CLINICAL CASE

ANALYSIS
COVID-19
BSN 4-2 (Group 3)
  60-year-old man presented to the hospital with five days of
fever, dry cough, and shortness of breath. Six years prior, he
was diagnosed with light-chain multiple myeloma (MM), for
which he received induction therapy with cyclophosphamide,
bortezomib, and dexamethasone followed by high-dose
melphalan and autologous hematopoietic cell transplantation. At
the time of admission, he was on maintenance therapy with 10
mg lenalidomide on days 1 to 21 of 28 days, and
dexamethasone with no evidence of disease. His vital signs

CASE showed a body temperature of 102.9°F, heart rate of 110 bpm,

blood pressure at 130/70 mm Hg, respiratory rate of 41, and
oxygen saturation of 94 percent at 4 L/min via nasal cannula.
SCENARIO  The patient appeared diaphoretic and in acute respiratory
distress, with rapid, shallow breathing. Diffuse inspiratory
crackles were audible throughout the bilateral lung fields.
Empiric broad-spectrum antibiotics (Piperacillin + Tazobactam
4.5 gms IV and Vancomycin 1 gm IV) were initiated, and the
patient was admitted to the special pathogens unit. Within 12
hours after admission, the patient developed increased
respiratory distress, and rapidly escalating oxygen requirements
prompted his transfer to the intensive care unit (ICU). Upon
arrival to the ICU, he was intubated for hypoxemic respiratory
failure due to severe ARDS.
  Chest X-ray - low lung volumes and bilateral atelectasis
 Urinary antigens - Streptococcus pneumonia (-) Legionella
pneumophilia (-)
 Nasopharyngeal reverse transcription-PCR for SARS-
CoV-2 – (Positive)
 Sodium- 147 mmol/L, Potassium- 3.6 mmol/L, Chloride-
112 mmol/L, Calcium- 8.3 mg/dl

LABS AND 

HCO3- 21 mmol/L, BUN- 28 mg/dl, Creatinine- 0.94 mg/dl
AST- 51 U/L, ALT- 23 U/L

RADIOLOGIC  Hemoglobin- 120 g/L, Hematocrit- 0.350 %, RBC- 4.19,

WBC- 8.6, Platelet- 233,000

FINDINGS  D-dimer- 791 mg/dl, High sensitivity C-reactive protein-

93.6 mg/dl, IL-6- 144 pg/ml
 The patient was treated with hydroxychloroquine but showed
no change in his clinical status. Given the patient’s elevated
and rising serum interleukin (IL-6) level, C-reactive protein,
and D-dimer, tocilizumab was administered with no
appreciable clinical improvement. He was subsequently
enrolled on a randomized clinical trial of remdesivir when it
became available at our site. After two weeks of mechanical
ventilation, the patient was successfully extubated and
continues to clinically improve. 
INTRODUCTION
 INTRODUCTION

 Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. Most people infected
with the virus will experience mild to moderate respiratory illness and recover without requiring special treatment.
However, some will become seriously ill and require medical attention. Older people and those with underlying
medical conditions like cardiovascular disease, diabetes, chronic respiratory disease, or cancer are more likely to
develop serious illness. Anyone can get sick with COVID-19 and become seriously ill or die at any age. (WHO,
2022)
 The Delta variant is a variant of concern classified by WHO on May 11, 2021 and is currently the dominant variant
that is circulating globally. Delta spreads more easily than earlier strains of the virus and is responsible for more
cases and deaths worldwide. (WHO, 2021)
 The Omicron variant, variant B.1.1.529, was first reported to WHO on 24 November 2021 and was classified as a
variant of concern by WHO on 26 November 2021. The classification was made on the advice of the Technical
Advisory Group on Virus Evolution, based primarily on information from South Africa that the variant has a large
number of mutations and has caused a detrimental change in COVID-19 epidemiology. (WHO, 2022)
 GLOBAL STATISTICS

 Globally, as of 4:00pm CET, 28 January 2022, there have been 364,191,494 confirmed cases
of COVID-19, including 5,631,457 deaths, reported to WHO. As of 27 January 2022, a total of
9,854,237,363 vaccine doses have been administered.
 Globally, the number of new COVID-19 cases increased in the past week (17-23 January
2022) by 5%, while the number of new deaths remained similar to that reported during the
previous week. Across the six WHO regions, over 21 million new cases were reported this
week, representing the highest number of weekly cases recorded since the beginning of the
pandemic. Nearly 50 000 new deaths were also reported. As of 23 January 2022, over 346
million confirmed cases and over 5.5 million deaths have been reported worldwide.
ASIA STATISTICS

 The number of new weekly deaths increased in the South-East

Asia Region (44%), the Eastern Mediterranean Region (15%) and
the Region of the Americas (7%), while the other Regions all
reported declines in new weekly deaths. In this edition, we
provide updates on the geographic distribution of circulating
SARS-CoV-2 variants of concern (VOCs), and summarize their
phenotypic characteristics based on available studies. A specific
brief update on the Omicron variant, is also provided.
 In Philippines, from 3 January 2020 to 4:00pm CET,
28 January 2022, there have been 3,493,447
confirmed cases of COVID-19 with 53,736 deaths,
LOCAL
reported to WHO. As of 19 January 2022, a total of
122,321,531 vaccine doses have been STATISTICS
administered.
TRIAGE/ER MANAGEMENT
FOR COVID 19 CASES
NURSING HISTORY
PERSONAL DATA

A. DEMOGRAPHIC DATA
Patient’s Pseudo Name: Patient X
Age: 60 years old
Sex: Male
Civil Status: Married
Religion: Roman Catholic
Address: Minane, Concepcion Tarlac
Date and Place of Birth: January 12, 1962 (Tarlac City)
Role/position in the family: Husband/Father
Occupation: Truck Driver
Nationality: Filipino
Chief complaint: Fever, Dry cough, and Shortness of breath.
Admitting diagnosis: Corona Virus Disease
Final Diagnosis: Corona Virus Disease (COVID 19)
Time and Date Admitted: February 2, 2022, at 10:00 am
 HISTORY OF PAST ILLNESS

 Six years prior, he was diagnosed with light-chain multiple myeloma (MM), for which he received
induction therapy with cyclophosphamide, bortezomib, and dexamethasone followed by high-dose
melphalan and autologous hematopoietic cell transplantation. He smoked 2 packs of cigarettes per day
for the past 50 years. According to him, he had measles when he was 9 years old, and he did not
receive any vaccines due to unavailability or it was not a trend in his time. He has no allergies.
 SURGICAL HISTORY: No past surgical history.
 ACCIDENT: No accident reported related to the present condition.
 MEDICATION: Patient X stated that he is not taking any medication.
 ALLERGIES: No known food and drug allergies.
HISTORY OF PRESENT ILLNESS

 The symptoms started 6 days prior to being seen by the physician. Over the course of a few days, the dry
cough worsens and is accompanied by a high fever with shortness of breath. According to him, after being
exposed to a covid positive patient, he also began to experience symptoms like loss of smell and taste,
headache, sore throat, and muscle pain. At the time of admission Patient X appeared diaphoretic and in acute
respiratory distress, with rapid, shallow breathing. Diffuse inspiratory crackles were audible throughout the
bilateral lung fields.
PHYSICAL
ASSESSMEN
T (13 AREAS)
 Social Status

13 AREAS OF • Patient X is a 60 year old man who lives in Concepcion, Tarlac

together with his wife and children. According to patient X, he has a
good relationship with his family members and he spends his extra
ASSESSMEN time with them.

Norms:
T • Social status includes family relationship or friends that state the
patient's support system in times of stress and in need. It meets a
fundamental human need for social ties, making life less stressful and
social support buffers the negative effects of the stress, thus, indicating
indirectly contributing to good health outcomes (Kozier, 2016).

Analysis:
• Patient X's social status is normal. He has a good relationship with his
family.
 General Appearance and Behavior
• Patient X is well groomed and organized in his appearance. He looks

Mental Status weak but he was able to answer all the questions asked to him with all
sincerity. Patient X is not erect posture. He can maintain eye contact
but was not that alert during the interview.

Level of Consciousness
• Patient X shows awareness and consciousness in his surroundings by
being able to respond and think properly.

Orientation
• Patient X can tell the exact date, time, and the place where he was
admitted. He is aware in the reason of his hospitalization.

Speech
• Patient X can speak clearly and express herself during the interview.
Mental Status

Intellectual Function
 Patient X was able to understand all of the questions during the interview and the purpose of conducting it.
Norms:
 The patient should appear relaxed with the appropriate amount of concern for the assessment. The patient should exhibit erect
posture, smooth gait and symmetrical body movement. The patient should be clean and well-groomed and should wear appropriate
clothing for age, weather, and socioeconomic status. Facial expressions should be appropriate to the content of the conversation and
should be symmetrical. The patient should be able to produce spontaneous, coherent speech. Content of the message should match
the patient educational level. The patient should be correctly responding to questions and to identify all the objects as requested.
Denial and poor eye contact is normal response on the first interaction that may be due to uneasiness on the presence of a stranger or
an attempt to screen or ignore unacceptable realities by refusing to acknowledge them. The patient should demonstrate a realistic
awareness and understanding of self. The patient should be able to evaluate and act appropriately in situations requiring judgment.
Thought process should be logical, coherent and goal-oriented. Thought content should be based on reality. (Health Assessment and
Physical Examination, 3rd Edition)
Analysis:
 Being responsive and able to answer questions accordingly are the major determinants, which indicate patient’s mental capabilities
are still functioning well. He has a normal mental status.
  While assessing Patient X, he was quite lacking of
ease. He is afraid that his condition might worsened
and might lead him to death. He has been stressed and
emotional for the past few days.
Norms:
 Normally, the patient should have the ability to
Emotional manage stress and to express emotion appropriately. It
also involves the ability to recognize, accept and
Status express feelings and to accept one’s limitations. (Kozier
& Erb's, 2016).
Analysis:
 Patient X is emotional because of his condition,
thinking that he may not be treated.
  Patient X has normal hearing acuity by doing the watch tick test. He responded
that she can hear the tick of the watch. He has diminished sense of smell whereas
the patient was asked to smell a spray of alcohol on one hand and he said that he
can barely smell it. His sense of taste appeared to be abnormal because he stated
that he cannot determine the flavor of the food that he eats almost every day. For
the sense of sight, Patient X is not wearing eyeglasses and claimed to be normal
vision of 20/20. Sense of touch is normal since the patient could easily react to
the inflicted pain and certain cold or warm temperature against her skin.
Norms:
Sensory  Each of the five senses becomes less efficient as the age advances. Changes
result in loss of visual acuity, less power of adaptation to darkness and dim light,

Perception
decreased in accommodation to near and far objects. The loss of hearing is the
ability related to aging effects people over age 65. Gradual loss of hearing is more
common among man than women, perhaps because men are more frequently in
noisy work environment. Older people have a poorer sense of taste and smell and
are less stimulated by food than young. Loss of skin receptors takes place
gradually, producing in increased threshold for sensations of pain, touch, and
temperature. (Fundamentals of Nursing 7th edition Barbara Kozier)
Analysis:
 Patient X has loss his sense of smell and taste due to inflammation of a viral
illness. His sense of touch is normal as well as his sight.
Motor Status

 Upon inspection we noted any asymmetry of muscle; unilateral atrophy will often indicate weakness. We assess the upper extremities, the patient
was asked to raise his arms parallel to the floor or bed, and then have her resist when we try to push them down. We do the same for the lower
extremities, having him raise her legs and resist when we push them down. While the patient is in bed, we assess motor strength bilaterally. Have
the patient flex and extend his arm against your hand, squeeze your fingers, lift his leg while you press down on his thigh, hold his leg straight and
lift it against gravity, and flex and extend his foot against your hand. Using the motor scale the grade of the patient is 4 which means that he
withdraws form pain

Norms:

 Normal motor stability includes the ability to perform different activities without causing pain and discomfort. It should be firm and have coordinated
movements. (Estes, 2011)

Analysis:
 In the test done, the patient feels pain and had some difficulty in moving his extremities because of his weakness. His grade in motor response is 4
 Body Temperature

The table shows the temperature of the patient

during his confinement:
Norms: Date Time Temperature Analysis
 The normal range for adults is considered to be
between 36°C and 37.5 °C. Febrile is marked or
caused by fever (Kozier & Erb’s, 2016). February 2, 2022 10:00 am 102.9 °F Abnormal
Analysis:
 Patient X noted to have abnormal body
temperature 102.9 °F. Fever is one of the ways our
body tries to fight off infection. For that reason, it’s a
common symptom of COVID-19.
 Respiratory Status

The table shows the respiratory status of the patient during his
confinement:
Norms:
Date Time Respiratory Analysis
 A normal respiratory rate for adult ranges from 12-20 cycles
per minute. Average is 18 cycles per minute. Breathing patterns
must be regular and even in rhythm. The normal breath sound is Rate
bronchial which is high in pitch, loud in intensity and blowing or
hollow in quantity, Broncho vesicular is moderate in pitch, moderate
intensity and combination of bronchial and vesicular, and vesicular
is low in pitch, soft intensity and gentle rustling or breezy in quality
(Berman et al., 2018).
February 2, 10:00 am 41 cpm Abnormal
Analysis:
2022
 Patient X has abnormal respiratory status. His respiratory
rate is above normal which is 41 cpm. Lungs were auscultated for
bilateral sound, diffuse inspiratory crackles were audible the
bilateral lung fields. Patient shows that he is in acute respiratory
distress.
 Circulatory Status

Norms: Date Time Blood Pressure Analysis

 Normal cardiac rate for an adult is 60-100 beats per minute February 2, 2022 10:00 am 130/70 mmHg Normal
while the normal blood pressure is 120/80 mmHg. The pulse must
have a regular beat and not bounding nor weak. (Kozier & Erbs,
Fundamentals of Nursing, Tenth Edition)
Analysis: Date Time Pulse Rate Analysis

 Patient’s blood pressure is normal, while his heart rate is February 2, 2022 10:00 am 110 bpm Above
slightly elevated with 110 bpm that may be due to high levels of Normal
inflammation circulating in the body.
  Patient X’s diet includes rice, fish, and meat. Sometimes fruits and vegetables.
He eats 3 times a day and drinks 8 glasses of water. He also drink coffee every
morning. However, since he started to feel the symptoms of the disease, he eat
less than usual.
Norms:
 Maintaining healthy or ideal body weight requires a balance between the
expenditure of energy and the intake of nutrients. The normal eating pattern of a

Nutritional 
person is minimum of three times per day depending upon the metabolic
demands and needs of the patient. (Kozier & Erb’s, 2016).
According to the Health Asian Diet Pyramid, there should be a daily

Status intake of rice, grains, bread, fruit and vegetables; optional daily for fish,
shellfish, and dairy products; weekly for sweets, eggs and poultry, and monthly
for meat. There should be an increase intake of a wide variety of fruits and
vegetables. Include in the diet foods higher in vitamins C and E, and omega-3
fatty acid rich foods. Fluid intake is on the average of 8-10 glasses per day
(Mohan, 2002).
Analysis:
 Patient X nutritional status is normal. However, he eats less than usual
because he can’t taste the food.
  Patient X claimed that he usually defecates once a day
with semi solid consistency, brownish in color and
normal amount in elimination. He voids 4 times a day,
light yellow in color with normal amount.
Norms:

Elimination
 The typical adult bowel movement consists of a
moderate amount of formed, brown stool that is passed
without difficulty. The normal frequency of bowel
Status elimination varies from several stools per day to only
two or three per week. Most adults experience bowel
elimination every 1 to 2 days. Normal voiding is 6 or 7
times a day with an output of 1200 to 1500 ml a day.
Urine is clear to yellowish in color. (Kozier, 2007)
Analysis:
 The patient’s elimination status is normal.
  Patient X had her first menstrual period at the
age of 14. The patient is not yet menopausal.
No menstrual period problems had arised as
verbalized by the client.
Norms:
Reproductive  The first menstruation which is menarche
occurs at an average of 9 to 17 years old.
Status (Pilliterri, 2010).
Analysis:
 The patient’s reproductive status is
normal.
Sleep-rest Pattern

 The patient has been having difficulty sleeping because of his cough and
for overthinking about his disease. He wakes up in the middle of the night
complaining for shortness of breath. He only sleeps for about 5-6 hours
compared to his previous sleeping time which is 8 hours.
Norms:
 Sleep refers to altered consciousness with general slowing of physiologic
process while rest refers to relaxation and calmness, both mental and
physical. A typical sleeper will pass through 7 to 9 hours of sleep and
take a rest using home relaxation activities such as reading, telling stories
and others. (Rick Daniels, 2017)
Analysis:
 Patient X was not able to achieve 8 hours of sleep because he is being
interrupted by his symptoms.
 State of Skin Appendages

 According to Patient X he had no history of skin allergy. Upon inspection, the patient is diaphoretic
and his skin warm to touch, pale brown in color, nail bed is pale pink, with slow capillary refill of 3-4
seconds.
Norms:
 Skin color varies from light to deep brown, pink to light pink and free from skin diseases. Hair is
resilient and evenly distributed. The nail plate is normally colorless and has a convex curve. The angle
between the fingernail and the nail bed is normally 160 degrees. (Kozier & Erb’s, 2015)
Analysis:
 Patient X is diaphoretic, and skin is warm to touch.
PATHOPHYSIOLOGY
 Continuum of Symptoms

Moderate-severe

 Worsening
Mild
dyspnea: increase
Critical
 Fever respiratory rate,
 Cough decrease O2  Respiratory failure
 Myalgia, fatigue saturation  Septic shock
 Nausea/vomiting  Bilateral interstitial  Multiple organ
 Diarrhea infiltrates on Chest dysfunction
 Loss of taste/smell X-ray,
progressively
worsening
LABORATORY AND
DIAGNOSTIC PROCEDURES
 LABORATORY & DATE INDICATION RESULTS INTERPRETATION NURSING RESPONSIBILITIES
DIAGNOSTIC PROCEDURE ORDERED
Chest X-ray 2/2/2022 An imaging test that uses Low lung volumes and Bilateral lung, atelectasis Before:
small amounts of radiation to bilateral atelectasis collapsing of the a lung
  produce pictures of the caused by a blockage of the  Instruct the client to remove any jewelry, eyeglasses, body
organs, tissues, and bones of air passages or by the piercings, or other metal objects.
the body. pressure on the lung.  Provide appropriate clothing. Patients are instructed to
remove clothing from the waist up and put on an X-ray
gown to wear during the procedure.
During:
 Instruct the client to hold his breath so that the chest stays
completely still.
 Move into different positions in order to take view from
both the front and the side of your chest.
 Instruct patient to cooperate during the procedure. The
patient is asked to remain still because any movement will
affect the clarity of the image.
After:
 No special care. Note that no special care is required
following the procedure.
 Provide comfort. If the test is facilitated at the bedside,
reposition the patient properly
 LABORATORY & DIAGNOSTIC DATE NURSING
INDICATION RESULTS INTERPRETATION
PROCEDURE ORDERED RESPONSIBILITIES

Urinary antigens 2/2/2022 To provide an etiological (-) Streptococcus pneumoniae is a Gram-positive  Results within 5-
diagnosis in community Streptococcus bacterium that is responsible for the majority of 10 mins
 
acquired pneumonia pneumoniae community-acquired pneumonia. It is a  Urine sample for
commensal organism in the human respiratory dectection of
(-) Legionella
tract, meaning that it benefits from the human pneumonia
pneumophilia
body, without harming it.  CSF sample for
detection of
L. pneumophila is a Gram-negative, non-
meningitis
encapsulated, aerobic bacillus with a single,
polar flagellum often characterized as being a 
coccobacillus
 
 
 LABORATORY &
DIAGNOSTIC DATE
PROCEDURE ORDERED INDICATION RESULTS INTERPRETATION NURSING RESPONSIBILITIES
RT-PCR Test 2/2/2022 To detect the various Positive Positive result. This means you  Sterilely open the outer case of the swab,
viruses and bacterial currently have an active
  infections. infection with the virus that  Insert the swab into nasal cavity by slightly elevating
causes COVID-19. the tip of the nose,
 

 Let the swab flow the floor of the nasal cavity (in
parallel with the hard palate),

 Keep the tip of the swab in the nasopharynx for a few

seconds, then rotate and extract.
 
 LABORATORY & DATE INDICATION RESULTS INTERPRETATION NURSING RESPONSIBILITIES
DIAGNOSTIC ORDERE
PROCEDURE D
Blood chemistry 2/2/2022 To measure amounts Sodium- 147 Sodium- Hypernatremia Potassium-  Avoiding specific foods and
of certain chemicals mmol/L,  Hypokalemia drinks such as cooked meats,
in a sample of blood. herbal tea, or alcohol
Potassium- 3.6 Chloride- Hyperchloremia
 Making sure not to overeat the
  mmol/L, 
Calcium- Hypocalcemia day before a test.
Chloride- 112  Not smoking
HCO3- Acidosis.  Avoiding specific behaviors
mmol/L, 
BUN high level indicste that the kidneys are such as strenuous exercise or
Calcium- 8.3 mg/dl sexual activity
not functioning normally
HCO3-21 mmol/L  Avoiding certain medicines
AST high level may indicate acute hepatitis and/or supplements. Be sure to
BUN- 28 mg/dl,  talk to your provider about what
High CRP result is a sign of acute
Creatinine- 0.94 inflammation you are currently taking,
mg/dl including 
IL-6 Elevated concentrations of Interleukin-6: over-the-counter medicines,
AST- 51 U/L >144 pg/ml may indicate an ongoing vitamins, and supplements.
inflammatory response, which could be
ALT- 23 U/L
consistent with a systemic infection or chronic
High sensitivity C- inflammatory disease.
protein- 93.6 mg/dl
High D-Dimer indicate that you have a blood
IL-6- 144 pg/ml clotting condition

D-Dimer- 791  
mg/dl
Creatinine and ALT are normal
 
 LABORATORY & DATE ORDERED INDICATION RESULTS INTERPRETATION NURSING
DIAGNOSTIC RESPONSIBILITIES
PROCEDURE
Complete Blood Cell 2/2/2022 To measures the size, Hemoglobin- 120 g/L,  Low hemoglobin,  If your health
(CBC) number, and maturity hematocrit, RBC care provider has
Hematocrit- 0.350 %, 
of the different blood indicate that you have also ordered
cells in a specific RBC- 4.19,  anemia other blood tests,
volume of blood. you may need to 
WBC- 8.6,  WBC and platelet are
fast (not eat or
normal
Platelet- 233,000 drink) for several
  hours before the
  test. 
 A health care
professional will
take a blood
sample from a
vein in your arm,
using a small
needle.
 After the needle
is inserted, a
small amount of
blood will be
collected into a
test tube or vial.
You may feel a
little sting when
the needle goes
in or out.
 
 MEDICAL MANAGEMENT
         
MEDICAL MANAGEMENT DATE PERFORMED/ GENERAL DESCRIPTION INDICATION/ CLIENT’S REACTION TO
CHANGED/DISCONTINUED PURPOSE TREATMENT
         Improved patient’s oxygenation,
    The nasal cannula is a device used Nasal cannulas and face masks are helped stabilize patient’s breathing
NASAL CANNULA Feb 2, 2022 to deliver supplemental oxygen or used to deliver oxygen to people
  increased airflow to a patient or who don't otherwise get enough of
person in need of respiratory help. it. They are commonly used
This device consists of a to provide relief to people with
lightweight tube which on one end respiratory disorders
splits into two prongs which are
placed in the nostrils and from
which a mixture of air and oxygen
flows.

         
    . Mechanical ventilation is a form A ventilator is a machine that helps Sustained patient’s need for
MECHANICAL Feb 2, 2022 of life support. A mechanical a patient breathe when sick, oxygen due to illness (Covid-19).
VENTILATION ventilator is a machine that takes injured, or sedated for an Helped patient breathe.
  over the work of breathing when a operation. It pumps oxygen-rich air
person is not able to breathe into the Iungs. It also helps to
enough on their own. The breathe out carbon dioxide, a
mechanical ventilator is also called harmful waste gas the body needs to
a ventilator, respirator, or breathing get rid of.
machine.  
 NURSING CARE PLAN
Ineffective Breathing Pattern
Name: Patient X
Age: 60 years old

CUES DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

S: “Nahihirapan po akong     INDEPENDENT: INDEPENDENT: SHORT TERM:

huminga.” as verbalized Ineffective breathing pattern SHORT TERM:    
 
by the patient. related to inflammation of   1. Assist the patient After 30 minutes of
1. An upright position
air sacs in the lungs Within 15 to 30 minutes of sitting up in a semi- rendering nursing
allows for a better
O: secondary to Covid-19 rendering nursing Fowler’s or high- interventions, the patient
lung expansion,
- Shortness of breath infection. interventions, the patient Fowler’s position.  was able to establish
hence more air
- Rapid and shallow will be able to establish a relaxed breathing pattern.
2. Direct patient in slow reaching the lungs
breathing relaxed breathing pattern.  
and deeper for gas exchange. 
- Diaphoretic
inspiration, and use 2. To help keep airways
- Dry cough
of breathing open and improves
- Audible diffuse
exercises such as lung mechanics and
inspiratory crackles
pursed lip breathing. breathing.
- Chest X-ray shows low
3. Mask patient and 3. To reduce viral
lung volume and bilateral
immediately transmission.
atelectasis
- Positive RT-PCR swab implement
test respiratory isolation 4. To limit the level of
- Vital signs taken and precaution. anxiety.
recorded as follows: 4. Maintain a calm
Temp: 102.9 F/39.3 C attitude when 5. Non-distracting
RR: 41 dealing with the environment
HR: 110 patient. provides optimal
BP: 130/70 mmHg 5. Provide a quiet opportunity for
O2Sat: 94 environment that is relaxation.
adequately
ventilated.
DEPENDENT: DEPENDENT:
1.  Provide respiratory 1.  Oxygen
support such as administration
oxygen therapy. corrects hypoxemia.
2. Administer 2. PRN (as needed)
respiratory medications help
medications as during episodes and
ordered. reduce
exacerbations. 
 CHARTING
Name: Patient X
Age: 60 years old
DATE/TIME/SHIFT FOCUS PROGRESS NOTE
01/31/22 Ineffective breathing pattern related to D:
3PM-11PM inflammation of air sacs in the lungs secondary to Subjective:
  Covid-19 infection “Nahihirapan po akong huminga.” as verbalized by the patient.
6:30 PM  
  Objective:
  - Shortness of breath
  - Rapid and shallow breathing
  - Diaphoretic
  - Dry cough
  - Audible diffuse inspiratory crackles
  - Chest X-ray shows low lung volume and bilateral atelectasis
  - Positive RT-PCR swab test
  - Vital signs: Temp-102.9 F/39.3 C; RR-41; HR-110; BP-130/70 mmHg; O2Sat-94
   
  A:
  - Monitored breath sounds and vital signs
  - Placed the patient in high fowlers position
  - Administered 4L/M of oxygen via nasal cannula as ordered
   - Administered Piperacillin + Tazobactam 4.5 gm IV and Vancomycin 1 gm IV as prescribed
  - Encouraged patient in slow and deeper inspiration and use of pursed lip breathing
   
 
R:
 
7:00 PM - Patient established an effective respiratory pattern. Absence of dyspnea.noted
  - Referred to the special pathogens unit accordingly