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Nursing Care of the Critically-Ill COVID Patients
Medical Intensive Care Unit (MICU) - correct answer designed to cater critically ill COVID patients. CCU - correct answer designed to cater critically ill COVID patients. SARS-CoV- 2 - correct answer leads to the state of hyperinflammation and hypercoagulability Multiple organ dysfunction: - correct answer most commonly affecting the lungs, kidneys, & heart A. Baumannii - correct answer w/c is panresistant to antibiotics. dexamethasone - correct answer to control inflammatory effects of COVID- 19 Colistin - correct answer pt is panresistant (resistant to antimicrobials, antibiotics) Remdesivir - correct answer the only approved drug tx of COVID- 19 transaminitis - correct answer - Elevated liver enzymes d/t legalon Tocilizumab - correct answer Interleukin 6 inhibitor โ lowers cytokine storm Boltey's 5 Nursing strategies - correct answer prevent ventilator associated pneumonia Boltey's 5 Nursing strategies - correct answer 1. Minimize ventilator exposure Minimize ventilator exposure - correct answer - When mechanical ventilation can't be avoided, work to minimize its duration Minimize ventilator exposure - correct answer - Ventilator weaning protocols; or evidence-based care bundles (for example, the Awakening, Breathing, Coordination, Delirium, and Early mobility [ABCDE] bundle) Boltey's 5 Nursing strategies - correct answer Provide excellent oral hygiene care Provide excellent oral hygiene care - correct answer - Consider developing a unit-specific protocol Boltey's 5 Nursing strategies - correct answer 3. Coordinate care for subglottic suctioning
- Coordinate care for subglottic suctioning - correct answer - May special trach to allow aspiration of secretions
- Maintaining optimal positioning and encourage mobility - correct answer usually 30- 45 degrees.
- Ensure adequate staffing and HWE - correct answer - Administratively, ensure adequate staffing and healthy work environment optimum nurse:patient ratio - correct answer 1:1 or 1: IMPAIRED GAS EXCHANGE - correct answer - CHEST PHYSIOTHERAPY (CPT) CHEST PHYSIOTHERAPY (CPT) - correct answer - A group of treatments/techniques designed to improve respiratory efficiency CHEST PHYSIOTHERAPY (CPT) - correct answer promote expansion of the lungs CHEST PHYSIOTHERAPY (CPT) - correct answer strengthen respiratory muscles. CHEST PHYSIOTHERAPY (CPT) - correct answer eliminate secretions from the respiratory system CHEST PHYSIOTHERAPY (CPT) benefits - correct answer 1. Increased removal of airway secretions CHEST PHYSIOTHERAPY (CPT) benefits - correct answer 2. Decrease in the occurrence of ventilator-associated pneumonia CHEST PHYSIOTHERAPY (CPT) benefits - correct answer 3. Accelerated weaning from mechanical ventilation CHEST PHYSIOTHERAPY (CPT) benefits - correct answer 4. Accelerated ICU discharge INDICATIONS OF CPT - correct answer Cystic Fibrosis INDICATIONS OF CPT - correct answer Bronchiectasis INDICATIONS OF CPT - correct answer Atelectasis INDICATIONS OF CPT - correct answer Lung Abscess
HAPI Preventive Interventions Bundle - correct answer 2. Turning the patient every two hours HAPI Preventive Interventions Bundle - correct answer 3. Obtaining a nutritional consult HAPI Preventive Interventions Bundle - correct answer 4. Application of protective dressings to the sacral area, bilateral heels, and on body parts where medical devices are in use HAPI Preventive Interventions Bundle - correct answer 5. Use of air vented mattresses on top of regular mattresses HAPI Preventive Interventions Bundle - correct answer 6. Education and training to the staf Swimming / Freestyle Position - correct answer - Patients in standard prone position can be repositioned using the swimming position Swimming / Freestyle Position - correct answer - Alternate the position of the arms and direction of the head, in a manner that is similar to that of a freestyle swimmer Swimming / Freestyle Position - correct answer - Pressure points on the diagram correspond to the body surface face the mattress CV MANAGEMENT - correct answer - hyperinflammation and hypercoagulability CV management - correct answer hyperinflammation and hypercoagulability COVID CV management - correct answer โ Vasopressin: norepinephrine COVID CV management - correct answer โ Intubate pt COVID CV management - correct answer โ BT COVID CV management - correct answer โ Veno-arterial ecmo COVID CV management - correct answer โ Thrombolysis COVID CV management - correct answer โ CV monitoring COVID CV management - correct answer โ Antithrombotic therapy COVID CV management - correct answer โ Venous duplex UTZ
COVID CV management - correct answer โ Anticoagulants: enoxaparin, heparin COVID CV management - correct answer โ Sequential Compression Device - avoid DVT Renal Management - correct answer hemodialysis and hemoperfusion T - correct answer hemoperfusion and hemodialysis are DIFFERENT (t/f) Hemoperfusion - correct answer used to reabsorb and remove yung ating mga inflammatory markers particularly yung ating mga interleukins and reactive protein cytokine storm - correct answer - experience severe ARDS ventilator dyssynchrony: - correct answer hindi nila masabayan yung ventilator โ need to sedate (pts w/ cytokine storm) usual precursors of pts who experience cytokine storm - correct answer sars cov 2 infection, ang receptor nya ay yung ace II receptor natin pinakatriggering factor cytokine storm - correct answer known hypertensive (uncontrolled usually), diabetic, obese Renmdesivir - correct answer antiviral; sya talaga pumupuksa kay covid; kay sars cov 2 Tocilizumab - correct answer interleukin 6 inhibitor day 21 - correct answer most critical day ng admission sa ICU ECMO machine - correct answer Extracorporeal Membrane Oxygenation ECMO machine - correct answer machine will be the one to breathe (hihinga) for them/ act as their lungs 2 Types of ECMO - correct answer - Veno-Venous ECMO Veno-Venous ECMO - correct answer - ikakabit ung isang ECMO sa Internal Jugular vein then sa femoral catheter nakaattach siya Veno-Venous ECMO - correct answer - the only affected organ is the lungs
12 POSSIBLE SYMPTOMS OF COVID- 19 - correct answer 11. Sore throat 12 POSSIBLE SYMPTOMS OF COVID- 19 - correct answer 12. Nausea or vomiting 12 POSSIBLE SYMPTOMS OF COVID- 19 - correct answer 13. Diarrhea SARS - correct answer this virus causes inflammation SARS - correct answer it primarily affects or promotes hyperinflammation and hypercoagulability Patients with SARS-COV 2 - correct answer Initially affects lungs and GI tract โ once pt cannot control inflammatory response SARS-COV 2 MANAGEMENT - correct answer Monitor VS, O2 sat, BP ( SARS-COV 2 MANAGEMENT - correct answer โ Check temp if may fever SARS-COV 2 MANAGEMENT - correct answer โ Check O2 sat if it falls below 94% SARS-COV 2 MANAGEMENT - correct answer โ Check BP: Inflammation can cause vasodilation โ can go to sepsis โ septic shock SARS-COV 2 MANAGEMENT - correct answer Supportive respiratory and renal replacement therapy SARS-COV 2 MANAGEMENT - correct answer - Initially if Mild s/s: O2 therapy thru face mask
- Severe s/s: might need intubation Renal replacement therapy - correct answer if the pt has already experienced cytokine storm SARS-COV 2 MANAGEMENT - correct answer Maintain hydration and electrolyte balance Maintain hydration and electrolyte balance - correct answer โ Bc inflammation can cause dehydration Maintain hydration and electrolyte balance - correct answer โ inflammation can cause vasodilation โ BP will go down โ so promote hydration to help increase BP
Maintain hydration and electrolyte balance - correct answer โ Electrolyte balance: bc of GI s/sx (nausea, vomiting, diarrhea) โ pt may suffer from hypokalemia โ can result into acid base imbalance and heart problems, cardiac arrhythmias SARS-COV 2 MANAGEMENT - correct answer Maintaining nutrition & controlling fever and cough Nutrition - correct answer โ hypermetabolic state (high demand) โ control blood sugar erratic blood sugar levels - correct answer can lead to cytokine storm Maintaining nutrition & controlling fever and cough - correct answer โ Fever - TSB, cooling measures Maintaining nutrition & controlling fever and cough - correct answer - Mild case: Coughing exercise
- Severe case/intubated: suctioning, nebulization to loosen secretions, CPT measures COMMON MEDICATIONS: COVID19 - correct answer - Corticosteroid Corticosteroid - correct answer - Anti-inflammatory effect
- Dexamethasone Remdesivir and ribavirin - correct answer Inhibition of the RNA-dependent RNA polymerase Interferon therapy - correct answer inhibition of viral entry, transcription, replication, translation, assembly Protease Inhibitors (lopinavir/ ritonavir) - correct answer Inhibition of papain-like protease and 3C-like protease Hydroxy chloroquine and chloroquine - correct answer - Inhibition of endosomal acidification
- negatively influences virus-receptor binding
- interfere with the glycosylation of cellular receptors of SARS-CoV Oseltamivir - correct answer - Neuraminidase inhibitor Tocilizumab - correct answer - A recombinant monoclonal antibody that competitively inhibits the binding of IL-6 to its receptor Convalescent plasma - correct answer Neutralizing the SARS-CoV-2 antibodies
Septic shock - correct answer โ Hypotension, despite adequate fluid restriction SEPSIS - correct answer - 2 or more of the ff criteria (SIRS) + suspected or present source of infection source of infection - correct answer culture and sensitivity test RT PCR - correct answer Gold standard to determine presence of COVID SEVERE SEPSIS - correct answer - Septic + sxs of lactic acidosis SEVERE SEPSIS - correct answer - hypotension SEVERE SEPSIS - correct answer - manifestations of organ dysfunction SEPTIC SHOCK - correct answer - Severe sepsis + hypotension despite adequate fluid resuscitation COVID19 management - correct answer GOAL: To disrupt progression along the continuum of shock and MODS COVID19 management - correct answer 1. Ensuring hemodynamic stability hemodynamic stability - correct answer โ Monitor for CVP or sometimes, the Pulmonary Capillary Wedge Pressure to identify if the px is already experiencing hypovolemia hemodynamic stability - correct answer โ Leg raising if px is hypotensive to promote venous return of the blood hemodynamic stability - correct answer โ IV fluid therapy to ensure fluid replacement COVID19 management - correct answer 2. Vasopressors and Inotropes Vasopressors and Inotropes - correct answer - promote tissue oxygenation by increasing CO Inotropes - correct answer to enhance cardiac contractility Vasopressors - correct answer to help inc BP; for hypotension COVID19 management - correct answer 3. Primary source control
Primary source control - correct answer - Halt the primary source control of SIRS COVID19 management - correct answer 4. Broad spectrum antibiotics Broad spectrum antibiotics - correct answer - Esp if swab test / C&S was not conducted COVID19 management - correct answer 5. Glucocorticoids
- Glucocorticoids - correct answer โ Inflammatory response โ anti-inflammatory drugs โ Dexamethasone - primary steroids given COVID19 management - correct answer 6. Blood glucose control
- Blood glucose control - correct answer will further promote inflammatory response CYTOKINE STORM - correct answer - Can happen anytime within the continuum of SIRS CYTOKINE STORM - correct answer - Cytokines are overproduced everytime that you experience an inflammatory response CYTOKINE STORM - correct answer - Anything that is in excess or deficient can promote detriorioration in the body SIRS & Cytokine Storm - correct answer precursor to MODS Cytokine Storm outcome - correct answer โ ARDS โ Multi-organ failure โ Hyperinflammation Syndrome โ Death False - correct answer all SIRS lead to Cytokine Storm (t/f) CYTOKINE STORM risk factors - correct answer โ Immunocompromised โ With CV problems โ With comorbidities CYTOKINE STORM clinical features - correct answer โ Fever โ Impaired hematopoietic function โ Disseminated intravascular coagulation
MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS) risk factors - correct answer โ Elderly MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS) risk factors - correct answer โ Chronic Illnesses MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS) risk factors - correct answer โ Malnourished MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS) risk factors - correct answer โ Cancer MULTIPLE ORGAN DYSFUNCTION SYNDROME (MODS) risk factors - correct answer โ Prolonged or exaggerated inflammatory responses (severe trauma and sepsis) MODS classification (primary) - correct answer - A well defined insult in which organ dysfunction occurs early and it is directly attributed to the insult itself MODS classification (primary) - correct answer - May or may not progress to SIRS MODS classification (primary) - correct answer - Example: Pulmonary injury MODS classification (secondary) - correct answer - Consequence of widespread systemic inflammation MODS classification (secondary) - correct answer - develops after a variety of insult MODS classification (secondary) - correct answer - results in dysfunction of organs not involved in the initial result MODS classification (secondary) - correct answer โ "Consequence of widespread systemic inflammation" MODS classification (secondary) - correct answer - Client enters HYPERMETABOLIC state 21 days - correct answer Ave stay in hospital of a pt with MODS death cannot be stopped anymore, death is imminent - correct answer If more than 21 - 28 days MODS classification (secondary) - correct answer - Occurs with SEPTIC SHOCK and ARDS SIRS - correct answer precursor of MOD
SIRS - correct answer an exaggerated inflammatory response, affects primarily the respiratory system (if the infection is respiratory in nature) โ ARDS manifestation MODS manifestations (onset) - correct answer โ Low grade fever โ Tachycardia โ Dyspnea with patchy infiltrates in x-ray MODS manifestations (onset) - correct answer โ Altered mental status โ NORMAL hepatic and renal function โ Increased blood sugar MODS manifestations (BETWEEN 7 TO 10 DAYS) - correct answer โ Elevated bilirubin โ Elevated creatinine โ Elevated blood sugar and lactate lactic acidosis - correct answer septic shock Severe sepsis - correct answer - can manifest around 7-10 days upon admission of the pt in the ICU MODS manifestations (BETWEEN 7 TO 10 DAYS) - correct answer โ Decreased serum albumin โ Bacteremia โ Delayed wound healing MODS manifestations (BETWEEN DAY 14 TO 21) - correct answer โ Unstable appears close to death MODS manifestations (BETWEEN DAY 14 TO 21) - correct answer โ Loss of consciousness MODS manifestations (BETWEEN DAY 14 TO 21) - correct answer โ Renal failure worsens MODS manifestations (BETWEEN DAY 14 TO 21) - correct answer โ Lactic acidosis MODS mgt - correct answer 1. RESTRAIN THE ACTIVATORS RESTRAIN THE ACTIVATORS - correct answer โ Antibiotics โ Incision and drainage for wound
