CASE PRESENTATION

- OPD
Case Scenario – OPD JBDMDH
At 10am, present date, patient 004 and 005, both from Polangui, Albay, sought consultation
with a pulmonologist in OPD OF JBDMDH. They travelled to JBDMDH via public transportation.
Both were complaining of dry cough, runny nose, sore throat and fever. Patient 004 has
mentioned feeling shortness of breath on top of the other symptoms. While patient 005,
despite not having shortness of breath, was exhibiting hacking cough and experiencing
diarrhea. Upon inquiring with ER - JBDMDH, the Physician found out that the ER department
was swamped with trauma victims from a high impact-head on collision between a passenger
bus and a delivery van, and hence can no longer accommodate incoming patients. You were
the nurse on duty in the OPD reception. The patient 004 was NOT a confirmed case of Covid-
19 at this time, while patient 005 is a confirmed case of Covid 19.
1. What will you include in the nursing history and assessment of patient 004 and 005?
Explain.

Chief complain: Chief complain:

(004) Dry cough; runny nose; (005) Dry cough; runny nose; sore throat;
sore throat; fever and shortness diarrhea and fever.
of breath.

Nursing history:
The two patients travelled to JBDMDH via public transportation. And both were
complaining of dry cough, runny nose, sore throat and fever. Patient 004 has mentioned
feeling shortness of breath on top of the other symptoms. While patient 005, despite not
having shortness of breath, was exhibiting hacking cough and experiencing diarrhea. The
patient 004 was NOT a confirmed case of Covid-19, while patient 005 is a confirmed case
of Covid 19.
2. Discuss briefly how a person acquires Covid-19. Here are some questions that are
commonly ask with brief explanation.

• How is the virus that causes Covid-19 most commonly transmitted between people?
Current evidence suggests that COVID-19 spreads between people through direct,
indirect (through contaminated objects or surfaces), or close contact with infected
people via mouth and nose secretions. These include saliva, respiratory secretions or
secretion droplets. These are released from the mouth or nose when an infected person
coughs, sneezes, speaks or sings, for example. People who are in close contact (within 1
metre) with an infected person can catch COVID-19 when those infectious droplets get
into their mouth, nose or eyes.
• What are the other ways in which Covid-19 virus could be transmitted?
People with the virus in their noses and throats may leave infected droplets on objects
and surfaces (called fomites) when they sneeze, cough on, or touch surfaces, such as
tables, doorknobs and handrails. Other people may become infected by touching these
objects or surfaces, then touching their eyes, noses or mouths before cleaning their
hands.

• When can infected people transmit the virus?

Based on what we currently know, transmission of COVID-19 is primarily occurring
from people when they have symptoms, and can also occur just before they
develop symptoms, when they are in close proximity to others for prolonged
periods of time. While someone who never develops symptoms can also pass the
virus to others, it is still not clear to what extent this occurs and more research is
needed in this area.
• What do we need to know about aerosol transmission?
Some medical procedures can produce very small droplets (called aerosolized droplet
nuclei or aerosols) that are able to stay suspended in the air for longer periods of time.
When such medical procedures are conducted on people infected with COVID-19 in health
facilities, these aerosols can contain the COVID-19 virus. These aerosols may potentially be
inhaled by others if they are not wearing appropriate personal protective equipment.
Therefore, it is essential that all health workers performing these medical procedures take
specific airborne protection measures, including using appropriate personal protective
equipment. Visitors should not be permitted in areas where such medical procedures are
being performed. There have been reported outbreaks of COVID-19 in some closed
settings, such as restaurants, nightclubs, places of worship or places of work where people
may be shouting, talking, or singing. In these outbreaks, aerosol transmission, particularly
in these indoor locations where there are crowded and inadequately ventilated spaces
where infected persons spend long periods of time with others, cannot be ruled out. More
studies are urgently needed to investigate such instances and assess their significance for
transmission of COVID-19.
• Can people without symptoms transmit the virus?
Yes, infected people can transmit the virus both when they have symptoms and when
they don’t have symptoms. This is why it is important that all people who are infected are
identified by testing, isolated, and, depending on the severity of their disease, receive
medical care. Even people confirmed to have COVID-19 but who do not have symptoms
should be isolated to limit their contact with others. These measures break chains of
transmission.
More information about transmission of Covid-19
• different transmission routes, including through droplets of different sizes, physical
contact, fomites, and the role of airborne transmission in the absence of aerosol
generating procedures;
• the dose of virus required for transmission to occur;
• the characteristics of people and situations that facilitate superspreading events such as
those observed in some closed settings;
• the proportion of infected people who remain asymptomatic throughout the course of
their infection;
• the proportion of truly asymptomatic persons who transmit the virus to others;
• the specific factors that drive asymptomatic and presymptomatic transmission;
• and the proportion of all infections transmitted from asymptomatic and presymptomatic
individuals.
3. What other conditions increases the risk for morbidity of a client diagnosed with
Covid-19?

• Older people, and those with underlying medical problems like cardiovascular
disease, diabetes, chronic respiratory disease, and cancer are more likely to
develop serious illness.
• There is increasing evidence that people with existing chronic conditions or
compromised immune systems due to disability are at higher risk of COVID-19.
• The most vulnerable children – including refugees, migrants, and children who are
internally displaced, deprived of liberty, living without parental care, living on the
street and in urban slums, with disabilities, and living in conflict-affected areas – are
a particular concern.
• People with lung problems such as tuberculosis (TB) and asthma.
Sources:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-an
swers-hub/q-a-detail/q-a-how-is-covid-19-transmitted

https://www.google.com/search?
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Presented By: Allessandria Daphne S. Bagacina

Course, Year, Block, & Group: BSN 2A (Group 6)