RESOURCES



Covid- 19 - Community Infirmary Sheet

 

Sheet prepared for IMS’s members – April 2020

 

NURSE SUPERVISION  

 

Monitoring parameters

 

The monitoring parameters to take into account for a patient showing non-serious symptoms requiring rest and monitoring of a few clinical criteria at home by a qualified nurse, in addition to the medical follow-up are :

 

 

Fever : Measurement of the temperature by the patient

Ask about symptoms of fever (shivering, feeling of fever)
Breathing assessment (See fact sheet: care of shortage of breath) : Respiratory frequency

Pulse oximetry (SpO2)

Cough

Heart function assessment : Blood pressure

Pulse

Marbling, cyanosis
General condition : Signs of dehydration (skin fold, dry tongue, feeling of thirst)

State of consciousness (drowsiness, confusion)

 

The goal of this monitoring is to detect serious symptoms in the patient, possibly requiring immediately contacting the emergency services so that the person can be hospitalised.

Note : pulse oximetry is a simple device, not expensive and very useful for monitoring patients suffering from shortage of breath or heart failure

 

Serious symptoms

 

The following serious symptoms indicate that hospitalisation is necessary :

  • Polypnea (respiratory frequency > 22/min)
  • Pulse oximetry (SpO2 ) < 90% in ambient air
  • Systolic blood pressure < 90 mmHg
  • Impaired consciousness, confusion, drowsiness
  • Dehydration
  • Sudden worsening of general condition in an elderly person

Particular attention must be given to patients with comorbidities for whom Covid 19 presents serious risks. These comorbidities are set out in the above care diagram.

 

Monitoring by a nurse example sheet

 

Patient’s contact détails: Date Date Date Date
Temperature X °C
Respiratory frequency X /min
SpO2 X %
Cough Yes/No
Blood pressure X/X mmHG
Pulse X /min
Marbling, cyanosis Yes/No
Dehydration Yes/No
State of consciousness Description

 

 

Nurse-physician communications

 

Three possible situations :

  • The patient has serious symptoms: the nurse contacts the emergency services who will decide how the patient’s hospitalisation should be organised.
  • The patient shows signs of worsening but without serious symptoms; a physician must immediately give an opinion.
  • The patient shows no serious symptoms: continuation of monitoring by the nurse.

 

These situations are outlines. They should be adapted to the particular context of each community.

NURSING CARE FOR SHORTAGE OF BREATH AND COVID 19

 

Markers

Serious risk factors

 

    • Comorbidities 
    • People aged 70 and over
    • Chronic respiratory failure
    • Chronic renal failure
    • Cardiovascular history: high blood pressure, stroke or coronary artery disease, heart surgery
    • Insulin-dependent diabetes or with secondary complications
    • Cirrhosis
    • Immunodeficiency (cancer, immuno-suppressive medication, etc.)
    • Other symptoms
    • Lack of alertness
    • Very high fever
    • Dehydration

 

Breathing difficulties (shortage of breath)

 

  • Breathing difficulty reported by the patient, assessed on a scale:
  • of 0 (I can breathe normally) to 10 (I find it very hard to breathe)
  • or by a simple verbal scale (no difficulty in breathing /slight/moderate/serious/very serious)
  • Respiratory Frequency (RF) >24/min (and <30/min) or use of ancillary breathing muscles (raising of the collar bone when taking breath) or paradoxical breathing (abdominal wall moves in when taking breath)

 

 

Acute respiratory distress

 

  • Feeling of suffocation with massive anxiety/agitation and feeling of imminent death
  • RF > 30/min, agitation, use of ancillary respiratory muscles (rising of the collar bone when taking breath), paradoxical breathing (abdominal wall moves in when taking breath), flaring of alae of the nose, end of expiration wheeze, fear facies.

Act

 

General principles

 

  • Palliative care

If risk factors are present, the shortage of breath of Covid-19 can quickly develop into respiratory distress and, in the absence of intensive car, lead to death. Dying of asphyxiation is extremely stressful physically and psychologically. Apart from intensive care, there is no curative care. The medicinal or other treatments set out below are therefore palliative care.

Palliative care is neither an alternative to the basic treatment of an illness nor assistance with dying. It is assistance in getting through painful times.

  • Planning care

With the usual GP, plan for care in the event of respiratory distress (planned prescription, telephone contact, etc.). Discuss with him/her what resources are available for palliative care.

  • Information to the patient

If possible, discuss with them what their informed choices are. Otherwise, search who the appointed person of trust is and any pre-planned instructions.

  • Tracing of Exchanging information

For better communication about the care.

 

Medicinal treatment

 

  • Two main principles:
  • Ease the shortage of breath with morphine-based medicines. Contrary to a preconceived idea, morphine-based medicines do not worsen shortage of breath but ease it.
  • Put to sleep. The feeling of dying by suffocation can be terrible. Putting the person to sleep, as for an anaesthesia is the solution to relieve this suffering. The products used are benzodiazepines.
  • Prescription (planned in advance if possible) by a physician and administered by the nurse depending on his/her own assessment of the clinical situation.

 

Non-medicinal treatments

 

  • Stay calm or arrive calm (do not forget before entering the room).
  • Explain simply what is being done, what is going to be done.
  • Air the room, open the window, if a fan is available, switch it on (cool air on the face).
  • Ensure the patient is comfortable in their clothes Have a gentle light.
  • Place the person in a sitting or half-sitting position in the bed (raise the head)
  • Stay in a somewhat silent atmosphere, with no agitation. Soft music possible.