Care of the Patient with COVID-19

Case Study 2

Ms. Joyce is a 52-year-old woman admitted to the COVID-19 unit owing to a 5-day history of
shortness of breath, fever, diarrhea, and sore throat. The patient initially presented to the
COVID-19 screening center 2 days ago, at which time she screened positive and was sent to
the emergency department (ED) for testing. A nasopharyngeal swab was obtained and sent to
the state laboratory for testing. Ms. Joyce’s spouse called 911 this morning when he found her
lying on the floor gasping for air.

Given Ms. Joyce’s history and recent testing, she is transferred via emergency medical services
(EMS) directly to the COVID-19 unit. The patient is lethargic but oriented and reports chest pain
on inhalation. She is struggling to speak in full sentences. Ms. Joyce’s vital signs on arrival are
heart rate 101 beats/minute, respiratory rate 26 breaths/minute, blood pressure 118/57 mm
Hg, temperature 102° F (38.9° C), and oxygen saturation 86% on room air.

Due to visitation restrictions, Ms. Joyce’s spouse provides a history over the phone. Mr. Joyce
reports that the patient is a cashier at the local grocery store and has been working overtime
lately because he cannot work during the pandemic. He states that her symptoms have
worsened significantly over the last 3 days.

Discussion Questions
1. While Ms. Joyce’s COVID-19 test results are pending, what precautions should the health
care professional take?
 Place the patient on airborne precautions to avoid the spread of Covid-19.
 Patient will need a negative air room
 PPE will be used at all times before entering the room. (Gloves, gown, hair net,
goggles or faces shield and masks)
 Use disposable patient care equipment or if unable to then leave the equipment
in the room, designated to that patient and clean often.

2. Given Ms. Joyce’s vital signs, what direct interventions should be provided?

 The number 1 priortity is to improve the patients O2 sat, place the patient on
supplemental oxygen and call the HCP for specific orders.
 The patients heart rate and respiratory rate are r/t inadequate oxygen, these
should stabilize with improved oxygenation, monitor them.
 Sit the patient in a high fowlers position to aid in comfortable breathing.
 The patients fever is concerning, call the doctor for an order of Acetaminophen,
while waiting for order you can make sure the patient is not over heated by
lessening the blankets and also provide the patient with fluids.
3. Ms. Joyce’s test results come back positive for COVID-19. Shortly after learning of her
results, Ms. Joyce’s condition begins to deteriorate, requiring a non-rebreather (NRB) oxygen
mask. Her oxygen saturation is currently 85% on 15 L/min NRB. What next steps must be
taken?

Ms. Joyce’s oxygen is plummeting, 15L on NRB is maxed for this device. Call HCP stat b/c this
patient will need to be placed on mechanical ventilation.

4. Ms. Joyce is successfully intubated and placed on mechanical ventilation. Her oxygen
saturation is stable at 96% on appropriate tidal volumes and increased positive end-expiratory
pressure (PEEP). The health care professionals are preparing to exit the room. What sequence
of doffing personal protective equipment (PPE) must be followed?

Remove all PPE.

1. Gown and gloves

2. Masks, goggles, hair net
3. Dispose of PPE
4. Wash hands thoroughly
References

1. McIntosh, K. Coronavirus disease 2019 (COVID-19): Epidemiology, virology, clinical

features, diagnosis, and prevention. (2020). In UpToDate, Hirsch, M.S., & Bloom, A. (Eds.).
Accessed December 2020 via the Web at www.uptodate.com
2. Centers for Disease Control and Prevention. (2020). “Evaluating and Testing Persons for
Coronavirus Disease 2019 (COVID-19)” [Online]. Accessed December 2020 via the Web at
https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html
3. Centers for Disease Control and Prevention. (2020). “Interim Clinical Guidance for
Management of Patients with Confirmed Coronavirus Disease (COVID-19)” [Online].
Accessed December 2020 via the Web at https://www.cdc.gov/coronavirus/2019-
ncov/hcp/clinical-guidance-management-patients.html
4. Centers for Disease Control and Prevention. (2020). “Using Personal Protective Equipment”
[Online]. Accessed December 2020 via the Web at https://www.cdc.gov/coronavirus/2019-
ncov/hcp/using-ppe.html