients
   2. Immunocompromised patients
   3. Patients with pre-existing illnesses
      1. Especially those who have heart or lung disease, cancer or diabetes

Assessment

1. Incubation Period
   1. Up to 14 days (suspected)
2.  Symptoms
   1. Fatigue
   2. Fever
   3. Dry cough
   4. Aches & pains
   5. Congestion
   6. Runny nose
   7. Diarrhea
   8. Sore throat

Therapeutic Management

1. Prevention
   1. Most effective way to protect oneself
      1. Wash hands frequently with soap and water
         1. If soap and water are unavailable, use alcohol-based sanitizer
      2. Avoid close quarters and contact with people with respiratory symptoms
         1. Stay at least 1 meter (3 feet) away from people who are coughing or sneezing
         2. Avoid highly populated areas such as shopping malls
      3. Cook food thoroughly
         1. There is no known indication of it being caused by food-borne pathogens, but cooking the food to the proper temperature should destroy any viruses directly in contact with food
      4. Clean office and household surfaces regularly and thoroughly
      5. Vaccines
         1. There is currently no vaccine on the market, thus there is no way to provide preventative immunization
2. Testing
   1. Done through a PCR test
3. Treatment
   1. Supportive treatment
      1. IV Fluids for severe dehydration
      2. Isolation if necessary
      3. Antibiotics only for secondary infections
      4. Promote nutrition
   2. Experimental studies
      1. Use of antiretrovirals for early trials
      2. This has not been established as the primary treatment method
   3. Discontinuation of isolation precautions
      1. Requires two negative PCR tests
      2. Complete resolution of clinical signs
      3. Follow Facility Policy as this can update quickly from WHO and CDC

Patient Education

1. Education
   1. Patients should see a provider immediately if they have a fever, coughing, chills or any other symptoms similar to COVID-19
   2. Wash hands frequently and avoid highly populated areas
   3. Stay at least 3 feet away from people with respiratory symptoms
2. Dispel myths
   1. Masks are an ineffective way of preventing the illness
      1. Many masks are not fit properly, which causes frequent adjusting (increase hand-to-face contact)
      2. Many masks are worn more than once, increasing the likelihood of illness
      3. Buying excessive masks prevent healthcare workers from having access
      4. Masks should only be worn if a patient suspects they are ill and need to be seen by a provider
   2. Pets and bugs cannot spread the virus
   3. There is no medication that can prevent or treat COVID-19.