Care of the Patient with COVID-19

Case Study 1

Mr. George is a 75-year-old man who presents to the COVID-19 screening center with a 4-day
history of worsening shortness of breath, sore throat, diarrhea, and chills. He lives at home with
his spouse and has been retired for nearly 8 years. Mr. George’s daily activities include walking
his dog every morning, tinkering in the garage, and helping his friend next door with household
projects. He has been unable to walk his dog for the past 2 days due to shortness of breath.

Further screening reveals that Mr. George’s next-door neighbor is an associate at the local
hardware store with frequent close interactions with the public. Mr. George’s spouse, who
accompanies him to the screening center, also reports recent travel to visit their adult child who
is a critical care nurse at a local hospital.

Mr. George’s vital signs include the following: temperature 101.2° F (38.4° C), heart rate 88
beats/minute, respiratory rate 22 breaths/minute, blood pressure 178/92 mm Hg, and oxygen
saturation 95% on room air. Given Mr. George’s symptoms and vital signs, he is moved to the
emergency department (ED) for further testing.

Discussion Questions
1. After receiving a brief hand-off communication from the screening center, what are the
health care professional’s priority screening questions?

Are you exoeriencing any of the following

 Trouble breathing
 Persistent pain or pressure in the chest
 New confusion
 Inability to wake or stay awake

2. Mr. George reports a history of hypertension, treated with metoprolol, but no other past
medical history. He takes one aspirin each day and eats a well-balanced diet. Given Mr.
George’s history and current vital signs, the decision is made to perform a COVID-19 test. What
steps should the health care professional take to prepare for the test?

o Place patient on airborne precautions in the meantime to prevent the spread of

covid.
o Thouroughly monitor the patients vitals, including breathing.
o It may be necessary to provide suppliental oxygen to the patient since his O2 sat
is @ 95%, monitor for drops and notify HCP to get an order.
3. What are the steps to perform an effective COVID-19 nasopharyngeal swab?

1. Disinfect the area designated for you swabbing kit. Remove kit onto disinfected
area and read instructions.
2. Hand hygiene, preferably soap and water.
3. Remove the swab from packaging, keeping the tip of the swab sterile.
4. Insert swab about 2cm into the nostril, or till resistance
5. Use slow circular motions along the inside of the nasal passage for about 30
seconds.
6. Gently remove the swab
7. Using the same swab, repeat steps 4-6 in the other nostril
8. Place the swab in a sterile tube and snap off the end of the swab at the break
line. Place the cap tightly.
9. Hand hygiene
10. Place the swab and tube in a biohazard bag and seal it.
11. Turn bag in to appropriate and designated area.
12.Throw away the remaining items from the kit.
13.Hand hygiene.

4. Mr. George states that he does not wish to be admitted today and asks about his options to
rest at home until his test results are ready. How should the health care professional advise Mr.
George?

Mr. George was admitted for shotness of breath, there is no reason he cannot go home to
quarantine until results are in so long as his vitals are stable and he provides no futher
complications. He will be needed to be sent home with thoroughough instructions of when to
return and how to prevent exposing any one else in his home.

When to return to hospital

o Trouble breathing / Increasing difficulty

o Pain/pressure in the chest
o New confusion
o Inability to wake or stay awake

How to prevent spread

o Self isolate for at least 10 days past the onset of symptoms

o Both you and the other person will need to wear mask when in close
proximity of one another, keep distance to at least 6 feeet
o Do not share household items
References

1. McIntosh, K. Coronavirus disease 2019 (COVID-19): Epidemiology, virology, clinical

features, diagnosis, and prevention. (2020). In UpToDate, Hirsch, M.S., & Bloom, A. (Eds).
Accessed December 2020 via the Web at www.uptodate.com
2. Centers for Disease Control and Prevention. (2020). “Evaluating and Testing Persons for
Coronavirus Disease 2019 (COVID-19)” [Online]. Accessed December 2020 via the Web at
https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html
3. Centers for Disease Control and Prevention. (2020). “Interim Guidelines for Collecting,
Handling, and Testing Clinical Specimens from Persons for Coronavirus Disease 2019
(COVID-19)” [Online]. Accessed December 2020 via the Web at
https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html
4. Centers for Disease Control and Prevention. (2020). “Interim U.S. Guidance for Risk
Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to
COVID-19” [Online]. Accessed December 2020 via the Web at
https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html

Centers for Disease Control and Prevention. (2020). “Coronavirus Disease 2019 (COVID-19)
Isolate if You Are Sick” [Online]. Accessed December 2020 via the Web at
https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/isolation.html