COVID-19

GROUP 2
RLE NCMB 418
 TABLE OF CONTENTS
01 02
Trace the Briefly, but thoroughly, describe and explain
pathophysiology of the each the laboratory and diagnostic
condition and course of procedures, including the relevance of each
her disease. in managing the patient.

03 04
Formulate a plan of care for
the patient focusing on
Discharge Plan
a. Prioritized needs
b. Anticipated needs
CASE SCENARIO: Young Peggy (Adapted from Case Reports in
Women’s Health, 2021)
A 30-year-old primiparous woman, Peggy, (BMI = 27.5 kg/m2) was referred to FUMC at
approximately 34 weeks of gestation because of a positive quantitative RT-PCR throat
swab for severe acute respiratory syndrome coronavirus. She has fever for 2 days
(average temp = 39.0°C) and saturation O2 (SpO2) was 95% (room air). A chest CT scan
revealed bilateral multifocal ground-glass opacities with partial consolidation,
corresponding to COVID-19 pneumonia. Admission laboratory data showed a WBC count
of 8800/μL, lymphocyte 12.4%, C-reactive protein (CRP) 3.54 mg/L, D-dimer 2.3μg/mL
(<1.0μg/mL), and IL-6487 pg/mL (<4.0). Ciclesonide inhalation 400μg/day,
dexamethasone 6.6 g/day, heparin sodium 10,000 U/day, and sulbactam/ampicillin 6
g/day were initiated.

On the second day after admission Peggy continued to have high fever with chills and
shivers; her dyspnea worsened. SpO2 was 95% with a 1-L/min oxygen flow via nasal
cannula. Remdesivir 200 mg/day and tocilizumab 8 mg/kg were administered on the
next day. On the fourth day after admission, her respiratory condition rapidly worsened,
and the SpO2 was 94%–95% with a 3–4 L/min oxygen mask. Laboratory data showed
WBC count of 9000/μl, lymphocyte 11.5%, CRP 10.41 mg/L, and D-dimer 1.5μg/mL, and
chest CT findings showed rapid deterioration. Due to Peggy’s respiratory status, her
physicians deemed of requiring ventilator or ECMO management and an emergency
cesarean section delivery.
On the 5th day of admission, Peggy's fever subsided, but her SpO2 remained at 94%–95%, even with a 10 L/min
oxygen mask. She was subsequently intubated and put on mechanical ventilation at the ICU. The initial
conditions for the mechanical ventilation were as follows: tidal volume 400 mL, respiratory rate 16 breaths/min,
PEEP 15 cm H2O, and FiO2 of 100%. Subsequent ventilator settings and Peggy’s ABG results are as follows:
 01
PATHOPHYSIOLOGY
Trace the pathophysiology of the condition and
course of her disease.
Modifiable Factors: Non-Modifiable Factors:
● Positive in RT-PCR swab test ● 30 y/o
● BMI of 27.5 - Overweight ● Female
● Pregnant 34 weeks, Primiparous

Weakened immune system of the host

(mother)

SARS-CoV-2 enters the lungs of the

susceptible host

S1 Spike protein of SARS-CoV-2 virus binds to the

ACE-2 receptors surface, while S2 Spike proteins of
SARS-CoV-2 fuses with the host cell membrane

SARS-CoV-2 nucleocapsid enters the host

cell
 Release of SARS-CoV-2 viral contents
to the host cell

Replication, Transcription, and Translation of

SARS-CoV-2 viral contents

Release of the new viral material to the

cytoplasm

RT-PCR
The new viral material is transported to
Positive quantitative throat
the extracellular space
swab for SARS-CoV-2
 Laboratory Results:
DAY1
Lymphocyte s- 12.4% -
(Decreased)
Macrophages will detect the new viral Signs and Symptoms
material and release inflammatory DAY1
D-dimer 2.3μg/mL -
mediators Fever - 39.0°C
(Increased)

IL-6487 pg/mL –
(Inceased)
Dilation of endothelial cells of smooth
muscles

Increased capillary membrane

permeability
Leakage of fluid plasma into the interstitial Attraction of neutrophils into the
space and inside the alveoli sac alveoli

Accumulation of fluid plasma into the Neutrophils destroys viral cells inside the
alveoli alveoli (including Type I and Type II cells)

Chest CT Scan
Multifocal ground
The new viral material is transported to Consolidation of the
glass opacities
the extracellular space alveoli
w/partial
consolidation

Impaired gas exchange

 S/Sx:
Hypoxemia
Day 1 - SpO² 95%

S/Sx:
Increased work for breathing
Day 2- Dyspnea worsened

Laboratory Result:
DAY 4
Continuous replication, transcription, and
Lymphocytes- 11.5% - S/Sx:
translation of SARS-CoV-2 viral contents;
(Decreased) Day 2 - High fever with chills
release of inflammatory mediators by
and shiver
the macrophages; and loss of type I and
CRP 10.41mg/L - (Increased) Day 5 - Fever subsided
type II cells in alveoli
D-dimer 1.5μg/mL –
(Increased)
 S/Sx:
Day 2 - SpO² 95%
Rapid deterioration of lung
Day 4 - Rapidly worsened: SpO²
tissue
94-95%
Day 5 - SpO² remained 94-95%

Covid-19 Pneumonia
 02
LABORATORY AND
DIAGNOSTIC TEST
Briefly, but thoroughly, describe and explain each the
laboratory and diagnostic procedures, including the
relevance of each in managing the patient.
 CHEST CT-SCAN
Chest Computed Tomography of the lungs are sensitive
and moderately specific in diagnosing COVID-19 thus, may have
more utility for ruling out COVID-19 than for differentiating
SARS-CoV-2 infection from other causes of respiratory illness
(Ebrahimzadeh, 2022).

❏ The respiratory condition of the patient

RESULT worsened, and a chest CT scan revealed GGO
The patient's respiratory and this can indicate potentially treatable
condition deteriorated, and disease, help guide the type and location
pneumonia findings on of biopsy and evaluate the effectiveness of
chest CT had worsened,
showing rapidly increased therapy.
consolidation with air ❏ The assumed pathology incorporate
bronchogram in both lung incomplete filling of the lung alveoli by
fields.
liquid, interstitial thickening,or fractional
breakdown of lung alveoli.
Relevance to the patient:
Clinical data is helpful in narrowing the range of diagnostic possibilities, or
even in suggesting a specific diagnosis, since by 34 weeks and 5 days of
gestation the CT-scan showed rapid deterioration, HCP manage immediately the
condition of the patient by requiring ECMO management.
 D -DIMER
The D-dimer is very sensitive to intravascular thrombus and
may be markedly elevated in disseminated intravascular
coagulation and Elevations occur in normal pregnancy,
rising two- to fourfold by delivery (Olson, 2022).

❏ This indicates towards excessive

RESULT
blood clot formation and
Increase D-dimer 2.3 degradation happening
μg/mL (<1.0μg/mL)
simultaneously somewhere in the
upon admission then
decreased by 1.5 body even though this test does
μg/mL after 4 days. not pinpoint the location of the
abnormality.

Relevance to the patient:

D-dimer levels are usually raised in patients contaminated with
SARS-CoV-2. Altogether more elevated levels are found in those with
basic disease and might be utilized as a prognostic marker for in-medical
clinic mortality. There is a variable rise in D-dimer in active malignancy
and indicates increased thrombosis risk in active disease.
 C-REACTIVE PROTEIN

CRP level determine the extent of lung lesion

and the severity of the condition of the
patient in relation to COVID-19. At the
beginning phase of COVID-19, CRP levels were
emphatically connected with lung sores that
could reflect infection seriousness and ought
to be utilized as a vital marker for illness
observation (Wang, 2020).

RESULT
Relevance to the patient:
3.54 mg/L then CRP provides significant clinical
decreased by evaluation index for this can reflect the
10.41 mg/L extent of lung lesion and disease severity
in early stage of COVID-19.
 LYMPHOCYTE
Lymphocyte count is one of features that
helps identify patients with severe Covid-19
(Ghizlane, 2021). During viral infection with
COVID-19, angiotensin converting enzyme
(ACE2) is a main receptor for Sars-Cov-2 as
well as Sars-CoV-2, this enzyme used by the
virus to enter the host and caused damage in
lymphoid organ (Leng, 2020).

RESULT
Relevance to the patient:
Lymphocyte
Lymphocytopenia is a dependable marker
12.4% upon
admission then of early SARS CoV-2 contamination and
became 11.5% helps in following of contacts other than
evaluation of sickness movement along
the course of COVID -19 Pneumonia.
 WBC
A white blood cell is a type of blood cell that is produced in the
bone marrow and found in the blood and lymph tissue. White blood
cells are components of the immune system. They aid the body's
defense against infection and other diseases. Granulocytes
(neutrophils, eosinophils, and basophils), monocytes, and
lymphocytes are all types of white blood cells (T cells and B cells).
A complete blood cell (CBC) test usually includes a count of white
blood cells in the blood. It can be used to screen for infections,
inflammation, allergies, and leukemia. (Cleveland Clinic, n.d.)

Relevance to the patient:

White blood cells (WBC) are commonly measured RESULT
to investigate suspected infection and inflammation in
pregnant women, but the pregnancy-specific reference
interval is variably reported, increasing diagnostic Patient: 8800/ML,
and 9000/L, Normal
uncertainty in this high-risk population. Hospitalized
Value:
patients with COVID-19 should undergo a comprehensive
4,500-11,000/L
daily CBC with manual WBC differential to monitor for
numerical and morphologic changes predictive of poor
outcome and signs of disease progression.
 RT PCR
Polymerase chain reaction is an abbreviation for PCR. It's a
test for detecting genetic material from a particular
organism, such as a virus. If you have the virus at the time of
the test, the test detects its presence. The test may also
detect virus fragments even after you are no longer infected.
The polymerase chain reaction (PCR) test for COVID-19 is a
molecular test that looks for genetic material (ribonucleic acid
or RNA) of SARS-CoV-2, the virus that causes COVID-19, in
your upper respiratory specimen. (MedlinePlus, n.d.)

Relevance to the patient: RESULT

Screening pregnant women on admission
will remain an important component in order positive quantitative
to minimise nosocomial infection. The PCR RT-PCR throat swab
for severe acute
test has been the gold standard for respiratory syndrome
diagnosing COVID-19. It is accurate and coronavirus
dependable.
 Oxygen Saturation

Oxygen saturation is measured using a pulse oximeter. It

indicates the amount of oxygen-carrying hemoglobin in the
blood relative to the amount of hemoglobin not carrying
oxygen.

Relevance to the patient:

Relevant to the case scenario, Peggy RESULT
manifested a normal oxygen saturation.
D2: 95% with a 1 -L/min oxygen -
NORMAL

D4: 95% with a 1-L/min oxygen -

NORMAL

D5: 94-95% with a 10 -L/min oxygen -

NORMAL
 ABG Analysis

The amounts of oxygen and carbon dioxide in your blood are

measured by an arterial blood gas (ABG) test, which takes a
blood sample from an artery in your body. The pH balance,
sometimes referred to as the acid-base balance, of your
blood is also examined during the test. (Cleveland Clinic, n.d.)

Relevance to the patient:

It is an efficient test to acknowledge how
well the lungs can move oxygen and remove
carbon dioxide from the blood. With the case
scenario, this test is essential in monitoring
Peggy's lung function and determining the
effectiveness of her mechanical ventilator.
 ABG Results
DAY 5 DAY 6 DAY 7 DAY 8 Normal
Values

pH 7.33 7.35 - 7.423 7.35 - 7.45

(Decreased) (Normal) (Normal)

pCO2 (mmHg) 42.8 41.8 - 41.8 35 - 45

(Normal) (Normal) (Normal) mmHg

pO2 (mmHg) 77 101 - 93.1 80 - 100

(Decreased) (Increased) (Normal) mmHg

HCO3 (mEq/L) 21.9 22.6 - 26.6 21 - 28

(Normal) (Normal) (Normal) mEq/L

BE (mEq/L) -3.0 -2.2 - 2.5 -2 to +2

(Decreased) (Decreased) (Increased)

SAT 95.2 97.3 - - 95%-100%

(Normal) (Normal)
 03
NURSING CARE
PLAN
Trace the pathophysiology of the condition and
course of her disease.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Ineffective SHORT TERM: Independent: Independent: SHORT TERM:

Within 1 hour of ▪Assess airway for ▪ Maintaining patent airway is Within 1 hour of nursing
- Dyspnea airway always the first priority.
nursing intervention, patency. intervention, the patient
clearance the patient will be was able to:
Objective: related to ▪Abnormal breath sounds can
able to: ▪Auscultate lungs for
be heard as fluid and mucus
CT scan reveals airway presence of normal or accumulate. This may indicate -improve airway
presence of obstruction as -improve airway adventitious breath ineffective airway clearance. patency
Bilateral multifocal evidenced by patency sounds, as in the following: These may indicate presence
Decreased or absent secretions or obstructions -expectorate/clear
ground-glass dyspnea, -expectorate/clear breath sounds,wheezing, secretions
opacities with presence of secretions crackles etc.
partial bilateral -demonstrate reduction
consolidation multifocal -demonstrate ▪Assess respirations. Note of congestion. improve
▪A change in the usual
corresponding to ground-glass reduction of quality, rate, pattern, oxygen exchange
respiration may mean
congestion, improve depth, flaring of nostrils, respiratory compromise. An
COVID-19 opacities with oxygen exchange dyspnea on exertion, -demonstrate behaviors
increase in respiratory rate
pneumonia. partial evidence of splinting, use and rhythm may be a with relation to
consolidation -demonstrate of accessory muscles, and compensatory response to improvement of airway
O2 Sat: SpO2 corresponding behaviors with position for breathing. airway obstruction. by participating in the
remained at to COVID-19 relation to treatment regimen.
improvement of ▪To determine if there are any
94%–95%, even pneumonia. ▪ Continuous monitoring of significant changes from the
airway by vital signs: HR, BP, __Goal met
with a 10 L/min previous shifts. Increased work
participating in the temperature __Goal partially met
of breathing can lead to
oxygen mask treatment regimen. tachycardia and hypertension. __Got not met
Retained secretions or
atelectasis may be a sign of an
existing infection or
inflammatory process
manifested by a fever or
increased temperature.
A D PLANNING INTERVENTION RATIONALE EVALUATION
S I
LONG TERM ▪ Monitor patient’s oxygen ▪To provide an evaluation of the LONG TERM
S A saturation using pulse oximeter effectiveness of therapy. Pulse oximetry
E G After 2 weeks of nursing while using mechanical is used to detect changes in After 2 weeks of nursing
S N interventions, the patient will ventilation oxygenation. Oxygen saturation should interventions, the patient
be maintained at 97% or greater.
S O be able to: was able to:
M S -maintain a clear patent
▪ Assess the ventilator settings, ▪Any discomfort that may occur while
-maintain a clear patent
alarm system, patient’s comfort patient is on Mech Vent maybe
E I airway as evidence by and ability to cooperate while secondary to incorrect settings of airway aeb improved
N S improved oxygen saturation, she is currently on mechanical ventilator that may result in further oxygen saturation, and
T absence of dyspnea ventilation. insufficient oxygenation identify appropriate
preventive and corrective
▪Teach the patient the following: actions.
-Position the head of the patient __Goal met
at 30°. -To increased thoracic capacity and __Goal partially met
increased lung expansion __Got not met
-Teach the patient the proper
ways of coughing and breathing. -The most convenient way to remove
(e.g., using pillow to protect the most secretions is coughing. So it is
abdomen, take a deep breath, necessary to assist the patient during
hold for 2 seconds, and cough this activity. Deep breathing, on the
two or three times in succession other hand, promotes oxygenation
or exhale). before controlled coughing.

-use of pillow or hand splints

when coughing
-To protect the abdomen.
A D P INTERVENTION RATIONALE E
S I L V
S A A A
-Importance of ambulation and frequent position changes
E G N -Ambulation promotes lung expansion, mobilizes L
S N N ▪Ensure that both side rails are raised. secretions, and lessens atelectasis. U
S O I ▪To reduce the risk of falling A
M S N ▪Increase fluid intake to at least 2,000 mL/day within cardiac tolerance. T
▪Hydration can help prevent the accumulation of
E G Encourage/provide warm versus cold liquids as appropriate.
viscous secretions and improve secretion
I
N I Dependent: clearance. O
T S ● Maintain humidified oxygen as prescribed. N
Dependent:
● Increasing humidity of inspired air will
reduce thickness of secretions and aid
● Administer medications as indicated: Ciclesonide inhalation their removal
(Corticosteroids are mainly used to reduce inflammation and suppress
the immune system) ● Medications such as Ciclesonide
inhalation Corticosteroids are mainly
important to reduce inflammation.
● Oxygen as prescribed by the physician at 10 lpm.
● Helps to restore the oxygen saturation of
● Use of incentive spirometry the body

● To help strengthen the lungs

COLLABORATIVE:
COLLABORATIVE:
● Refer to a dietitian. ● A high protein diet can help to improve
the healing of alveoli sacs
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE: Risk for SHORT TERM: INDEPENDENT INDEPENDENT SHORT TERM:

● N/A bleeding ●Monitor VS frequently. ●Hypotension and
After 8 hours of tachycardia are initial After 8 hours of nursing
related to nursing intervention, compensatory mechanisms intervention, the
OBJECTIVE: post surgical the patient’s risk for usually noted with bleeding. patient’s risk for
incision bleeding will be ●Educate the at-risk bleeding was reduced
● D-Dimer 2.3 reduced as evidenced patient about ●Information about as evidenced by vital
ug/ml 10,000 by vital signs within precautionary measures precautionary measures signs within normal
U/day of normal range and to prevent tissue trauma lessens the risk for bleeding. range and absence of
absence of narrowed or disruption of the narrowed pulse
heparin
pulse pressure. normal clotting pressure.
sodium was mechanisms.
initiated. __Goal met
-Use a soft-bristled __Goal partially met
● Peggy had toothbrush and -This method providing oral __Got not met
an non-abrasive toothpaste. hygiene reduces trauma to
emergency Avoid the use of toothpicks oral mucous membranes and
C-section and dental floss. the risk for bleeding from the
gums.
-Limit straining with bowel
movements, forceful nose
blowing, coughing, or -These activities may cause
sneezing trauma to the mucosal linings
in the rectum, nasal
-Be careful when using passages, or upper airways.
sharp objects like scissors
and knives. Use an electric -The patient needs to avoid
razor for shaving (not situations that may cause
razor blades). tissue trauma and increase
the risk for bleeding.
A D PLANNING INTERVENTION RATIONALE EVALUATION
S I
LONG TERM: ●Tell the patient to observe skin ●Oozing of blood is often an early sign LONG TERM:
S A and mucous membranes for of coagulation abnormalities that
E G After 3 days of nursing oozing of blood. increase the risk of bleeding. After 3 days of nursing
S N intervention, the patient will be intervention, the patient was
able to demonstrate no signs of ●Post-CS, assess and monitor ●To treat any unexpected bleeding as able to demonstrate no signs
S O bleeding (bruises and petechial the patient’s surgical wound early as possible of bleeding (bruises and
M S rashes around the incision site site for any signs of petechial rashes around the
with BP at normal range and unexpected bleeding incision site with BP at normal
E I stable hematocrit and range and stable hematocrit
N S hemoglobin levels and desired ●Teach proper wound care and ●Prevents infection and other and hemoglobin levels) and
ranges for coagulation profiles. hygiene complications, and also helps speed desired ranges for coagulation
T up the healing process with less profiles
●Maintain direct pressure or scarring
pressure dressings as __Goal met
indicated for a longer period of ●To prevent oozing or active bleeding __Goal partially met
time over arterial puncture sites __Got not met

●Teach or include foods that are
rich in fiber and increase fluid
intake
●Hard and dry feces may cause trauma
to the mucous membranes of the colon
and rectum. Increasing fluid intake and
dietary fiber such as fruits and
vegetables: apple, banana, papaya,
carrots, squash, etc. soften the fecal
mass for easier defecation
A D P INTERVENTION RATIONALE E
S IA L V
S G INDEPENDENT INDEPENDENT A
A ●Monitor hematocrit and hemoglobin regularly as indicated ●Decreased HgB and Hct levels may be an early indicator of
E N N bleeding. L
S O N U
S S ●Monitor the state of the wound ●Helps define the status of the wound and helps identify A
I impediments to the healing process
M I T
N
E S ●Monitor coagulation therapy studies frequently (PTT, PT, INR, ●These values may indicate an increased risk of bleeding. I
N G Platelet count, fibrinogen) as indicated. O
T N
●Obtain type and crossmatch of patients blood. Anticipate the ●To prepare for any need to perform blood transfusion as
need for the patient to have whole blood replacements prescribed. If the blood loss is too much and immediate
correction is warranted, whole blood transfusion administered.

DEPENDENT DEPENDENT
● For bleeding linked with excessive anticoagulant use, ● Protamine sulfate reverses the effect of heparin
give appropriate antidotes as prescribed

COLLABORATIVE COLLABORATIVE
● Refer to the Medical Technologist ● For further inclusion of laboratory findings.
 04
DISCHARGE PLAN
MEDICATION
Discharge medications should be explained well before discharge. Discuss with patients the intended effects and possible or expected
side effects of the medication. This will help patients determine whether a medication is working appropriately. It will also help
patients identify undesired side effects that may require intervention

DEXAMETHASONE
Women at risk of imminent preterm delivery receive a short course of dexamethasone or betamethasone to accelerate
fetal lung maturation. In a severe COVID-19 condition, such patients must receive a corticosteroid that poses the least
effects on the growing fetus.

Common side effects:

○ upset stomach
○ stomach irritation
○ Vomiting
○ Headache
○ Dizziness
○ Insomnia
○ Restlessness
○ depression
How to use dexamethasone oral
○ Take this medication by mouth. Take with food or milk to prevent stomach upset.
Tablet
○ Take the tablet form of this medication with a full glass of water (8 ounces/240 milliliters)
Liquid
○ If the patient is using the liquid form of this medication at home, carefully measure the dose using a
special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.
○ If the patient is taking this medication once daily, better to take it in the morning before 9 AM.
 Overdose
Advice patient
● If the patient has overdosed and has serious symptoms such as passing out or trouble
Do not stop taking this breathing. Immediately go to the hospital.
medication without
consulting your doctor. To
prevent; Missed Dose
● Some conditions ● If you are taking this medication daily and on a regular schedule, and you miss a
may become worse dose, take it as soon as you remember.
when this drug is ● If it is near the time of the next dose, skip the missed dose. Take your next dose at
suddenly stopped. the regular time. Do not double the dose to catch up.
Also, you may
experience
symptoms such as
Storage
nausea, dizziness,
weakness, or ● Store at room temperature away from light and moisture. Do not store it in the
muscle/joint pain. bathroom. Keep all medications away from children and pets.
 HEPARIN SODIUM
Heparin is an anticoagulant drug. This means that is slows down blood clotting or “thins” the
blood

How to use dexamethasone oral

Side effects:
This medication is given by injection into a vein or under the skin as directed by your doctor. Do not inject this
● easy medication into a muscle.
bleeding and
bruising Overdose
● pain,
If the patient has overdosed and has serious symptoms such as passing out or trouble breathing. Immediately go
redness,
to the hospital.
warmth,
irritation, or Missed Dose
skin changes
where the It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or
pharmacist right away for a new dosing schedule. Do not double the dose to catch up.
medicine
was injected
● itching of Storage
your feet
● bluish-colore Consult the product instructions and your pharmacist for storage details. Keep all medications away from
d skin. children and pets.
 SULBACTAM/AMPICILLIN
Ampicillin and sulbactam combination is used to treat bacterial infections in many different
parts of the body. This drug should be used during pregnancy only if clearly needed.

Side effects: How to use dexamethasone oral

● diarrhea This medication is given by injection into a vein, usually every 6 hours or as directed by your doctor.
● rash
● swollen, Overdose
black, or
If the patient has overdosed and has serious symptoms such as passing out or trouble breathing. Immediately go
"hairy" to the hospital.
tongue
● vaginal Missed Dose
itching or
discharge It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or
pharmacist right away for a new dosing schedule. Do not double the dose to catch up.
● pain where
the medicine
was injected. Storage

Consult the product instructions and your pharmacist for storage details. Keep all medications away from
children and pets.
 REMDESIVIR
Remdesivir injection is used to treat coronavirus disease 2019 (COVID-19) in hospitalized patients. It is also
used to treat mild to moderate COVID-19 in non-hospitalized patients who are at high risk for progression to
severe COVID-19

Side effects: How to use dexamethasone oral

● Back pain. This medication is given by injection into a vein by a healthcare professional. It is given as directed by your
● chest doctor, usually once daily for 5 to 10 days. It is infused over a period ranging from 30 minutes to 2 hours.
tightness.
● dark-colored Overdose
urine. If the patient has overdosed and has serious symptoms such as passing out or trouble breathing. Immediately go
● flushing. to the hospital.
● headache.
● hives, Missed Dose
itching.
It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or
● light-colored pharmacist right away for a new dosing schedule.
stools.
● nausea and Storage
vomiting.
Not applicable. This medication is given in a hospital and will not be stored at home.
 TOCILIZUMAB
The immunotherapy strategy about Tocilizumab treatment has been formally included in the diagnosis and
treatment program of COVID-19. Tocilizumab can be used in patients with extensive bilateral lung lesions
opacity or in severe

Side effects How to use dexamethasone oral

● a cough or Read the Medication Guide provided by your pharmacist before you start using tocilizumab and each time you
sore throat, get a refill. If you have any questions, ask your doctor or pharmacist.
blocked or
runny nose. Overdose
● headaches or If the patient has overdosed and has serious symptoms such as passing out or trouble breathing. Immediately go
dizziness. to the hospital.
● mouth
ulcers. Missed Dose
● high blood
It is important to get each dose of this medication as scheduled. If you miss a dose, ask your doctor or
pressure. pharmacist right away for a new dosing schedule.
● hypercholest
erolaemia Storage
(increased
cholesterol Not applicable. This medication is given in a hospital and will not be stored at home.
in the blood)
ENVIRONMENT/ EXERCISE
Environment
● Restricting Visitors
● Masks and Hand Sanitizer
● Cleaning, Reorganization and Check-In
Options
● Disinfecting the place frequently
Exercises
● Breathing exercises
○ The 4-7-8 breathing technique, also known as “relaxing breath,”
involves breathing in for 4 seconds, holding the breath for 7
seconds, and exhaling for 8 seconds
● Stretches:
○ Regular exercise is essential for a healthy and happy pregnancy,
and stretching is a great, gentle way to do so.Stretching works
all the right muscles to help keep you feeling your best as your
pregnancy progresses.
● Cat cow pose:
○ It is a classic yoga pose and is often a favorite. It not only
enhances mobility but also increases the strength of the back
and abdomen. Plus it can be done anywhere in the house.
● Weight training exercise:
○ Try simple weight training exercises by doing a free weight
regime involving simple hand and leg movements.
TREATMENT
● Once she is weaned out of the ventilator, advise the patient to monitor her Spo2 levels every 4
hourly.
● Check vitals mainly temperature and heart rate
● Take the medication as prescribed by the doctor
● Keep at least a 1-metre distance from others, even from your family members.
● Wear a medical mask to protect others, including if/when you need to seek medical care.
● Clean your hands frequently.
● Stay in a separate room from other family members, and if not possible, wear a medical mask.
● Keep the room well-ventilated.
● If you share a room, place beds at least 1 metre apart.
● Stay positive by keeping in touch with loved ones by phone or online, and by exercising at home.
● Incentive Spirometer
○ An incentive spirometer is a medical device that helps your lungs recover after surgery or a
lung illness. An incentive spirometer is a hand-held device that helps people to take slow,
deep breaths. It's like exercise equipment for the lungs to keep them strong and working well
❖ Health Teaching

● Instruct the patient to do breathing exercises to help the lungs

function more efficiently.
➢Relax shoulders and upper chest
➢Take a slow, deep breath in through the nose to fill the lungs fully
➢Hold the breath for 2-3 seconds
➢Breathe out slowly through the mouth, as if gently blowing on a
candle

● If mucus secretion is present, coughing is a natural way to clear the

lungs. To help in coughing, place a rolled towel or pillow over the
abdomen as a support then cough. A few strong coughs have more
effect than many weak ones.

● Do simple physical exercise like walking to improve circulation and

strengthen the tissue around the lungs, helping them function,
improve digestion, decrease muscle stiffness, and prevent blood clots.

● Get adequate sleep (7-9 hours) helps boost immune system and
preserve energy. Have a supportive pillow that can make it easier to
get rest.
❖ Health Teaching

● Instruct patient to adhere to the medications prescribed

by the physician. Do not take cough or cold medicines
unless the physician is consulted.

● Instruct patient that it is better to have a pulse oximeter

and thermometer at home to check for the oxygen
saturation and temperature.

● Maintain proper hygiene such as dental hygiene and body

care.

● Instruct the patient and family to observe precautionary

measures such as wearing a mask, hand washing, ensure a
well-ventilated space, and to stay at home as much as
possible.

● If the patient is unvaccinated, instruct the patient to get

Covid-19 vaccine if instructed or allowed by the physician.
Instruct the family members as well to get vaccinated.

● In case the patient asks, it is safe and recommended to

breastfeed even the patient acquired Covid-19.
❖ Outpatient

● · Adhere to the follow-up check-up schedule. It is better to set a reminder in the phone or calendar.
● If experiencing fever, shortness of breath, headache, dizziness, or oxygen saturation below normal
notify the physician.

❖ Diet

● Eat small frequent meals and have healthy snacks in between.

● Limit refined and processed foods as these are higher in salt, sugar, and fats as these may harm
the immune system and constipation.
● Eat plenty of fruits such as papaya, oranges, apples, grapes, tomatoes, mangoes, and vegetables
such as malunggay, carrots, eggplant, cabbage, cauliflower, squash. Include a protein food with
every meal such as tofu, beans, cheese, fish, poultry, or lean meats) and drink at least 6 to 10
cups (1.5 to 2.5 liters) of water a day.
 References:
Pathophysiology
●

Diagnostics and Laboratory

● Clinic, C. (n.d.). Function of White Blood Cells. Retrieved from my.clevelandclinic.org:

https://my.clevelandclinic.org/health/body/21871-white-blood-cells
● MedlinePlus. (n.d.). PCR Tests. Retrieved from medlineplus.gov:
https://medlineplus.gov/lab-tests/pcr-tests/
● Clinic, C. (n.d.). Arterial Blood Gas (ABG) Analysis. Retrieved from my.clevelandclinic.org:
https://my.clevelandclinic.org/health/diagnostics/22409-arterial-blood-gas-abg
● Healthline. (n.d.). Pulse Oximetry Retrieved from healthline.com:
https://www.healthline.com/health/pulse-oximetry

Nursing Care Plan

● Nurse’s Pocket Guide - Diagnoses, Prioritized Interventions, and Rationales

 References:
Discharge Plan

● Centers for Disease Control and Prevention. (2022, March 22). What to Do If You Are Sick. CDC.
Retrieved September 15, 2022, from
https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html
● MedlinePlus. (2022, August 5). Severe COVID-19 - discharge. MedlinePlus. Retrieved September 15,
2022, from https://medlineplus.gov/ency/patientinstructions/000978.htm
● PregActive. (2020, October 15). Exercise After A C-Section - MUST KNOW FACTS! PregActive.
Retrieved September 15, 2022, from https://www.pregactive.com/blog/exercise-after-c-section
● Keizer RJ, Huitema AD, Schellens JH, Beijnen JH: Clinical pharmacokinetics of therapeutic monoclonal
antibodies. Clin Pharmacokinet. 2010 Aug;49(8):493-507. doi: 10.2165/11531280-000000000-00000.
● Abdallah H, Hsu JC, Lu P, Fettner S, Zhang X, Douglass W, Bao M, Rowell L, Burmester GR, Kivitz A:
Pharmacokinetic and Pharmacodynamic Analysis of Subcutaneous Tocilizumab in Patients With
Rheumatoid Arthritis From 2 Randomized, Controlled Trials: SUMMACTA and BREVACTA. J Clin
Pharmacol. 2017 Apr;57(4):459-468. doi: 10.1002/jcph.826. Epub 2016 Nov 17.
● Li YH, Tanno M, Itoh T, Yamada H: Role of the monocarboxylic acid transport system in the intestinal
absorption of an orally active beta-lactam prodrug: carindacillin as a model. Int J Pharm. 1999 Nov
30;191(2):151-9.
GROUP 2 RLE NCMB 418

● BERONGOY, CHRISTIAN JAY

● CONCLARA, SARAH
● CUSTODIO, JEHERSON ART
● DUEY, LORIE MAE
● ESPLEGUIRA, AIRA
● LANDERO, JANELLA MAEGAN
● MARCELO, JANIEL CYNTH
● MACARUBBO, PRINCESS ALLIAH
● PEMPENA, NIKKA SHAINE