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Home  Notes  Infectious Diseases

Notes Infectious Diseases

Coronavirus Disease 2019 (COVID-19)

By Marianne Belleza, R.N. - Updated on March 28, 2020  5
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In this study guide, learn all the important information about Coronavirus 2019 (COVID-19) including how it
is transmitted, its symptoms, how it is diagnosed, its preventive measures, nursing management, and

advice for the health workers.

Coronavirus Disease 2019 (COVID-19) identified as the cause of an outbreak first discovered at a local
seafood /wild animal market in Wuhan, China. The COVID-19 has been declared by the World Health
Organization (WHO) as a pandemic where it is reported that around 500,000 people are affected in more
than 100 countries around the world.

1. What is Coronavirus 2019 (COVID-19)?

2. Pathophysiology
3. Causes
4. Statistics and Incidences
5. Clinical Manifestations
6. Assessment and Diagnostic Findings
7. Medical Management
7.1. For Healthcare Workers
7.2. Pharmacologic Management
8. Nursing Management
8.1. Nursing Assessment
8.2. Nursing Diagnosis
8.3. Nursing Care Planning and Goals
8.4. Nursing Interventions
8.5. Evaluation
8.6. Documentation Guidelines
9. References

What is Coronavirus 2019 (COVID-19)?

Coronavirus 2019 (COVID-19) is a disease caused by a new strain of coronavirus called severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) that can cause symptoms from common cold to more
severe disease such as pneumonia and eventually it may lead to death especially those in vulnerable
groups such as the elderly, the very young, and people with an underlying chronic health condition.

Limited information is available to characterize the spectrum of clinical illness associated with COVID-
19.
The CDC clinical criteria for a COVID-19 patient under investigation (PUI) have been developed based on
what is known about MERS-CoV and SARS-CoV and are subject to change as additional information
becomes available.
 Early on, many of the patients in the outbreak in Wuhan, China reportedly had some link to a large
seafood and animal market, suggesting animal-to-person spread.
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However, a growing number of patients reportedly have not had exposure to animal markets, indicating
person-to-person spread is occurring.

Pathophysiology
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Coronaviruses are common in many different species of animals, including bats, camels, cats, and cattle.

COVID-19 (Coronavirus Disease 19) - February Update - causes, symptoms, di…

di…

COVID-19 is a betacoronavirus, like MERS and SARS, all of which have their origins in bats.
The sequences from US patients are similar to the one that China initially posted, suggesting a likely
single, recent emergence of this virus from an animal reservoir.
When person-to-person spread has occurred with MERS and SARS, it is thought to have happened
mainly via respiratory droplets produced when an infected person sneezes, similar to how influenza and
other respiratory pathogens spread.
 Most coronaviruses infect animals, but not people; in the future, one or more of these other
coronaviruses could potentially evolve and spread to humans, as has happened in the past.
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Many of the patients have direct or indirect contact with the Wuhan Huanan Seafood Wholesale Market
that is believed to be the original place of the outbreak of COVID-19.
However, the transmission of COVID-19 from fish to humans is unlikely.
The COVID-19 and fish coronaviruses such as Beluga Whale CoV/SW1 belong to different genera and
apparently have different host ranges.
As the Wuhan market seafood market also sells other animals, the natural host of COVID-19 awaits to
be identified.
Due to the possibility of transmission from animal to human, CoVs in livestock and other animals
including bats and wild animals sold on the market should be constantly monitored.
In addition, more and more evidence indicates the new virus COVID-19 is spread via the route of human-
to-human transmission because there are infections of people who did not visit Wuhan but had close
contact with family members who had visited Wuhan and got infected.

Causes
Coronaviruses are named for the crown-like spikes on their surface.

There are four main sub-groupings of coronaviruses, known as alpha, beta, gamma, and delta.
Human coronaviruses were first identified in the mid-1960s.
The seven coronaviruses that can infect people are 229E (alpha coronavirus), NL63 (alpha coronavirus,
OC43 (beta coronavirus), and HKU1 (beta coronavirus).
Other human coronaviruses are MERS-CoV, SARS-CoV, and COVID-19.

Statistics and Incidences

An outbreak of pneumonia of unknown etiology in Wuhan City was initially reported to WHO on December
31, 2019.

For complete and current statistics with live updates, visit:

https://www.worldometers.info/coronavirus/
 Chinese health authorities have confirmed more than 40
infections with a novel coronavirus as the cause of the

outbreak.
Reportedly, most patients had epidemiological links to a
large seafood and animal market; the market was
closed on January 1, 2020.
Globally, there are 597,250 confirmed cases and 27,365
deaths confirmed as of March 28, 2020. Health care personnel transporting a patient
The United States has the highest number of at the Wuhan Red Cross Hospital in Wuhan,
coronavirus cases in the world surpassing Italy and China. Image source: Hector
China with more than 100,000 cases (New York City Retamal/Agence France-Presse — Getty
being the most affected). Images
Italy has 86,498 cases and a death toll of 9,134 as of
March 28, 2020.
China has a number of cases with 81,394 and 3,295 deaths as of March 28, 2020.
Spain is the fourth-highest in the world (65,719 cases) and it has the second-highest number of deaths
(5,138 deaths) as of March 28, 2020 .
Most countries have declared nationwide lockdowns and have restricted travel.
International conveyance cases identified on the Diamond Princess cruise ship currently in Japanese
territorial waters have reached 634.

Clinical Manifestations
For confirmed COVID-19 infections, reported illnesses have ranged from people being mildly sick to people
being severely ill and dying; these symptoms may appear in as few as 2 days or as long as 14 after
exposure based on what has been seen previously as the incubation period of MERS viruses.

Fever
Dry cough
Shortness of breath

Other symptoms may include:

Sore throat
Runny nose
Diarrhea
Fatigue/tiredness
 Difficulty of breathing (in severe cases)

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Assessment and Diagnostic Findings
At this time, diagnostic testing for COVID-19 can be conducted only at CDC

To increase the likelihood of detecting infection, CDC

recommends collection of three specimen types: lower
respiratory, upper respiratory, and serum specimens for
testing.
CDC has deployed multidisciplinary teams to
Washington, Illinois, California, and Arizona to assist
health departments with clinical management, contact
tracing, and communications.
CDC has developed a real-time Reverse Transcription-
Laboratory professionals examine
Polymerase Chain Reaction (rRT-PCR) test that can
specimens inside a laboratory in Wuhan.
diagnose COVID-19 in respiratory serum samples from
Image via: China Daily/Reuters
clinical specimens.
Currently, testing for this virus must take place at CDC,
but in the coming days and weeks, CDC will share these tests with domestic and international partners.
CDC uploaded the entire genome of the virus from all five reported cases in the United States to
GenBank.
CDC is also growing the virus in cell culture, which is necessary for further studies, including for
additional genetic characterization.

Medical Management
The best way to prevent infection is to avoid being exposed to this coronavirus.

Hand hygiene. Wash hands often with soap and water

for at least 20 seconds; if water and soap are not
available, use an alcohol-based hand sanitizer.
Keep hands off your face. Avoid touching the eyes,
nose, and mouth with unwashed hands.
Maintain social distancing. Avoid close contact with
people at least 3 feet (1 meter) who are sick, and stay at
home when you are sick.
 Proper cough and sneeze etiquette. Cover your cough
Hand washing is considered as an important
or sneeze with a tissue, then throw the tissue in the
precautionary measure to prevent and slow
trash.
the spread of NCOV-2019. Image source:
Supportive care. People infected with COVID-19 should
Somerset Sentinel
receive supportive care to help relieve symptoms.
Severe cases. For severe cases, treatment should
include care to support vital organ functions.

For Healthcare Workers

Healthcare workers are the very people who will be working day-and-night to treat and assist coronavirus
patients are among the most exposed population for becoming infected. The protection of vulnerable
members is one of the priorities for the response to COVID19 outbreaks. Occupational health services in
healthcare facilities play a vital role in helping, supporting, and ensuring that workplaces are safe and
healthy and addressing health problems when they arise. WHO emphasizes the rights and responsibilities
of health workers, including explicit criteria required to preserve occupational safety and health.

Read more about WHO’s guidelines for health workers here.

Health worker rights include that employers and managers in health facilities:

Assume overall responsibility to ensure that all

necessary preventive and protective measures are taken
to minimize occupational safety and health risks.
Provide information, instruction, and training on
occupational safety and health, including;
Refresher training on infection prevention and
control (IPC)
Use, putting on, taking off and disposal of personal
protective equipment (PPE).
According to the CDC, the recommended
Provide adequate IPC and PPE supplies (masks, gloves,
PPE when caring for a patient with known or
goggles, gowns, hand sanitizer, soap and water,
suspected COVID-19 includes facemask or
cleaning supplies) in sufficient quantity to healthcare or
respirator, goggles, gloves, and gown. Image
other staff caring for suspected or confirmed COVID-19
source: Simon Maina/AFP via Getty Images
patients, such that workers do not incur expenses for
occupational safety and health requirements.
 Familiarize personnel with technical updates on COVID-19 and provide appropriate tools to assess,
triage, test and treat patients and to share infection prevention and control information with patients
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and the public.
As needed, provide appropriate security measures for personal safety.
Provide a blame-free environment for workers to report on incidents, such as exposures to blood or
bodily fluids from the respiratory system or to cases of violence, and to adopt measures for immediate
followup, including support to victims.
Advise workers on self-assessment, symptom reporting and staying home when ill.
Maintain appropriate working hours with breaks.
Consult with health workers on occupational safety and health aspects of their work and notify the
labor inspectorate of cases of occupational diseases.
Not be required to return to a work situation where there is continuing or serious danger to life or health,
until the employer has taken any necessary remedial action.
Allow workers to exercise the right to remove themselves from a work situation that they have
reasonable justification to believe presents an imminent and serious danger to their life or health. When
a health worker exercises this right, they shall be protected from any undue consequences.
Honor the right to compensation, rehabilitation, and curative services if infected with COVID-19
following exposure in the workplace. This would be considered occupational exposure and resulting
illness would be considered an occupational disease.
Provide access to mental health and counseling resources.
Enable co-operation between management and workers and/or their representatives.

Health workers should:

Follow established occupational safety and health

procedures, avoid exposing others to health and safety
risks and participate in employer-provided occupational
safety and health training.
Use provided protocols to assess, triage and treat
patients.
Treat patients with respect, compassion, and dignity.
Maintain patient confidentiality.
Swiftly follow established public health reporting
A pediatric nurse in Wuhan’s Children
procedures of suspected and confirmed cases.
Hospital is handling a baby who is diagnosed
Provide or reinforce accurate infection prevention and
with COVID-19. Image source: China Daily via
control and public health information, including to
Reuters
concerned people who have neither symptoms nor risk.
 Put on, use, take off and dispose of personal protective equipment properly.
Self-monitor for signs of illness and self-isolate or report the illness to managers, if it occurs.
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Advise management if they are experiencing signs of undue stress or mental health challenges that
require support interventions.
Report to their immediate supervisor any situation which they have reasonable justification to believe
presents an imminent and serious danger to life or health.

Pharmacologic Management
There is no specific antiviral medication yet is recommended for COVID-19 infection, and no current
vaccine to prevent it.

Nursing Management
Nursing management for patients with COVID-19 infection include the following:

Nursing Assessment
Assessment of a patient suspected of COVID-19 should include:

Travel history. Health care providers should obtain a

detailed travel history for patients being evaluated with
fever and acute respiratory illness.
Physical examination. Patients who have fever, cough,
and shortness of breath and who has traveled to Wuhan,
China recently must be placed under isolation
immediately.
A health officer uses a handheld infrared
thermometer on a passenger at the airport.
Nursing Diagnosis
Image source: Vatican news

Based on the assessment data, the major nursing

diagnosis for a patient with COVID-19 are:

Infection related to failure to avoid pathogen secondary to exposure to COVID-19.

Deficient knowledge related to unfamiliarity with disease transmission information.
Hyperthermia related to increase in metabolic rate.
Impaired breathing pattern related to shortness of breath.
Anxiety related to unknown etiology of the disease.
Nursing Care Planning and Goals
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The following are the major nursing care planning goals for COVID-19:

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Prevent the spread of infection.

Learn more about the disease and its management.
Improve body temperature levels.
Restore breathing pattern back to normal.
Reduce anxiety.

Nursing Interventions
Listed below are the nursing interventions for a patient diagnosed with COVID-19:

Monitor vital signs. Monitor the patient’s temperature; the infection usually begins with a high
temperature; monitor the respiratory rate of the patient as shortness of breath is another common
symptom.
Monitor O2 saturation. Monitor the patient’s O2 saturation because respiratory compromise results in
hypoxia.
Maintain respiratory isolation. Keep tissues at the patient’s bedside; dispose secretions properly;
intsruct the patient to cover mouth when coughing or sneezing; use masks, and advise those entering
the room to wear masks as well; place respiratory stickers on chart, linens, and so on.
Enforce strict hand hygiene. Teach the patient and folks to wash hands after coughing to reduce or
prevent the transmission of the virus.
Manage hyperthermia. Use appropriate therapy for elevated temperature to maintain normothermia
and reduce metabolic needs.
 Educate the patient and folks. Provide information on disease transmission, diagnostic testing, disease
process, complications, and protection from the virus.
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Evaluation
Nursing goals are met as evidenced by:

Patient was able to prevent the spread of infection.

Patient was able to learn more about the disease and its management.
Patient was able to improve body temperature levels.
Patient was able to restore breathing pattern back to normal.
Patient was able to reduce anxiety.

Documentation Guidelines
Documentation guidelines for a patient with COVID-19 include the following:

Individual findings, including factors affecting, interactions, nature of social exchanges, specifics of
individual behavior.
Cultural and religious beliefs, and expectations.
Plan of care.
Teaching plan.
Responses to interventions, teaching, and actions performed.
Attainment or progress toward the desired outcome.

Practice Quiz: Coronavirus 2019 (COVID-19)

Nursing practice questions for 2019 Novel Coronavirus (2019-nCoV). For more practice questions, visit our
NCLEX practice questions page.

EXAM MODE

In Exam Mode: All questions are shown but the results, answers, and rationales (if any) will only be
given after you’ve finished the quiz.

Practice Quiz: 2019 Novel Coronavirus (2019-nCoV)

 Start


PRACTICE MODE

Practice Mode: This is an interactive version of the Text Mode. All questions are given in a single
page and correct answers, rationales or explanations (if any) are immediately shown after you have
selected an answer. No time limit for this exam.

Practice Quiz: 2019 Novel Coronavirus (2019-nCoV)

Start

TEXT MODE

Text Mode: All questions and answers are given on a single page for reading and answering at your
own pace. Be sure to grab a pen and paper to write down your answers.

1. A client who has recently traveled to China comes to the emergency department (ED) with
increasing shortness of breath and is strongly suspected of having a COVID-19. Which of these
prescribed actions will you take first?

A. Place the client on contact and airborne precautions

B. Obtain blood, urine, and sputum for cultures
C. Administer methylprednisolone (Solu-Medrol) 1 gram/IV
D. Infuse normal saline at 100ml/hr

1. Answer: A. Place the client on contact and airborne precautions.

Option A: Since COVID-19 is a severe disease with a high mortality rate, the initial action should
be to protect other clients and health care workers by placing the client in isolation. If an airborne-
 agent isolation (negative pressure) room is not available in the ED, droplet precautions should be
initiated until the client can be moved to a negative-pressure room.
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Options B, C, and D: The other options should also be taken rapidly but are not as important as
preventing transmission of the disease.

2. You are preparing to leave the room after performing oral suctioning on a client who is on
contact and airborne precautions. In which order will you perform the following actions?

1. Take off the gown.

2. Remove N95 respirator.
3. Perform hand hygiene.
4. Take off goggles.
5. Remove gloves.

A. 5, 4, 1, 2, 3
B. 4, 5, 2, 1, 3
C. 1, 2, 4, 5, 3
D. 2, 4, 2, 1, 3

2. Answer: A. 5, 4, 1, 2, 3.

Option A: The sequence will prevent contact of the contaminated gloves and gowns with areas
(such as your hair) that cannot be easily cleaned after client contact and stop transmission of
microorganisms to you and your other clients.

3. A 10-year-old client contracted COVID-19 when traveling abroad with her parents. The nurse
knows she must put on personal protective equipment to protect herself while providing care.
Based on the mode of transmission, which personal protective should the nurse wear?

A. Gloves
B. Gown and gloves
C. Gown, gloves, and mask
D. Gown, gloves, mask, and eye goggles or eye shield

3. Answer D. Gown, gloves, mask, and eye goggles or eye shield.

 Option D: The transmission of COVID-19isn’t fully understood. Therefore, all modes of
transmission must be considered possible, including airborne, droplet, and direct contact with the

virus. For protection from contracting COVID-19, any health care worker providing care for a client
with COVID-19should wear a gown, gloves, mask, and eye goggles or an eye shield.

4. Which of the following is the most important purpose of handwashing?

A. To promote hand circulation

B. To prevent the transfer of microorganism
C. To avoid touching the client with a dirty hand
D. To provide comfort

4. Answer: B. To prevent the transfer of microorganisms.

Option B: Hand washing is the single most effective infection control measure.

5. The school nurse is asked which action will take to have the most impact on the incidence of
infectious diseases in school. The correct response is:

A. Grant written information about infection control to all parents

B. Ensure that students are immunized according to national guidelines
C. Make soap and water easily accessible in the classrooms
D. Educate students on how to cover their mouths when coughing

5. Answer: B. Ensure that students are immunized according to national guidelines.

Option B: Prioritization. The incidence of once-common infectious diseases like measles,

chickenpox, and mumps has been most effectively reduced by immunization of all school-aged
children.
Options A, C, and D: The other options are also important but will not have much impact as
immunization.

References
References and additional sources for COVID-19:
Centers for Disease Control and Prevention. Includes what you need to know about COVID-19, what to
do if you think you are sick and resources for businesses, schools, etc.

World Health Organization (WHO) Coronavirus Diseases 2019 (COVID-19) Outbreak. Main page of the
WHO for the COVID-19 disease. Includes everything you need to know about COVID-19 and WHO
recommendations for COVID-19.
Coronavirus Update Live Statistics. Worldwide stats for COVID-19 includes recoveries, deaths, and
active cases.
 

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Middle East Respiratory Syndrome Coronavirus (MERS-CoV) SARS-CoV Wuhan Coronavirus

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Marianne Belleza, R.N.

Marianne is a staff nurse during the day and a Nurseslabs writer at night. She is a registered nurse since 2015
and is currently working in a regional tertiary hospital and is finishing her Master's in Nursing this June. As an
outpatient department nurse, she is a seasoned nurse in providing health teachings to her patients making her
also an excellent study guide writer for student nurses. Marianne is also a mom of a toddler going through the
terrible twos and her free time is spent on reading books!

5 COMMENTS

shirley March 13, 2020 At 8:40 PM

Very nice, updating with current events, well done
Reply

Angela Wood March 13, 2020 At 10:02 PM

Great article!
Reply

Alin March 15, 2020 At 9:05 AM

Nice…. Got many knowledge
Reply

Amadou March 17, 2020 At 9:56 PM

Thanks… I have learned much things about COVID19
Reply
Elisa martinez March 20, 2020 At 7:50 PM

I’m an RN in California, and I’m also a dialysis pt, I’m struggling with the fact that my dialysis center is
not following CDC guidelines, for COVID 19, for infection control. For one, pts, visitors are all sitting next
to each other in the waiting area. Pts and visitors get screened for coronavirus, once they have entered
the door leading to the patient treatment area. Instead of prior to passing the door.

Patients are not instructed on washing hands and how hands should be washed, even though there is a
sign to wash hands but is not at eye level. Nor are they offered sanitizer. Also in the waiting area. I spoke
with the administrator, which is an LVN, the clinical coordinator which is an Rn(who is lower on the chain
of command), and the coordinator of operations( don’t know his credential) regarding my concerns that
guidelines are not being followed and pts were at risk. Told them they should be checking everyone at
main entrance and not when inside the treatment area. Separate the waiting area chairs, as much as
possible. Instruct pt verbally not only on signs but on proper handwashing and to demand hands to be
washed or use sanitizer before and after treatment.

I got upset because they said they couldn’t monitor everyone because not enough staff to do so. I got
upset and told them it was their responsibility to do so. They got upset at me and told me to leave. I left
but told them they will be liable and them will hear from my lawyer for telling me to leave for advocating
for myself and for other or

TS. As I Nurse it is my responsibility to do so. Tithe administrator and clinic coordinator followed to be
out to have me be dialyzed and said they will implement what I had suggested. I went back to get
dialyzed but called the health department the next day to file complaint. Even the health department
didn’t want to do much but offered to transfer me to another center. That really got me upset because I
told them that that action on their part would not solve the situation. And that it is there responsibility if
nothing was done, now that they were informed by a licensed professional.

It was to be taken seriously during the pandemic and when the President, Governor, CDC, WHO, have all
stated the seriousness of infection control. In order to try to prevent the spread and more deaths. What
do you think and did I follow the correct step. The Governor of California said today to first make the
person or facility what they are doing wrong, so they can correct the action and learn from it and they if
they continue with the same action, one should then notify the health department so they can then
investigate and have the license revoked. I’ve been dealing with this for two weeks. I have dialysis
tomorrow and if no changes I will have to proceed with further action. The health department told me I
should expect a call tomorrow. Wish me luck. I would like feedback and is any nurse has dealt with
similar issue.
Reply

Add something to the discussion. Leave a comment!

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