Temple of Healing

VOLUME 4 , ISSUE 5, SEPTEMBER-OCTOBER, 2021 

Website: https://psg.sssihms.org.in


COVER STORY

 nurse's role on management of covid-19 patients

DEPARTMENT OF NURSING, SSSIHMS, PRASANTHIGRAM

Covid ICU at SSSIHMS, Prasanthigram

Nurses play a pivotal role in the health care response to infectious diseases, epidemics and pandemics.  The pandemic of a novel coronavirus (COVID19 or 2019CoV) infection has posed significant threats to international health and the economy. The novel coronavirus (2019-nCoV) outbreak, which initially began in China, spread to many countries around the globe, with the number of confirmed cases increasing every day. In December 2019, a number of patients were admitted to hospitals with an initial diagnosis of pneumonia. On Jan 7, a novel coronavirus (2019-nCoV) was identified by the Chinese Center for Disease Control and Prevention (CDC) from the throat swab sample of a patient. This pathogen was later renamed as severe acute respiratory syndrome coronavirus (SARS-CoV-2) by the Coronavirus Study Group and the disease was named coronavirus disease 2019 (COVID-19) by the WHO.

As the largest group of health professionals (World Health Organization, 2020), nurses play a key role in the public health response to such crises. Being a new disease condition, there existed a huge gap in the knowledge and understanding about the nursing care of COVID 19 patients admitted under health care facilities. This article endevours to covers some salient points of nursing management of COVID 19 patients. 

 

NURSING ASSESSMENT

Assessment is the first step in the care of COVID 19 patients, which involves critical thinking skills, clinical judgment, risk identification, history, physical examination and appropriate decision making strategies by the nurses.

History of

International travel in the previous 14 days

Migration and return from one place to other

Contacts with laboratory confirmed cases

Hotspots/containment zones

Physical Examination

•    Symptoms of influenza like infection (ILI) such as acute respiratory infection with fever >  38oC AND cough.

•    Symptoms of severe acute respiratory infection (SARI) which included acute respiratory infection with fever > 38oC and cough requiring hospitalization.

•             Breathlessness

Fatigue

Sore throat

Body ache

Chest congestion

GI upset

Anosmia

Ageusia (Altered taste sensation)

Respiratory and Cardiovascular status of Patients

•    In respiratory system, check for respiratory rate, breathing pattern, bilateral air entry, breathing difficulty, Spo2 level, PaO2 /FiO2 ratio, lactate level and radio diagnostic findings

•    In cardiovascular system, monitor for heart rate, heart sounds, blood pressure, capillary refill time and Mean Arterial Pressure.

•    Assess pain using visual analogue scale, numerical pain assessment scale or behavioral pain assessment scale as appropriate.

       •      Assess anxiety.

•    Look for development of complications like acute respiratory distress syndrome (ARDS) or any organ failure.

Depending on the assessment findings, various nursing diagnosis can be formulated for the patients. Specific Nursing Diagnosis, Goal and Interventions are explained in the subsequent section:

Nursing Diagnosis

Difficulty in breathing related to disease condition as evidenced by increased respiratory rate, cough, decreased oxygen saturation and use of accessory muscles.

Goal

1.        To reduce breathing difficulty

2.        To promote patient comfort

Nursing Interventions

Nursing Diagnosis

Respiratory failure and Acute Respiratory Distress Syndrome (ARDS) related to disease condition as evidenced by hypoxemia, respiratory distress and decreased Pao2/Fio2 ratio.

Goal

To prevent hypoxemia

To relieve respiratory distress

To maintain oxygen saturation above 90%

Nursing Intervention

Nursing Diagnosis

Impaired hemodynamic status related to disease condition.

Goal

To achieve hemodynamic stability

Interventions

Nursing Diagnosis

Septic shock related to disease condition as evidenced by persisting hypotension with reduced MAP (<65mmHg) and raised serum lactate level (>2mmol/l).

Goal

Nursing Intervention

Nursing Diagnosis

Altered thermoregulation related to disease condition as evidenced by raised body temperature

Goal

To bring down the body temperature to normal range

Interventions

Nursing Diagnosis

Body ache related to disease condition as evidenced by patient verbalization, facial expressions and pain rating scale.

Goal

To reduce pain and promote comfort

Interventions

Nursing Diagnosis

Altered nutritional status related to disease condition as evidenced by decreased oral intake and decreased weight.

Goal

To promote adequate nutritional intake among patient

Interventions

Nursing Diagnosis

Anxiety related to disease condition as evidenced by frequent questioning and facial expressions of the patient.

Goal

Interventions

Nursing Diagnosis

Fear of unknown related to isolated environment, less interaction and unrecognizable health workers as evidenced by patient’s facial expressions.

Goal

To relieve the fear of the patient

Interventions

Nursing diagnosis

Knowledge deficit related to disease condition as evidenced by frequent questioning, related misconceptions.

Goal

To provide knowledge about the disease process

Interventions

Nursing Diagnosis

Risk for multiple organ failure related to disease condition

Goal

To identify and reduce the risk of multiple organ failure

Interventions

Nursing Diagnosis

Risk for kidney dysfunction related to disease condition.

Goal

To prevent the onset of kidney dysfunction

Interventions

Nursing Diagnosis

Risk for stress ulcer related to poor nutritional intake.

Goal

Nursing Intervention

Nursing Diagnosis

Risk for pressure sores related to prolonged bed ridden status.

Goal

Nursing Intervention

Nursing Diagnosis

Risk of venous thromboembolism/DVT related prolonged immobilization.

Goal

To prevent the incidence of venous thromboembolism/ DVT

Nursing Intervention

Nursing Diagnosis

Risk for the development of ventilator associated pneumonia related to intubation, frequent suctioning and non-adherence to infection control practices.

Goal

To reduce the incidence of ventilator associated pneumonia.

Interventions

Nursing Diagnosis

Risk for catheter related blood stream infections related to invasive catheter lines.

 

Goal

To prevent catheter related blood stream infections.

Interventions

Nursing Diagnosis

Risk for fluid overload related to excessive fluid administration.

Goal

To prevent fluid overload

Interventions

Nursing Diagnosis

Risk for cross infection to health care team members related to the infectious nature of the disease.

Goal

To prevent cross infection

Interventions

Evaluation

This final step of the nursing process is vital to a positive patient outcome. Evaluation is an ongoing process. Whenever a healthcare provider intervenes or implements care, they must reassess or evaluate to ensure the desired outcome has been met. Reassessment may frequently be needed depending upon overall patient condition. The plan of care may be adapted based on new assessment data. Nurses must ensure to evaluate the patients following each intervention to guide further planning and management.

Discharge Teaching

Make sure that patient and his/her family members understand the discharge instructions, need for follow up (if any) and warning signs for which to seek medical attention

CONCLUSION

Nurses being the frontline COVID warriors must have adequate knowledge and skills to manage COVID 19 cases effectively. They are required to keep themselves updated with the new guidelines on COVID 19 from authentic resources. This will improve their confidence in dealing with such cases and patient outcome as well. This review provides knowledge on nursing management of patients with COVID 19 based on the recent available information. This will be helpful in empowering the nursing task force to provide quality care to the patients and to deal with this pandemic in the best way possible.


 Jai Sai Ram