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

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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 March 6, 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. By March 5, 2020, COVID-19 reached the United States
      1. 148 Confirmed cases with 10 deaths
  3. Transmission
    1. Person-to-person
      1. Direct contact
      2. Respiratory droplets by coughing or sneezing
  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.

FAQs

How can nurses protect themselves when caring for the coronavirus (COVID-19)?

I’m scared that I will have to care for someone with coronavirus (COVID-19) and I might get it.

I’m nervous/anxious because of the coronavirus (COVID-19). Are there any tips or tricks to staying calm during what feels like an emergency?

My family is nervous about me working in a hospital with the coronavirus (COVID-19) spreading. How should I talk to my family about working in an infectious landscape?

Will coronavirus (COVID-19) be a pandemic?

Why is coronavirus (COVID-19) spreading so rapidly?

Can coronavirus (COVID-19) live on objects?

Can coronavirus (COVID-19) in dogs spread to humans?

Can coronavirus (COVID-19) be treated?

Will coronavirus (COVID-19) continue to spread?

Why is coronavirus (COVID-19) causing such a devastating effect on the general public?

Why coronavirus (COVID-19) is dangerous?

What is the difference between coronavirus (COVID-19) and the seasonal flu (influenza)?

What are the most common coronavirus (COVID-19) symptoms?

How does coronavirus (COVID-19) spread to humans?

How can you prevent the coronavirus (COVID-19) infection?

Is it safe to travel with the current coronavirus (COVID-19) illness spreading?

How does coronavirus (COVID-19) affect children?

Is there a current coronavirus (COVID-19) test?

Who does coronavirus (COVID-19) affect the most?

Reference Links

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Video Transcript

We’re going to talk about the Coronavirus infection or COVID 19. So we’re also going to cover everything from the viral ology and the epidemiology, any testing, the treatment and the nursing implications. So what you’re going to be responsible for. And also patient education. So what is the coronavirus well, everybody keeps hearing this term, COVID 19. Well, what is COVID 19 will Cove in 19 is the disease that’s been designated by the world health organization to describe the virus that causes the illness. What is the virus? The virus is known as SARS-COV2. So the sudden acute respiratory syndrome CoV2. So, the CoV2 stands for coronavirus too. Now, the thing about these types of viruses, these stars viruses is they’re also the one that causes, just the basic cold. the differences are, the problem with this one is that it has become so aggressive that there is a, it’s what they call a novel.

Viruses are one that hasn’t been seen yet and there are no, preventative things on the market. And we’ll get into that a little bit, but it’s affecting communities at large. And here’s where the problem gets even worse, is that it’s actually started on one hand, China. And what happened was we had these patients that we were seeing for this common type of cold or the SARS virus. But because it’s a novel virus, there’s no immunity built up for it and it ends up becoming pneumonia. It ends up becoming all of these other respiratory problems. It becomes sepsis, it starts to affect other organs, and then it becomes highly transmittable. So if we go back to [inaudible] in China, this is, it started around December 1st, 2019. And since then, it’s actually a today is March 6th. And so right around reported date, March 5th, 2020 in the United States, there have been 10 confirmed deaths and there have been over 148 cases of the of this Coronavirus, which has become a major problem.

So let’s talk about transmission and the patient population. Transmission is person to person. And what do I mean by person to person? Will, I mean droplet. And this is where it’s so important. So if you have a patient that’s coughing or sneezing, you need to make sure that you’re taking the right precautions and make sure that whatever facility you’re in, that they’re exercising those right precautions too. The other problem is with the droplet, they could actually cough or sneeze onto a surface and then it gets picked up on their hands and then people touch the face and the mouth. And that’s, that’s another method of transmission. So it’s person to person, primarily droplet. So this is where your education comes in a little bit later. Now, what’s the difference between COVID 19 and influence? It will influence. A lot of people get their preventative measures, so they go and get their flu and they’ll get, um, they also have, everybody has a little bit of a, a built-up immune system for the common flu.

And so everybody has the ability to fight this off. Even some instances where where patients don’t have great immunity, they get their flu shots, they have at least a little bit of buildup, um, of that immunity. Now the problem with the COVID 19, because it’s a novel virus, that’s where it becomes a problem is that there is no there no methods of prevention. it’s so new and it’s becoming a highly aggressive, and what’s happening is it’s also starting to affect these at risk patient populations. So what populations are these? Well, we’re seeing a lot in the geriatric patient population. So what are these types of patient populations? You’ve got your geriatric patient populations, they’re either immunocompromised, um, or they have some sort of, um, preexisting condition. So especially, um, like lung disease or heart disease or cancer or any other type of, illness that’s going to cause their body a lot of work.

Now you’re putting them in a position where they have some other, some other comorbidity, and now they’re getting this,this COVID 19, this coronavirus illness and it’s just causing all of these other, problems for them. So let’s talk about assessment. The incubation period for the COVID 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 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, maybe, an area where Cobra 19 was found, whether it was in China overseas, um, or in a highly, or highly populated areas where there have been known, um, confirmed cases of COVID 19, that’s where you’re actually gonna see a lot of these 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 [inaudible] 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 this coronavirus, this COVID, what do I, what can I do?

The biggest thing they can do is wash our 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, 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 know that you’re going to have to hold onto them for a little bit and you’re going to 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 try to help them stave off those fevers, 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, all their, systems are functioning and provide the supportive therapy if they end up needing, IB 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 this 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 coronavirus and you are using these antiretrovirals, that that’s what they’re being used for. Now, the big part about the discontinuation of the of your infection precautions, your droplet precautions is that you’re going to, you’re often going to pay attention to this testing. What the CDC is currently recommending is a two negative two negative PCR tests and there has to be a complete resolution of all of their symptoms in order for them to have the the discontinuation of the infection precautions. That doesn’t mean that they can be discharged, that 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, the transmission by washing hands, washing, having your patient wash their hands, you washing your hands, have you, 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 the droplet precautions because the, that means that it’s a cough, and those droplets are going to land on the surface.

And what happens to, and we’ll get to this in a minute with when we’re dispelling this, is that anytime that cough is there, we want to make sure that we are 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, they don’t feel well that that’s another time that they should you know, exercise caution there. Now, the other thing about that I’m gonna come back to that is that if you have a patient who 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 COPD in 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 it’s a friend or some, um, somebody that you know, and if it’s a patient, get them a mask, 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 myths. The thing about the mask, when should a patient where I’m asking, I’m sure that your patients are going to ask you this. When should a patient wear a mask? the only time a patient should wear a mask with this, this illnesses. When they are S they think that they are sick with it, it actually does not help prevent the, um, it doesn’t help keep it. The masks are not going to help people prevent the illness by wearing them. The masculinity are by people. So hard to do this.

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 incur or discourage patients from going out and buying mass is because they are often, they need to be fit, tested, especially the, in 95 mask. It’s really common to go out.

You can go to anyone of your, um, your home improvement stores and they have those in 95 mass. But like, if you’re like me and you have a beard and it’s not gonna fit and 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 a mask. And by reusing the mask, it actually creates a couple of problems. Number one, they’re constantly adjusting it because it doesn’t fit well. And number two is that they are reusing something that potentially has, 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, 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, another type of common question is, is are there any medications on the market to helpcure 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 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, 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 in my, can my dog, give me a coronavirus can my cat carry coronavirus can any of my pets do it? Can Mizel 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, of transmission, methods. So we need to make sure that our, 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, reducing that transmission. The next thing is treatment. If treatment, 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 anti-retrovirals 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, 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 those really populated areas, 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 a coronavirus, have them seek treatment early. We hope that this lesson has been extremely helpful and understanding what’s going on with the Corona virus. We love you guys. Now go out and be your best self today. And as always, happy nursing.

 

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