3. Treatment and prophylaxis
Prevention and control
Nursing intervention
Care of ventilated patient
Refrences
4. Introduction
Coronavirus disease (COVID-19) is an
infectious disease caused by a newly
discovered coronavirus.
Corona virus are the group of virus that
causes respiratory infections that are usally
mild , including some cases of common
cold.
It was first identified in December 2019 in
Wuhan, China.
5. This group of virus is named for club shaped
protein spikes that protude from a viral surface
and create an apperence corona(crown) when
viewed via microscope.
6. Epidemiology
In the past week, over 3.3 million new
cases have been reported globally.
As of 1 November, nearly 46 million
cases and 1.2 million deaths have been
reported globally.
In Nepal, from Jan 3 to 4 November
2020, there have been 179,614 confirmed
cases of COVID-19 with 1,004 deaths.
7. Epidemiological status acccording to
WHO
Reporting Country/Territory/Area- Nepal
New cases in last 7 days- 15,510
Cumulative cases-1,70,743
Cumulative cases per 1 million population -5,860
New deaths in last 7 days-95
Cumulative deaths-937
Cumulative deaths per 1 million population-32
8.
9.
10.
11. Risk Factors
Conditions in which there’s strong evidence of increased risk
include:
Chronic kidney disease
COPD,emphysema
People with lower immune health because of a solid organ
transplant
Obesity-- those with a BMI greater than 30
Serious heart conditions like heart failure and coronary
artery disease
Sickle cell disease
Type 2 diabetes
13. Pathophysiology
Spike surface glycoprotein of the virus binds to the
host via receptor binding domains of the angiotensin
converting enzyme 2 (ACE2), which is most abundant
in type II alveolar cells
10 - 20 times higher binding affinity as compared with
the SARS-CoV-1 virus
After a SARS-CoV-2 attaches to a target cell, the virion
releases RNA into the cell, initiating replication of the
virus which further disseminates to infect more cells
14. Pathophysiology cont…
Covid 19 produces several virulence factors that
promote shedding of new virions from host cells and
inhibit immune response
Virus independent immunopathology in fatal COVID-
19
Organ injury and death in COVID-19 is immune
mediated rather than pathogen mediated
15.
16. Symptoms
Symptoms usually begin 2 to 14 days after you come into
contact with the virus.
Common symptoms
Fever
Fatigue
Dry cough
Loss of appetite
Body aches
Shortness of breath
17. Other symptoms
Sore throat
Headache
Chills
Loss of test and smell
Runny nose
Nausea , vomiting
Diarrhoea
18. Sever symptoms
Constant pain or pressure in your chest
Bluish lips or face
Sudden confusion
Trobled breathing
Organ failure
Coma
Decreased wbc
19.
20.
21. Incubation period
On average, symptoms showed up in the newly
infected person about 5 days after contact.
Rarely, symptoms appeared as soon as 2 days after
exposure.
Most people with symptoms had them by day 12. And
most of the other ill people were sick by day 14.
In rare cases, symptoms can show up after 14 days.
Researchers think this happens with about 1 out of
every 100 people.
22. Some people may have the coronavirus and never show
symptoms.
Others may not know that they have it because their
symptoms are very mild.
Current studies might not include the mildest cases,
and the Incubation period could be different for these.
People who get infected with can spread it to others 2
to 3 days before symptoms start and are most
contagious 1 to 2 days before they feel sick.
23. How Long Should I Quarantine
After I’ve Been Exposed to the
Coronavirus?
If you might have come into contact with the virus and
have no symptoms, you should self-monitor.(watching
for signs such as fever, cough, and shortness of breath)
Stay out of crowded places, keep at least 6 feet away
from other people, and wear a cloth face maskwhen
you have to go out.
24. If you traveled recently or know that you came into contact
with someone who has COVID-19, you should self-
quarantine.
Stay home for 14 days.
It’s very rare for symptoms to show up after that much time.
Check your temperature twice a day, and watch for other
symptoms.
Stay away from other people, especially those who are at
high risk of serious illness because of their age or another
medical condition.
25. Transmission
Person to person transmission
Droplets or aerosols:
When an infected person coughs, sneezes, or talks,
droplets or tiny particles called aerosols carry the virus
into the air from their nose or mouth.
Anyone who is within 6 feet of that person can
breathe it into their lungs.
26. Fecal-oral:
Studies also suggest that virus particles can be found
in infected people's poop. But experts aren't sure
whether the infection can spread through contact with
an infected person's stool.
If that person uses the bathroom and doesn't wash
their hands, they could infect things and people that
they touch.
27. Airborne transmission.
Research shows that the virus can live in the air for
up to 3 hours. It can get into your lungs if someone
who has it breathes out and you breathe that air in.
Surface transmission:
Another way to catch the new coronavirus is when
you touch surfaces that someone who has the virus has
coughed or sneezed on.
28. Cont…
You may touch a countertop or doorknob that's
contaminated and then touch your nose, mouth or
eyes.
The virus can live on surfaces like plastic and
stainless steel for 2 to 3 days.
To stop it, clean and disinfect all counters, knobs,
and other surfaces you and your family touch several
times a day.
31. Treatment
There is no vaccines . Work is underway to develop one
, but a vaccine is unlikely to be developed before 2021.
There is no antiviral treatment specifically for COVID-
19.
Symptoms are managed using standard methods of
care for viral infections.
Antibiotics , which only treat bacterial infections are
not useful to treat COVID-19 or other viral disease.
Treatments depends on stage of illness.
32. Prophylaxis
Antiviral drugs( Hydroxychloroquine ,Chloroquine):
Both chloroquine and hydroxychloroquine have in
vitro activity against SARS-CoV and SARS-CoV-2.5,6 A
small cohort study without a control group has
suggested that hydroxychloroquine might reduce the
risk of SARS-CoV-2 transmission to close contacts.7
33. Cont..
Antibiotics:
. Azithromycin are quite effective in preventing
pulmonary infections in patients with viral
pneumonias, in addition to having a significant anti-
inflammatory effect on the airways.
vitamin supplements:
vitamin B complex, vitamin D, vitamin C, zinc
34. Cont…
Corticosteroids
Steroids can be used for a short period of time, that
is, 3–5 days in patients who show progressive
deterioration of oxygen saturation, increased
activation of the pro-inflammatory response and rapid
worsening of features on chest imaging.
Dexamethasone has also been found to be effective
for decreasing mortality in severe and critically ill
cases.
35. Cont..
Plasma therapy:
Blood is taken from a previously infected but
completely recovered patient, the plasma component
of that blood is separated and that contains the
antibodies against SARS-CoV-2 virus.
This plasma is injected into an infected person’s
body that will fight the virus and neutralise it from
spreading.
36. Prevention and control
There are a number of ways to prevent the spread of
COVID-19 infection. These include:
Avoid touching your eyes, nose and mouth
Avoid close contact with people who are sick
Remember that some people without symptoms can still
spread the virus
Stay at home when you are sick
Cover your cough or sneeze with a tissue, then
dispose of it properly
37. Use a face covering when physical distancing is difficult
or when going into closed spaces8
Physical distancing should be at least 1 meter (3 ft)
Clean and disinfect frequently touched objects and
surfaces
Perform hand hygiene with soap and water or use
alcohol-based hand rub
Hand Rub should contain at least 60% alcohol9
Hand washing should be done for at least 40-60 seconds
based on WHO’s recommendations
38. IPC Priorities
Rapid identification of suspect cases
Screening/Triage at initial healthcare facility encounter and
rapid implementation of source control
Limiting the entry of healthcare workers and/or visitors with
suspected or confirmed COVID-19
Immediate isolation and referral for testing
Group patients with suspected or confirmed COVID-19
separately
Test all suspected patients for COVID-19
39. Safe clinical management
Immediate identification of inpatients and healthcare
workers with suspected COVID-19
Adherence to IPC practices
Appropriate use of Personal protective equipment (PPE)
PPE are recommended for healthcare workers before
entering the room of suspected or confirmed COVID-19
patients
https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf
40.
41. Nursing Intervention
Nursing assessment:
History Taking
Physical examination
Nursing diagnosis:
Impaired breathing pattern related to shortness of
breath
Anxiety associated with the unknown etiology of the
disease
Deficient knowledge related to unfamiliarity with
disease transmission information
42. Planning :
Assessing altered skin integrity risks, fatigue,
impaired comfort, gas exchange, nutritional needs, and
nausea.
Preventing the spread of coronavirus infection to the
patient’s family members, community, and healthcare
providers.
Reducing fever and Restoring normal respiratory
patterns.
Reducing anxiety.
43. Nursing interventions:
Monitor vital signs – temperature and respiratory rate,
Monitor O2 saturation
Manage fever
Maintain respiratory isolation
Enforce strict hand hygiene
provide information related to disease condition
44. Evaluation
The patient successfully prevented the spread of
infection to family, the community, or to healthcare
staff.
The patient learned more about COVID-19 and its
management.
The patient had improved body temperature levels.
Restoration to normal breathing patterns.
Reduced anxiety.
45. Care of ventilated patient
Covid 19 can cause verious complications like ARDS,
Pneumonia , organ failure etc. this can lead to use of
mechanical ventilation to the patient.
For the care of ventilated patient , we should have
enough knowledge regarding the mechanical
ventilation
Nursing care related to ventilated patient are:
46. Maintain ventilator settings
Maintain sealed system between ventilator and client so that
volume to be delivered is kept constant and air is not lost
around tubing accomplished by inflating the cuff of ET tube.
Prevent high pressure alarm
Perform suction as needed, use bite block if the patient is
biting ET tube
Consult with the health care provider about need for sedative
or neuromuscular blocking agent if patient seems to fight
ventilator.
47. Ascess for signs of respiratory insufficency ie adventitious
breath sound , hypoventilation , cynosis
Maintain PEEP to alveoli open , increasing functional
residual capacity .
Check pulse oximeter and blood gases to determine
effectiveness of ventilation.
Establish means of communication because patient will be
unable to speak while in ventilator.
Provide oral care and suction oral cavity as needed.
Pariticipate with respiratory therapist to gradually increase
spontaneous breathing trials to wean hemodynamically
stable client from ventilator.
