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

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Outline

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.

Transcript

In this lesson we’re going to talk about the Corona virus infection or coven 19. So we’re also going to cover everything from the virology and the epidemiology, any testing, the treatment and the nursing implications. Uh, so what you’re going to be responsible for. And also patient education.

 

So what is the Corona virus? Well, the first thing we have to look at is the virology and the epidemiology of what’s going on with it. So when we talk about virology, we’re actually talking about the study of the actual virus itself. Now this virus is known as SARS, C O V two, which is the actual name of the virus. Now when we talk about, uh, and kind of in common nomenclature with the, the media and what we’re hearing and reports from the world health organization and the CDC, they’re often using this term covert 19. And what Covin 19 is it’s the actual illness that’s been designated by the world health organization. So that’s the difference. Now when we talk about epidemiology, we also want to look at the study and the progression of the illness. So back when this all started in the, in the first, uh, kind of version that we put in this lesson out, there had been about 150 cases in the United States and uh, somewhere in the vicinity of about 50 deaths.

 

That was somewhere around the beginning of March. So today is actually April 9th, uh, 2020. And what we’ve figured out is from that time, from that very beginning of of March, um, all the way to this point that in the world there have been 89,000, 733 deaths and 1.5 million infected, um, with the confirm test. Now in the United States, when we talk about that number, remember we were at about 150 and about, you know, somewhere in the vicinity of 50 deaths beginning of March. Now as of this date, there’s been 431,000 confirmed coronavirus or coven, 19 cases and 14,700 deaths in the United States. And what that means is that this is very, very aggressive. Now when we’re looking at the progression of the illness, we also need to consider how contagious it is. Now the interesting thing about the flu versus Corona viruses that even though the flu, uh, it makes a lot of people sick and it, and it unfortunately has, uh, uh, you know, it kills a lot of people.

 

But the difference between the Corona virus and the flu is that the coronavirus is a novel virus. We have no built up immunity, we have no vaccine currently. And what’s happening is there’s no herd immunity, there’s no ability for us to find it. There’s a lot of things that are in question in terms of trials. And what we found is that, uh, when this illness progresses, it actually, uh, it triggers a lot of inflammatory reactions and that puts people, uh, susceptible to sepsis and multiple organ failure and respiratory failure. And it’s requiring high levels of ICU care and it’s become extremely, extremely challenging. The healthcare community. Now when we talk about transmission and safety, we want to think about it from the nursing perspective. When you’re taking care of a covered 19 patient, what you need to remember is that, and there’s a lot of evidence that’s now showing that this is an airborne illness.

 

So we need to be, um, you know, putting on in 95 masks, we need to be, we need to make sure that we have all the necessary proper protective equipment. Um, and this has been a bit of a challenge in the United States and that there has been such an accumulation by the consumer to go out and grab all of the, the, the masks and gloves and gowns and goggles and all that stuff from consumer stores. And what’s happened is it’s created a major shortage for actual healthcare workers. So much so that they’re actually having to reuse, um, personal protective equipment. And that’s become an extreme challenge and it’s become extremely frustrating for healthcare workers. But the best case scenario is that you have your gown, you have the necessary, I protected, uh, the face shields are extremely important. Um, but in terms of what, uh, every healthcare facility is doing, make sure you’re following those protocols.

 

But at a minimum, you mean you need an in 95 mass, which is going to be extremely helpful. Now when we also look at at risk patient populations, that initially the concern was that it was affecting, um, disproportionately higher amounts of geriatric patients. What we’ve actually found is that it’s still affecting, uh, even younger patients. Now there are a couple of factors that play in and make, uh, the geriatric patient population or, uh, patients that have certain comorbidities that actually makes them more susceptible to getting sick and um, having a longterm or more detrimental effects from the virus versus younger patients who have higher, uh, immunities. Um, but just because you’re younger and you’ve got a really healthy immune system does not mean that you are not susceptible to this illness. So we all need to be practicing the social distancing in our own personal lives. And then we also need to make sure that we are protecting ourselves at work.

 

So let’s talk about assessment. The incubation period for the coven 19 is about 14 days. It can be up to 14 days. Some of the literature is saying anywhere starting around two days, but it can actually be somewhere around five. So if you have a patient that exhibits these common types of symptoms, you can see a lot of the symptoms here, but the number, the top three that you’re going to see, the first one is going to be fatigue. They’re going to be tired. The next one you’re going to see is this shortness of breath. This is a, another big issue of because it’s a primary, a primary respiratory illness, that’s where you’re going to see it. And the last one that you’re going to see is fever. These are going to be your number three. You’re also going to see some of these other ones.

 

So if you have a patient that’s been exposed to, uh, maybe, uh, uh, an area where code 19 was found, whether it was in China, overseas, um, or in a highly, uh, or highly areas where there have been known, um, confirmed cases of Coby 19, that’s where you’re actually going to see a lot of, uh, the symptoms start to build up. And then this is where it becomes a major problem. So now let’s go to therapeutic management. The biggest thing about therapeutic management is prevention. You can go through your patient education, we’ll talk about Peggy patient education in a minute, but the biggest thing you have for your patients, especially, um, in like a clinic setting where they’re like, I’m concerned, I’m going to get, uh, this Corona virus, this coven, what about, what can I do? The biggest thing that can do is wash your hands and make sure that they stay away from populated areas.

 

Now next thing that we can do is something, a testing. If there is a concern that a patient has, uh, the, the Corona virus, you can actually use these tests. There’s something called a PCR test and we’ll get into kind of how we discontinue those. Um, but the thing about this is it takes a couple of days and this is where it becomes important, especially for those hospitalized cases that you need. Then you knew that you’re going to have to hold on to them for a little bit and you gotta make sure that we get through that. So what are we going to do for our patient? Well, the thing we’re going to do is provide supportive treatment. We’re going to maintain their hydration levels, we’re going to maintain their nutrition status. We’re also going to, uh, maybe uh, try to help them stave off those fevers.

 

Uh, so we can use like acetaminophen or ibuprofen to help with those, try to make them comfortable. But the big thing is to make sure they’re eating and drinking. Uh, all their systems are functioning and provide the supportive therapy if they end up needing, uh, IV fluids or that kind of support, that’s another Avenue that you can experiment with or that you can explore. In terms of experimental studies, there are a couple on the market because there is no vaccine out there. The problem is, is that we have to start to try some other things in the meantime to try to help reduce the prevalence of this illness. So what they’re trying now are these antiretrovirals and what these anti-retrovirals do is they are used in things like the flu. Um, other viruses like HIV. They’re trying to see how well these work for these cases.

 

In some cases they’re working. Again, it is highly experimental. Just know that if you start, if you have a patient that is testing positive for Corona virus and you are using these antiretrovirals, that that’s what they’re being used for. Now, the big part about the discontinuation of the, uh, the of your infection precautions, your droplet precautions is that you’re going to, uh, you’re often going to pay attention to this testing. What the CDC is currently recommending is two negative, uh, two negative PCR tests and there has to be a complete resolution of all of their symptoms in order for them to have the, uh, the discontinuation of the infection precautions. That doesn’t mean that they can be discharged. It just says that, Hey, we don’t think that they’re a concern. But the biggest thing here is you need to follow your facility policy because that facility policy is going to pay attention to what the CDC says.

 

And also with the world health organization is saying. So just make sure that you’re following those policies specifically. But these are kind of general guidelines. So patient education is where you can be of real value to their patients. The big thing here is prevention. You want to prevent the, uh, the transmission by washing hands, washing, having your patient wash their hands, you washing your hands, having everybody that, you know, wash their hands is what to help prevent the transmission of this illness. The thing about it too is that because again, if we look at things like, uh, the droplet precautions because the, that means that it’s a cough, uh, and those droplets are gonna land on surface. And what happens to, and we’ll get to this in a minute with when we’re dispelling this, is that any time that cough is there, we want to make sure that we are, uh, washing our hands thoroughly.

 

The other thing you want to do is avoid highly populated areas. And by doing that, you actually reduce that risk. If a patient is home sick, uh, they don’t feel well that that’s another time that they should, uh, you know, exercise caution there. Now the other thing about that, I’m going to come back to that is that if you have a patient that has those onset of symptoms, remember we have the fatigue, we have, we have fatigue, we have the shortness of breath, and we have the fever. And let’s take into account if a patient has been exposed to an area that has code 19. Hey, give them a mask, which we’ll talk about thoroughly in a second. Give them a mask, send them to the doctor. If you’re in a, if, if, if it’s a friend or some, um, somebody that you know, and if it’s a patient, get them a mask to get them to the hospital, get them tested or have them seen by a provider.

 

That’s going to be the best thing that you can do. The mask is really important. But here is why we’re going to go to dispelling this. The thing about the mask. When should a patient where I’m asking, I’m sure that your patients are gonna ask you this. Uh, when should a patient wear a mask? Uh, the only time a patient should wear a mask with this, uh, this illnesses when they are, they think that they are sick with it. The masks are not going to help people prevent themselves from getting the illness. Here’s what’s going to happen with that. Number one, they’re actually going to buy up all of the masks. And by doing so, it actually decreases the amount of masks available for healthcare workers. This is a problem. So by having a bunch of people go out and buy these masks to hoard for themselves and it actually creates a problem within the system.

 

So by just explain to your patients, Hey, don’t go buy a masks. You’re not actually doing yourself any good. It doesn’t prevent you from getting the Corona virus. Number two, the reason you should, that you should try to encourage or discourage patients from going out and buying mass is because they are often, uh, they need to be fit, tested, especially the, in 95 mask. It’s really common to go out. You can go to any one of your, um, your home improvement stores and they have those in 95 masks. But like, if you’re like me and you have a beard and it’s not gonna fit in seal, right, it needs to be fit, tested. So the in 95 masks aren’t going to work well. And the other problem is that people will reuse the mask. And by reusing the mask, it actually creates a couple of problems.

 

Number one, they’re constantly adjusting it because doesn’t fit well. And number two is that they are reusing something that potentially has, uh, either bacteria or they have viruses or they’ve been exposed to the virus and now they’re taking their hands and touching their face with it, and they’re potentially exposing themselves to that, uh, to that coronavirus we don’t want to do that. So do you know if you have the opportunity, encourage your patients to wash their hands to avoid populated areas and try to, they don’t need to go out and buy a mask because it’s not going to do them any good. The other, uh, another type of common question is, is are there any medications on the market to help, uh, cure or prevent, um, the coronavirus and the answer is currently no. There are some, like we talked about earlier, there are some experimental studies, but the thing here is that there, uh, there are some, some future plans to get a vaccine developed, but there’s nothing concrete right now.

 

There are no medications, there are no preventative measures, uh, in terms of medication to keep people from getting it or to treat it. So it’s all about supportive therapy. And the last thing about animals, a lot of people will ask him, my, can my dog, uh, give me a Corona virus. Can my cat carry Corona virus? Can, uh, any of my pets do it? Can my lizard do it? No, the answer is no, they’re not carriers for it. Um, so just be prepared that you know, Hey can, if that’s a question you have, Hey no you’re not going to get it from your pet or I guess so let’s recap the first thing about the coronaviruses. We need to focus on prevention. This is the most effective way to stay healthy. Number two, a droplet transmission is the most common type of uh, of transmission methods.

 

So we need to make sure that our, uh, we need to avoid people that are sick. We’re going to wash hands. That’s going to be your best option in order for, uh, reducing that transmission. The next thing is treatment. If treat, if you are taking care of a patient, supportive therapy is going to beat your best option and then you don’t be surprised if you are seeing some experimental studies like those antiretrovirals, those can are starting to be introduced but we don’t know, we don’t have enough data on them yet to determine how effective they are. Then you have protection. Protection is going to be your best bet. And especially when you’re taking care of patients, exercise, whatever facility policy there is, protect yourself as a nurse. Um, if you think you need to do something a little extra, uh, make sure you’re following this facility.

 

Policies and protecting yourself. And then the, the last thing is education. This ties back to prevention. You want to focus on prevention for those patients. Make sure they’re washing their hands, avoiding, uh, those really populated areas, uh, coughing into their elbow. Um, staying at least, you know, three feet away to six feet away. That’s sometimes not enough. But make sure you’re staying away from patients who may have respiratory illness. And if you do think, um, you have a patient that thinks that they are sick with coronavirus, have them seek treatment early. We hope that this has been extremely helpful and understanding of what’s going on with the Corona virus. We love you guys. Don’t go out and be your best self today. And as always, happy nursing.