COVID-19, TB, and Pneumonia Notes

COVID/SARS (Coronavirus)

• COVID, coronavirus, or SARS is a virus.

• Spreads through airborne droplets.

• Signs and symptoms include:

  • Cough: Usually a dry cough.
  • Shortness of breath
  • Fever
  • Body aches
  • Headache
  • Loss of smell or taste

• Mild respiratory symptoms (not COVID pneumonia).

• Diagnosis:

  • COVID test (swab).
  • Symptoms assessment.
  • Chest X-ray: To check for pneumonia.
  • Antibody test: To determine if the patient has been exposed.
    • Positive antibodies indicate prior exposure.

• Questions to ask patients:

  • Recent travel history (especially out of the country within 10 days of symptom onset).
  • Exposure to known cases.

• Treatment:

  • COVID is a virus, so antibiotics are ineffective against the virus itself.
  • Antibiotics may be used prophylactically to prevent secondary bacterial infections due to a compromised immune system.
  • Antivirals may be administered, but their efficacy is debated.

• Isolation:

  • Patients are typically placed on droplet isolation in the hospital.
  • Hospital quarantine was initially 14 days exposure, but check book as this changes regularly.
  • Nursing Considerations
    • Infection Control
      • Adhere to correct isolation protocols (droplet).
      • Ensure proper signage on doors.

Tuberculosis (TB)

• Caused by bacteria called Mycobacterium tuberculosis.

• Usually affects the lungs, but can also involve the GI tract, GU tract, bones, joints and nervous system.

• Populations at risk: Urban poor, minority groups, immunocompromised (including HIV patients, chemotherapy patients, and cancer patients).

• Transmission: Airborne.

• Precautions: Airborne precautions (N95 mask required).

• Diagnosis:

  • Chest X-ray
  • Sputum cultures
  • PPD (purified protein derivative) skin test: Indicates exposure to TB.
    • Read 48-72 hours after administration.
    • Looking for an enlarged area (rad range lesion).

• Signs and Symptoms:

  • Coughing
  • Night sweats
  • Fever
  • Weight loss
  • Weakness
  • Productive cough
  • Loss of appetite
  • Coughing up blood

• TB is not easily transmited.

• Health Department Notification

  • Required upon diagnosis for tracing contacts.

• Treatment:

  • Airborne isolation
  • Multiple drugs for 6-9 months.
    • Important for patient to complete the full course of medication to prevent recurrence.
    • Inform provider before you miss a dose.

• Nursing Considerations:

  • Isolation Room Protocol
    • Enter one door, close it, then open the other door.
    • Educate patients and visitors on this protocol.
  • Visitors must wear an N95 mask.
  • Nutrition:
    • Adequate fluid and nutritional intake is essential.
    • Patients with active TB are often weak and frail.
    • Address side effects of medications (nausea, vomiting) to maintain nutrition.
  • Medication Safety
    • Review medications on pages 404 and 405

Pneumonia

• Acute inflammation of the bronchioles usually caused by some sort of infection can be viral or bacterial.
• Common in patients in the hospital due to:
  • Prolonged sedation and intubation.
  • Immobility.
  • Aspiration.
• Most common during winter and early spring.
• Populations at risk: Older adults and infants.
• Diagnosis:
  • Chest X-ray
  • Sputum culture: To identify the microorganism.
    • Collect before administering antibiotics.
  • Blood cultures: To identify the source of the infection. (blood cultures)
  • White blood cell count: Elevated.
  • ABGs can't diagnose pneumonia but indicates gas exchange.
• Signs and Symptoms:
  • Shortness of breath
  • Elevated temperature
  • Productive cough
  • Increased heart rate and respiratory rate
  • Crackles in the lungs
  • Older adults may present with sluggishness, tiredness, altered mental status (confusion, agitation).
• Treatment:
  • Antibiotics
  • Nebulizers: bronchodilator.
  • Oxygen
  • Physiotherapy: To loosen mucus (e.g., smart vest).
  • Pain medication.
  • Rest
  • High Fowler's position.
  • Encourage coughing, turning, and deep breathing.
  • Incentive spirometer: 10 times every hour during waking hours.
  • Small, frequent meals (at least 1500 calories).
• Prevention: Pneumococcal vaccine.
  • Recommended for:
    • Nursing home patients
    • People with chronic illnesses
    • Adults 65 years or older
    • Those recovering from severe illness
    • Those planning a nursing home stay