MSN presentation

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Assessment

1. Patient History:

- Symptoms: Fever, cough, shortness of breath, fatigue, loss of taste or smell.

- Exposure History: Contact with confirmed COVID-19 cases, travel history.

- Medical History: Comorbidities like diabetes, hypertension, chronic respiratory diseases.

2. Physical Examination:

- Vital Signs: Temperature, respiratory rate, heart rate, oxygen saturation.

- Respiratory Assessment: Breath of sounds, presence of wheezing or crackles, effort of breathing.

3. Diagnostic Tests:

- PCR Testing: Nasopharyngeal or oropharyngeal swabs for SARS-CoV-2 detection.

- Blood Tests: CBC, inflammatory markers (CRP, D-dimer, ferritin).

- Imaging: Chest X-ray or CT scan to identify pneumonia or other lung involvement.

4. Special Populations:

- Pediatrics: Unique presentation and complications such as Multisystem Inflammatory Syndrome in


Children (MIS-C).

- Geriatrics: Higher risk of severe illness and complications; monitoring for atypical symptoms like
confusion or delirium.

- Pregnant Women: Monitoring for effects on both mother and fetus, considering changes in immunity
and respiratory physiology.

5. Continuous Monitoring:

- Telehealth: Use of telehealth for remote monitoring and consultations.

- Wearable Devices: Monitoring vitals through devices like pulse oximeters for patients at home.

Diagnosis
Based on the assessment, nursing diagnoses may include:

Comprehensive Risk Assessment such as;

- Severity Scales: Use of severity scales like the CURB-65 for pneumonia to guide treatment decisions.

- Risk Factors: Identification of risk factors for severe disease progression (e.g., obesity, chronic kidney
disease).
-Ineffective airway clearance related to infection.

- Impaired gas exchange related to alveolar-capillary membrane changes.

- Risk for infection transmission related to a contagious virus.

- Anxiety related to the uncertainty and isolation of the illness.

Planning
1. Nursing goals and outcomes might involve:

- Maintaining adequate oxygenation.

- Preventing the spread of infection.

- Managing symptoms effectively.

- Providing psychological support.

2. Multidisciplinary Approach:

- Collaborative Care: Involvement of respiratory therapists, infectious disease specialists, dietitians,


and mental health professionals.

- Rehabilitation Planning: Early planning for post-acute care rehabilitation, especially for those with
prolonged ICU stays.

3. Resource Management:

- Contingency Plans: Planning for resource scarcity, including alternative care sites and strategies for
rationing care.

Implementation
1. Infection Control Measures:

- Use of PPE (masks, gloves, gowns, face shields).

- Isolation protocols for COVID-19 positive patients.

- Hand hygiene and surface disinfection.

2. Respiratory Support:

- Oxygen therapy (nasal cannula, face mask, high-flow oxygen).

- Mechanical ventilation for severe cases.

- Prone positioning to improve lung perfusion.

3. Medication Administration:

- Antiviral agents (e.g., remdesivir).

- Anti-inflammatory medications (e.g., corticosteroids).


- Supportive care medications (antipyretics, analgesics).

4. Patient Education:

- Information on disease process and transmission.

- Importance of adherence to treatment and isolation guidelines.

- Techniques for self-care and monitoring symptoms at home.

5. Psychological Support:

- Providing reassurance and accurate information.

- Facilitating virtual communication with family and friends.

- Referral to mental health professionals if necessary.

6. Advanced Respiratory Interventions:

- Non-Invasive Ventilation (NIV): CPAP or BiPAP for respiratory support before intubation.

- ECMO (Extracorporeal Membrane Oxygenation): For patients with severe respiratory failure not
responding to conventional therapies.

7. Nutritional Support:

- Enteral Nutrition: Ensuring adequate nutritional intake to support immune function and recovery.

- Hydration Management: Monitoring and managing fluid balance to prevent dehydration or fluid
overload.

8. Rehabilitation Services:

- Physical Therapy: Early mobilization and exercises to prevent deconditioning.

- Occupational Therapy: Assistance with activities of daily living (ADLs) and cognitive function.

9. Long-Term Management:

- Post-Acute Care: Planning for discharge and follow-up care, including monitoring for long COVID
symptoms.

- Chronic Disease Management: Adjusting management plans for chronic conditions affected by
COVID-19.

Evaluation
Regular assessment and evaluation of:

1. Outcome Measuremen:

- Clinical Outcomes: Tracking recovery rates, ICU admissions, ventilator use, and mortality rates.
- Quality of Life: Assessing the impact on patients’ physical, emotional, and social well-being post-
recovery.

2. Feedback Mechanisms:

- Patient and Family Feedback: Incorporating patient and family feedback into care planning and
process improvement.

- Staff Debriefings: Regular debriefings to address challenges faced by healthcare workers and improve
future responses.

3. Respiratory status (improvement or deterioration).

4. Effectiveness of oxygen therapy and other treatments.

5. Patient adherence to infection control measures.

6. Psychological well-being and support needs.

Challenges and Considerations


1. Resource Allocation:

- Ensuring adequate supply of PPE, ventilators, and medications.

- Managing surge capacity and bed availability.

2. Staff Well-being:

- Addressing burnout and mental health of healthcare providers.

- Providing adequate rest periods and psychological support.

3. Ethical Issues:

- Decision-making in resource-limited situations.

- Balancing patient care with public health concerns.

4. Ongoing Education and Training:

- Keeping nursing staff updated with the latest guidelines and treatment protocols.

5. Informed Consent:

- Ensuring patients and families are fully informed about treatment options and potential outcomes.

- Documenting consent and understanding of the risks and benefits.

6. Privacy and Confidentiality:

- Maintaining patient confidentiality while using electronic health records and telehealth platforms.

- Adhering to legal requirements for reporting and data sharing.


7. Equity in Care:

- Addressing disparities in healthcare access and outcomes, ensuring vulnerable populations receive
appropriate care.

- Community outreach and education to improve public health measures and vaccine uptake.

Education and Training

1. Ongoing Professional Development:

- Continuous education on emerging COVID-19 variants and updated treatment protocols.

- Simulation training for critical scenarios like cardiac arrest in COVID-19 patients.

2. Public Health Education:

- Educating the public on preventive measures, vaccination, and managing misinformation.

- Collaborating with community leaders to enhance public health messaging.

Research and Innovation


1. Clinical Trials:

- Participation in clinical trials for new treatments and vaccines.

- Encouraging patient enrollment in research to advance understanding and treatment of COVID-19.

2. Data Collection and Analysis:

- Contributing to data collection efforts for epidemiological studies.

- Using data analytics to track disease trends and inform public health strategies.

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