Corona virus -

19
A CASE PRESENTATION
OBJECTIVES
- -

01 03
Understand etiological Recommend
factors associated with interventions based
COVID-19; on the risk factors,
status, and
progression of  coronavirus
disease; and

- -

02 04
Build knowledge
related to the Define the roles of
patient’s experience Nurses and the
of coronavirus contributions they
disease; make to the
healthcare team.
 Coronavirus disease
(COVID 19)
Coronavirus disease (COVID-19) is an
infectious disease caused by a newly
discovered coronavirus (WHO, 2021). It is
a respiratory illness which can be severe,
and has caused millions of deaths around
the world as well as lasting health
problems in some who have survived the
illness.
It is contagious disease caused by severe
acute respiratory syndrome coronavirus
2 (SARS-CoV-2)
 AT RISK
Elderly Men Weakened immune
system

Certain clinical conditions (diabetes, obesity,

cancer, respiratory diseases, heart, kidney, liver,
neurological and autoimmune conditions)
 AGE 102 Pathophysiology
IHD
Pre-diabetes
Weakened immune system

Exposure to SARS-CoV 2 Decreased

SARS-CoV 2 Inflammation
patient with PO2 Chemoreceptors
enters into the enters alveoli of the alveoli
COVID-19 (hypoxemia) are activated
lungs

Increased work
Sympathetic
Difficulty in of breathing due
Increased HR nervous system
breathing to fluid
and RR acts
accumulation
PATIENT PRESENT ILLNESS
CLIENT’S INITIALS: S. A. B.

Age Chief complaint

102 years Labored brathing

Gender Final diagnosis

Female Acute respiratory failure
Confirmed CVOID-19 (Critical)
Pneumonia
IHD
Prediabetes
MEDICATION AND TREATMENT

remdesivir dexamethasone enoxaparin sodium cefuroxime

for anti-inflammatory in treatment for the treatment of
COVID-19 agent for IHD pneumonia
DRUG STUDY
IMPORTANT INFORMATION FOR NURSING INTERVENTIONS

remdesivir - Information prior to administration of the

Patient or designee must be aware that drug is not FDA approved and they
may decline the use of the drug if they wish
Patient or designee must sign Informed Consent for Remdesivir.

Warnings/Precautions
If infusion reactions occur, discontinue administration and institute appropriate
treatment if a clinically significant reaction and notify provider immediately

dexamethasone - Question for hypersensitivity

Monitor I&O, daily weight, serum glucose. Assess for edema z (inc Na level)
Check vital signs at least twice daily.
Monitor electrolytes (hypercalcemia, hypokalemia, paresthesia )
Assess emotional status
DRUG STUDY
IMPORTANT INFORMATION FOR NURSING INTERVENTIONS

enoxaparin sodium - contraindicated in pork hypersensitivity

monitor for signs of bleeding
administer in subcutaneous tissue
DO NOT eject air bubble prior to injection
DO NOT aspirate or massage site

cefuroxime - Question for history of allergies, particularly cephalosporins, penicillins. (skin test)
Assess oral thrush (side effect) z
Continue antibiotic therapy for full length of treatment.
PHYSICAL EXAMINATION
Blood Pressure 100/70 mmHg

Temperature 36 °C Lungs: Harsh breath sounds on both lungs

CVS: NRRR (normal rate and regular rhythm),

negative murmur

Pulse rate 63 bpm Extremities: Weak pulses, muscle atrophy

Respiratory rate 22 cpm

FINDINGS (BLOOD TEST)
Normal Range Patient’s Range

Eosinophil 0.2 to 15.5 LOW 0.00 g/dL

Neutrophils 2,000 to 7,000 LOW 1,460

WBC 5,000 to 10,000 LOW 3,300 cells/µL

20%-40%
Lymphocytes HIGH 44.7%

RESULTS
FINDINGS (Flourescence Immunoassay)
Normal Range Patient’s Range

C-Reactive
10 mg/L LOW 7.32
Protein
LOW likelihood of
Procalcitonin <0.50 ng/mL 0.17
sepsis

D-DIMER 500 ng/mL HIGH 1,245.49

Ferritin Test 20-250 ng/mL HIGH 274.7

RESULTS
 X-Ray revealed :

Minimal Pulmonary tuberculosis

Pneumonia
Cardiomegaly
Atheromatous aorta

ABG Interpretation:

Compensated respiratory alkalosis

 NURSING CARE
PLAN

Impaired gas exchange related to alveolar-capillary

membrane changes as evidenced by dyspnea, hypoxia &
hypoxemia, abnormal skin color, and abnormal breathing of
the client
 Impaired gas exchange related to alveolar-capillary
membrane changes as evidenced by dyspnea, hypoxia &
hypoxemia, abnormal skin color, and abnormal breathing of
the client
SUBJECTIVE DATA:
“Nahihirapan ako huminga” as verbalized by the client.

OBJECTIVE DATA:
With comorbidities:
O2 saturation: • Labored breathing
88-89% • Harsh breath sounds from Age (102 years old)
  both lungs upon auscultation History of illness (IHD, pneumonia,
Respiratory rate :26 • Skin pallor and prediabetes, Pulmonary TB)
• Weak pulses Exposure to patient with Covid-19
PLANNING

Participate in treatment regimen

(breathing exercises, effective
coughing, and use of oxygen)
within level of ability or situation.
NURSING INTERVENTIONS
Assess vital signs Administer medications
as indicated.

Assess level of Elevate head of bed and

consciousness and position client
mentation changes. appropriately.

Observe infection
Assist with procedures as prevention and avoid
individually indicated. acquiring and
  transmitting COVID-19
EVALUATION
The client The client was not able
was able to participate to restore her normal
in treatment regimen breathing patterns. (May
(breathing exercises, 25).
effective coughing, and
use of oxygen) within
level of ability or
situation as evidenced
by client’s responses to
treatment, teaching,
and actions performed.

The client successfully Due to the age of the

prevented the spread of client and her specific
covid-19 to medical comorbidities alongside
staff and family. with being positive for
covid-19, the patient
expired at May 25,
2021.
RR: 26

02 SAT: 89-
91%
 EXPIRED:
05/25/202
1
 Recommendations
In prevention, some measures can reduce the risk of
acquiring and transmitting COVID-19 and this can decrease
the chance of experiencing the respiratory illness. This
includes:
Cover mouth/nose
with tissue or sleeve
Hand hygiene Avoid contact with when
sick people coughing/sneezing
GET
VACCINATED!!

Avoid touching Stay at home while you Clean and disinfect

eyes, mouse and are sick: avoid people frequently touched
nose objects and surfaces
CASE PRESENTATION

Kate Tenorio
z
THANKS!
Do you have any questions?

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REFERENCES
Jones, M. W. (2021, February 8). Acute Cholecystitis - StatPearls - NCBI
Bookshelf. Ncbi. https://www.ncbi.nlm.nih.gov/books/NBK459171/

Brazier, Y. (2018, January 22). What to know about cholecystitis?

Medicalnewstoday.
https://www.medicalnewstoday.com/articles/172067#prevention

Acute calculous cholecystitis: Review of current best practices. (2017b, May

27).

Ncbi. https://www.wjgnet.com/1948-9366/full/v9/i5/118.htm Risk

factors for the clinical course of cholecystitis in patients who undergo
cholecystectomy. (2011, August 1). PubMed Central (PMC).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582536/