Question

1,What is the worst possible/most likely complication(s) to Impaired gas exchange related to Covid-19

List 3 on each

Nursing Interventions to PREVENT this Complication:

Assessments to Identify Problem EARLY:

Nursing Interventions to Rescue:

Answer 1

1. Most likely complications to Impaired gas exchange related to COVID 19:

i) Pneumonia : An acute or chronic inflammation of the lungs caused by viruses , bacteria or other Microorganisms or sometimes by chemical or physical irritants. One of the common complication of COVID 19 disease is Pneumonia .

Nursing Interventions:

* Change the position of the patient every two hours to prevent stagnation of lung  secrections

* Assist or encourage with early ambulation as per physician's order

* Administer medications as per physician's order.

ii) Acute Respiratory distress syndrome ( ARDS) : is also one of the most common complications of COVID 19. Due to the increased severity in damage to the lungs , fluid leakage to the lungs occur, that results in the insufficient intake of oxygen by the blood stream through alveoli, causes the Respiratory distress syndrome.

Nursing Interventions:

* Provide the patient the semi Fowlers position, or semi sitting position that can ease breathing due to increased chest expansion .

* Help patient to do deep breathing exercises / demonstrate and encourage deep breathing exercises.

* Administer humidified oxygen as per physician's order.

iii) Acute Respiratory failure : lungs will not be able to exchange   the adequate oxygen to the blood and may fail to expell out Carbon dioxide too. Acute Respiratory failure is one of the leading cause of death in COVID 19

* Schedule rest periods in between the activities to prevent fatigue and to reduce demand of oxygen

* let the patient lean over a bedside table , if tolerated to reduce dyspnoea

* Administer medications and oxygenation as per physician's order

iv) Acute cardiac injury:

* Check the patient regularly, monitor oxygen saturation and pulse oxymetry

* Administer medications for cardiovascular diseases in time , if the patient is already a cardiac patient as the risk of cardiac injury is more in COVID 19 patient.

* Monitor ECG, Check the cardiac enzyme levels in the blood to know the early signs of cardiac disturbance .

* Administer humidified oxygen .

Assessments to prevent problems:

* Assess respiratory depth, rate and efforts

* Assess for abnormal breathing pattern and abnormal breath sounds like wheezing, whistling etc.

* Monitor any sign and symptoms of pneumonia and Atelectasis like crackle lung sounds.

* Monitor vital signs especially Heart rate and BP every 4 hourly

* Monitor oxygen saturation

* Assess the presence of cough or sputum production

Early interventions:

* Manage hyperthermia by applying cold sponging , proper ventilation, adequate fluids,antipyretics etc

* Encourage warm salt water gargling , at the early stage, if there is a presence of throat irritation and throat pain.

* Encourage strict hand hygiene to the patient and the family members

* Maintain respiratory isolation :

- strictly instruct the use of mask , whoever enters patient's room

- Instruct the patient to cover nose and mouth while coughing or sneezing.

- Provide tissues for appropriate disposal of nasal secretions

- Provide hand sanitizers / soap and water.

- Provide nutritious diet along with vitamin c rich foods to strengthen immune system.  

- Provide psychological support and reassurance