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