S. Umarani, Reena Ignatius*, S. Prema, K. Priyadharshini, K. Arockiyammal
Nursing Department, Kauvery Heartcity, Tamilnadu
*Correspondence: Tel: 9789612707; email: reena.ignatius2011@gmail.com
Efficient Nursing Care equals Early Recovery
Case Presentation
A 63-Year-old male patient presented with complaints of breathlessness and fast breathing. He was diagnosed to have COVID – 19 Pneumonia earlier for which he was initially treated for 15 days in a hospital, where he developed a bedsore. He was referred here for further management.
Past History
Patient had Acute Coronary Syndrome four years earlier and had undergone angiography at Heartcity and was diagnosed to have non-obstructive Coronary Artery Disease.
On Examination,
(a). SpO2 – 80% on room air, HR – 110 to 130 bpm and BP – 80/60 mmHg
(b). HRCT showed extensive COVID pneumonia and RT-PCR positive.
(c). ECG showed Atrial Fibrillation and Echo indicated biatrial dilatation, moderate tricuspid regurgitation and moderate PAH.
(c). ECG showed Atrial Fibrillation and Echo indicated biatrial dilatation, moderate tricuspid regurgitation and moderate PAH.
As advised by the doctor, the nurse placed the patient under CPAP, started with ionotropic drugs and stabilized. The family explained the critical condition of the patient. Informed consent was obtained for admission to the COVID isolation ward and ventilator support.
Nursing care, reassurance and support
(1) Maintained interpersonal relationships with the patient & family members.
(2) Maintained interpersonal relationships with the patient & family members.
(3) Diversional therapies like newspaper reading, and listening to music was given.
(4) AIDET communication technique was followed for effective communication
(5) Bundle care was strictly adhered to and was updated in the chart to prevent hospital-acquired infections.
(6) Strict compliance with HICC standard precautions ensured.
(7) Attenders were not allowed to visit the patient in the COVID ward and the nurses took care of the patient, round the clock.
(8) CPAP was maintained with adequate precaution to prevent device-associated pressure effects on the skin.
(9) The nurses assessed the skin integrity of the patient on a daily basis to prevent dehydration, skin tear and pressure points for bedsores.
(10) Necessary investigations are done on a daily basis to monitor his health improvement.
(11) The assigned nurses communicated with the patient reassuring him about his health status and gave him orientation to time, place and person.
(12) Nurses coordinated with other health care professionals for care while doing X-ray, arranging diet at the appropriate time and for other timely investigations.
(13) In each shift, he used to ask the nurses “How I am today?†“Will I be alrightâ€. Nurses reassured him and gained his confidence by assisting him in his activities of daily living (ADL).
(14) Nurses encouraged and engaged him in active and passive exercises like deep breathing exercises and spirometry. Also, they have coordinated his physiotherapy as well.
(15) Advised and observed for not straining on defaecation to prevent the dyspnoeic and hypertensive crisis.
(16) Nurses positioned him two- hourly, round the clock and provided back care and back massage like effleurage, petrissage, tapping and friction, for prevention of bedsore. Each nurse communicated effectively and developed a good rapport with the patient, and attender and he cooperated well in his care.
(17) Nurses developed a home-like environment for him to relax and encouraged him to sit on the chair with O2 support, every day.
(18) Opinions were obtained from hematologists, pulmonologist, general physicians, urologist surgical gastro enterologist and orders were carried out respectively.
(19) Adequate hydration was maintained with oral liquids and IV fluid.
(20) Routine catheter care was provided.
(21) Protein rich diet like raw egg white and crushed pulses were fed to him.
Recovery
After a prolonged stay in the hospital (DOA: 22.05.2021, DOD: 20.06.2021) patient become stable with the efficient care of nurses and went home happily with good prognosis.
Ms. Reena Ignatius
Nurse Educator