Good Samaritan Colleges

Burgos Ave., Cabanatuan City, Nueva Ecija

COVID-19

Submitted by:

Hannah Reyeen F. Pascual

As a Partial Fulfillment on the Course RLE

(MEDICAL/SURGICAL WARD)
 Introduction:

The SARS-COV-2 or COVID-19 shocked the world in the last quarter

of 2019 and early 2020s. It was first isolated from three people

with pneumonia connected to the cluster of acute respiratory

illness cases in Wuhan. All structural features of the novel

SARS-CoV-2 virus particle occur in related coronaviruses in

nature. Coronaviruses (CoV) are a large family of viruses that

cause illnesses ranging from the common cold to more severe

diseases. A novel coronavirus (nCoV) is a new strain that has not

been previously identified in humans. The official names COVID-19

and SARS-CoV-2 were issued by the WHO on 11 February 2020. The

World Health Organization declared the outbreak a Public Health

Emergency of International Concern on 30 January 2020, and a

pandemic on 11 March 2020. The global lockdown takes place in

early May 2020.

 Definition:

COVID-19 affects different people in different ways. Most

infected people will develop mild to moderate illness and recover

without hospitalization. Coronaviruses are a group of related

viruses that cause diseases in mammals and birds. In humans,

coronaviruses cause respiratory tract infections that can range

from mild to lethal. The novel coronavirus is a new strain of

coronavirus that has not been previously identified in humans. A

highly contagious respiratory disease caused by the SARS-CoV-2

virus. SARS-CoV-2 is thought to spread from person to person

through droplets released when an infected person coughs,

sneezes, or talks. It may also be spread by touching a surface

with the virus on it and then touching one’s mouth, nose, or

eyes, but this is less common. The most common signs and symptoms

of COVID-19 are fever, cough, and trouble breathing. Fatigue,

muscle pain, chills, headache, sore throat, runny nose, nausea or

vomiting, diarrhea, and a loss of taste or smell may also occur.

The signs and symptoms may be mild or severe and usually appear 2

to 14 days after exposure to the SARS-CoV-2 virus. Some people

may not have any symptoms but are still able to spread the virus.

Most people with COVID-19 recover without needing special

treatment. But other people are at higher risk of serious

illness. Those at higher risk include older adults and people

with serious medical problems, such as heart, lung, or kidney

disease, diabetes, cancer, or a weak immune system. Serious

illnesses may include life-threatening pneumonia and organ

failure. Research is being done to treat COVID-19 and to prevent

infection with SARS-CoV-2. Also called coronavirus disease 19.

Review of Anatomy and Physiology

What is the Respiratory System?

- The respiratory system is the network of organs and tissues

that help you breathe. It includes your airways, lungs and

 blood vessels. The muscles that power your lungs are also

part of the respiratory system. These parts work together to

move oxygen throughout the body and clean out waste gases

like carbon dioxide.

What does the respiratory system do?

-The respiratory system has many functions. Besides helping you

inhale (breathe in) and exhale (breathe out), it:

- Allows you to talk and to smell.

- Warms air to match your body temperature and moisturizes it

to the humidity level your body needs.

- Delivers oxygen to the cells in your body.

- Removes waste gases, including carbon dioxide, from the body

when you exhale.

- Protects your airways from harmful substances and irritants.

What are the parts of the respiratory system?

The respiratory system has many different parts that work

together to help you breathe. Each group of parts has many

separate components.

Your airways deliver air to your lungs. Your airways are a

complicated system that includes your:

  Mouth and nose: Openings that pull air from outside your

body into your respiratory system.

 Sinuses: Hollow areas between the bones in your head that

help regulate the temperature and humidity of the air you

inhale.

 Pharynx (throat): Tube that delivers air from your mouth and

nose to the trachea (windpipe).

 Trachea: Passage connecting your throat and lungs.

 Bronchial tubes: Tubes at the bottom of your windpipe that

connect into each lung.

 Lungs: Two organs that remove oxygen from the air and pass

it into your blood.

From your lungs, your bloodstream delivers oxygen to all your

organs and other tissues.

Muscles and bones help move the air you inhale into and out of

your lungs. Some of the bones and muscles in the respiratory

system include your:

 Diaphragm: Muscle that helps your lungs pull in air and push

it out.

 Ribs: Bones that surround and protect your lungs and heart.

When you breathe out, your blood carries carbon dioxide and other

waste out of the body. Other components that work with the lungs

and blood vessels include:

 Alveoli: Tiny air sacs in the lungs where the exchange of

oxygen and carbon dioxide takes place.

 Bronchioles: Small branches of the bronchial tubes that lead

to the alveoli.

 Capillaries: Blood vessels in the alveoli walls that move

oxygen and carbon dioxide.

 Lung lobes: Sections of the lungs — three lobes in the right

lung and two in the left lung.

 Pleura: Thin sacs that surround each lung lobe and separate

your lungs from the chest wall.

Some of the other components of your respiratory system include:

 Cilia: Tiny hairs that move in a wave-like motion to filter

dust and other irritants out of your airways.

 Epiglottis: Tissue flap at the entrance to the trachea that

closes when you swallow to keep food and liquids out of your

airway.

 Larynx (voice box): Hollow organ that allows you to talk and

make sounds when air moves in and out.

 Pathophysiology:

To understand the pathogenic mechanisms of SARS-CoV-2 and to

discuss the current therapeutic targets; it is important to

describe the viral structure, genome, and replication cycle. CoVs

are positive-stranded RNA viruses with a nucleocapsid and

envelope. A SARS-CoV-2 virion is approximately 50–200 nm in

diameter and has a +ssRNA genome of approximately 29.9 kb in

length—the largest known RNA virus with a 5′-cap structure and

3′-poly-A-tail and possess 14 putative open reading frames (ORFs)

encoding 27 proteins. The virion has four structural proteins,

known as the S (spike), E (envelope), M (membrane), and N

(nucleocapsid) proteins; the N protein holds the RNA genome, and

the S, E, and M proteins together create the viral envelope [19].

The spike glycoprotein-S facilitates the virus attachment to the

angiotensin-converting enzyme 2 (ACE2) receptor and fuses with

the membrane of the host cell [19]. SARS-CoV-2 then uses serine

proteases TMPRSS2 (transmembrane protease serine 2) for S protein

priming, infecting the target cells [20] (Fig. 2). The spike

proteins of SARS-CoV-2 contains two subunits; S1 receptor binding

subunit and S2 fusion subunit, to mediate the virion binding to

receptor protein and initiate membrane fusion. The S1 and S2

subunits are divided by the S cleavage site (Fig. 2). To

facilitate virion attachment to receptor and fuses with cells

membrane, the spike protein needs to be cleaved by cellular

proteases from the S1/S2 cleavage site (Fig. 2). Interestingly,

the molecular analysis of S proteins identified an insertion at

S1/S2 site, which is absent in other SARS-CoV [21], though the

importance of this insertion is still unknown, it seems that this

unique insertion is providing a gain-of-function advantage for an

easy cell infection and efficient spreading throughout the human

host. The viral RNA hijacks the host cell’s machinery to initiate

the viral genome replication and polypeptides chain synthesis and

form the replication-transcription complex (RCT) needed to

synthesize the sub-genomic RNAs as well as structural proteins

(envelope and nucleocapsid).The viral envelope has a crucial role

in the viral assembly, release, and promoting viral pathogenesis

[22]. However, the exact role of the many small viral peptides

(e.g., those of glycoprotein subunits) has not yet been

described. More research is needed to understand the structural

characteristics of SARS-CoV-2 that underlie various pathogenic

mechanisms.

Signs and Symptoms:

Most common symptoms:

- fever
- cough
- tiredness
- loss of taste or smell
Less common symptoms:
- sore throat
- headache
- aches and pains
- diarrhoea
- a rash on skin, or discoloration of fingers or toes
- red or irritated eyes
Serious symptoms:
- difficulty breathing or shortness of breath
- loss of speech or mobility, or confusion
- chest pain
- Seek immediate medical attention if you have serious
symptoms. Always call before visiting your doctor or health
facility.

Diagnosis:

If you develop symptoms of coronavirus disease 2019 (COVID-19) or

you've been exposed to the COVID-19 virus, contact your health
care provider. Also let your health care provider know if you've
had close contact with anyone who has been diagnosed with COVID-
19.

Factors used to decide whether to test you for the virus that
causes COVID-19 may differ depending on where you live. Depending
on your location, you may need to be screened by your clinic to
determine if testing is appropriate and available.

To test for the COVID-19 virus, a health care provider takes a

sample from the nose (nasopharyngeal swab), throat (throat swab)

or saliva. The samples are then sent to a lab for testing. If

you're coughing up sputum, that may be sent for testing.

The FDA has authorized at-home tests for the COVID-19 virus.

These are available only with a doctor's prescription.

Serologic Testing

- CDC's serologic test is an enzyme-linked immunosorbent

assay (ELISA)-based test to detect SARS-CoV-2 antibodies in

serum or plasma components of blood. The ELISA test uses

purified SARS-CoV-2 S protein (no live virus) as antigen

(designed by the Vaccine Research Center at the National

Institutes of Health).

RT PCR
 Real time RT–PCR is a nuclear-derived method for detecting the

presence of specific genetic material in any pathogen,

including a virus. ... Real time RT–PCR is one of the most

widely used laboratory methods for detecting the COVID-19

virus.

Drug Study:

The FDA has approved an antiviral drug called remdesivir

(Veklury) to treat COVID-19 in adults and children who are age 12
and older. Remdesivir may be prescribed for people who are
hospitalized with COVID-19 and need supplemental oxygen or have a
higher risk of serious illness. It's given through a needle in
the skin (intravenously).
The FDA has authorized for emergency use a drug called Paxlovid.
This drug combines two types of medications in one package. The
first drug is nirmatrelvir. It blocks the activity of a specific
enzyme needed for the virus that causes COVID-19 to replicate.
The second drug is an antiviral drug called ritonavir. It helps
slow the breakdown of nirmatrelvir. Paxlovid is authorized to
treat mild to moderate COVID-19 in people age 12 and older who
are at higher risk of serious illness. The medications are taken
by mouth as pills.

Researchers are studying other potential treatments for COVID-19,

including:

 Antiviral drugs. Researchers are testing the antiviral drugs

favipiravir and merimepodib. Studies have found that the
combination of lopinavir and ritonavir isn't effective.
 Anti-inflammatory therapy. Researchers study many anti-
inflammatory drugs to treat or prevent dysfunction of several
organs and lung injury from infection-associated inflammation.
 Dexamethasone. The corticosteroid dexamethasone is one type of
anti-inflammatory drug that researchers are studying to treat
or prevent organ dysfunction and lung injury from
inflammation. Studies have found that this drug reduces the
risk of death by about 30% for people on ventilators and by
about 20% for people who need supplemental oxygen.

Medical/Surgical Management:

Medical treatments
Scientists around the world are working to find and develop
treatments for COVID-19.
Optimal supportive care includes oxygen for severely ill patients
and those who are at risk for severe disease and more advanced
respiratory support such as ventilation for patients who are
critically ill.

Dexamethasone is a corticosteroid that can help reduce the length

of time on a ventilator and save lives of patients with severe
and critical illness.
WHO does not recommend self-medication with any medicines,
including antibiotics, as a prevention or cure for COVID-19.

Nursing Management:

Monitor vital signs – particularly temperature and respiratory

rate, as fever and dyspnea are common symptoms of COVID-19.
Monitor O2 saturation – normal O2 saturation as measured with
pulse oximeter should be 94 or higher; patients with severe
COVID-19 symptoms can develop hypoxia, with values dropping low
enough to warrant supplemental oxygen.

Manage fever – use appropriate therapy for hyperthermia,

including adjusting room temperature, eliminating excess clothing
and covers, using cooling mattresses, applying cold packs to
major blood vessels, starting or increasing intravenous (IV)
fluids as allowed, administering antipyretic medications as
prescribed, and readying oxygen therapy in the event of
respiratory problems resulting from the metabolic demands for
oxygen during a fever.

Maintain respiratory isolation – isolation rooms should be well-

marked with limited access; all who enter the restricted-access
room should use personal protective equipment, such as masks and
gowns.

Enforce strict hand hygiene – to reduce or prevent transmission

of coronavirus, patients should wash hands after coughing, as
should all who enter or leave the room.

Provide information – educate the patient and patient’s family

members of the transmission of COVID-19, the tests to diagnose
the disease, disease process, possible complications, and ways to
protect oneself and one’s family from coronavirus.

References:

https://everynurse.org/nursing-management-covid-19/
https://www.mayoclinic.org/diseases-conditions/coronavirus/

diagnosis-treatment/drc-20479976#:~:text=To%20test%20for%20the

%20COVID,for%20the%20COVID%2D19%20virus.