Nursing Management for Patients with COVID-19

Nursing Management of COVID-19

Since the global outbreak of COVID-19, nurses have answered the call to take care of those affected by coronavirus and to help prevent further spread of the deadly disease. The creation of clear nursing management guidelines can help nurses offer better care for patients with COVID-19 and optimize patient outcomes. Establishing and initiating clear guidelines, before the pandemic causes an overwhelming influx of severely ill patients, can ultimately provide better results. Knowing what to do before the tsunami of very sick patients can also keep your nursing staff safe, on track, and fully in control.

Nursing management for patients with COVID-19 infection includes assessment, diagnosis, the development of nursing care plans and goals, interventions, evaluations, and documentation.

Nursing Assessment

Careful assessment is essential in the evaluation and management of patients who may have COVID-19, and particularly in those with fever, acute respiratory illness, and other symptoms of infection. Nursing assessments of these patients should include:

Travel history – a detailed travel history should include travel to other countries, states, or cities with active COVID-19 cases; resources such as Johns Hopkins Coronavirus Resource Center can be helpful in determining geographic “hotspots” in the United States and worldwide.

Physical examination – careful documentation of the patient’s signs and symptoms, which may develop 2 to 14 days after exposure to the virus; the Centers for Disease Control and Prevention (CDC) lists the following symptoms of COVID-19:

  • Fever, chills
  • Cough
  • Dyspnea
  • Headache
  • Fatigue
  • Myalgia
  • Sore throat
  • New loss of smell (anosmia) or taste (ageusia)
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

Not every patient with COVID-19 experiences all of these symptoms. In fact, a study published on June 23, 2020, found that 78 percent of COVID-19 patients had a fever, 57 percent reported a cough, and 31 percent said they had suffered fatigue. Interestingly, 25 percent had lost their sense of smell and 23 percent lost their sense of taste.

Nursing Diagnosis

A nursing diagnosis provides clinical judgment about the patient’s experiences and responses to potential coronavirus infection. Nursing diagnosis for a patient with COVID-19 can include:
  • Possible exposure to the virus that causes COVID-19
  • The patient’s level of knowledge about the transmission of COVID-19
  • Fever
  • Impaired breathing pattern related to shortness of breath
  • Anxiety associated with the unknown etiology of the disease

Nursing Care Planning and Goals

Establishing nursing care plan goals can help improve patient outcomes and decrease the transmission of COVID-19. Major nursing care planning goals for COVID-19 may include:

  • Establishing goals, interventions
  • Assessing altered skin integrity risks, fatigue, impaired comfort, gas exchange, nutritional needs, and nausea
  • Preventing the spread of coronavirus infection to the patient’s family members, community, and healthcare providers
  • Providing more information about COVID-19 and its management to the patient – in a Pew Research Center poll released June 29, 2020, only 64 percent of adults said the CDC “mostly gets the facts about the outbreak right”
  • Reducing fever
  • Restoring normal respiratory patterns
  • Easing anxiety, which is relatively common in COVID-19 patients, with a combination of anxiolytic medications and psychotherapy that includes relaxation techniques, breathing exercises and encouragement

Nursing Interventions

Based on assessment data, nursing interventions for COVID-19 should focus on monitoring vital signs, maintaining respiratory function, managing hyperthermia, and reducing transmission.

Monitor vital signs – particularly temperature and respiratory rate, as fever and dyspnea are common symptoms of COVID-19.

Monitor O2 saturation – normal O2 saturation as measured with pulse oximeter should be 94 or higher; patients with severe COVID-19 symptoms can develop hypoxia, with values dropping low enough to warrant supplemental oxygen.

Manage fever – use appropriate therapy for hyperthermia, including adjusting room temperature, eliminating excess clothing and covers, using cooling mattresses, applying cold packs to major blood vessels, starting or increasing intravenous (IV) fluids as allowed, administering antipyretic medications as prescribed, and readying oxygen therapy in the event of respiratory problems resulting from the metabolic demands for oxygen during a fever.

Maintain respiratory isolation – isolation rooms should be well-marked with limited access; all who enter the restricted-access room should use personal protective equipment, such as masks and gowns.

Enforce strict hand hygiene – to reduce or prevent transmission of coronavirus, patients should wash hands after coughing, as should all who enter or leave the room.

Provide information – educate the patient and patient’s family members of the transmission of COVID-19, the tests to diagnose the disease, disease process, possible complications, and ways to protect oneself and one’s family from coronavirus.


Evaluation helps nurses determine if they have met their goals. Evidence for meeting nursing goals for COVID-19 might include:
  • The patient successfully prevented the spread of infection to family, the community, or to healthcare staff
  • The patient learned more about COVID-19 and its management
  • The patient had improved body temperature levels
  • Restoration to normal breathing patterns
  • Reduced anxiety

Documentation Guidelines

Documentation is always important, but perhaps more so when caring for patients with COVID-19. Documentation guidelines for COVID-19 patients include:

  • Individual findings, including any external factors affecting the patient’s illness, interactions, nature of social exchanges, and specifics patient behaviors
  • Cultural and religious beliefs expressed by the patient
  • Patient expectations
  • Care plan
  • Teaching plan
    Responses to nursing interventions, education, and information, and nursing actions performed
  • Attainment of, or progress toward, the desired clinical outcome and fulfillment of patient expectations
Many organizations and healthcare facilities have established guidelines for the nursing management of COVID-19. These guidelines may change quickly, though, in response to new information from researchers or as the result of overwhelming patient caseloads. For more information on the nursing management of COVID-19, consult with the hiring hospital, nursing facility, healthcare organization, or institution.

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