A CASE OF:

Confirmed COVID-19 Critical with Acute Respiratory Failure, Pneumonia, Ischemic Heart

Disease and Pre-Diabetes in older adult.

Presented by:

Borcena, Raphael T.

Flores Gladys V.

Montanez, Sophia Gift V.

Roderos, Yessamin Paith M.

Tenorio, Kate Angeli D.

Velada, Ghiezel R.

Group 1

Bachelor of Science in Nursing III

Presented to/Submitted to:

College of Allied Medical Professions, Nursing Department

Ms. Andrea Nica A. Cabanatan, RN, EMT-B, MANc

Ms. Wilomena A. Angeles, RN, M.A.N

Submitted on:

August 07,2021
II. DEMOGRAPHIC PROFILE

NAME: S.A.B

ADDRESS: San Bartolome, Novaliches, Quezon City

AGE: 102 BIRTDATE: September 18, 1918 BIRTH PLACE: N/A

GENDER: Female

RELIGION: Roman Catholic RACE/ETHNIC ORIGIN: Filipino

OCCUPATION: None EDUCATIONAL ATTAINMENT: N/A

MARITAL STATUS: Widowed NAME OF SPOUSE: N/A

NUMBER OF CHILDREN: N/A

CHIEF COMPLAINTS: Labored Breathing

DATE OF ADMISSION: May 18, 2021

ROOM & BED NUMBER: 203

ATTENDING/ADMITTING PHYSICIAN: Dra. Medina

ADMITTING/FINAL DIAGNOSIS: Acute Respiratory Failure, Confirmed Covid 19,

Pneumonia: old age, Ischemic Heart Disease (IHD), and Pre-Diabetes.

MEDICAL INSURANCE: Philippine Health Insurance Corporation (PhilHealth)

III.NURSING HEALTH HISTORY

A. HISTORY OF PRESENT ILLNESS

1. SIGNS AND SYMPTOMS

5 days prior to admission, the client has an exposure to confirmed covid

19 client, after that, she experienced labored breathing and appeared cyanotic.

During her admission, the client vital signs were as follows: blood pressure is

100/70, cardiac rate is 63 bpm, respiratory rate is 22 cpm, temperature is 36 °C

and her oxygen saturation measured by pulse oximeter is 95% in room air. During

physical examination, there were harsh breath sounds noted on both of her lungs

upon auscultation, there were normal rate and regular rhythm on her

cardiovascular system and negative for murmur, her pulse appears weak and there

was muscle atrophy.

Later on her hospital stay, the client experienced body weakness, difficulty

in breathing, and began to have an unproductive cough. She remained afebrile and

negative for any distress as mentioned on the nurses’ notes. On her x-ray it was

found that she has a minimal pulmonary tuberculosis and pneumonia is to be

suspected.

2. INCLUSIVE DATES

 May 13, 2021 -the client experienced labored breathing and appeared cyanotic

 May 14,2021 – RT-PRC Test for COVID 19 confirmation was done.

  May 18,2021 – The client was admitted to La Consolacion General Hospital

(LCUGH)

 May 18, 2021 -the client appears afebrile and (+) body weakness

 May 19, 2021 -the client appears afebrile, (+) body weakness, (-) distress

 May 20, 2021 -the client is afebrile, weak in appearance, (-) DOB, (-) SOB,

 May 21, 2021 -the client had begun to have cough

 May 22, 2021 -the client had begun to have a nonproductive coughing

 May 24, 2021 -the client has experienced (+) DOB, weak in appearance

 May 25,2021 –the client has experienced (+) DOB

 May 25, 2021 -the patient expired.

3. PRECIPITATING AND ALLEVIATING FACTORS

Since the client was already 102 years old, she is susceptible in acquiring various

types of diseases and ailments due to her weak immune system. There were no

recorded previous history of medical illnesses or diseases on the client’s chart and it

is mentioned as (-) for Hypertension and (-) for Diabetes Mellitus that was considered

as a risk factor or comorbidities to easily infected by the said disease. According to an

article published on Centers for Disease Control and Prevention (CDC, 2021), Older

adults are more likely to get severely ill from COVID-19. More than 80% of COVID-

19 deaths occur in people over age 65, and more than 95% of COVID-19 deaths

occur in people older than 45.

 The client was tested for positive COVID 19 results, and this was not the only

reason for her admission to the hospital, through various tests performed on the

patient, it was found out that she has ischemic heart disease, minimal pulmonary

tuberculosis, pre-diabetes and pneumonia which later on has been a contributing

factor to worsen her condition. Having heart conditions such as heart failure, coronary

artery disease, cardiomyopathies, and possibly high blood pressure (hypertension) can

make you more likely to get severely ill from COVID-19 (CDC, 2021).

4. EFFECTS TO OTHER BODY PARTS/FUNCTIONS

As a result of client’s current condition, she experienced labored breathing as

her chief complaint prior to her admission and she also appeared cyanotic . There were

harsh breath sounds noted on both of her lungs upon auscultation and her x-ray

revealed minimal pulmonary tuberculosis, pneumonia to consider, cardiomegaly

and atheromatous aorta and her ABG interpretation is compensated respiratory

alkalosis. Her pulse appears weak and there was muscle atrophy to her

extremities.

5. INTERVENTION/TREATMENT DONE

Pharmacologic

 remdesivir 200mg, 100mg

 dexamethasone 6mg

 enoxaparin sodium 0.4mL

 cefuroxime
Diagnostic Interventions

 Arterial Blood Gas (ABG)

 Complete blood Count (CBC)

 Fluorescence Immunoassay

 RT-PCR TEST (tested Positive for COVID 19)

 X-Ray (Minimal pulmonary tuberculosis was found, Pneumonia T/C)

Medical Intervention

 Assess and examine health condition (Visited by Dra. Medina)

 IVF check and regulated

 IVF maintain and regulated

 KVO

 Oxygen Administration

 Positioning of the patient

 ICGO parenteral nutrition

 Iv transfusion D5W

 CBG monitoring

Nursing Interventions

 Provide adequate sleep and rest

 Safe and comfortable environment

  Vital signs taken and recorded

 Oral medications given

 Needs attended

 Keep under observation

 Keep well ventilated

 IV-line reinsertion

6. EFFECT OF INTERVENTION/TREATMENT

Through various interventions and management performed on the client, it

helps to maintain and monitor the current condition of the patient where it does

not develop fever, shortness of breath and difficulty breathing in the course of

action.

B. PAST HEALTH HISTORY

1. IMMUNIZATIONS

No information was found on the client’s chart about vaccination records.

2. CHILDHOOD ILLNESSES

No record of childhood illnesses was found on client’s chart.

3. PAST ILLNESSES

No record of past illnesses noted on client’s chart.

 4. HEREDOFAMILIAL DISEASE

No records of heredofamilial disease were mentioned on the client’s chart.

5. ACCIDENTS/INJURIES

No available data was found on the client’s chart about her past and current accidents

and injuries.

6. HOSPITALIZATIONS

No information was found on client’s chart about the history of her previous

hospitalizations.

7. SURGICAL PROCEDURES DONE

No records of surgical procedures were mentioned on the client chart.

8. TRAVELS LOCAL AND ABROAD

No data was found on client’s chart about her travel history.

C. OCCUPATIONAL HISTORY

INCLUSIVE DATES/ YEARS OCCUPATION

No data was found No data was found
 D. FAMILY HISTORY

No record of family history of illnesses and diseases found on the client’s chart

IV. GORDON’S HEALTH ASSESSMENT

Due to high cases of Covid-19 positive patient in the country, we were only able to see the
patient’s chart. No interview was done to collect patients’ data during the hospitalization. Due to this
reason, we were not able to do the Gordon’s health assessment part of this paper.

V. PHYSICAL ASSESSMENT (CEPHALO CAUDAL)

Note: Head-to-toe assessment, general survey, as well as body measurements data were

incomplete due to limited information given from the client’s chart.

a. General Survey (n/a)

b. Measurements

Height

Weight

BMI

Vital signs

Blood pressure: 100/70 mmHg

Temperature: 36 °C

Pulse rate: 63 bpm

Respiratory rate: 22 cpm

Assessment Body Part Norms Actual Findings Analysis &

Method Used (Cephalo- Interpretation

caudal) (with reference)

Inspection and HEENT  Head: The head of Anicteric In a healthy eye,

palpation the client is sclerae, pink the conjunctiva

rounded; palpable appears clear and

Equipment: normocephalic and conjuctivar pink and the

Penlight symmetrical. sclera is white.

(inspection of  Skull: There are no Anicteric sclera

eyes) nodules or masses means the white

and depressions part of your eye

when palpated. has no yellowing

 Face: The face of and is healthy in

the client appeared appearance

smooth and has (Pietrangelo, A.

uniform consistency 2020)

and with no

presence of nodules

or masses.

Ears: The Auricles

are symmetrical and

has the same color

with his facial skin.

The auricles are

aligned with the

outer canthus

of eye. When

palpating for the

texture, the auricles

are mobile, firm and

not tender. The

pinna recoils when

folded. During the

assessment of

Watch tick test, the

client was able to

hear ticking in both

ears.

Eyes

The Bulbar

conjunctiva

appeared

transparent with

few capillaries

evident.

The sclera appeared

white.

The palpebral

conjunctiva

appeared shiny,

smooth and pink.

There is no edema

or tearing of the

lacrimal gland.

Cornea is

transparent, smooth

and shiny and the

details of the iris

are visible.

The client blinks

when the cornea

was touched.

The pupils of the

eyes are black and

equal in size. The

iris is flat and

round. PERRLA

(pupils equally

round respond to

light

accommodation),

illuminated and

non-illuminated

pupils constricts.

Pupils constrict

when looking at

near object and

dilate at far object.

Pupils converge

when object is

moved towards the

nose.

When assessing the

peripheral visual

field, the client can

see objects in the

periphery when

looking straight

ahead.

When testing for

the

Extraocular Muscle

, both eyes of the

client coordinately

moved in unison

with parallel

alignment.

The client was able

to read the

newsprint held at a

distance of 14

inches.
Inspection, Chest/ Lungs The chest wall is Presence of Crackles occur if

palpation, intact with no harsh breath the small air sacs

percussion and tenderness and sounds on both in the lungs fill

auscultation masses. There’s a lungs with fluid and

full and symmetric there’s any air

Equipment: expansion and the movement in the

Stethoscope thumbs separate 2-3 sacs, such as

Examination light cm during deep when you’re

inspiration when breathing. The

assessing for the air sacs fill with

respiratory fluid when a

excursion. The client person has

manifested quiet, pneumonia Kahn,

rhythmic and A. 2019).

effortless

respirations.

Inspection,

auscultation, and CVS Heart: There were NRRR (normal No murmur is a

palpation no visible pulsations rate and regular normal finding

on the aortic and rhythm), (heart). On the

Equipment: pulmonic areas. negative in neck vessels, no

Stethoscope There is no presence murmur blowing/swishing

Small pillow of heaves or lifts. or other sounds

Penlight/ are heard

Examination light Neck vessels: No indicates normal

Watch with second blowing or swishing findings (Weber

hand sound upon & Kelley, 2017).

Centimeter rulers auscultation.

The jugular vein

should not be

distended, bulging or

protruding at 45

degrees or greater.

Pulses should be

equally string; a 2+

or normal with no

variation in strength

from beat to beat

Inspection, upon palpation

auscultation,

percussion, and

palpation Abdomen Abdomen: The Flat, no Abdomen that

abdomen of the abnormal does not bulge

Tool used: client has an sounds and when client

Stethoscope unblemished skin negative for raises head

and is uniform in tenderness (abdomen is flat)

 color. The abdomen suggests a

has a symmetric normal findings.

contour. There were

symmetric Bruits are not

movements caused normally heard

associated with over abdominal

client’s respiration. aorta/renal, iliac

or femoral

The jugular veins arteries.

are not visible. Therefore,

absence of

When nails pressed abnormal sound

between the fingers suggests normal

(Blanch Test), the findings.

nails return to

usual color in less An abdomen that

than 4 seconds. is non-tender and

Inspection, soft suggests

auscultation, and normal findings.

palpation

Extremities The extremities are Weak pulses, Weak femoral

Equipment: symmetrical in size muscle atrophy and radial pulses

Centimeter tape and length. indicate partial

Stethoscope occlusion of

Doppler Muscles: The artery (Weber &

ultrasound device muscles are not Kelley, 2017).

Conductivity gel palpable with the

Tourniquet absence of tremors.

Gauze or tissue They are normally

Waterproof pen firm and showed

Blood pressure smooth,

cuff coordinated

movements.

Bones: There were

no presence of

bone deformities,

tenderness and

swelling.

Joints: There were

no swelling,

tenderness and

joints move

smoothly.
 Neurological

examination

(n/a)

VI. LABORATORY/DIAGNOSTIC EXAMINATIONS

Date Laboratory/Diagnosti Normal Actual Results Clinical

done c Values/Findings Interpretation

Examination & Analysis

(with reference)
May COMPLETE

5, BLOOD COUNT

2021

WBC 5.00-10.00 3.30 10^9/L (LOW) Possible cause of

decreased WBC and

Neutrophils number 2.00-7.00 1.46 10^9/L (LOW) neutrophils is due to

viral infections

Lymphocytes number 0.80-4.00 1.48 10^9/L (Berman A., Snyder

S., & Frandsen G.,

Monocytes number 0.12-1.20 0.36 10^9/L 2016).

Eosinophil number 0.02-0.50 0.00 10^9/L (LOW) Possible causes of

decreased eosinophil

Basophil number 0.000.10 0.00 10^9/L are due to stress and

 adrenocortical

RBC 3.50-5.0 4.39 10^12/L hyperfunction

(Berman A., Snyder

Hemoglobin 110-150 140 g/L S., & Frandsen G.,

concentration 2016).

Hematocrit 37.0-47.0 46.3%

Platelet count 150-350 120 10^9/L

May FLOURESCENCE 10 7.32 ng/Ml (L) High CRP test result

18, IMMUNOASSAY is a sign of acute

2021 inflammation. It

C-Reactive <0.50 0.17 ng/Ml (L) may be due to

Protein serious infection,

500 1,245.49 ng/Ml (H) injury or chronic

Procalcitonin disease (MFMER,

274.7 ng/Ml (H) 2021).

D-DIMER 20-250

Serum procalcitonin
Ferritin Test and high-sensitivity

C-reactive protein

(hs-CRP) elevations

have been associated

with pneumonia in

adults (Nouvenne,

A., 2016).

Heart conditions can

result elevated D-

dimer (MedlinePlus,

2021).

Elevation in serum

ferritin can be seen

in pre-diabetes

stage, before the

occurrence of an

overt diabetes

mellitus (SAGE

Journals, 2008).

Impression:
  Minimal PTB,

right upper lobe.

X-RAY  Pneumonia, both Interpretation

lung fields. (according to

 Cardiomegaly chart):

 Atheromatous

aorta Fibrohazed

densities are

seen in the right

upper lobe.

Hazy densities

are both seen in

both lower

lobes.

Hearty is

enlarged. Aorta

is tortuous and

calcified.

Hemidiaphragms

7.35-7.45 7.45 are intact.

 34-45 mmHg 21.9

80-100 mmHg 63

ARTERIAL 0-3 mmol/L -7.9 A normal pH level,

BLOOD GAS (ABG) 22-26 mmol/L 16 inadequate PaCO2.

23-27 mmol/L 17.9 And normal

pH 90-100% 93 bicarbonate is

PCO2 interpreted as

PO2 “compensated

BE respiratory

tCO2 alkalosis” (Berman

HCO3 A., Snyder S., &

SO2 Frandsen G., 2016).

VIII. DRUG STUDY

Drug Data Classification Mechanism Indications Contraindic Adverse Nursing

of Action ation Effects Interventions

Generic PHARMACOTHE Used Anti- Contraindic Long- Baseline

name: RAPEUTIC: Long- primarily as Inflammat ations: term assessment
Dexameth acting an anti- ory Hypersensi therapy: Question for
asone glucocorticoid. inflammator tivity to Muscle hypersensitivit
y or Cerebral dexametha wasting y to any
Brand CLINICAL: immunosupp Edema sone. (esp. corticosteroids.
name: Corticosteroid. ressant Systemic arms, Obtain
Apo- agent in a Nausea/Vo fungal legs), baselines for
Dexameth variety of miting in infections, osteopor height, weight,
asone diseases Chemother cerebral osis, B/P, serum
(e.g., allergic, apy Pts malaria. spontan glucose,
Dexameth inflammator eous electrolytes.
asone y, Physiologic Cautions: fractures Question
Intensol autoimmune Replaceme Thyroid , medical history
). OFF-LABEL: nt disease, amenorr as listed in
Available Antiemetic, renal/hepa hea, Precautions.
forms: treatment of Usual tic cataracts
0.1%/3.5 croup, Ophthalmi impairment , Intervention/e
mg/10,000 dexamethas c Dosage, , glaucom valuation
units per g one Ocular cardiovascu a, peptic Monitor I&O,
or mL suppression Inflammat lar disease, ulcer daily weight,
test ory diabetes, disease, serum glucose.
ROUTE OF (indicator Conditions glaucoma, HF. Assess for
ADMINISTRA consistent cataracts, Ophthal edema.
TION:
with suicide Dosage in myasthenia mic: Evaluate food
and/or Renal/Hep gravis, pts Glaucom tolerance.
Elixir: 0.5
depression), atic at risk for a, ocular Monitor daily
mg/5 mL.
accelerate Impairmen seizures, hyperten pattern of
Injection,
fetal lung t osteoporosi sion, bowel activity,
Solution: 4
maturation. s, post-MI, cataracts stool
mg/mL, 10
Treatment of elderly. . consistency.
mg/mL.
acute Report
Ophthalmi
mountain Abrupt hyperacidity
c Solution:
sickness, withdra promptly.
0.1%.
high-altitude wal Check vital
Ophthalmi
cerebral followin signs at least
c
edema g long- twice daily. Be
Suspensio
term alert to
n
therapy: infection (sore
(Maxidex):
Severe throat, fever,
0.1%.
joint vague
Solution,
pain, symptoms).
Oral: 0.5
severe Monitor serum
mg/5 mL.
headach electrolytes,
Solution,
e, esp. for
Oral
anorexia hypercalcemia,
Concentra
, nausea, hypokalemia,
te
fever, paresthesia
(Dexamet
rebound (esp. lower
hasone inflamm extremities,
Intensol): ation, nausea/vomiti
1 mg/mL. fatigue, ng, irritability),
Tablets: weaknes Hgb, occult
0.5 mg, s, blood loss.
0.75 mg, 1 lethargy, Assess
mg, 1.5 emotional
mg, 2 mg, status, ability
4 mg, 6 to sleep.
mg. Abrupt
Tablets withdrawal
(TaperPak may cause
[DexPak]): adrenal
1.5 mg (35 insufficiency;
or 51 taper dose
tablets on gradually.
taper dose
card) Patient/family
teaching
• Do not
change
dose/schedule
or stop taking
drug.
• Must taper
off gradually
under medical
supervision.
• Report fever,
sore throat,
muscle aches,
sudden weight
gain, edema,
exposure to
measles/chicke
npox. • Severe
stress (serious
infection,
surgery,
trauma) may
require
increased
dosage. •
Inform dentist,
other
physicians of
dexamethason
e therapy
 within past 12
mos.
• Avoid
alcohol, limit
caffeine.

Drug Data Classifica Mechanis Indications Contraindica Adverse Effects Nursing

tion m of tions Interventio
Action ns

Remdesivir VEKLURY is GENERAL Important

Generic Antiviral Remdesivi is approved contraindicat Preparatio
r is an  Generall
name: Drug for the ed in n and
Remdesivir adenosine treatment patients with y well Administra
nucleotide of a history of tolerated tion
Brand name: prodrug coronavirus clinically  Adverse Instruction
Veklury that is disease significant s
events up to
metaboliz 2019 hypersensitiv 60% were
Available ed to (COVID-19) ity reactions • See the
active reported in
forms: requiring to VEKLURY full EUA
form clinical trials;
100 mg hospitalizati or any Prescribing
nucleoside on in adult components however, it Informatio
ROUTE OF triphospha and of the is unclear if n for
ADMINISTRAT te pediatric product. all were complete
ION: metabolit patients (12 preparatio
Remdesivir-
e which years of age n and
acts as an and older, related.
IV (Vial) administra
analog of Adverse
and who tion
adenosine weigh at events were instruction
triphospha least 40kg) generally s.
te (ATP) higher in
and • VEKLURY
 In patients
competes for
with the animal receiving 10-
Injection,
natural studies day duration
100 mg:
ATP when of treatment Reconstitut
substrate Remdesi compared to e VEKLURY
for vir was 5 days. for
incorpora
used as  Remdes injection
tion into lyophilized
nascent prophyla ivir is
powder
RNA xis, it contraindicat
with 19 mL
chains by prevente ed in of Sterile
the SARS- d MERS- patients with Water for
CoV-2 CoV clini hypersensiti Injection
 cal vity to any and further
RNA- dilute in
dependen disease, ingredient of
0.9%
t RNA reduced  Remdesivir.
sodium
polymeras MERS- COMMON
chloride
e, CoV level  GI: prior to
inhibiting s, and o C administra
viral
lung onstipatio tion.
replication
. injury[5] n (6-14%)
• Only use
[6]. o N
Sterile
 Rem ausea (5- Water for
Remdesivi desivir 10%) Injection to
r has been o V reconstitut
showed in tested in omiting e VEKLURY
vitro activi humans (3%) lyophilized
ty for the powder.
o D
against SA
treatmen iarrhea
RS-CoV-2 i • After
n animal t (3%) reconstituti
models, of Ebola  Infusion on, use
and in virus infe -related vials
vitro and i ction, in reactions: immediatel
n a large y to
hypotension,
vivo activit prepare
study of nausea,
y diluted
against M 681 vomiting, solution.
ERS-CoV a patients diaphoresis, Administer
nd SARS- Remdesi shivering diluted
CoV. vir  Acute VEKLURY
EC50 for (n=175) as an
respiratory
SARS- intravenou
was failure (6-
CoV2 was s infusion
0.77 μM in inferior 11%) over 30 to
one  in to  Hypoalb 120
vitro study human uminemia minutes.
. monoclo (13%)
nal  Hypokal • Discard
any
antibodi emia (5-12%)
remaining
es  Anemia reconstitut
(REGN- (8-12%) ed
EB3 and  Thromb VEKLURY
MAb114) ocytopenia lyophilized
[7]. (10%) powder

and diluted
In a  Increase
solution.
mouse d bilirubin
model, (10%)
Remdesi OCCASIONAL
vir was  Transa
effective minase
when elevations
tested as (4-7%)
a o R
treatmen emdesivir
t should be
for SARS- discontin
CoV-1. ued in
patients
who
develop A
LT ≥ 5
times the
upper limi
t of
normal
during
treatment
with Rem
desivir
or ALT
elevation
accompan
ied by
signs or
symptoms
of liver
inflamma
tion or
increasing
conjugate
d
bilirubin,
alkaline
phosphat
ase, or
INR.
 Prothro
 mbin time
(PT)
elevation
without a
change in
INR
 Rash
-7%
 Renal:
AKI (2-8%),
decreased
CrCl (3-12%).
Rates are
higher with a
10-day
course
compared to
5 days.
 Pyrexia
(5%)
 Hypogly
cemia (4%)
 Insomni
a (5%)

Drug Data Classificati Mechani Indications Contraindica Adverse Effects Nursing

on sm of tion Interventi
Action ons

Clexane Clexane is used Do not use The safety

Generic Anticoagul is one of in a number of Clexane if More common and
name: ant, low a group medical you have an effectiven
enoxaparin molecular of conditions. It is allergy to  Bleeding ess of
sodium weight medicin used to: Clexane, gums Clexane
Heparin es called heparin or  coughing has not
Brand name: low  Treat its up blood been
Clexane molecul blood clots; derivatives  difficulty establishe
ar  Treat including with d in
Available weight certain other breathing children.
forms: heparins types of LMWHs. or
30mg q12h or (LMWH). heart Some signs swallowing Do not
40 mg OD These disease and  dizziness use
medicin (eg. angina  symptoms  headache Clexane
ROUTE OF es work and heart of an allergic  increased after the
ADMINISTRAT by attacks), reaction can menstrual expiry
ION: reducing when used include flow date
SC blood with aspirin; swelling of or vaginal printed
clotting  Prevent the face, lips bleeding on the
activity. blood clots or tongue,  nosebleeds syringe.
forming wheezing or  paralysis
Clexane after an troubled  prolonged Do not
contains operation, breathing, bleeding use
the during skin rash, from cuts Clexane if
active hospitalisati itching  red or the
ingredie on or hives, black, tarry packaging
nts extended blisters or stools is torn or
enoxapa bed rest or peeling skin.  red or dark shows
rin during brown signs of
sodium. purification Do not use urine tampering
of the blood Clexane if  shortness .
Clexane by an you have, or of breath
also artificial have ever
contains kidney had any of Less common
water (haemodialy the Patient
for sis). following  Bruising teaching:
injection Your doctor medical  chest
s. may have conditions: discomfort If you are
prescribed  collection not sure
Clexane for  Maj of blood whether
another or blood under the you
reason. disorders skin should
;  confusion start
Ask your doctor  Cert  continuing using
if you have any ain types bleeding or Clexane,
questions of stroke; oozing talk to
about why  Sto from the your
Clexane has mach or nose doctor or
been bowel and/or pharmacis
prescribed for problems mouth, or t.
you. such as surgical
ulcers or wound
There is no ulcerativ  convulsions
evidence that e colitis; (seizures)
Clexane is  Bact  fever
addictive. erial  irritability
infection  lightheade
This medicine is s in your dness
 only available heart.  lower back
with a doctor’s Do not give pain
prescription. Clexane to a  pain or
child. burning
while
urinating
 swelling of
the hands
or feet
 tightness in
the chest
 uncontrolle
d bleeding
at the site
of injection
 vomiting of
blood or
material
that looks
like coffee
grounds
 wheezing

Drug Data Classification Mecha Indications Contraindication Adverse Nursing

nism of Effects Interventions
Action

PHARMACOTH Binds Treatment : History of Side Baseline

Generic ERAPEUTIC: to of hypersensitivity/ effects assessment
name: Second- bacteri susceptible anaphylactic Frequent: Obtain CBC,
cefuroxime generation al cell infections reaction to Discomfor renal function
cephalosporin. membr due to cefuroxime, t with IM tests.
Brand anes, group B cephalosporins. administr Question for
name: CLINICAL: inhibits streptococci, ation, oral history of
Apo- Antibiotic cell pneumococc Cautions: Severe candidiasi allergies,
Cefuroxim wall i, renal s (thrush), particularly
e Ceftin synthe staphylococ impairment, mild cephalosporin
Zinacef sis. ci, H. history of diarrhea, s, penicillins.
Therap influenzae, penicillin allergy. mild
Available eutic E. coli, Pts with hx of abdomina Intervention/
forms: Effect: Enterobacte colitis, GI l evaluation
Injection, Bacteri r, Klebsiella, malabsorption, cramping,
Powder for cidal. including seizures. vaginal Assess oral
Reconstitu acute/chroni candidiasi cavity for
tion: 750 c bronchitis, s. white patches
mg, 1.5 g. gonorrhea, Occasiona on mucous
Injection, impetigo, l: Nausea, membranes,
Solution: early Lyme serum tongue
1.5 g/50 disease, sickness– (thrush).
mL. Oral otitis media, like Monitor daily
Suspension pharyngitis/t reaction pattern of
(Ceftin): onsillitis, (fever, bowel
125 mg/5 sinusitis, joint pain; activity, stool
mL, 250 skin/skin usually consistency.
mg/5 mL. structure, occurs Mild GI
Tablets UTI, after effects may
(Ceftin): perioperativ second be tolerable
250 mg, e course of (increasing
500 mg. prophylaxis therapy severity may
and indicate onset
resolves of antibiotic-
ROUTE OF after drug associated
ADMINIST is colitis).
RATION: discontin Monitor I&O,
IV ued). renal function
IM Rare: tests for
PO Allergic nephrotoxicit
reaction y. Be alert for
(rash, superinfectio
pruritus, n: fever,
urticaria), vomiting,
thrombop diarrhea,
hlebitis anal/genital
(pain, pruritus, oral
redness, mucosal
swelling changes
at (ulceration,
injection pain,
site). erythema).
Adverse
effects/to Patient/family
xic teaching
reactions • Discomfort
Antibiotic may occur
- with IM
associate injection.
d colitis, • Doses
other should be
superinfe evenly
ctions spaced.
(abdomin • Continue
al cramps, antibiotic
severe therapy for
watery full length of
diarrhea, treatment.
fever) • May cause
may GI upset (may
result take with
from food, milk).
altered
bacterial
balance in
GI tract.
Nephroto
xicity may
occur,
esp. in pts
with
preexistin
g renal
disease.
Pts with
history of
penicillin
allergy
are at
increased
risk for
developin
g a severe
hypersens
itivity
reaction
(severe
pruritus,
angioede
ma,
bronchos
pasm
anaphylax
is).
VIII. PHATOPHYSIOLOGY

Anatomy and Physiology

The respiratory system is composed of the upper and lower respiratory tracts. Together,

the two tracts are responsible for ventilation. The upper respiratory tract, known as the upper

airway, warms and filters inspired air so that the lower respiratory tract (the lungs) can

accomplish gas exchange or diffusion. Gas exchange involves delivering oxygen to the tissues

through the bloodstream and expelling waste gases, such as carbon dioxide, during expiration.

The respiratory system depends on the cardiovascular system for perfusion, or blood flow

through the pulmonary system (Porth, 2011).

Upper respiratory tract structures consist of the nose; paranasal sinuses; pharynx, tonsils,

and adenoids; larynx; and trachea and the lower respiratory tract composed of the lungs, which

contain the bronchial and alveolar structures needed for gas exchange. The lower respiratory

tract is the main focus of this topic.

Lower respiratory tract anatomy and physiology

Pleura

The lungs and wall of the thoracic cavity are lined with a serous membrane called the

pleura. The visceral pleura covers the lungs; the parietal pleura lines the thoracic cavity, lateral
wall of the mediastinum diaphragm and inner aspects of the ribs. The visceral and parietal pleura

and the small amount of pleural fluid between these two membranes serve to lubricate the thorax

and lungs and permit smooth motion of the lungs within the thoracic cavity during inspiration

and expiration.

Bronchi and Bronchioles

There are several divisions of the bronchi within each lobe of the lung. First are the lobar

bronchi (3 in the right lung and 2 in the left lung). Lobar bronchi divide into segmental bronchi

(10 on the right and 8 on the left); these structures facilitate effective postural drainage in the

patient. Segmental bronchi then divide into subsegmental bronchi. These bronchi are surrounded

by connective tissue that contains arteries, lymphatics, and nerves.

The bronchioles branch into terminal bronchioles, which do not have mucous glands or

cilia. Terminal bronchioles become respiratory bronchioles, which are considered to be the

transitional passageways between the conducting airways and the gas exchange airways. Up to

this point, the conducting airways contain about 150 mL of air in the tracheobronchial tree that

does not participate in gas exchange, known as physiologic dead space. The respiratory

bronchioles then lead into alveolar ducts and sacs and then alveoli. Oxygen and carbon dioxide

exchange takes place in the alveoli.

Alveoli

The lung is made up of about 300 million alveoli, constituting a total surface area

between 50 to 100 square meters, the approximate size of a tennis court (Porth, 2011). There are
three types of alveolar cells. Type I and type II cells make up the alveolar epithelium. Type I

cells account for 95% of the alveolar surface area and serve as a barrier between the air and the

alveolar surface; type II cells account for only 5% of this area but are responsible for producing

type I cells and surfactant. Surfactant reduces surface tension, thereby improving overall lung

function. Alveolar macrophages, the third type of alveolar cells, are phagocytic cells that ingest

foreign matter and, as a result, provide an important defense mechanism.

Hinkle, J. L., & Cheever, K. H., PhD. (2014)

Coronavirus Disease (COVID-19)

There are four genera of Coronavirus:

Alpha, Beta, Gamma and Delta

Only alpha and beta infect animals. In humans, these viruses cause respiratory diseases

such as the common cold and at time, gastrointestinal diseases. This infection usually mild and

resolve without the need of further medicals treatment.

However, beta coronaviruses may cause severe conditions such as the following:

 2002 Severe Acute Respiratory Syndrome (SARS) Coronavirus

 2012 MERS

 2019 SARS-COV-2 responsible for COVID-19

According to WHO 2021, COVID-19 is a dangerous disease caused by a virus discovered in

December 2019 in Wuhan, China. It is very contagious which can be spread by droplets to

smaller aerosols and has quickly spread around the world.

COVID-19 most often causes respiratory symptoms that can feel much like a cold, flu, or

pneumonia, but COVID-19 can also harm other parts of the body.

 Most people who catch COVID-19 have mild symptoms, but some people become

severely ill.

 Older adults and people who have certain underlying medical conditions are at increased

risk of severe illness from COVID-19.

 Hundreds of thousands of people have died from COVID-19 in the United States.

 Vaccines against COVID-19 are safe and effective.

 Collection of fluid in the alveoli, alveolar cell damage, alveolar inflammation and

alveolar collapse can lead to acute respiratory distress syndrome (ARDS) which is where

lungs cannot provide the body with enough oxygen and is life threatening condition &

main cause of death in coronavirus disease patients.

IX. ECOLOGICAL MODEL

A.HYPOTHESIS

Due to old age and comorbidities, client faced severe COVID-19 symptoms that
caused her to die.

B. PREDISPOSING FACTORS

1. Agent

 Infectious agent – 2019 SARS-CoV-2

2. Host

a. Age- 102 years old

b. Sex / gender - female

c. Ethnic/ race - Filipino

d. Religion - Roman Catholic

e. Occupation – None

3. Environment

A. Physical
  The virus is transmitted through droplet to smaller aerosols
meaning people could easily get infected.

 Cases of COVID-19 positive people are high in the country.

 Lack of supplies of vaccine available in the country

B. Biologic
 Experts say SARS-CoV-2 originated in bats. That’s also how the
coronaviruses behind Middle East respiratory syndrome (MERS) and
severe acute respiratory syndrome (SARS) got started. SARS-CoV-2
made the jump to humans at one of Wuhan’s open-air “wet markets.”
They’re where customers buy fresh meat and fish, including animals
that are killed on the spot. Some wet markets sell wild or banned
species like cobras, wild boars, and raccoon dogs. Crowded conditions
can let viruses from different animal swap genes. Sometimes the virus
changes so much it can start to infect and spread among people. Still,
the Wuhan market didn’t sell bats at the time of the outbreak. That’s
why early suspicion also fell on pangolins, also called scaly anteaters,
which are sold illegally in some markets in China. Some coronaviruses
that infect pangolins are similar to SARS-CoV-2. - (Webmd.com,
2020)

 Coronaviruses are often found in bats, cats and camels. The viruses
live in but do not infect the animals. Sometimes these viruses then
spread to different animal species. The viruses may change (mutate) as
they transfer to other species. Eventually, the virus can jump from
animal species and begins to infect humans. In the case of COVID-19,
the first people infected in Wuhan, China are thought to have
contracted the virus at a food market that sold meat, fish and live
animals. Although researchers don’t know exactly how people were
infected, they already have evidence that the virus can be spread
directly from person to person through close contact. - (Cleveland
clinic,2020)

 The first case of COVID-19 was reported Dec. 1, 2019, and the cause
was a then-new coronavirus later named SARS-CoV-2. SARS-CoV-2
may have originated in an animal and changed (mutated) so it could
cause illness in humans. In the past, several infectious disease
outbreaks have been traced to viruses originating in birds, pigs, bats
and other animals that mutated to become dangerous to humans.
Research continues, and more study may reveal how and why the
coronavirus evolved to cause pandemic disease. – (hopskin medicine,
2020).
 C. Socio-Economic

a. Urban overcrowding- overcrowding are major factors in the

transmission of diseases

b. Culture- Filipinos hold parties from time to time to celebrate with

friends and families.

C. ECOLOGICAL MODEL

D.ANALYSIS

 According to World Health Organization, "Older adults are more likely

to get very sick from COVID-19. Getting very sick means that older
adults with COVID-19 might need hospitalization, intensive care, or a
ventilator to help them breathe, or they might even die. The risk
increases for people in their 50s and increases in 60s, 70s, and 80s.
People 85 and older are the most likely to get very sick." The client is
102 years old and has physical comorbidities like Prediabetes, Ischemic
heart disease and acute respiratory failure. Because of the comorbidities,
client's immune system weakened. The reason why she has higher risk of
getting severely sick from COVID-19. Due to this reason client died.
 E.CONCLUSION AND RECOMMENDATION

 In conclusion, Covid-19 is a deadly virus that could affect anyone

regardless of age, race, gender and status in life. However, the risk of
developing dangerous symptoms increases with age and underlying
diseases.

 According to World Health Organization, here are some tips or advices

on what to do to keep yourselves and others from Covid-19:

1. Maintain at least a 1-metre distance between yourself and

others

2. Make wearing a mask a normal part of being around other

people. The appropriate use, storage and cleaning or disposal
are essential to make masks as effective as possible.

3. Avoid the 3Cs: spaces that are closed, crowded or involve

close contact.

4. Meet people outside.

5. Avoid crowded or indoor settings but if you can’t, then take

precautions

6. Regularly and thoroughly clean your hands with an alcohol-

based hand rub or wash them with soap and water.

7. Avoid touching your eyes, nose and mouth.

8. Cover your mouth and nose with your bent elbow or tissue
when you cough or sneeze.

9. Clean and disinfect surfaces frequently especially those which

are regularly touched.

X. Problem Identification and Prioritization

B. Level 3 and 4

Nursing Diagnosis Rank Justification

Impaired gas exchange related 1 Alveolar-capillary membrane
to alveolar-capillary membrane alterations, such as fluid shifts and
changes as evidenced by fluid accumulation into the interstitial
dyspnea, hypoxia & hypoxemia, space and alveoli, cause a decrease in
abnormal skin color, and
abnormal breathing of the client
Cues
Subjective Cue:
“Nahihirapan ako huminga” as
verbalized by the client.
Objective Cue:
 Labored breathing
 Harsh breath sounds from
both lungs upon auscultation
 Skin pallor
 Weak pulses
Vital Signs:
 O2 saturation: 88-89%
 Respiratory rate :26 bpm
ABG Analysis:
 Compensated respiratory
alkalosis
Ineffective Breathing Pattern
related to alteration in client’s
Normal O2 & CO2 ratio as
evidenced by labored breathing,
changes in patient’s color and
ABG Analysis.
Cues
Subjective Cue:
“Nahihirapan ako huminga” as
verbalized by the client.
Objective Cue:
 Labored breathing
 Harsh breath sounds from
both lungs upon auscultation
 Skin pallor
gas exchange. This results in an excess
or deficit of oxygen at the alveolar
capillary membrane, as well as
reduced CO2 elimination. According
to Abraham Maslow's Hierarchy of
Needs, the problem of breathing was
assigned the highest priority since it is
a real actual problem that has to be
addressed right away. This is one of
the most basic physiological
requirements for human survival, and
it requires immediate care. It is
possible to intervene quickly if
indications and symptoms of impaired
gas exchange are recognized early.
The nursing risk for impaired gas
exchange care note can help clients
with impaired gas exchange
symptoms and prevent life-
threatening complications. Lack of
attention in this health care problem
may cause bigger threat to the health
of the patient (simplenursing.ph,
2020).
2 One of the issues that nurses must
address is ineffective breathing
patterns. It is defined as a state in
which one's breathing rate, depth,
timing, rhythm, or pattern has
changed. The body is most likely not
obtaining enough oxygen to the cells
when the breathing pattern is
inefficient. According to the ABC rule,
which stands for Airway, Breathing,
and Circulation, this also requires
attention. This is an actual problem
that needs to be address. Failure to
address this health-care issue might
result in dyspnea, which could pose a
greater risk to the patient's health
(Wayne, 2019).
  Weak pulses

Vital Signs:
 O2 saturation: 88-89%
 Respiratory rate :26 bpm

ABG Interpretation:
Compensate
Risk for Infection related to Infections develop when an
leukopenia, inadequate individual's natural defense
vaccination and exposure to mechanisms are insufficient to protect
multiple healthcare workers in them. Bacteria, viruses, fungi, and
multiple care settings other parasites infect vulnerable hosts
as a result of unavoidable injuries and
Cues exposures. People have dedicated
cells or tissues that deal with the
Lab Values: threat of infection. These are known
 WBC : 3,300 cells/µL as the immune system. In a world full
with potentially lethal and dangerous
microorganisms, the human immune
system is essential for life. This
system's significant dysfunction can
put you at risk for serious, even life-
3 threatening infections. According to
ABC problem prioritization this is also
a priority problem because it is
related to an individual's body
circulation. It doesn't require
immediate action but it must be
resolved as quickest as possible to
prevent life-threatening conditions,
older adults are more susceptible to
infection. They may be more prone to
pneumonia and other conditions.
The combination of increased
comorbid conditions and the decrease
in activity of the immune system can
make people more prone to
infections. (Vera, 2021).

XI. NURSING CARE PLAN

Cues Nursing Analysis Goal Intervention Rationale Evaluation

 Diagnosis
Subjective Impaired Gas is At the end INDEPENDENT: On the
cues: gas exchanged of one week following 5
exchange between the of nursing Note respiratory rate, Provides insight days of
“Nahihirapa related to alveoli and intervention depth, use of into the work of nursing
n ako alveolar- the s, the client accessory muscles, breathing and intervention
huminga” as capillary pulmonary will be able pursedlip breathing; adequacy of s, the client
verbalized membran capillaries to areas of alveolar was able to
by the e changes via diffusion. participate pallor/cyanosis, such ventilation. participate
client. as Diffusion of in treatment as peripheral Tachypnea is in treatment
evidenced oxygen and regimen (nailbeds) versus usually present regimen
Objective by carbon within level central (circumoral) or to some degree within level
cues: dyspnea, dioxide of ability or general duskiness. during illness of ability or
hypoxia & occurs situation. (especially with situation as
O2 hypoxemi passively, fever or upper evidenced
saturation: a, according to respiratory by the
88-89% abnormal their infections), but client’s vital
skin color, concentratio if tachypnea is signs were
Respirato and n differences accompanied maintained
ry rate : abnormal across the by use of normal, as
26 breathing alveolar- accessory well as the
of the capillary muscles of oxygen
 Labored client barrier. inspiration (e.g. saturation
breathin These external for 5 days.
g concentratio intercostals),
n differences the client may However, on
 Harsh must be have sixth-
breath maintained insufficient seventh days
sounds by muscle strength of hospital
from ventilation to sustain the stay, the
both (airflow) of work of client was
lungs the alveoli breathing not able to
upon and (Doenges, maintain
ausculta perfusion Moorhouse, & normal vital
tion (blood flow) Murr, 2008). signs from
of the Auscultate breath May 24,
 Skin pulmonary sounds, note areas of Abnormal 2021.
pallor capillaries. decreased/ breath sounds
Once this adventitious breath are indicative of Vital signs
 Weak balance is sounds as well as numerous (May 24,
pulses altered, it fremitus. problems (e.g., 2021):
will result to hypoventilation RR – 26CPM
impaired gas such as might O2
exchange occur with saturation –
(Wayne G., atelectasis or 89-91%
2017). presence of
secretions, Due to
improper comorbiditie
According to endotracheal s like age
the North (ET) tube (102 years
American placement, old),
Nursing collapsed lung) prediabetes,
Diagnosis and must be IHD, and
Association evaluated for weakened
(NANDA-I), further immune
this diagnosis intervention system, the
belongs to (Doenges, client’s
the domain Moorhouse, & situation
Elimination Murr, 2008). continued to
and deteriorate
Exchange, Assess level of and expired
Respiratory consciousness and Decreased level on May 25,
Function mentation changes. of 2021.
class, and consciousness
the defining can be an Therefore,
characteristic indirect the goal was
s of it measurement partially
include: of impaired met.
nasal flaring; oxygenation,
headache but it also
upon impairs one’s
awakening; ability to
cyanosis (in protect the
neonates airway,
only); potentially
confusion; further
abnormal adversely
skin color affecting
(e.g., pale, oxygenation
dusky); (Doenges,
diaphoresis; Note client reports of Moorhouse, &
decreased somnolence, Murr, 2008).
carbon restlessness,
dioxide; headache on arising.
dyspnea; Assess energy level These are
visual and activity tolerance, associated with
disturbances; noting reports or diminished
abnormal evidence of fatigue, oxygenation
arterial weakness, and (Doenges,
blood gases; problems with sleep. Moorhouse, &
hypercapnia; Murr, 2008).
hypoxia;
hypoxemia; Elevate head of bed
restlessness; and position client
irritability; appropriately.
abnormal
arterial pH; Elevation or
XII. DISCHARGE PLAN

The client was diagnosed to have an acute respiratory failure due to Coronavirus disease
(COVID-19). She was able to take part in treatment procedures and was able to prevent the spread of
the disease to people that surrounds her, however she was not able to have a normal breathing since
May 18,2021 when she was admitted. The client was never discharged because she died on May
25,2021 primarily due to the weaker immune system cause by age and COVID-19.

XIII. EVIDENCE BASED NURSING

I. Clinical Questions

General Question:

 What are the age-specific rates of COVID-19 mortality at the population level? Is case-
fatality from the disease has been reported to be relatively high in patients age 65 years or
older?

Reconstructed General Question related to client’s problem:

 Is case-fatality from the disease has been reported to be relatively high in patients age 65 
years or older?
 Patient Intervention Comparison Outcome

Focus population

The researchers Tabulations of The researchers As a result, in the 16

obtained information COVID-19 deaths performed an countries examined,
regarding the total were obtained from ecological study to persons age 65 years
number of COVID-19 the 21 countries with model COVID-19 or older had strikingly
reported deaths for six the highest recorded mortality rates per higher COVID-19
consecutive weeks number of cases of week by age group mortality rates
beginning at the 50th COVID-19 as of April (54 years or younger, compared to younger
recorded death, 12, 2020. 55–64 years, and 65  individual (Yanez,
among 16 countries years or older) and sex N.D., Weiss, N.S.,
that reported a using a Poisson mixed Romand, JA. et al,
relatively high effects regression 2020).
number of COVID-19 The researchers model.
cases. collected the total
number of deaths each
country over 6 weeks
starting the day of a
Over the six-week
The countries were as country’s fiftieth period of data, there
follows: recorded COVID-19 were 178,568
death. COVID-19 deaths
from a total
population of
 Austria, Belgium, approximately 2.4
Brazil, Canada, May 8, 2020- The billion people. Age
China, France, complete 6-weeks of and sex were
Germany, India, Iran, data were available associated with
Israel, Italy, for 19 of the 21 COVID-19 mortality.
Netherlands, Portugal, countries. Age and sex Compared with
Russia, South Korea, distributions for individuals ages 54 
Spain, Sweden, COVID-19 deaths years or younger, the
Switzerland, Turkey, were procured for 16 incident rate ratio
the United Kingdom, of the 19 countries, (IRR) was 8.1,
and the United States. predominantly from indicating that the
government ministries mortality rate of
of public health. The COVID-19 was 8.1
researchers estimated times higher (95%CI 
the number of = 7.7, 8.5) among
 COVID-19 deaths for those 55 to 64 years,
each age and sex and more than 62
group for the 6-week times higher (IRR = 
totals of COVID-19 62.1; 95%CI = 59.7,
deaths for each 64.7) among those
country. COVID-19 ages 65 or older.
mortality rates were
determined using age
and sex specific
population sizes for
each country using
2020 population
estimates from the
Central Intelligence
Agency (CIA) World
Factbook.

The researchers
performed an
ecological study to
model COVID-19
mortality rates per
week by age group
(54 years or younger,
55–64 years, and 65 
years or older) and sex
using a Poisson mixed
effects regression
model.

3. Critical Review with Summary of the Literature:

Summary of the Literature:

The researchers sought to determine the age-specific rates of COVID-19 mortality at the
population level. From the study, the researchers obtained information regarding the total
number of COVID-19 reported deaths for six consecutive weeks beginning at the 50th recorded
death, among 16 countries that reported a relatively high number of COVID-19 cases as of April
12, 2020 (Austria, Belgium, Brazil, Canada, China, France, Germany, India, Iran, Israel, Italy,
Netherlands, Portugal, Russia, South Korea, Spain, Sweden, Switzerland, Turkey, the United
Kingdom, and the United States).The data source for COVID-19 cases and deaths was the Johns
Hopkins University, Center for Systems Science and Engineering Coronavirus Resource Center
(CSSE). CSSE provides numbers of deaths and confirmed cases for each country across the
globe. Ecological study to model COVID-19 mortality rates per week by age group (54 years or
younger, 55–64 years, and 65 years or older) and sex was performed by the use of Poisson mixed
effects regression model.

There were 178,568 COVID-19 deaths over the six-week period of data from a total
population of approximately 2.4 billion people. Compared with individuals ages 54 years or
younger, the mortality rate of COVID-19 was 8.1 times higher among those ages 65 or older.
Therefore, in the 16 countries examined, persons age 65 years or older had strikingly higher
COVID-19 mortality rates compared to younger individual (Yanez, N.D., Weiss, N.S., Romand,
JA. et al, 2020).

Critical review:

For the availability of data and resources, the data sets from the study were publicly
available. Therefore, the population were enough for this study to be conducted. Case-fatality has
been initially reported similar across the countries. However, there are several factors that may
contribute to these differences (Kang, S., 2020). This includes the types of healthcare systems,
patients’ characteristics, or prevalence of diagnostic testing. Patient comorbidities (hypertension,
diabetes, and obesity, etc.) have been shown to be associated with higher COVID-19 mortality
(Imam, Z., 2020). Given the fact those comorbidities conditions increase with age, this gives us a
logical explanation of the increased mortality rate from older patients. This shows that this may
affect the results of the study. In addition, it was reported that elderly in other conditions like
cardiovascular disease, changes associated with immunosenescence might explain the increased
vulnerability to infection and the disproportionately high mortality due to COVID-19 in older
patients (Kang, S., 2020).

The study is very useful as we are still under the midst of pandemic, especially for those
doctors, as well as the rest of the healthcare professionals in prioritizing the patients, especially
when getting vaccines. We all know that we are categorizing the patients when it comes to their
age. On the other hand, the research answered all my questions; especially it is highly relative to
my patient’s condition. The research conclusion has reached

The research conclusion is final. For the recommendation about the study, the researchers
should have data about the ethnicity and comorbidity conditions of each that are especially
known to be at risk factors for COVID-19 mortality.
II. CITATIONS

 Imam, Z. (2020, October 1). Older age and comorbidity are independent mortality
predictors in a large cohort of 1305 COVID 19 patients in Michigan, United States.
Wiley Online Library. https://onlinelibrary.wiley.com/doi/10.1111/joim.13119

 Kang, S. (2020, June 1). Age-Related Morbidity and Mortality among Patients with
COVID-19. Https://Doi.Org/10.3947/Ic.2020.52.2.154. https://icjournal.org/DOIx.php?
id=10.3947/ic.2020.52.2.154

 Yanez, D. N. (2020, November 19). COVID-19 mortality risk for older men and women.
BMC Public Health.
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09826-8#Sec5

III. STUDY CHARACTERISTICS

A. Patients included (population and sample)

Higher comorbidity and older age have been reported as correlates of poor
outcomes in COVID-19 patients worldwide. The relationship between age and COVID-
19 associated morbidity or mortality has also been addressed among health professionals
and the general population. The surge of infected patients beyond the limits of medical
systems has raised social concerns on whether age should be considered in determining
treatment intensity. The countries in the sample were; Austria, Belgium, Brazil, Canada,
China, France, Germany, India, Iran, Israel, Italy, Netherlands, Portugal, Russia, South
Korea, Spain, Sweden, Switzerland, Turkey, the United Kingdom, and the United States.
We collected the total number of deaths each country over 6 weeks starting the day of a
country’s fiftieth recorded COVID-19 death

B. Intervention

The researchers estimated the number of COVID-19 deaths for each age and sex
group for the 6-week totals of COVID-19 deaths for each country. COVID-19 mortality
rates were determined using age and sex specific population sizes for each country using
 2020 population estimates from the Central Intelligence Agency (CIA) World Factbook.
The researchers performed an ecological study to model COVID-19 mortality rates per
week by age group (54 years or younger, 55–64 years, and 65 years or older) and sex
using a Poisson mixed effects regression model.

C. Comparison

The researchers performed an ecological study to model COVID-19 mortality

rates per week by age group (54 years or younger, 55–64 years, and 65 years or older) and
sex using a Poisson mixed effects regression model.

D. Outcome monitored

Over the six-week period of data, there were 178,568 COVID-19 deaths from a
total population of approximately 2.4 billion people. Age and sex were associated with
COVID-19 mortality. Compared with individuals ages 54 years or younger, the incident
rate ratio (IRR) was 8.1, indicating that the mortality rate of COVID-19 was 8.1 times
higher (95%CI = 7.7, 8.5) among those 55 to 64 years, and more than 62 times higher
(IRR = 62.1; 95%CI = 59.7, 64.7) among those ages 65 or older. These observations
suggest that the previously observed high COVID-19 case-fatality among older persons
translates into a similarly high mortality rate at the population level

E. Does the study focus on the significant problem in clinical practice

Yes, due to the increasing number of patients with COVID-19 not only in our
country but around the world, this study is very helpful and relevant to the current
situation that everyone is facing as of the moment, especially to the health care providers
and clinical practitioners. It is beneficial to formulate more complex coherent information
that may contribute to the existing body of knowledge about COVID-19. One of the most
critical issues dealt by clinical and public health professionals during the pandemic is the
spectrum of illness severity. This affects the triage, diagnostic and therapeutic decision
making and prognostic expectation, therefore, understanding COVID-19 associated
morbidity and mortality according to age is important (Kang, S., 2020).

IV. METHODOLOGY/DESIGN

A. Methodology
 The researcher begins to obtained information regarding the total number of
COVID-19 reported deaths for six consecutive weeks beginning at the goth recorded
death.

B. Design

The researcher performed ecological study to model COVID-19 mortality rates by

age group (54 years or younger, 55-64 years, and 65 years or older) and sex using a
Poisson mixed effects regression model.

C. Setting

Data of COVID-19 deaths were obtained from the 21 countries with the highest
recorded number of cases of COVID-19 as of April 12, 2020. The countries in the study
sample were (in alphabetical order): Austria, Belgium, Brazil, Canada, China, France,
Germany, India, Iran, Israel, Italy, Netherlands, Portugal, Russia, South Korea, Spain,
Sweden, Switzerland, Turkey, the United Kingdom, and the United States

D. Data sources

The researcher’s data source for COVID-19 cases and deaths was the Johns
Hopkins University, Center for Systems Science and Engineering Coronavirus Resource
Center (CSSE). CSSE provides numbers of deaths and confirmed cases for each country
across the globe. COVID-19 mortality rates were determined using age and sex specific
population sizes for each country using 2020 population estimates from the Central
Intelligence Agency (CIA) World Factbook

E. Has the original study been replicated?

Yes, there are other researches similar to this study which aims to determine the
effect of age and sex in acquiring COVID-19. Similar to the research study that was
conducted by Kang, S., (2020), The dynamics of age-specific mortality for COVID-19 is
relatively familiar because they mirror other major causes of mortality. Case fatality from
COVID-19 has been reported to be relatively high in patients age 65 years. Advanced age
and an increasing number of comorbidities are independent predictors of in-hospital
mortality for COVID-19 patients.

F. What were the risk and benefit of nursing actions/interventions tested in the
study?

In this research study, no nursing action was performed as the sole purpose of this
paper was to perpetuate the relationship between age, sex and COVID-19 morbidity and
mortality.
V. RESULTS OF THE STUDY

Out of the 178,568 COVID-19 deaths reported in the six-week sample from a total
population of approximately 2.4 billion people, 153,923 deaths (86.2%) were in persons age 65
years or older. The United States had the highest number of COVID-19 deaths per week,
followed by several of the western European countries initially affected by COVID-19. By age
group, the researcher see that the mortality rates and model estimate clearly show COVID-19
mortality rates have been higher in the older age categories.

VI. AUTHOR’S CONCLUSIONS/RECOMMENDATIONS

In the 16 countries examined, persons age 65 years or older had strikingly higher
COVID-19 mortality rates compared to younger individuals, and men had a higher risk of
COVID-19 death than women. It will be important that future choices be tailored to account for
the demographics of the population and specifically consider the prevalence of people ages 65 or
older in the population in specific regions, or communities in which nursing homes are located.
Within countries, mapping of regional age distribution potentially could help identify areas at
particularly high risk of being affected. At a more granular level, tracking older population
dynamics and interactions may provide further guidance on how to protect the more vulnerable
older population

VII. APPLICABILITY

COVID-19 fatality rates vary significantly depending on the country, as the data
published in the study was from different nation, there would be a bit difference because of the
different populations, extent of available laboratory tests, and medical health care systems and
facilities. Advanced age and an increasing number of comorbidities are independent predictors of
mortality for COVID-19 patients. This study is useful to be the basis or baseline data for
developing new research and studies.

VIII. REVIEWER’S CONCLUSION/COMMENTARY

This research study is timely and relevant to the current situation that everyone is facing
as of the moment. Identifying morbidity and mortality related to COVID-19 is beneficial to
provide adequate measures to each people in the society. The article was able to determine age
specific rates of COVID-19 mortality at the population level. Their conclusion was
comprehensive in discussing mortality rates of clients depends on their age and sex. The model
that the researchers used was able to explained the data more easily and their population was
huge enough to validate and support the study they conducted.
IX. RECOMMENDATION

With the ever-increasing number of COVID-19 cases worldwide, it is important to have a

continuous researches and particulars about the virus as early determination of different
alleviating risk factor is beneficial to decrease the escalation of the disease and prevent its
transmission to others. As the data published in the study was from different country, there
would be a bit difference because of the different populations, extent of available laboratory
tests, and medical systems. The researchers should have data about the ethnicity and comorbidity
conditions of each that are especially known to be at risk factors for COVID-19 mortality.

References:

 Bhargava, H. D. (2020, April 15). Coronavirus history: How did coronavirus start?
WebMD. https://www.webmd.com/lung/coronavirus-history.

 Cleveland Clinic. (n.d.). Coronavirus disease (covid-19): What is it, symptoms, causes &
prevention. https://my.clevelandclinic.org/health/diseases/21214-coronavirus-covid-19.

 Centers for Disease Control and Prevention. (n.d.). Certain medical conditions and risk
for severe covid-19 illness. Centers for Disease Control and Prevention.
https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-
medical-conditions.html.

 Centers for Disease Control and Prevention. (2021, August 2). Older adults risks and
vaccine information. Centers for Disease Control and Prevention.
https://www.cdc.gov/aging/covid19/covid19-older-adults.html?
fbclid=IwAR1743q62ScuRqGc8YHu56lUQMY2tPZ5h52WFRiGCnjzu3FHS1oAtb0Bw
us.

 Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide:
Diagnoses, prioritized interventions, and rationales. Philadelphia: F.A. Davis.

 EdD, R. J. W. R., & Rn, J. K. H., PhD. (2017a). Health Assessment in Nursing (6th ed.).
LWW.

 Et.Al, B. A. (2021). Kozier Erb’s Fundamentals of Nursing, Global Edition (Global

edition of 10th revised ed). PEARSON EDUCATION.

 Gil Wayne graduated in 2008 with a bachelor of science in nursing. He earned his license
to practice as a registered nurse during the same year. His drive for educating people
stemmed from working as a community health nurse. He conducted first aid traini. (2019,
February 6). Ineffective breathing pattern – Nursing diagnosis & care plan. Nurseslabs.
https://nurseslabs.com/ineffective-breathing-pattern/.
 Hinkle, J. L., & Cheever, K. H., PhD. (2014). Brunner & Suddarth’s Textbook of
Medical-Surgical Nursing, Two-Volume Set, Thirteenth Edition + Lippincott
CoursePoint Access Code (13th ed.). Lippincott Williams & Wilkins.

 Imam, Z. (2020, October 1). Older age and comorbidity are independent mortality
predictors in a large cohort of 1305 COVID- 19 patients in Michigan, United States.
Wiley Online Library. https://onlinelibrary.wiley.com/doi/10.1111/joim.13119
 Jasper, B. (2017, September 23). Impaired gas Exchange – Nursing diagnosis & care
plan. Nurseslabs. https://nurseslabs.com/impaired-gas-exchange/.

 Kang, S. (2020, June 1). Age-Related Morbidity and Mortality among Patients with
COVID-19. Https://Doi.Org/10.3947/Ic.2020.52.2.154. https://icjournal.org/DOIx.php?
id=10.3947/ic.2020.52.2.154

 Kahn, A. (2019, September 18). Breath Sounds. Healthline.

https://www.healthline.com/health/breath-sounds

 Nouvenne, A. (2016, January 15). The association of serum procalcitonin and high-
sensitivity C-reactive protein with pneumonia in elderly multimorbid patients with
respiratory symptoms: retrospective cohort study. BMC Geriatrics.
https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-016-0192-7

 Pietrangelo, A. (2020, August 12). What It Means to Have an Anicteric or Icteric Sclera.
Healthline. https://www.healthline.com/health/eye-health/anicteric-sclerae

 SAGE Journals: Your gateway to world-class research journals. (2008). SAGE Journals.
https://journals.sagepub.com/action/cookieAbsent

 Sauer, L. M. (n.d.). What is Coronavirus? Johns Hopkins Medicine.

https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus.

 seervi, R., & Joan. (2021, July 24). Risk for infection nursing diagnosis and nursing care
plan. Nurseslabs. https://nurseslabs.com/risk-for-infection/.

 Simple Nursing. (2021, February 4). Risk for IMPAIRED gas exchange.
https://simplenursing.ph/risk-for-impaired-gas-exchange-care-note/.

 World Health Organization. (n.d.). Advice for the public On covid-19. World Health
Organization. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-
for-public.

 Yanez, D. N. (2020, November 19). COVID-19 mortality risk for older men and women.
BMC Public Health.
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-09826-8#Sec5