A Case Study on a Past COVID- 19 Patient

A Thesis
Presented to
The Faculty of the Senior High School Department
SCHOOL OF ST. JOSEPH THE WORKER
Echague, Isabela

In Partial Fulfillment of the Requirements for the subject

INQUIRY, INVESTIGATION, AND IMMERSION

By
Santiago, Angel Gabrielle
Feliciano, Ma. Angela
Mamuri, Hanzelma
Echorre, Ana-lee
Galpao, Melisa
Yuson, Christine
Bassig, Jared
Ortiz, Danilo
Fanio, Henry

APRIL 2021
 APPROVAL SHEET

The thesis attached hereto, entitled “A CASE STUDY ON A PAST COVID- 19

PATIENT”, prepared and submitted by ANGEL GABRIELLE SANTIAGO, MA. ANGELA

FELICIANO, HANZELMA MAMURI, ANA- LEE ECHORRE, MELISSA GALPAO,

CHRISTINE JOY YUSON, DANILO ORTIZ JR., JARRED BASSIG AND HENRY

FANIO in partial fulfillment of the requirements for the subject INQUIRY, INVESTIGATION,

AND IMMERSION, is hereby endorsed.

ABRAHAM P. NICOLAS, RN, MSN

Research Adviser

Approved and accepted as partial fulfillment of the requirements for the subject

INQUIRY, INVESTIGATION, AND IMMERSION.

PANEL OF EXAMINERS
PRECIOUS LYRA GRABADOR
Member
ABRAHAM P. NICOLAS JOYCE N. ABASCO
Member Member

KRISTIAN R. VINO MICHAEL A. ALINDADA

Member Member

ABEGAIL A. RENIEGO BARTOLOME A. CARIAGA

Member Member

Approved :

CHEN R. FIGURACION TERESITA N. PAGADOR, MAEd

SHS Academic Coordinator School Principal
 ACKNOWLEDGEMENT

The researcher wishes to extend sincerest thanks and appreciation to the following

persons who shared their support in the completion of this study. Truly, this study reflects their

assistance, utmost concern and full cooperation.

Mrs. Teresita N. Pagador, the School Principal of School of St. Joseph the Worker, for

her motivation and encouragement to finish our research study.

Abraham P. Nicolas and Kristian Robert I. Vino, our research advisers for the invaluable

support, guidance and comments in reviewing the manuscript and their statistical expertise.

Our parents, for their financial and moral support and understanding in making our

research.

Above all, to the Creator for His unending guidance and blessings in the competition of

this achievement.
 DEDICATION

We wholeheartedly dedicate this research to our community and environment to spread

knowledge and awareness to the readers in regards to COVID 19. We also dedicated this

research to our loving parents, research advisers, friends and Father almighty. Without their love

and support this work would not have been made.

 TABLE OF CONTENTS

TITLE PAGE ……………………………………………………………………………………. i

APPROVAL SHEET……………………………………………………………………………...ii
ACKNOWLEDGEMENT………………………………………………………………………..iii
DEDICATION…………………………………………………………………………………....iv
TABLE OF CONTENTS………………………………………………………………………….v
LIST OF TABLES………………………………………………………………………………..vi
LIST OF FIGURES……………………………………………………………………………...vii
ABSTRACT…………………………………………………………………………………….viii
CHAPTER I………………………………………………………………………………………1
Introduction
CHAPTER II……………………………………………………………………………………...2
Demographic Profile
CHAPTER III……………………………………………………………………………………..3
MEDICAL HISTORY
Reason for Seeking Healthcare
History of Present Illness
Past Health History
Immunization History
Allergies
Home Medication/Alternative Medicines
CHAPTER IV……………………………………………………………………………………..4
Physical Assessment
CHAPTER V………………………………………………………………………………….......5
GORDON’S FUNCTIONAL HEALTH PATTERN
Health Perception
Nutritional Metabolic
Elimination
 Activity/Exercise
Sleep/Rest
Self-Perception and Self-Concept
Role Relationship
Sexuality Reproductive
Coping/Stress Tolerance
Values/Beliefs
CHAPTER VI……………………………………………………………………………………..6
Laboratory Result
CHAPTER VII……………………………………………………………………………………7
ANATOMY AND PHYSIOLOGY
Respiratory System
Immunity
CHAPTER VIII………………………………………………………………………………….8
Pathophysiology
CHAPTER IX……………………………………………………………………………………9
Pharmacology
CHAPTER X…………………………………………………………………………………...10
Nursing Care Plan
CHAPTER XI…………………………………………………………………………………..11
Discharge Plan
CHAPTER XII…………………………………………………………………………………12
Psychological Assessment and Evaluation
Recommendations
REFERENCES
APPENDICES
 LIST OF TABLES

PHYSICAL ASSESSMENT

LABORATORY TEST

PHARMACOLOGY

NURSING CARE PLAN

DISCHARGE PLAN
 LIST OF FIGURES

DIAGRAM OF THE RESPIRATORY SYSTEM

PATHOPHYSIOLOGY
 ABSTRACT

A coronavirus is a kind of common virus that causes an infection in your nose, sinuses, or

upper throat. The virus that causes COVID-19 is mainly transmitted through droplets generated

when an infected person coughs, sneezes, or exhales. These droplets are too heavy to hang in the

air, and quickly fall on floors or surfaces.

You can be infected by breathing in the virus if you are within close proximity of

someone who has COVID-19, or by touching a contaminated surface and then your eyes, nose or

mouth.

The coronavirus disease 2019 emerged in Wuhan, China at the end of 2019. Since then,

it has spread to 200 countries and has been declared a global pandemic by the World Health

Organization. Lockdown measures were perceived as necessary to curb the spread of the virus as

rapid human to human transmission occurred and much about the virus remained unknown.

Due to the obscurity of this novel virus, there has been a lot of confusion and

misunderstanding about the virus itself, how it can spread and the necessary precautions that

should be taken to prevent infection. This becomes increasingly challenging with the vast

amount of misinformation and disinformation shared on social media that is clouding people’s

understanding of COVID- 19.

It is highly infectious and has spread widely around the world. In this study, we report a

24 year- old female who got infected with COVID- 19. The aim of this study was to describe the

clinical outcomes and share knowledge about a person who got infected with the virus.
 CHAPTER I

INTRODUCTION

A coronavirus is a kind of common virus that causes an infection in your nose, sinuses,

or upper throat. The virus that causes COVID-19 is mainly transmitted through droplets

generated when an infected person coughs, sneezes, or exhales. These droplets are too heavy to

hang in the air, and quickly fall on floors or surfaces.

You can be infected by breathing in the virus if you are within close proximity of

someone who has COVID-19, or by touching a contaminated surface and then your eyes, nose or

mouth.

The first human cases of COVID-19, the disease caused by the novel coronavirus causing

COVID-19, were first reported by officials in Wuhan City, China, in december 2019.

Retrospective investigations by Chinese authorities have identified human cases with onset of

symptoms in early December 2019. While some of the earliest known had a link to the wholesale

food market in Wuhan, some did not. Many of the initial patients were either stall owners,

market employees, or regular visitors to this market. The market in Wuhan city was the source of

this outbreak or played a role in the initial amplification of the outbreak. The market was closed

on 1 January 2020.

The coronavirus disease 2019 emerged in Wuhan, China at the end of 2019. Since then, it

has spread to 200 countries and has been declared a global pandemic by the World Health

Organization. Lockdown measures were perceived as necessary to curb the spread of the virus as

rapid human to human transmission occurred and much about the virus remained unknown.
 Due to the obscurity of this novel virus, there has been a lot of confusion and

misunderstanding about the virus itself, how it can spread and the necessary precautions that

should be taken to prevent infection. This becomes increasingly challenging with the vast

amount of misinformation and disinformation shared on social media that is clouding people’s

understanding of COVID- 19.

The COVID-19 pandemic in Cagayan Valley is part of the worldwide pandemic of

coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus

2 (SARS-CoV-2). The virus reached Cagayan Valley on March 21, 2020, when the first case of

the disease was confirmed in Tuguegarao. All provinces have confirmed at least one COVID-19

case, with Batanes being the last province to confirm a COVID-19 case on September 28, 2020.

Cagayan Valley confirmed its first case on March 21, 2020, that of a 44-year-old male who

had traveled via bus to Tuguegarao. The man arrived in Cagayan on March 11 and was treated at

the Cagayan Valley Medical Center. Further cases were recorded in the province as well as in

Isabela and Nueva Vizcaya.

By April 21, there were no active cases in Cagayan Valley, with a total of 27 confirmed in the

region, among which one had died. Cagayan Valley treated an imported case recorded as a case

of the neighboring Cordilleras, that of a man from Lamut, Ifugao who was transferred from the

Panopdopan District Hospital to the Region-2 Trauma and Medical Center in Bayombong,

Nueva Vizcaya by April 26. The man's case was also the first confirmed case of Ifugao province.

Quirino recorded its first case on August 12 after provincial Governor Dakila Carlo Cua's

househelp tested positive for COVID-19 despite having no previous travel history to known

affected areas.
Batanes was the last province in the region and the whole Philippines. It confirmed its first case

on September 28. The case was that of a locally stranded individual who was brought home via a

military helicopter on September 22. The patient was asymptomatic.

The Department of Health, the National Task Force Against COVID-19 (NTF), and the

Food and Drug Administration (FDA) appreciate the COVID-19 vaccine initiatives of the Local

Government Units (LGUs). However, as mentioned by the Vaccine Czar Secretary Carlito

Galvez, LGUs cannot procure and roll out COVID-19 vaccines on their own. This must be

coordinated with the national government, through the NTF and the DOH in a tripartite

agreement involving local governments and pharmaceutical companies. This is meant to align

the efforts of LGUs with the vaccine initiative of the National Government which integrates and

consolidates all resources and initiatives.

The FDA also clarifies that the EUA issued by the Philippine FDA does not cover the

commercial use of the vaccines. This means that manufacturers cannot sell directly to the LGUs

nor to any entity, unless they are under the vaccine initiative of the National Government.

Further, the DOH recognizes the equity issues raised on the distribution of the vaccine.

The public that the National Government adheres to the principle of equity where delivery of

services are biased towards the vulnerable and the disadvantaged.

The Philippine Government, through a coordinated network of stakeholders composed of

National Government Agencies and private sector partners, conducted a full-scale simulation

exercise of vaccine deployment to showcase the country’s readiness for COVID-19 vaccine

deployment. The simulation exercise demonstrated the general function and responsibilities of
the national and regional vaccine operations centers and stakeholders, and aimed to identify

potential challenges in the vaccine delivery, handling, transport, and cold chain management, in

anticipation of the expected arrival of Pfizer vaccines from COVAX Facility by mid of February.

The simulation exercise displayed how vaccines will be received upon arrival at the

Ninoy Aquino International Airport Terminal 2, transported to its temporary holding at the

Research Institute for Tropical Medicine to its deployment to designated hospitals in the

Philippine General Hospital, Lung Center of the Philippines, Dr. Jose N. Rodriguez Hospital,

Vicente Sotto Memorial Medical Center and the Southern Philippines Medical Center.

Upon deplaning, the vaccines, as pre-cleared by Customs, will be loaded to a reefer van.

The van will transport the vaccines to the RITM Storage and Distribution Department where it

will be inspected and stored. Once the vaccines have been properly allocated, a reefer van will

once again pick up the vaccine trays and ship the vaccines to the designated hospitals. If the said

designated hospital is off the island of Luzon, the vaccines will be transported to NAIA and

flown to the receiving airport.

More than 480,000 doses of AstraZeneca vaccines arrived in the Philippines from the

COVAX Facility, the international partnership established to ensure equitable distribution of

COVID-19 vaccines around the world. The Philippines is among the first countries in Southeast

Asia to receive vaccines from the COVAX Facility. COVAX is co-led by Gavi, the Vaccine

Alliance, the World Health Organization and the Coalition for Epidemic Preparedness

Innovations, working in partnership with UNICEF as well as the World Bank, civil society

organizations, manufacturers, and others.

 Officials from the Philippines Inter-Agency Task Force on the Management of Emerging

Infectious Diseases, Department of Health, World Health Organization and UNICEF Philippines

received the vaccine doses at the Ninoy Aquino International Airport. The Philippine

Government will lead the rollout of the COVID-19 vaccination campaign.

The COVAX Facility leads an unprecedented effort to provide at least 2 billion doses of

COVID-19 vaccines by the end of 2021 to low- and middle-income countries. For several

months, COVAX partners have been supporting governments and partners in readiness efforts, in

preparation for this moment. This includes assisting with the development of national

vaccination plans, support for cold chain infrastructure, as well as stockpiling of half a billion

syringes and safety boxes for their disposal, masks, gloves and other equipment to ensure that

there is enough equipment for health workers to start vaccinating priority groups as soon as

possible.

The WHO launched the Access to COVID-19 Tools Accelerator, a global collaboration

to accelerate development, production, and equitable access to COVID-19 diagnostics,

therapeutics, and vaccines. COVAX is the vaccines pillar of the ACT Accelerator and is led

jointly by Gavi, WHO, the CEPI, and UNICEF, which is leading vaccine procurement and

delivery operations. WHO is tasked with ensuring fair allocation and prioritization of countries

eligible to receive vaccines from the COVAX Facility.

UNICEF is leading the procurement and delivery of COVID-19 vaccines through

COVAX facility to countries - the biggest, most sophisticated ground operation in the history of

immunization. In the Philippines, apart from supporting COVID-19 vaccine introduction and roll

out, UNICEF continues to support the immunization programmes of the government through
planning, cold chain and vaccine management, technical know-how and training. Building on

over 70 years of experience in providing simple, effective and accurate information to build

public knowledge, awareness and confidence in vaccines, UNICEF is working with partners to

ensure that local communities are engaged in the overall vaccination process.

The COVAX Facility aims to procure 2 billion doses by the end of 2021. The vaccines

are intended to protect frontline health care and social workers, as well as high risk and

vulnerable people. COVAX was set up to address concerns around fairness and making vaccines

available to all. To control and end the global pandemic, vaccines must be available to all.

The provinces of Cagayan, Nueva Vizcaya and Isabela have started administering the

Chinese developed Sinovac CoronaVac to their medical front liners. Cagayan province is the

first to commence with the Covid-19 vaccination program on Sunday, March 7 at the Cagayan

Valley Medical Center. As announced, CVMC Chief Dr. Glenn Matthew Baggao was the first to

receive the Sinovac Covid-19 vaccine yesterday, who went through the proper screening process

beforehand.

Tuguegarao City People’s General Hospital has also started giving the said vaccine doses

to 191 out of their 212 employees on Monday, March 8, while the remaining 21 senior citizens

will be awaiting the arrival of British AstraZeneca vaccine. Isabela province has also started

giving doses of the Sinovac CoronaVac at the Ilagan Community Center to several medical front

liners from the San Antonio City of Ilagan Hospital (SACIH) on Monday, March 8.

Concurrently on Monday, March 8, the provincial government of Nueva Vizcaya has also

given their first allocated doses to medical front liners at the Region 2 Trauma and Medical
Center (RITM) in Bayombong town. A total of 10,800 doses of the Sinovac CoronaVac Covid-

19 vaccine arrived at the Tuguegarao City airport last Friday, March 5.

The doses have been properly allocated by the DOH and carefully transported to CVMC

in Cagayan, Southern Isabela Medical Center in Santiago City, RITM in Nueva Vizcaya, Batanes

General Hospital, Tuguegarao City People’s General Hospital, the PNP Health Service Hospital

and to other tertiary hospitals all over the region to get the immunization program underway.

Quirino Province and Santiago City in Isabela, are both in Cagayan Valley, and will be

under Modified Enhanced Community Quarantine (MECQ), starting on April 1, as announced by

President Rodrigo Duterte last March 29, 2021. Quirino’s MECQ will last until April 15, with

the task of determining a de-escalation of quarantine classification given to the Cagayan Valley

regional pandemic task force. Santiago City’s MECQ, meanwhile, will last until April 30.

The Government earlier announced Metro Manila and four adjacent provinces, including

Bulacan, Cavite, Laguna and Rizal will be under Enhanced Community Quarantine from March

29 to April 4, in a bid for a surge of COVID- 19 cases.

We’ve chosen this condition because it is phenomenal within the whole world right now. It

can help us to gain more knowledge about the ongoing pandemic in terms of its effect and how

to avoid it. It can benefit the people in a way of spreading and sharing our knowledge to others to

be aware of it.
 CHAPTER II
DEMOGRAPHIC PROFILE

The person who had the coronavirus disease 2019 (COVID-19) is named Patient X. A 24

year-old female who lives in Talavera, Nueva Ecija. Her status is a Single Mother and has two

kids. She is currently working as a personal assistant.

According to Patient X, she had symptoms of fever, sore throat, cough, diarrhea,

vomiting, loss of senses in taste and smell. Patient X said she was experiencing the symptoms

two weeks already, she feels that she needs to consult the doctor immediately. Because she has

the symptoms of the Coronavirus. August 12, 2020, 3:10 in the afternoon. SARS-CoV-2 viral

RNA was reported to be detected by RT-PCR on initial nasopharyngeal/oropharyngeal

(NPS/OPS) swabs. On her way home, when Patient X received the result of the test she

immediately went to the hospital. August 13, 2020 at 12 o’clock am she was confined at Dr.

Paulino J. Garcia Memorial Research and Medical Center Hospital, Cabanatuan City, Nueva

Ecija.
 CHAPTER III

MEDICAL HISTORY

Reason for Seeking Health Care

- According to Patient X she was experiencing three days of vomiting, diarrhea, high fever,

non-productive cough, loss of senses in taste and smell and sore throat in a week. She

decides to seek a doctor and suggests doing a RT-PCR test. Because she was

experiencing symptoms of the virus. Days after the result of the test is confirmed on her

way home, she is immediately confined to a hospital when she arrives.

History of Present Illness

- According to Patient X last year August 2, 2020 she started to become not feeling well.

She is experiencing three days of vomiting and diarrhea, she lost her sense of smell and

taste and has a sore throat that caused her loss of appetite. She had a high fever with the

body temperature of 39 C. She had a cough also, that is a non-productive type. She

decides to seek a doctor a week after and the doctor suggested to do a RT-PCR test,

because she has the symptoms. On her way home to Talavera, Nueva Ecija, August 12,

2020, 3:10 in the afternoon. SARS-CoV-2 viral RNA was reported to be detected by RT-

PCR on initial nasopharyngeal/oropharyngeal (NPS/OPS) swabs. And was confined

August 13, 2020 at 12o’clock am at Dr. Paulino J. Garcia Memorial Research and

Medical Center Hospital, Cabanatuan City, Nueva Ecija.

Past Health History

- Patient X had Anemia and Acid Reflux. Until now she has this disease and it is

sometimes attacking.
Immunization History
- According to Patient X she had completed her immunization shots like Hepatitis A,

Hepatitis B, Anti-Polio, Anti-Measles and Flu Vaccine.

Allergies
- Patient X doesn't have any allergy related to food, dust or anything.

Home Medication/ Alternative Medicine

- According to Patient X she is taking Paracetamol and Fluimucil during her confinement.

She is also taking Multi-Vitamins as prescribed by her doctor. And she was also drinking

home alternative medicine like warm water with ginger and lemon with a pinch of salt.
 CHAPTER IV

PHYSICAL ASSESSMENT

Name : Patient X
Age: 24 years old
Date of Assessment: February 22, 2021
Vital Signs: Temperature: 36 Blood Pressure: 120/80 PR: 90 bpm
Height: 5’0 Weight: 45kg RR: 15 per minute

PARTS TECHNIQUES NORMAL ACTUAL ANALYSIS

FINDINGS FINDINGS
HEAD /SKULL INSPECTION, Head symmetrically The head of the Normal Findings
PALPATION round, hard, and patient is
smooth without rounded,
lesions or bumps. normocephalic
Face oval, smooth, and symmetrical.
and symmetrical.

MOUTH INSPECTION Lips pink in color, Lips are white. Dryness of lips
soft moist, smooth in The lips of the caused by
texture, ability to patient are dehydration.
purse lips; the teeth slightly dry.
are smooth and The teeth are
white, firm texture smooth and white,
to gums. Tongue is firm texture to
in the Central gums.
position. The tongue is in a
common spot and
the color is
normal.
 NECK INSPECTION The neck muscles The neck muscles Normal Findings
are equal in size, are equal in size.
The patient showed The patient
coordinated, smooth showed
head movement with coordinated,
no discomfort. The smooth head
lymph nodes of the movement with
patient are not no discomfort. No
palpable. The enlargement of
trachea is placed in lymph nodes. The
the midline of the trachea is placed
neck. The thyroid in the midline of
gland is not visible the neck. The
on inspection and thyroid gland is
the glands ascend not visible on
during swallowing inspection and the
but are not visible glands ascend
during
swallowing but
are not visible

THORAX/ PERCUSSION Chest symmetrical. Absence of sound Normal Findings

LUNGS AUSCULTATION Spine vertically and normal
aligned, spinal breathing.
column is straight,
left and right
shoulders and hips
are at the same
height. With normal
breath sound without
a dyspnea. Quiet,
rhythmic and
effortless
respiration.
ABDOMEN PALPATION Uniform color, no Abdomen is Normal Findings
PERCUSSION evidence of enlarged normal and
AUSCULTATION liver or spleen. pinkish in color.
Audible bowel
sounds, absence at
arterial bruits, and
absence at friction
rubs, no tenderness.
 CHAPTER V
GORDONS FUNCTIONAL HEALTH ASSESSMENT
Health Perception

Before Hospitalization : Patient X is not usually going to a doctor. She also drinks and is

a type of casual drinker. She is also using a vaping device which is a disposable vape that is an e-

cigarette that comes ready to vape and is thrown away once it runs out of charge or e-liquid. Like

a typical user, Patient X puffs consistently and the disposable device is up to 400 puffs that will

last for three days.

After Hospitalization : Patient X goes to the doctor once for her check-up. She is still a

type of casual drinker and is still puff consistently using disposable vape.

Nutritional Metabolic

Before Hospitalization : Patient X eats thrice a day. When she is at work, she eats fast

food and when at home she cooks. She is fond mostly of eating vegetables and fruits and not

fond of meat.

After Hospitalization: Patient X eats twice a day and still eats fast food when she is at

work and still not fond of eating meat. She still cooks at home.

Elimination

Before Hospitalization: Patient X usually takes a bowel movement twice a day. She

usually urinates thrice a day and her urine is pale yellow.

After Hospitalization: Patient X still takes a bowel movement twice a day. She still

urinates thrice a day and her urine is bright yellow because of taking vitamins.
Activity/Exercise

Before Hospitalization: Patient X is a Personal Assistant, who works 5 to 8 hours daily.

She’s also fond of cooking, reading and watching some eating shows.

After Hospitalization : She’s working a night shift schedule as a Receptionist in a

Japanese Restaurant from 5 pm to 12 am.

Sleep/Rest

Before Hospitalization: Patient X is working 5- 8 hours daily from morning till afternoon.

She sleeps late at night because of her insomnia

After Hospitalization: Patient X is at night shift, from 5pm to 12am. She sleeps after her

work at 1am and wakes at 7am.

Cognitive/Perceptual

Before Hospitalization: Patient X always thinks of things normally. She loves going out

for a trip.

After Hospitalization : Patient X still thinks normally and is fond of going out for a trip

with her partner.

Self-Perception and Self-Concept

Before Hospitalization : Patient X is the main provider of the family.

After Hospitalization : Patient X is still providing the needs of her loved ones.
Role- Relationship

Patient X is the breadwinner of the family, the eldest and the only daughter of the family.

A very jolly and a positive type of person. And also a very affectionate mother to her two kids

and a caring sister and daughter.

Sexuality Reproductive

Before Hospitalization: Patient X is active in doing sex intercourse regularly and she is

using contraceptive pills.

After Hospitalization: Patient X is still active and using contraceptive pills.

Coping/Stress Tolerance

Before Hospitalization: Patient X and her family didn’t experience any challenges or

stress.

After Hospitalization: Patient X experienced a challenge in her life, which she got

infected with COVID- 19. But, still a positive type of person and also a strong one.

Values/Beliefs

Patient X is a Roman Catholic. She has a strong faith in God and a real believer. But,

they’re not practicing any beliefs in their family.

 CHAPTER VI
LABORATORY TESTS

LABORATORY RESULT FORM

NAME: PATIENT X DATE: 8/12/20 3:10 PM

AGE: 24

TEST RESULT: SARS-CoV-2 viral RNA detected

Interpretation of Result:

Final Result Interpretation

SARS-CoV-2 viral RNA detected Positive for SARS-CoV-2 (causative

agent of COVID-19) virus

SARS-CoV-2 viral RNA not detected Negative for SARS-CoV-2 (causative

agent of COVID-19) virus

Invalid due to specimen quality Negative for test internal control (most
likely due to poor specimen quality)

Test Methodology: RNA extraction is followed by Reverse transcription Polymerase Chain

Reaction (RT-PCR) amplification and detection of SARS-CoV-2 viral gene targets, with positive

and negative controls included in each run to confirm validity and accuracy.
 CHAPTER VII

ANATOMY AND PHYSIOLOGY

RESPIRATORY SYSTEM

FUNCTIONS OF THE RESPIRATORY SYSTEM

1. Gas Exchange. The respiratory system allows oxygen from the air to enter the blood and

carbon dioxide to leave the blood and enter the air. The cardiovascular system transports oxygen

from the lungs to the cells of the body and carbon dioxide from the cells of the body to the lungs.

Thus the respiratory and cardiovascular system work together to supply oxygen to all cells and to

remove carbon dioxide. Without a healthy respiratory and cardiovascular system, the capacity to

carry out normal activity is reduced, and without adequate respiratory and cardiovascular system

functions, life itself is impossible.

2. Regulation of blood pH. The respiratory system can alter blood pH by changing blood

carbon dioxide levels.

3. Voice production. Air movement past the vocal cords makes sound and speech possible.

4. Olfaction. The sensation of smell occurs when airborne molecules are drawn into the nasal

cavity.

5. Innate Immunity. The respiratory system provides protection against some microorganisms by

preventing their entry into the body and by removing them from respiratory surfaces.
DIAGRAM OF THE RESPIRATORY SYSTEM

PARTS OF RESPIRATORY SYSTEM

1. Nose

- The nose has an external part and internal part that is inside the skull. Externally, the nose

is formed by a framework of cartilage and bone covered with skin and lined internally with

mucous membrane. The bridge of the nose is formed by the nasal bones that help support the
external nose and hold it in a fixed position. On the undersurface of the external nose are two

openings called nostrils or external nares. The hard palate of the mouth forms the floor of the

nasal cavity, separating the nasal cavity from the oral cavity. Anteriorly, the internal nose merges

with the external nose. Posteriorly, it connects with pharynx or throat via two openings called the

internal nares. The nasolacrimal ducts from the lacrimal or tear sacs empty into the nose, as well

as four paranasal sinuses (air-filled spaces inside bone) : sphenoidal, frontal, ethmoidal,

maxillary. The inside of both the internal and external nose is divided into right and left nasal

cavities by a vertical partition known as the nasal septum. The septum is made primarily of

cartilage. The top of the septum is formed by the perpendicular plate of the ethmoid bone, and

the lowermost portion is formed by the vomer bone. The anterior portions of the nasal cavities

just inside the nostrils are known as the vestibules. These interior structures of the nose have

three specialized functions. First, air is warmed, moistened, and filtered as it enters the nose.

Second, olfactory stimuli are detected for the sense of smell. Third, large hollow resonating

chambers are present for creating speech sounds. (Rizzo, 2018)

2. Pharynx

- The pharynx is a muscular passageway about 1cm (5 inches) long that vaguely resembles

a short length of red garden hose. Commonly called the throat, the pharynx serves as a common

passageway for food and air. It is continuous with the nasal cavity and these descend through the

oropharynx and laryngopharynx to enter the larynx below. Food enters the mouth, and then

travels along with air through the oropharynx and laryngopharynx. But instead of entering the

larynx, food is directed into the esophagus posteriorly by a flap called epiglottis. The

pharyngotympanic tubes, which drain the middle ear, open into the nasopharynx. The mucosae

of these two regions are continuous, so ear infections such as otitis media may follow a sore
throat or other types of pharyngeal infections. Clusters of lymphatic tissue called tonsils are also

found in the pharynx. The single pharyngeal tonsil, often called the adenoid, is located high in

the nasopharynx.

The two palatine tonsils are in the oropharynx at the end of the soft palate, as are the two lingual

tonsils, which lie at the base of the tongue. The tonsils also play a role in protecting the body

from infection.

3. Larynx

- The larynx, or voice box, routes air and food into the proper channels and plays a role in

speech. Located inferior to the pharynx, it is formed by eight rigid hyaline cartilages and a

spoon-shaped flap of elastic cartilage, the epiglottis. The largest of the hyaline cartilages is the

shield-shaped thyroid cartilage, which protrudes anteriorly and is commonly called Adam’s

Apple. Sometimes referred to as the guardian of the airway, the epiglottis protects the superior

opening of the larynx. During regular breathing, the epiglottis allows the passage of air into the

lower respiratory passages. When we swallow food or fluids, the situation changes dramatically;

the larynx is pulled upward, and the epiglottis tips, forming a lid over the larynx’s opening. The

routes food into the esophagus, which leads to the stomach, prosteriorly.

If anything other than air enters the larynx, a cough reflex is triggered to prevent the substance

from continuing into the lungs. Because this protective reflex does not work when we are

unconscious, never try to give fluids to an unconscious person when attempting to revive. Part of

the mucous membrane of the larynx forms a pair of folds, called the vocal folds, or true vocal

cords, which vibrate with expelled air. This ability of the vocal folds to vibrate allows us to

speak. The vocal folds and the slit like passageway between them are called glottis.
4. Trachea

- Air entering the trachea, or windpipe, from the larynx travels down its lengths (10-12cm,

or about 4 inches) to the level of the fifth thoracic vertebra, which is approximately mid chest.

The trachea is fairly rigid because its walls are reinforced with C-shaped rings of hyaline

cartilage. These rings serve a double purpose. The open parts of the rings about the esophagus

and allow it to expand anteriorly when we swallow a large piece of food. The solid portions

support the trachea walls and keep it patent, or open, in spite of the pressure changes that occur

during breathing. The trachealis muscle lies next to the esophagus and completes the wall of the

trachea posteriorly. (Marieb & Keller, 2019)

5. Bronchi

- The trachea terminates in the chest by dividing into a right primary bronchus that goes to

the right lung and left primary bronchus that goes to the left lung. The right primary bronchus is

more vertical, shorter, and wider than the left. Consequently, if a foreign object gets past the

throat into the trachea, it will frequently get caught and lodge in the right primary bronchus. The

bronchi, like the trachea, also contain the incomplete rings of hyaline cartilage, and are lined

with the same pseudostratified, ciliated columnar epithelium. On entering the lungs, the primary

bronchi divides to form a smaller bronchi called the secondary or lobar bronchi, one for each

lobe of the lung. The right lung has three lobes and the left lung has two lobes. The secondary

bronchi continues to branch, forming even smaller bronchi called tertiary or segmental bronchi.

These branch into the segments of each lobe of the lung. Tertiary or segmental bronchi divide

into smaller branches called bronchioles. Bronchioles finally branch into even smaller tubes

called terminal bronchioles. This continuous branching of the trachea resembles a tree trunk with
branches. For this reason, this branching is commonly referred to as a bronchial tree. As the

branching becomes more and more extensive, the rings of cartilage get replaced with plates of

cartilage. These finally disappear completely in the bronchioles. As the cartilage decreases, the

amount of smooth muscle in the branches increases. In addition, the pseudostratified, ciliated

columnar epithelium changes to a simple, cuboidal epithelium. (Rizzo, 2018)

6. Lungs

- The lungs are fairly large organs. They occupy the entire cavity except for the most

central area, the mediastinum, which houses the heart, the great blood vessels, bronchi, the

esophagus, and other organs. The narrow superior portion of each lung, the apex, is just deep to

the clavicle. The broad lung area resting on the diaphragm is the base. Each lung is divided into

lobes by fissures, the left lung has two lobes, and the right lung has three. The surface of each

lung is covered with its own visceral serosa, called pulmonary pleura or visceral pleura, and the

walls of the thoracic cavity are lined by the parietal pleura. The pleural membranes produce

pleural fluid, slippery serous fluid, which allows the lungs to glide easily over the thorax wall

during breathing and causes the two pleural layers to cling together.

The pleura can slide easily from side to side across one another, but they strongly resist being

pulled apart. Consequently, the lungs are held tightly to the thorax wall, and the pleural space is

more of a potential space than an actual one. As we describe shortly, this tight adherence of the

pleural membranes is absolutely essential for normal breathing.

IMMUNITY
- Is the ability to resist damage from foreign substances such as microorganisms, harmful

chemicals, such as toxins released by microorganism; and internal threats such as cancer cells.

Immunity is categorized as innate immunity and adaptive immunity, although the two systems

are fully integrated in the body. In innate immunity, the body recognizes and destroys certain

foreign substances, but the response to them improves each time the foreign substances are

encountered. Specificity and memory are characteristics of adaptive immunity, but not innate

immunity. Specificity is the ability of adaptive immunity to recognize a particular substance. For

example, innate immunity can act against bacteria in general, whereas adaptive immunity can

distinguish among various kinds of bacteria. Memory is the ability of adaptive immunity to

remember previous encounters with particular substances. As a result, the response is faster,

stronger, and longer-lasting. In innate immunity, each time the body is exposed to a substance,

the response is the same because specificity and memory of previous encounters are not present.

For example, following the first exposure to the bacteria, the body can take many days to destroy

them. During this time, the bacteria damage tissues, producing the symptoms of disease.

Following the second exposure to the same bacteria, the response is rapid and effective. Bacteria

are destroyed before any symptoms develop, and the person is said to be immune. Innate and

adaptive immunity are intimately linked. Most importantly, mediators of innate immunity are

required for the initiation and regulation of the adaptive response.

INNATE IMMUNITY

- Innate Immunity is accomplished by physical barriers, chemical mediators, white blood

cells, and the inflammatory response.

Physical Barriers
 - Physical barriers prevent microorganisms and chemicals from entering the body in two

ways : (1) The skin and mucous membranes from barriers that prevent their entry , and

(2) tears, saliva and urine wash these substances from body surfaces. Microorganisms

cannot cause a disease if they cannot get into the body.

Chemical Mediators

- Chemical mediators are molecules responsible for many aspects of innate immunity.

Some chemicals on the surface of cells kill microorganisms or prevent their entry into the cells.

For example, lysozyme in tears and saliva kills certain bacteria, and mucus on the mucous

membranes prevents the entry of some microorganisms.

Other chemical mediators, such as histamine, complement, prostaglandins and leukotrienes,

promote inflammation by causing vasodilation, increasing vascular permeability, and stimulating

phagocytosis. In addition, interferons protect cells against viral infections.

Complement

- Complement is a group of approximately 20 proteins found in plasma. The operation of

complement proteins is similar to that of clotting proteins. Normally, complement proteins

circulate in the blood in an inactive form. Certain complement proteins can be activated by

combining with foreign substances, such as parts of a bacterial cell, or by combining with

antibodies.

Interferons
- Interferons are proteins that protect the body against viral infections. When a virus infects

a cell, the infected cell produces viral nucleic acids and proteins, which are assembled into new

viruses. The new viruses are released to infect other cells. Because infected cells usually stop

their normal functions or die during viral replication, viral infections are clearly harmful to the

body. Some interferons play a role in activating immune cells, such as macrophages and natural

killer cells.

White Blood Cells

- White blood cells are produced in red bone marrow and lymphatic tissue and released into

the blood. Chemicals released from microorganisms or damaged tissues attract the white blood

cells and they leave the blood and enter affected tissues.

Phagocytic Cells

- Phagocytosis is the ingestion and destruction of particles called phagocytes. The particles

can be microorganisms or their parts, foreign substances, or dead cells from the body. The most

important phagocytes are neutrophils and macrophages, although other white blood cells also

have limited phagocytic ability.

Inflammatory Response

- The Inflammatory response to injury involves many of the chemicals and cells. Most

inflammatory responses are very similar although some details vary, depending on the intensity

of the response and the type of injury. Bacteria enter the tissue , causing damage that stimulates

the release or activation of chemical mediators, such as histamine, prostaglandins, leukotrienes,

complement and kinins.

ADAPTIVE IMMUNITY

Activation and Multiplication of Lymphocytes

- The specialized B-cell or T-cell clones can respond to antigen and produce adaptive

immune response. For the adaptive immune response to be effective, two events must occur: (1)

antigen recognition by lymphocytes and (2) proliferation of the lymphocytes recognizing the

antigen.

Antigen Recognition

Lymphocytes have protein, called antigen receptors, on their surfaces. The antigen

receptors on B cells are called B-cell receptors and those on T cells are called T-cell receptors.

Each receptor binds with only a specific antigen. Each clone consists of lymphocytes that have

identical antigen receptors on their surfaces. When antigens combine with the antigen receptors

of a clone, the lymphocytes in that clone can be activated, and the adaptive immune response

begins. B cells and T cells typically recognize antigens after large molecules have been

processed or broken down into smaller antigen fragments. The processed antigen fragments are

bound to major histocompatibility complex molecules, transported to the surface of the

macrophages, and presented to B cells and T cells.

Major histocompatibility complex (MHC) molecules are glycoproteins that have different

binding sites for antigens. Different MHC molecules have different binding sites, that is, they are

specific for certain antigens. The MHC molecules function as serving trays that hold and present

a processed antigen on the outer surface of the cell membrane. The combined MHC molecule

and processed antigen can then bind to the antigen receptor on B cell or T cell and stimulate it.

The MHC molecule/antigen combination is usually only the first signal necessary to produce a
response from a B cell or T cell. In many cases, costimulation by a second signal is also required.

Costimulation can be achieved by cytokines which are proteins or peptides secreted by one cell

as a regulator of neighboring cells. For example interleukin-1 is a cytokine release by

macrophages that can stimulate helper T cells. Lymphocytes have other surface molecules

besides MHC molecules that help bind cells together and stimulate a response. For example,

helper T cells have a glycoprotein called CD4, which helps connect helper T cells to the

macrophages by binding to MHC molecules. The CD4 protein is also bound by the virus that

causes AIDS. As a result, the virus preferentially infects helper T cells. Cytotoxic T cells have a

glycoprotein called CDS, which helps connect cytotoxic T cells to cells displaying MHC

molecules.

Lymphocyte Proliferation

Before exposure to a particular antigen, the number of helper T cells that can respond to

that antigen is too small to produce an effective response against it. After the antigen is

processed and presented to a helper T cell by a macrophage, the helper T cell responds by

producing interleukin-2 and interleukin-2 receptors. Interleukin-2 binds to the receptors and

stimulates the helper T cells to divide. The daughter helper T cells produced by this division can

again be presented with the antigen by macrophages and again be stimulated to divide. Thus, the

number of helper T cells is greatly increased. It is important for the number of helper T cells to

increase because helper T cells are necessary for the activation of most B cells or T cells. For

example, B cells have receptors that can recognize antigens. Most B cells, however, do not

respond to antigens without stimulation from helper T cells. B-cell proliferation begins when a B

cell takes in the same kind of antigen that stimulated the helper T cell. The antigen is processed

by the B cell and presented on the B-cell surface by an MHC class II molecule. A helper T cell is
stimulated when it binds to the MHC class II/antigen complex. There is also costimulation

involving CD4 and interleukins. As a result, the B cell divides into two daughter cells.

The division process continues, eventually producing many cells capable of producing antibodies

to destroy all the antigen.

Antibody-Mediated Immunity

Exposure of the body to an antigen can lead to the activation of B cells and the

production of antibodies. The antibodies bind to the antigens, which can be destroyed through

several mechanisms. Because antibodies are in body fluids, antibody-mediated immunity is

effective against extracellular antigens, such as bacteria, viruses, and toxins. Antibody-mediated

immunity is also involved in certain allergic reactions.

Structure of Antibodies

Antibodies are proteins produced in response to an antigen. They are Y-shaped molecules

consisting of four polypeptide chains: two identical heavy chains and two identical light chains.

The end of each arm of the antibody is the variable region, the part of the antibody that combines

with the antigen. The variable region of a particular antibody can join only with a particular

antigen; this is similar to the lock-and-key model enzymes. The rest of the antibody is the

constant region, and it has several functions. For example, the constant region can activate

complement, or it can attach the antibody to cells, such as macrophages, basophils and mast

cells. Antibodies make up a large portion of the proteins in plasma. Most plasma proteins can be

separated into albumin and alpha, beta, and gamma globulin portions. Antibodies are sometimes

called gamma globulins, because they are found mostly in the gamma globulin part of plasma, or
immunoglobulins (Ig), because they are globulin proteins involved in immunity. The five general

classes of antibodies are denoted IgG, IgM, IgA, IgE, and IgD.

Effect of Antibodies

Antibodies can affect antigens either directly or indirectly. Direct effects occur when a

single antibody binds to an antigen and inactivates the antigen, or when many antigens are bound

together and are inactivated by many antibodies. The ability of antibodies to join antigens

together is the basis for many clinical tests, such as blood typing, because when enough antigens

are bound together, they form visible clumps. Most of the effectiveness of antibodies results

from indirect effects. After an antibody has attached its variable region to an antigen, the

constant region of the antibody can activate other mechanisms that destroy the antigen. For

example, the constant region of antibodies can activate complement, which stimulates

inflammation, attracts white blood cells through chemotaxis, and lysed bacteria. When an

antigen combines with the antibody, the constant region triggers the release of inflammatory

chemicals from mast cells and basophils. For example, people who have hay fever inhale the

antigens (usually plant pollens), which are then absorbed through the respiratory mucous

membrane. The combination of the antigen with antibodies stimulates mast cells to release

inflammatory chemicals, such as histamine. The resulting localized inflammatory response

produces swelling and excess mucus production in the respiratory tract. Finally, macrophages

can attach to the constant region of the antibody and phagocytize both the antibody and the

antigen.

Antibody Production
 The production of antibodies after the first exposure to an antigen is different from the

following a second of subsequent exposure. The primary response results from the first exposure

of B cells to an antigen. When the antigen binds to the antigen-binding receptor on the B cell, the

B cell undergoes several divisions to form plasma cells and memory B cells. Plasma cells

produce antibodies. The primary response normally takes 3-14 days to produce enough

antibodies to be effective against the antigen. In the meantime, the individual usually develops

disease symptoms because the antigen has had time to cause tissue damage. Memory B cells are

responsible for the secondary response, or memory response, which occurs when the immune

system is exposed to an antigen against which it has already produced a primary response. When

exposed to the antigen, the memory B cells quickly divide to form plasma cells, which rapidly

produce antibodies. The secondary response provides better protection than the primary response

for two reasons:

The time required to start producing antibodies in less (hours to a few days), and more plasma

cells and antibodies are produced. As a consequence, the antigen is quickly destroyed, no disease

symptoms develop, and the person is immune. The secondary response also includes the

formation of new memory cells, which provide protection against additional exposures to a

specific antigen. Memory cells are the basis of adaptive immunity. After destruction of the

antigen, plasma cells die, the antibodies they released are degraded, and antibody levels decline

to the point where they can no longer provide adequate protection. However, memory cells

persist for many years, for life, in some cases. If memory cell production is not stimulated, or if

the memory cells produced are short-lived, it is possible to have repeated infections of the same

disease. For example, the same cold virus can cause the common cold more than
 CHAPTER VIII
PHATOPHYSIOLOGY
 CHAPTER IX
PHARMACOLOGY

GENERIC NAME: Paracetamol

BRAND NAME: Biogesic
CLASSIFICATION: Non-Opioids, Nalgesic and Antipyretic
GENERIC NAME: Acetylsysteine

BRAND NAME: Fluimucil

CLASSIFICATION: Cough and Cold preparations
 CHAPTER X
NURSING CARE PLAN

DOSAGE AND FR MECHANISM OF ADVERSE REACTION SPECIAL ABSORPTION EXCRETION

EQUENCY ACTION CONSIDERA
TION

Adults: 1 sachet of Acetylcysteine, The most frequent adverse It should be In humans, Renal clearance may
Acetylcysteine active ingredient of events associated with the used with acetylcysteine is account for about
(Fluimucil) 200 mg FLUIMUCIL, exerts oral administration of caution in completely- 30% of the total
or 2 sachets of an intensive acetylcysteine are asthmatic absorbed after oral body clearance.
Acetylcysteine Following oral
mucolytic- gastrointestinal in nature. patients and administration.
(Fluimucil) 100 mg administration the
2-3 times a day. fluidifying action on Hypersensitivity reactions patients with a Because of the gut terminal half-life of
the mucous and including anaphylactic history of wall metabolism total acetylcysteine
1 Acetylcysteine mucopurulent shock, peptic and first pass effect, is 6.25 (4.59-10.6).
(Fluimucil) 600 mg secretions by anaphylactic/anaphylactoid ulceration the bioavailability
effervescent tablet depolymerizing the reaction, bronchospasm, especially in of acetylcysteine
daily (preferably in mucoproteic angioedema, rash and case of taken orally is very
the evening).
complexes and the pruritus have been reported concomitant low (approximately
nucleic acids which less frequently. administration 10%).
confer viscosity to of other
the vitreous medicines with
a known
irritating effect
on the gastric
and purulent No differences were
mucosa.
component of the reported for the
sputum and other various
secretions. pharmaceutical
forms.
Furthermore,
acetylcysteine exerts Patients In patients with
a direct antioxidant suffering from various respiratory
action, having a free bronchial or cardiac diseases,
thiol (-SH) asthma must the maximum
nucleophilic group be strictly plasma
which is able to monitored concentration is
interact directly with during the obtained between
the electrophilic therapy. two and three hours
group of the oxidant Should after administration
radicals. bronchospasm and the levels
occurs, the remained high over
Of particular interest treatment must a period of 24
is the recent finding be hours.
that acetylcysteine discontinued
protects α1- immediately
antitrypsin enzyme and
inhibiting elastase appropriate
from the inactivation treatment must
by hypochlorous be initiated.
acid (HOCl),

a powerful oxidant
agent produced by
the myeloperoxidase
enzyme of activated
phagocytes

These features make

Acetylcysteine
(Fluimucil)
particularly suitable
for the treatment of
acute and chronic
affections of the
respiratory system,
characterized by
thick, viscous
mucous and
mucopurulent
secretions
 ASSESSMENT PLANING INTERVENTION RATIONALE EVALUATION

Subjective: After 2 hours Monitor patient Fever patterns After 1 hour of nursing
"1 week na akong of nursing temperature may aid in intervention the patient
nilalagnat." as intervention the degrees and diagnosing will observe the
verbalized by the patient’s patterns. underlying temperature will lower
patient. temperature Wash hands disease. down to normal levels.
Objective: will decrease to with Reduces cross As evidenced by:the
Temperatur 36.5⁰C antibacterial contamination patient’s temperature
e 39⁰C soap before and and prevents decrease to 36.5
Continuous after each care the spread of
Fever of activity and infection.
Hot flushed encourage To decrease
skin proper hygiene. temperature by
Promote surface means through
cooling by evaporation
means of tepid and
sponge bath. conduction.
Provide To offset
supplemental increased
oxygen oxygen
Maintain demands and
bedrest consumption.
To reduce
metabolic
demands and
oxygen
consumption.