Nursing Care for Coronavirus 2019 Patients with Acute Respiratory Distress Syndrome : Two Case Studies

Abstract

Background: Coronavirus Disease 2019 (COVID-19) is a novel infectious disease that primarily affects the respiratory system. The outbreak initially occurred in China and subsequently spread globally, including to Thailand. It is caused by the infection with the SARS-CoV-2 virus, which can be transmitted through respiratory droplets produced during coughing, sneezing, nasal discharge, and contact with contaminated surfaces or objects. Infection with this virus leads to respiratory symptoms, with some individuals experiencing symptoms similar to the common flu, while others may develop severe pneumonia. Severe cases can result in respiratory failure and fatalities in the subsequent course of the illness.

Objective: To study and compare nursing care approaches for patients with acute respiratory distress syndrome due to Coronavirus Disease 2019: A case study of two patients.

Methods: The study aimed to investigate and compare patients with acute respiratory failure due to COVID-19 admitted to the respiratory medicine ward at Sikoraphum Hospital, totaling 2 cases. Data were collected from patient records, the Functional Assessment of FANCAS, and the Self-Care Ability Scale by synthesizing Orem's self-care theory. Comparative analysis was conducted on baseline data, disease diagnosis, medical history, laboratory test results, health plan assessments, self-care requisites assessments based on Orem's self-care theory, treatment, nursing diagnoses, discharge planning, and follow-up care.

Results: Both cases in this study involve elderly patients, increasing the risk of developing pneumonia and severe disease progression. Case study 1 is a 64-year-old Thai female who presented with symptoms of respiratory distress, orthopnea, and dyspnea for 1 hour. She has a medical history of high blood pressure, end-stage renal disease, and gout. During treatment, the patient experienced volume overload, requiring close monitoring and nursing care for respiratory distress. Case study 2 is a 79-year-old Thai male with symptoms of chills, confusion, and diarrhea for 5 hours. He has a medical history of diabetes, hypertension, stage 2 renal failure, and atrial fibrillation. Due to a history of thrombolytic drug, there was a need to closely monitor for the risk of bleeding, in addition to managing respiratory distress. Both cases received nursing care according to standard protocols, with nursing diagnoses and discharge planning based on similar criteria. After treatment, both patients showed improvement in symptoms and could follow appropriate recommendations, leading to discharge and continued care at home.

Conclusion: Nurses play a crucial role in assessing and monitoring symptoms, signs, and potential complications that may arise, as this infection can lead to severe symptoms and even fatalities. Nurses need to develop competencies in assessing the patient's health status, considering the unique nursing problems in each patient, and possessing skills to promptly manage the patient's symptoms. This is essential to prevent life-threatening situations or severe complications in patients.