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Coordinating Care for Patients With COVID-19, Exams of Medical Sciences

A comprehensive overview of the management and care of patients with covid-19. It covers the classification of covid-19 patients based on symptom severity, risk factors for severe illness, transmission modes, personal protective equipment (ppe) requirements, diagnostic testing, outpatient management strategies, oxygen therapy options, mechanical ventilation considerations, prone positioning, and the importance of nutrition and self-care for healthcare providers. The document aims to equip healthcare professionals with the necessary knowledge and guidelines to effectively coordinate and deliver care for covid-19 patients, while also addressing the potential long-term impacts of the illness on patients, families, and society. With its detailed information on clinical manifestations, treatment modalities, and preventive measures, this document serves as a valuable resource for healthcare providers, researchers, and policymakers in the ongoing fight against the covid-19 pandemic.

Typology: Exams

2023/2024

Available from 08/27/2024

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Coordinating Care for Patients With COVID-19
Novel coronavirus is identified as - correct answer A severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2)
When did a large cluster of viral pneumonia cases begin to be reported in Wuhan, China - correct
answer December 2019
The World Health Organization declares pandemic on this date - correct answer March 11, 2020
Classification of COVID-19 Patients: *Asymptomatic* - correct answer COVID nucleic acid test
positive. Without any clinical symptoms and signs, and the chest imaging is normal
Classification of COVID-19 Patients: *Mild* - correct answer Symptoms of acute upper
respiratory tract infection (fever, fatigue, myalgia, cough, sore throat, runny nose, sneezing) or
digestive symptoms (nausea, vomiting, abdominal pain, diarrhea)
Classification of COVID-19 Patients: *Moderate* - correct answer Pneumonia (frequent fever,
cough) with no obvious hypoxemia, chest computed tomography imaging showing lesions
Classification of COVID-19 Patients: *Severe* - correct answer Pneumonia with hypoxemia
(SpO2 < 92%)
Classification of COVID-19 Patients: *Critical* - correct answer Acute respiratory distress
syndrome (ARDS); may also have shock, encephalopathy, myocardial injury, heart failure,
coagulation dysfunction, and acute kidney injury
Risk factors in determining severe illness include - correct answer Age
Comorbidities
Demographics
Comorbidities that increase the risk for severe illness include - correct answer • cardiovascular
disease
• diabetes mellitus
• hypertension, obesity
• chronic lung disease
• chronic kidney disease, cancer
• smoking
Droplets are produced during - correct answer • coughing
• sneezing
• laughing
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Coordinating Care for Patients With COVID- 19

Novel coronavirus is identified as - correct answer A severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) When did a large cluster of viral pneumonia cases begin to be reported in Wuhan, China - correct answer December 2019 The World Health Organization declares pandemic on this date - correct answer March 11, 2020 Classification of COVID-19 Patients: Asymptomatic - correct answer COVID nucleic acid test positive. Without any clinical symptoms and signs, and the chest imaging is normal Classification of COVID-19 Patients: Mild - correct answer Symptoms of acute upper respiratory tract infection (fever, fatigue, myalgia, cough, sore throat, runny nose, sneezing) or digestive symptoms (nausea, vomiting, abdominal pain, diarrhea) Classification of COVID-19 Patients: Moderate - correct answer Pneumonia (frequent fever, cough) with no obvious hypoxemia, chest computed tomography imaging showing lesions Classification of COVID-19 Patients: Severe - correct answer Pneumonia with hypoxemia (SpO2 < 92%) Classification of COVID-19 Patients: Critical - correct answer Acute respiratory distress syndrome (ARDS); may also have shock, encephalopathy, myocardial injury, heart failure, coagulation dysfunction, and acute kidney injury Risk factors in determining severe illness include - correct answer Age Comorbidities Demographics Comorbidities that increase the risk for severe illness include - correct answer • cardiovascular disease

  • diabetes mellitus
  • hypertension, obesity
  • chronic lung disease
  • chronic kidney disease, cancer
  • smoking Droplets are produced during - correct answer • coughing
  • sneezing
  • laughing
  • singing
  • talking Pathophysiology: Transmission - correct answer Direct transmission from one person to another is thought to be the primary means of SARS-CoV-2 transmission Contact and droplet transmissions are the highest contributors to viral spread; there is evidence that the virus can be aerosolized Indirect contact transmission: - correct answer SARS-CoV-2 present on surfaces through human contamination can be transferred to the mucus membranes of the mouth, eyes, or nose Aerosolizing Procedures - correct answer It is recommended that airborne precautions be used during aerosol-generating procedures such as intubations, tracheostomies, and bronchial lavage. If given orders for Aerosolizing Procedures - correct answer Avoid aerosolized interventions, nebulizers, incentive spirometer, flutter valve, and suctioning without a closed system because of potential spread of the virus PPE required for aerosolized procedures - correct answer Wear airborne, contact, and droplet personal protective equipment. Recommended equipment includes fitted respirator masks (N95 respirator or powered air-purifying respirator [PAPR]), face shield, eye protection, gloves, and gown Recommended PPE for COVID—19 Positive Patients - correct answer Fitted respirator mask:
  • N95 respirator
  • Powered air-purifying respirator
  • Elastomeric respirator Eye protection Face shield Gloves Gown Recommended PPE for All Other Patients - correct answer • Surgical mask
  • Face shield
  • Gloves Negative Pressure Rooms - correct answer • Confirmed COVID-19 patients should be placed in negative pressure rooms
  • Isolation technique and ventilation system
  • Prevents contaminated air flow from inside the room to escape outside the room
  • Telehealth
  • Testing
  • Management of all outpatients should include reinforcement of infection control practices such as self-isolation, hand hygiene, and use of masks in communal areas
  • Patients should be educated on symptom management and recovery expectations Where available, dedicated housing units should be provided for people with COVID-19 that do not require hospitalization but are unable to self-quarantine due to factors such as living with high- risk individuals, living in multi-generational housing, or experiencing homelessness Isolation at Home—Special Precautions to Prevent Spread of Infection - correct answer • Prevent potential transmission among family members
  • Teach importance of hand hygiene, social distancing, face mask use, avoiding touching face
  • Consider not sharing commonly shared items such as utensils, plates, glasses, cups
  • If possible, have separate bathrooms, bedrooms
  • If not able to isolate from family members, teach importance of cleaning environment, hand hygiene, social distancing Inpatient Management - correct answer • Oxygen therapy
  • Mechanical ventilation
  • Prone positioning
  • Extracorporeal membrane oxygenation (ECMO)
  • Tracheostomy Oxygen Therapy (limited in the effort to minimize aerosolization) - correct answer • Nasal cannula
  • High-flow nasal cannula (HFNC)
  • Noninvasive ventilation (NIV) Nasal cannula - correct answer The first option for oxygen delivery, although the use of a bubble humidifier is discouraged. Even though this low-flow oxygen modality is low risk for aerosolization of the virus, many experts choose to place a droplet or surgical mask over the patient's nose and mouth, especially during transport or when staff are in the room. High-flow nasal cannula (HFNC) - correct answer A type of nasal oxygen delivery system that entrains a specific percentage of oxygen into a high flow current of ambient air delivering 24 to 100% oxygen at rates of 20 to 60L/m. This high rate of oxygen flow can "wash out" the dead space in the patient's airways, making it slightly easier to exchange CO2. It also delivers, with a snug fitting nasal cannula and closed mouth, about 1 cm H2O of positive end expiratory pressure (PEEP) per 10L/m of flow, increasing the surface area in the lung for oxygen delivery and exchange by decreasing atelectasis Noninvasive ventilation (NIV) - correct answer Like CPAP or BIPAP, can deliver high concentrations of oxygen to the patient, and in the case of BIPAP it can also help with ventilation.

It is important to note, that assisting the patient with high levels of inspiratory pressure on BiPAP can increase tidal volumes to a deleterious level and cause ventilator associated lung injury. The decision to try HFNC or NIV is best made by an interprofessional team, including respiratory therapists, based upon an understanding of the benefits and drawbacks for each therapy. Mechanical Ventilation - correct answer • The decision to intubate a patient who is rapidly deteriorating should never be delayed

  • Ventilator management of the COVID-19 patient follows similar principles for patients with ARDS caused by viral pneumonia
  • Intubation should be done early, while the patient still has significant pulmonary reserve. This is because during intubation the patient will be subjected to paralysis, which will cause derecruitment, or severe atelectasis, of lung tissue, and apnea, because bag valve mask ventilation is not being utilized.
  • The minimum number of staff should be in the room during the intubation, as this is a procedure that has a high risk of aerosolization. Prone Positioning - correct answer • Prone positioning of awake, nonintubated patients is shown to increase peripheral oxygen saturation
  • Prone position has been used therapeutically to treat hypoxemia in ARDS
  • When a patient is proned, the aerated upper part of the lung is placed below the areas of atelectasis and fluid accumulation, better matching aeration to perfusion
  • Patients should be placed in a position that facilitates expansion of lungs.
  • Patient head elevated greater than 30 degrees is shown to prevent ventilator associated pneumonias in ventilated patients and keeps the abdominal organs from pressing on the diaphragm. Extracorporeal Membrane Oxygenation (ECMO) - correct answer • Severe ARDS often leads to very "stiff" (non-compliant) lungs
  • Even with very low tidal volumes, lung pressures increase to dangerous level
  • Ventilation and CO2 exchange can become a significant challenge
  • This therapy uses a large double lumen cannula placed in a central vein to remove blood and perform the gas exchange function of the lungs in a circuit outside the body. The blood is oxygenated and then CO2 is removed, then the blood is returned to the body Medications - correct answer • Antipyretics
  • Anticoagulants
  • Pulmonary vasodilators
  • Glucocorticoids
  • Antiviral
  • Monoclonal antibody therapy
  • Convalescent plasma
  • Interleukin-6 (IL-6)
  • Antimalarial
  • Vaccines
  • Use moldable pillow for face, creating divot for ear, nose, and tube
  • Position bed in reverse Trendelenburg to elevate head
  • Turn patient at least every 4 hours to avoid pressure ulcer
  • Feed patient if tolerated; usually lower rates up to 20 mL/hr Post-intensive care syndrome (PICS) - correct answer ‒ Cognitive effects ‒ Emotional challenges ‒ Physical weakness ‒ Post-traumatic stress disorder (PTSD) Interventions required to sedate and chemically paralyze patients can lead to: - correct answer ‒ Delirium ‒ Anxiety ‒ Depression ‒ Confusion ‒ Cognitive deficits ‒ Muscle loss ‒ Weakness Evaluating Care Outcomes - correct answer • Impact of social isolation from friends and family
  • Patient discharge to rehabilitation centers or skilled nursing centers can be altered
  • Longer inpatient hospitalization or delay in rehabilitation
  • Long-term impact of COVID-19 is still under investigation
  • COVID-19 is not solely a respiratory illness and has systemic impacts
  • As the pandemic continues, more information on the impact of illness on patient, family, and society will be discovered Nurse Self-Care • Foster self-care by: - correct answer ‒ Reconnecting with friends and family via phone calls or letters ‒ Reading a book ‒ Planting a garden ‒ Eating healthy ‒ Laughing with friends ‒ Making a list of things one is thankful for ‒ Learning something new