Planning

CLIENT POSITIONING

PRONE POSITION

Prone position is when a patient is positioned face down on their anterior chest and abdomen to
benefit from physiologic changes that can result in improved oxygenation through decreased V/Q
mismatch (In a V/Q ratio: The V stands for ventilation, which is the air you breathe in. The Q,
somewhat confusingly, stands for perfusion, which is blood flow. happens when part of your lung
receives oxygen without blood flow or blood flow without oxygen.) and, decreased lung injury. In
patients with hypoxic respiratory failure, prone positioning improves oxygenation. The increased
aeration and recruitment of these dorsal regions outweigh the derecruitment(The failure of the lungs
to be fully aerated, typically as a result of closure of an airway.) of the now-dependent ventral
regions, thereby reducing shunt and improving ventilation-perfusion matching and oxygenation when
in the prone position.
- PREVENTING DESATURATION

As a healthcare provider, you know that people with COVID-19 can have a wide range of symptoms –
from no symptoms to mild symptoms to severe illness. Many people with COVID-19 have low oxygen
levels, a life-threatening condition. However, not everyone with a low oxygen level will have difficulty
breathing, so you must regularly monitor the oxygen levels of your COVID-19 patients. You can measure
a patient’s oxygen level using a device called a pulse oximeter, which you place on their finger, toe, or
earlobe. It’s a painless test and takes less than two minutes. Pulse oximeters measure the oxygen
saturation, or percentage of oxygen in the patient’s blood

You should start oxygen therapy on any COVID-19 patient with an oxygen saturation below 90 percent
even if they show no physical signs of a low oxygen level If the patient has any warning signs of low
oxygen levels, start oxygen therapy immediately.

You should start oxygen therapy on any COVID-19 patient with an oxygen saturation below 90 percent
even if they show no physical signs of a low oxygen level.

True / false

PATIENT EDUCATION

What to do if you suspect you have been exposed to COVID-19

If you were exposed to the virus that causes COVID-19, or have been told by a healthcare provider or
public health authority that you were exposed, here are the steps that you should take, regardless of
your vaccination status or if you have had a previous infection:

• Wear a mask as soon as you find out you were exposed. Take Precautions - wear a high-quality mask
or respirator (e.g., N95) any time you are around others inside your home or indoors in public.

Advise client to Stay home for at least 5 days

• Stay home for 5 days and isolate from others in your home. Most people with COVID-19 have mild
illness and can recover at home without medical care. Do not leave your home, except to get medical
care. Do not visit public areas and do not go to places where you are unable to wear a mask

Tell them to Separate their self from other people

As much as possible, stay in a specific room and away from other people and pets in your home. If
possible, you should use a separate bathroom. If you need to be around other people or animals in or
outside of the home, wear a well-fitting mask.

Instruct the client to Monitor their symptoms

symptoms of COVID-19 include fever, cough, or other symptoms.

Follow care instructions from your healthcare provider and local health department. Your local health
authorities may give instructions on checking your symptoms and reporting information.

Instruct them When to seek emergency medical attention

Trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay
awake, pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone. Please call your
medical provider for any other symptoms that are severe or concerning to you.

Instruct client to Cover their mouth and nose when they cough and sneezes

• Cover your mouth and nose with a tissue when you cough or sneeze and throw away used tissues in a
lined trash can.

Advise client to clean hands often

• Wash your hands often with soap and water for at least 20 seconds. This is especially important after
blowing your nose, coughing, or sneezing; going to the bathroom; and before eating or preparing food.

• Use hand sanitizer if soap and water are not available. Use an alcohol-based hand sanitizer with at
least 60% alcohol, covering all surfaces of your hands and rubbing them together until they feel dry.

Take steps to improve ventilation at home

• Improve ventilation (air flow) at home to help prevent from spreading COVID-19 to other people in
your household.

• Clear out COVID-19 virus particles in the air by opening windows, using air filters, and turning on fans
in your home.

Optimizing Oxygenation and Ventilation:

The main reason for being admitted to hospital with COVID-19 is to receive supplemental oxygen, to
increase the amount of oxygen in the lungs and blood, which will be enough treatment before recovery
in most cases. This can be administered in several ways, including into the nose using plastic tubing, or
via a loose-fitting face mask.
Preventing Atelectasis
 Performing deep-breathing exercises (incentive spirometry) and using a device to assist with
deep coughing may help remove secretions and increase lung volume.
 Positioning your body so that your head is lower than your chest (postural drainage). This
allows mucus to drain better from the bottom of your lungs.
 Tapping on your chest over the collapsed area to loosen mucus. This technique is called
percussion. You can also use mechanical mucus-clearance devices, such as an air-pulse
vibrator vest or a hand-held instrument.

Implementation

Management
Administering Oxygen Therapy -

Hypoxia is one of the primary causes that leads to multiple organ injuries and death in COVID-19
patients. Aggressive oxygen therapy for the treatment of hypoxia is important in saving these patients.

The goal of supportive treatment is to get enough oxygen into your bloodstream and deliver it to
your body to prevent the damage that can occur when you have a low oxygen level in your body. here
are the Options for providing enhanced respiratory support include:

 high-flow nasal cannula (HFNC) oxygen - high flow oxygen therapy helps reduce the effort your
body needs to put into breathing. By decreasing the effort of breathing and creating a small
amount of positive pressure in the upper airways, this therapy helps improve oxygen delivery. It
is use in patient with respiratory distress who still have low oxygen levels despite trying
traditional oxygen therapy. Traditional nasal cannula delivers flow rates of 2–6 L / min. But
patients with respiratory distress can have much higher peak inspiratory flow rates.
 noninvasive ventilation (NIV)- NIV machine helps you to breathe more efficiently. it also helps
you to breathe in more oxygen and breathe out more carbon dioxide. Non-invasive ventilation
gives your chest muscles a break and reduces your breathing effort.

there are two types of non-invasive ventilation options:

 Bi-level Positive Airway Pressure (BiPAP) – the airflow is strongest when you breathe in,
dropping to a lower pressure when you breathe out.
 Continuous Positive Airway Pressure (CPAP) – the mask keeps your airways open
continuously, allowing more air to flow in and out of the lungs.

 intubation - In patients who have a severe form of COVID-19, the novel coronavirus will move
deep into the lungs and impact the tissue that helps a person breathe properly. Often, these
patients develop pneumonia or acute respiratory distress syndrome, both of which can be fatal.
“If you reach a point where your lungs cannot provide your body oxygen or they can’t get rid of
the carbon dioxide, the only choice to save your life is intubation, The process essentially helps
get oxygen in and carbon dioxide out, which allows doctors “to deliver air faster.”
  extracorporeal membrane oxygenation - Patients that do not respond to optimal conventional
mechanical ventilation or pharmacologic intervention may be candidates for management with
extracorporeal membrane oxygenation (ECMO) in institutions with appropriate resource
- COVID-19 is different from pneumonia or an influenza A or B because it affects
all five lobes of the lung. In that they can’t properly exchange oxygen and
carbon dioxide. As carbon dioxide levels in the body increase, so does
respiratory rate However, since the lungs are damaged and are unable to
function, this carbon dioxide remains in the blood and turns to acid. The body
doesn’t work well in an acidic environment. The lungs get stiffer and the
pressure to push blood through the lungs goes up, known as pulmonary
hypertension. This puts strain on the right side of the heart and causes it to fail.
When the body fails to this degree, that is when ECMO can help.” (RVAD) and
oxygenator within the ECMO machine is used. The RVAD is placed inside the
patient through the tube that goes into the patient’s neck, down through the
right atrium and right ventricle of the heart and into the pulmonary artery. This
allows for blood to be taken out of the right atrium and sent to the ECMO
machine. There, it’s filtered, temperature-modulated and oxygenated, and the
carbon dioxide is removed. This blood then enters the body through a tube
placed into the pulmonary artery.

Mechanical Ventilation/ support- A ventilator doesn’t cure COVID-19 or other illnesses that caused
your breathing problem. It helps you survive until you get better, and your lungs can work on their
own.

Normally, when someone takes a breath, their chest wall expands, which creates negative pressure (i.e.,
a vacuum) inside the lungs that draws air in. When a person is sick and weak and can’t pull the breaths
in on their own, a ventilator creates positive pressure that forces air into the lungs.

You should start oxygen therapy on any COVID-19 patient with an oxygen saturation below 90 percent
even if they show no physical signs of a low oxygen level.

True / false

TRUE

It is a heated and humidified system that allows prescribed fraction of inspired oxygen (FIO2)
levels to be delivered at very high flow rates.
a. extracorporeal membrane oxygenation
b. noninvasive ventilation
C. HIGH-FLOW NASAL CANNULA (HFNC) OXYGEN
d. intubation
What to do if you suspect you have been exposed to COVID-19 SELECT ALL APPLY

 Advise client to Stay home for at least 3 days

 ADVISE CLIENT TO CLEAN HANDS OFTEN

 WEAR A MASK AS SOON AS YOU FIND OUT YOU WERE EXPOSED

 instruct client not to cover their mouth and nose when they cough and sneezes

 TELL THEM TO SEPARATE THEIR SELF FROM OTHER PEOPLE

It is a client positioning wherein the patient is positioned face down on their anterior
chest and abdomen to benefit from physiologic changes that can result in improved
oxygenation through decreased V/Q mismatch and decreased lung injury.

a. Trendelenburg position
b. Supine position
c. Sitting upright Position
d. PRONE POSITION