MICROPARA-1 REPORT:

CORONAVIRUS 2019 ACUTE

RESPIRATORY DISTRESS
(covid 19 ard)

Arlyn Sonio Marcelino BSN 1Y2-6

 ETIOLOGY / CAUSE

(DETAIL DISCUSSION ABOUT MYCOBACTERIUM TUBERCULOSIS

BACILLI, VIRUS, INCUBATION, BACTERIAL GROWTH)
 ETIOLOGY / CAUSE: COVS ARE POSITIVE-STRANDED RNA
VIRUSES WITH A CROWN-LIKE APPEARANCE UNDER AN
ELECTRON MICROSCOPE (CORONAM IS THE LATIN TERM
FOR CROWN) DUE TO THE PRESENCE OF SPIKE
GLYCOPROTEINS ON THE ENVELOPE. 

• The subfamily Orthocoronavirinae of the Coronaviridae family (order Nidovirales) classifies

into four genera of CoVs: Alphacoronavirus (alphaCoV), Betacoronavirus (betaCoV),
Deltacoronavirus (deltaCoV), and Gammacoronavirus (gammaCoV).
 Alphacoronavirus
(alphaCoV)

Furthermore, the betaCoV genus divides into

five sub-genera or lineages. Genomic
characterization has shown that probably bats
and rodents are the gene sources of alphaCoVs Gammacoronavirus
Coronaviridae
Betacoronavirus
(gammaCoV) (betaCoV
and betaCoVs. On the contrary, avian species
seem to represent the gene sources of deltaCoVs
and gammaCoVs. 

Deltacoronavirus
(deltaCoV)
CAUSE:

Members of this large family of viruses can cause respiratory, enteric, hepatic, and
neurological diseases in different animal species, including camels, cattle, cats, and
bats. To date, seven human CoVs (HCoVs) — capable of infecting humans — have
been identified. Some of HCoVs were identified in the mid-1960s, while others
were only detected in the new millennium.
SITUATIONER
GEOGRAPHICAL DISTRIBUTION

• The distribution is based on the 2002–2003 epidemic. The disease appeared in November
2002 in the Guangdong province of southern China. This area is considered as a potential
zone of re-emergence of SARS-CoV.
• Other countries/areas in which chains of human-to-human transmission occurred after early
importation of cases were Toronto in Canada, Hong Kong Special Administrative Region of
China, Chinese Taipei, Singapore, and Hanoi in Viet Nam
WAY OF TRANSMISSION

Because the first cases of the CoVID-19 disease were linked to

direct exposure to the Huanan Seafood Wholesale Market of
Wuhan, the animal-to-human transmission was presumed as
the main mechanism. Nevertheless, subsequent cases were
not associated with this exposure mechanism. Therefore, it
was concluded that the virus could also be transmitted
from human-to-human, and symptomatic people are the most
frequent source of COVID-19 spread.
WAY OF TRANSMISSION

• The possibility of transmission before symptoms develop seems to be infrequent, although it

cannot be excluded. Moreover, there are suggestions that individuals who remain
asymptomatic could transmit the virus. This data suggests that the use of isolation is the best
way to contain this pandemic.
• As with other respiratory pathogens, including flu and rhinovirus, the transmission is
believed to occur through respiratory droplets from coughing and sneezing.
Aerosol transmission is also possible in case of protracted exposure to elevated aerosol
concentrations in closed spaces.
 CONCISE BASIC IMMUNOLOGY
(UPPER AND LOWER RESPIRATORY
TRACT, ANTIBODIES, AND INTERFERON)

The upper respiratory tract includes the mouth, nose, sinus,

throat, larynx (voice box), and trachea (windpipe). Upper
respiratory infections are often referred to as "colds."
The lower respiratory tract includes the bronchial tubes and
the lungs. Bronchitis and pneumonia are infections of the
lower respiratory tract.
 CONCISE BASIC IMMUNOLOGY (UPPER AND
LOWER RESPIRATORY TRACT, ANTIBODIES,
AND INTERFERON)

Sign and Symptoms of the common cold may include:

• stuffiness (nasal congestion), runny nose, low grade fever, post-
nasal drip, and cough;

• the cough is usually dry (no sputum from the lung is being
produced);

• with post-nasal drip, the cough may bring up some of the nasal
secretions that have dripped into the back of the throat; and

• sinusitis symptoms such as fullness in the face, increased nasal

drainage, and occasionally pain and fever;
 CONCISE BASIC IMMUNOLOGY (UPPER AND
LOWER RESPIRATORY TRACT, ANTIBODIES,
AND INTERFERON)

• In some infants and children, the upper airways may become inflamed causing croup
 (laryngotracheobronchitis, acute LTB). In addition to runny nose and stuffiness, the upper
airways, especially the larynx can become inflamed causing a croupy or "barking cough.“
 WHAT CAUSES UPPER RESPIRATORY
INFECTIONS?/ DISEASE PROCESS

• People "catch" colds when they come into contact with airborne viruses. Most often, the
virus spreads from person to person in respiratory droplets from sneezing or coughing.
Transmission of viruses can also occur due to poor hand washing techniques An infected
person may shed viral particles onto their hands and then pass on these particles to someone
else through a handshake or by handing them an object such as a pen or credit card.
 WHAT CAUSES UPPER RESPIRATORY INFECTIONS?
/ DISEASE PROCESS

• The second person then touches their own nose, eyes or mouth, thereby acquiring the virus.
Some viruses can live on surfaces such as sink faucets, door and drawer handles, table
surfaces, pens, and computer keyboards for up to two hours, providing another way of
spreading the infection.
• People should understand that upper respiratory infections are contagious and are spread
from person to person. Individuals are infected with the virus before symptoms arise and are
therefore potentially contagious even before they know they are ill.
 WHAT CAUSES UPPER RESPIRATORY INFECTIONS?
/ DISEASE PROCESS

• Thus, hygienic measures such as covering sneezes and coughs, and regular hand washing
should be a routine habit practiced by everyone even when not ill.
• Rhinovirus ("rhino" from the Greek word for nose) and coronavirus are the two most
common viruses causing upper respiratory infections. Other viruses including parainfluenza
virus, respiratory syncytial virus, and adenovirus can cause colds but may also cause 
pneumonia, especially in infants and children.
 DIAGNOSTIC TEST/LAB TEST

History and physical examination

• The diagnosis of a cold or upper respiratory infection is usually made by history and
physical examination. The health care practitioner may ask questions in regard to the onset
and duration of symptoms. The physical examination may concentrate on the head, neck,
and lungs.
• Examination of the ears may reveal fluid behind the ear drums suggesting Eustachian tube
swelling due to the cold. Nasal examination may show a clear discharge and throat
examination may reveal some redness and post-nasal drip.
 DIAGNOSTIC TEST/LAB TEST

• If the health care practitioner suspects sinusitis, he/she may use their fingers to tap on the
face in areas overlying the large sinuses; the forehead for the frontal sinuses and the cheeks
for the maxillary sinuses.
• The neck may be palpated or felt exploring swollen lymph nodes associated with an
infection.
• The lungs may be assessed with a stethoscope to listen for wheezing (a whistling noise) or
crackling sounds, both signs of inflammation or infection.
• Few tests are required for the diagnosis of an upper respiratory infection.
 DIAGNOSTIC TEST/LAB TEST

Imaging and testing

• If strep throat infection is suspected, a rapid strep test or throat culture may be performed.
• If sinusitis is a suspected, plain X-rays of the sinus structures may be ordered to check for air
fluid levels or clouding of the sinuses consistent with infection. Under some circumstances,
a limited CT scan of the sinuses may be an ordered to look for infection. Antibiotics may be
prescribed if there is fever, facial pain, and a purulent (yellowish green) discharge from the
nose indicating a bacterial component to the sinusitis.
 MONITORING (PUM) MANAGEMENT
(PUI) AND TREATMENT
Treatment
• The current best strategy of treatment of patients with COVID-19 is purely supportive.
Clinicians and intensive care specialists are applying much of what they have learned during
the SARS epidemic to guide current therapy of COVID-19. Recommendations for admission
to critical care units, guidelines for infection control, and procedures to minimize
nosocomial transmission are being established . However, there are several fronts that are
being studied to develop targeted treatments.
 MONITORING (PUM) MANAGEMENT
(PUI) AND TREATMENT

• The most efficient approach to the treatment of COVID-19 is to test whether existing
antiviral drugs are effective. In previous betacoronavirus epidemics, several antiviral drugs,
such as ribavirin, interferon, lopinavir-ritonavir, and darunavir/cobicistat (prezcobix) were
tested, with some showing promising in vitro resultsMERS-CoV), was a candidate Ebola
treatment with promising in vitro. Remdesivir, an adenosine analog used against RNA
viruses (including SARS and results but disappointing in vivo effects against Ebola .
 MONITORING (PUM) MANAGEMENT
(PUI) AND TREATMENT

• There is currently in vitro evidence that remdesivir may be effective in controlling SARS-
CoV-2 infection. In fact, compassionate use of remdesivir was employed in the treatment of
the first COVID-19 case in the United States, during a period of rapid clinical deterioration,
and within one day there was dramatic improvement of the clinical condition.
 MONITORING (PUM) MANAGEMENT
(PUI) AND TREATMENT
• A simple but very effective treatment modality is the use of convalescent plasma, or serum from
patients who have recovered from the virus, to treat patients. Patients with resolved viral
infection will have developed a specific antibody response which may be helpful in neutralizing
viruses in newly infected individuals. This modality was successfully employed during the 2014–
2015 Ebola outbreak. However, the use of convalescent sera is of limited benefit in an outbreak
situation since the exponential growth of infected patients exceeds the ability of previous patients
to provide donor plasma.
 MONITORING (PUM) MANAGEMENT
(PUI) AND TREATMENT
• The first strategy would be to employ either a small receptor-binding domain (RBD) or a neutralizing
antibody targeting the ACE-2 receptor, thus blocking the binding of S protein and preventing virus
entry into cells. Initial in vitro results have shown promising results and specific monoclonal antibodies
are being contemplated as candidates for treatment. The main limitation of using RBDs or antibodies is
that the treatment must be given within a specific time window, before the initiation of viral replication
In addition, the side effects of ACE-2 blockade, especially since ACE-2 is also present in non-
pulmonary tissue, must be understood and minimized before implementation.
 MONITORING (PUM) MANAGEMENT
(PUI) AND TREATMENT

• A second strategy is to create an ACE-2-like molecule that would bind to the S protein of the
coronavirus itself. Again, research in to the 2002 SARS virus demonstrated that soluble ACE-2
proteins blocked the SARS virus from infecting cells in vitro. The additional benefit to using this
strategy lies in the possible prevention of S protein-mediated ACE-2 shedding that has been shown
to induce the pulmonary edema characteristic of SARS . A phase II clinical trial of recombinant
ACE-2 in ARDS reported significant modulation of inflammatory proteins, but no significant
differences in respiratory parameters,
 NURSING MANAGEMENT FOR
COVID – 19 ARD (DOH,WHO,CDC)

Person (including caregivers , nurses and HCWs) who have been exposed to individuals with suspected
COVID - 19 are considered contacts and should be advised to monitor their health for 14 days from the
last day of possible contacts.
A contact is a person who is involved in any of the following from 2 days before and up to 14 days
after the onset of symptoms in the patient.
 NURSING MANAGEMENT FOR
COVID – 19 ARD (DOH,WHO,CDC)

• Having face to face contact with COVID - 19 patient with 1 meter and for >15 minutes
• Providing direct care for patient with COVID - 19disease without using proper personal
protective equipment
• Staying in the same close environment as a COVID – 19 patient (including sharing a
workplace , classroom or household or being at the same gathering) for any amount of time:
 NURSING MANAGEMENT FOR
COVID – 19 ARD (DOH,WHO,CDC)

• A way of nurses to communicate with a health care provider should be established for the
duration of the observation period. Also, health care personnel should review the health of
contacts regularly by phone but ideally and if feasible, through daily in person visits, so
specific diagnostic test can be performed as necessary.
• If a contact develops symptoms, the following steps should be taken
 NURSING MANAGEMENT FOR
COVID – 19 ARD (DOH,WHO,CDC)

• Notify the receiving medical facility that a symptomatic contact will be arriving.
• While traveling to seek care, the contact should wear a medical mask
• The contact should avoid taking public transportation to the facility if possible; an
ambulance can be called
 PREVENTION, QUARANTINE, AND
ISOLATION (DOH, CDC)
Home remedies and OTC medication
• Drink plenty of fluids to prevent dehydration, and also to moisten the nose and sinus
membranes.
• An air humidifier to keep the air moist will assist in keeping the nose and sinus membranes
moist. However, use caution to avoid scalding burns due to hot water when humidifying air.
Cool mist humidifiers may be a better option.
• Alternative treatments such as vitamin C, echinacea, and zinc have been used by some
individuals; however, their benefits have not been scientifically proven.
 PREVENTION, QUARANTINE, AND
ISOLATION (DOH, CDC)
• Acetaminophen or ibuprofen may be used to relieve minor fevers or facial soreness.
• Aspirin should not be used in children or teenagers because of the risk of Reye's syndrome.
• According to the American Academy of Pediatrics, over-the-counter (OTC) cold
medications should not be used in infants and children because of their lack of effectiveness
in controlling symptoms and the potential for significant side effects.
 PREVENTION, QUARANTINE, AND
ISOLATION (DOH, CDC)
• Over-the-counter cold medications should be used with caution is adults as well. These
preparations may contain multiple active ingredients that can increase blood pressure, cause
heart palpitations, and promote sleepiness. Alcohol is one of the active ingredients in many
OTC cold medications.
• Read the labels before taking any medications and discuss any questions or concerns with a
pharmacist or health care practitioner in regard to potential side effects.
LATEST UPDATE PHILIPPINE
SETTING
SOURCES:

• https://www.ncbi.nlm.nih.gov/books/NBK554776/
• https://www.mdpi.com/2076-0817/9/3/231/htm
• https://­iris.wpro.who.int/­bitstream/handle/­10665.1/14482/­COVID-19-022020.pdf
• https://www.who.int/­publications-detail/­clinical-management-o­f-severe-acute-respi­ratory-inf
ection-whe­n-novel-coronavirus-­(
ncov)-infection-is-­suspected