Running head: COVID 19 1

Covid 19

Lauretta Gilson

Nursing 217

February 10, 2022

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Covid 19

Covid 19 is virus that causes acute respiratory infections and belongs to the family of

(SARS) coronavirus-2. Covid 19 has caused a worldwide pandemic due to the exceptionally

rapid spread. Covid 19 has been responsible for millions of positive infections and thousands of

deaths, as well as debilitating long term effects (Parasher, 2021).

Pathophysiology

The Covid 19 virus transmits through droplets and aerosols. There are four structural

proteins that make up the coronavirus, which include the spike protein, membrane, envelope and

the nucleocapsid protein. The spike protein is essential to the virus for attachment and

penetration of the host cell. When the spike protein binds to ACE 2, it primes and activates the

virus and the host cell membrane fusion. After fusion, and within the alveolar, the host cell and

the virus replicate and form a negative strand RNA by the single strand RNA. Once the covid

virus is inhaled it adheres to the ciliated cells in the nose through the ACE 2 receptor. Once in

the nose, the virus replicates which induces a limited immune response. The virus infects the

upper respiratory tract and moves to the lower respiratory tract where it attacks the alveolar

through the ACE 2 receptors. The patient then typically develops a cough, fever and fatigue. In

most cases (about 80%), the virus replicates and releases particles which results in the death of

the host cell, therefore clearing the virus within 10 to 14 days. In more severe cases, about 1/5 of

infected people will experience a cytokine storm (a mass release of cytokines, interleukins, TNF

Factor, CXCL, MCP-1, MIP-1). This mass release encourages CD4 helper T cells and CD8

cytotoxic T cells to gather and stick in the lung causing cytotoxicity and lung injury (Parasher,

2021).
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Nursing Interventions

Mild cases are characterized by oxygen levels maintained at 94%-97% on room air.

Oxygen saturation would need to be monitored and oxygen administered using a nasal canula,

mask or non-breather mask. A treatment plan should include acetaminophen for treating fever

and pain, as well as providing hydration and nutrition (Parasher, 2021).

Moderate cases are characterized by oxygen levels between 90%-94%. Interventions

would include isolating the patient, monitoring vitals and oxygen saturation. In addition,

collecting a complete blood count, performing a 12 lead EKG and chest x-ray. Oxygen therapy at

this stage could include high-flow nasal oxygen and continuous positive airway pressure

(CPAP). Steroids, heparin (used to prevent blood clots), and antibiotics (administered for

secondary infections that result from covid infection) (Parasher, 2021).

Severe cases are all cases with oxygen levels equal to or less than 90% on room air and

patients exhibiting acute respiratory distress. Interventions may include ventilation and

intubation. ECMO (extracorporeal membrane oxygenation) and prone ventilation for 16-18

hours per day may also be recommended. In cases where sepsis or shock are present, antibiotics,

IV hydration and vasopressors should be administered (Parasher, 2021).

In addition, antiviral drugs can be administered, such as Remdesivir, that has been used

against other RNA viruses (Ebola). Immunomodulatory drugs such as tocilizumab (monoclonal

antibodies) can be used to boost the immune system. Plasma exchange (convalescent plasma) is

another treatment effective by infusing patients with blood from previous infected and recovered

donors. Supplemental therapy is targeted toward the treatment of comorbidities affected by covid

(for example, high blood pressure) (Parasher, 2021).

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Risk to Patients and Long-Term Consequences

There are many long-term effects that are caused by the Covid 19 virus. The symptoms

range from mild to severe, and last from weeks to months. The more common symptoms include

fatigue, dyspnea, cough, joint or chest pain, problems with memory and concentration, insomnia,

headache, tachycardia, dizziness and loss of smell and taste. More severe symptoms include

inflammation of organs and tissue, blood clots that can affect the lungs, liver, kidneys and legs,

with the potential of also causing other complications such as heart attack and stroke. Organ

damage to the heart and kidneys are also long-term complications, as well as Guillain-Barre

syndrome, a disorder that causes temporary paralysis. With Covid 19 being recently introduced,

there is still a tremendous amount of information about the virus that is unknown, and therefore

continuing research will increase better outcome by utilizing evidence-based practice for future

treatment (Mayo Clinic, 2021).

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References

Mayo Clinic. (2021). Covid-19 (coronavirus): Long term effects.

https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-long-

term-effects/art-20490351

Parasher, A. (2021). COVID-19: Current understanding of its pathophysiology, clinical

presentation and treatment. Postgraduate Medical Journal 2021; 97:312-320.

https://pmj.bmj.com/content/97/1147/312.citation-tools