REPUBLIC OF THE PHILIPPINES

JOSE RIZAL MEMORIAL STATE UNIVERSITY

The Premier University in Zamboanga del Norte
GOV. GUADING ADAZA ST., STA. CRUZ, DAPITAN CITY, ZAMBOANGA DEL NORTE
College of Nursing and Allied Health Sciences

OUTPATIENT
DEPARTMENT (OPD) RLE
REQUIREMENTS
2nd SEMESTER OF ACADEMIC YEAR 2019-2020

JUSTINE MALOU Z. CAGATAN

BSN II-B

MA’AM JOANNA JAUCULAN

CLINICAL INSTRUCTOR

MAY 30, 2021

DATE SUBMITTED
DEFINITION:

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a newly

discovered coronavirus. It is an RNA virus, with a typical crown-like appearance under
an electron microscope due to the presence of glycoprotein spikes on its envelope. It
has become a major health problem causing severe acute respiratory illness in humans.
It has spread rapidly around the globe since its first identification in Wuhan, China, in
December 2019. The causative virus is called severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2), and the World Health Organization (WHO) named the
new epidemic disease Coronavirus Disease (COVID-19).

SYMPTOMS:

The most common symptoms of COVID-19 are:

 Fever
 Dry cough
 Fatigue

Other symptoms that are less common and may affect some patients include:

 Loss of taste or smell,

 Nasal congestion,
 Conjunctivitis (also known as red eyes)
 Sore throat,
 Headache,
 Muscle or joint pain,
 Different types of skin rash,
 Nausea or vomiting,
 Diarrhea,
 Chills or dizziness.

Symptoms of severe COVID‐19 disease include:

 Shortness of breath,
 Loss of appetite,
 Confusion,
 Persistent pain or pressure in the chest,
 High temperature (above 38 °C).

Other less common symptoms are:

  Irritability,
 Confusion,
 Reduced consciousness (sometimes associated with seizures),
 Anxiety,
 Depression,
 Sleep disorders,
 More severe and rare neurological complications such as strokes, brain
inflammation, delirium and nerve damage.

People of all ages who experience fever and/or cough associated with difficulty
breathing or shortness of breath, chest pain or pressure, or loss of speech or movement
should seek medical care immediately. If possible, call your health care provider, hotline
or health facility first, so you can be directed to the right clinic.
 COVID-19 PATHOPHYSIOLOGY

Carrier or Infected Person Coughs or Sneezes

Droplets with Virus

Inhalation by another person Fomites (Contaminated Objects)

w/ in 3 feet

Direct Contact

Hyperactive
Fever
Immune Response
Entry to the Mucous Membranes
(Mouth, Nose, Eyes)

Destruction of
Abnormal and Injury to the Bronchial Mucosa
Normal Lung Tissue
by CYTOKINES
Damage to Destruction of Irritation of Nerves
Goblet Cells Cilia in Bronchi
Damage to Blood
Scarring and Dyspnea
Vessels in the
Fibrosis
Alveoli Decrease Accumulation Cough Dyspnea
Mucous of Cell Debris
&
Systemic Viral Permanent Inflammation
Replication Lung Damage fluids

02 – Hypoxemia – If <50
Multi-organ Inflammation mmHg
Failure of Alveoli
Co2 – HypercapnIa - If >50
mmHg
Consolidation
Retention
 Pneumonia Acute Respiratory
Distress Syndrome
PREVENTION

Prevention is, so far, the best practice in order to reduce the impact of COVID-19
considering the lack of effective treatment. At the moment, there is no vaccine available
and the best prevention is to avoid exposure to the virus.
In order to achieve this goal, the main measures are the following:
 To use face masks
 To cover coughs and sneezes with tissues
 To wash hands regularly with soap or disinfection with hand sanitizer
containing at least 60% alcohol
 To avoid contact with infected people
 To maintain an appropriate distance from people
 To refrain from touching eyes, nose, and mouth with unwashed hands

Interestingly, the WHO issued detailed guidelines including:

 Regularly and thoroughly clean your hands with an alcohol-based hand
rub or wash them with soap and water
 Avoid touching eyes, nose and mouth
 Practice respiratory hygiene covering your mouth and nose with your bent
elbow or tissue when you cough or sneeze
 If you have fever, cough and difficulty breathing, seek medical care early
 Stay informed and follow advice given by your healthcare provider
 Maintain at least 1 m (3 feet) distance between yourself and anyone who
is coughing or sneezing.

In particular, regarding the use of face mask, health care workers are
recommended to use particulate respirators such as those certified N95 or
Filtering Face Piece 2 (FFP2) when performing aerosol-generating procedures
and to use medical masks while providing any care to suspected or confirmed
cases. Moreover, while an individual without respiratory symptoms is not required
to wear a medical mask when in public, people with respiratory symptoms are
advised to use medical masks both in health care and home care settings.
NURSING INTERVENTIONS
Based on assessment data, nursing interventions for COVID-19 should focus on
monitoring vital signs, maintaining respiratory function, managing hyperthermia, and
reducing transmission.

 Monitor vital signs – particularly temperature and respiratory rate, as fever and
dyspnea are common symptoms of COVID-19.

 Monitor O2 saturation – normal O2 saturation as measured with pulse oximeter

should be 94 or higher; patients with severe COVID-19 symptoms can develop
hypoxia, with values dropping low enough to warrant supplemental oxygen.

 Manage fever – use appropriate therapy for hyperthermia, including adjusting

room temperature, eliminating excess clothing and covers, using cooling
mattresses, applying cold packs to major blood vessels, starting or increasing
intravenous (IV) fluids as allowed, administering antipyretic medications as
prescribed, and readying oxygen therapy in the event of respiratory problems
resulting from the metabolic demands for oxygen during a fever.

 Maintain respiratory isolation – isolation rooms should be well-marked with

limited access; all who enter the restricted-access room should use personal
protective equipment, such as masks and gowns.

 Enforce strict hand hygiene – to reduce or prevent transmission of coronavirus,

patients should wash hands after coughing, as should all who enter or leave the
room.

 Provide information – educate the patient and patient’s family members of the
transmission of COVID-19, the tests to diagnose the disease, disease process,
possible complications, and ways to protect oneself and one’s family from
coronavirus.
UPDATES

Globally, new COVID-19 cases rose for the eighth consecutive week, and new COVID-
19 deaths increased for the fifth consecutive week. More than 83,000 new deaths were
reported, which is an 8% jump from the previous week.

The overall COVID-19 death toll surpassed 3 million last week, the WHO said. It took 9
months to reach 1 million deaths, then 4 months to surpass 2 million, and 3 months to
pass 3 million, according to The New York Times.

All regions reported an increase in cases during the past week except for Europe, which
saw a 3% decline, the WHO said. The largest increase continues to be reported in
Southeast Asia, which is largely driven by a surge in infections in India.

April 23, 2021 -- More COVID-19 cases were reported worldwide last week than in any
other 7-day period during the pandemic, according to new data published Tuesday by
the World Health Organization.

Last week’s tally of 5.24 million new cases broke the previous record of 5.04 million new
cases reported at the beginning of January.

India reported more than 314,800 cases on Thursday, breaking the worldwide record for
the most infections recorded in a single day. The U.S. set the previous record of more
than 300,600 cases on Jan. 8.

India now accounts for nearly one-third of all new cases worldwide, the WHO said. The
country’s total neared 16 million cases on Thursday, second only to the 31.8 million
infections reported by the U.S. during the pandemic.

A large number of hospitals in India are reporting shortages of beds, medicines and
oxygen, particularly in the capital region of New Delhi. On Wednesday, the New Delhi
High Court ordered the government to divert oxygen from industrial use to hospitals, the
Associated Press reported.

“You can’t have people die because there is no oxygen,” the court wrote. “Beg, borrow
or steal, it is a national emergency.”

India reported the highest number of new cases last week with more than 1.4 million
infections, which was a 64% increase, according to the WHO report. The U.S. reported
the second-highest number with 477,000 new cases, which was a 2% increase. Brazil
and Turkey also reported more than 400,000 new cases during the past week.

The global surge in cases is likely related to the emergence of COVID-19 variants, the
WHO said, as well as easing of public health measures.

“The COVID-19 pandemic shows no signs of easing, with global case and death
incidence increasing at a concerning rate since mid-February 2021,” the WHO wrote in
the report. “A third of the global cumulative COVID-19 cases and deaths has been
reported in the last 3 months alone, with weekly cases reaching similar levels as the
previous peak in January 2021.”

Crist, C. (2021). WHO: Worldwide COVID Cases Reached New Weekly Record. WebMD
Health News Brief. https://www.webmd.com/lung/news/20210422/who-says-worldwide-
covid-cases-reached-new-weekly-record

The COVID-19 pandemic in the Philippines is part of the worldwide pandemic of

coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2). The first case in the Philippines was identified on January
30, 2020 and involved a 38-year-old Chinese woman who was confined at San Lazaro
Hospital in Metro Manila. On February 1, a posthumous test result from a 44-year-old
Chinese man turned out positive for the virus, making the Philippines the first country
outside China to record a confirmed death from the disease.

After over a month without recording any cases, the Philippines confirmed its first local
transmission on March 7, 2020. Since then, the virus has spread with at least one case
being recorded in the country's 81 provinces. Socio-economic status has been
associated with the prevalence of COVID-19 cases across the country. Lockdowns, or
community quarantines, have been imposed throughout the country since March 15,
2020 as a measure to limit the spread of the virus. The largest of these measures was
the enhanced community quarantine in Luzon.

As of April 30, 2021, the Philippines has reported 1,037,460 cases of the disease. Out
of these cases, 946,318 recoveries and 17,234 deaths have been recorded. In terms of
confirmed COVID-19 cases, it has the 2nd highest in Southeast Asia (after Indonesia),
ranks 7th in Asia, and 26th in the world. The largest single-day increase in the number
of confirmed cases was reported on April 2, 2021, when the Department of Health
(DOH) announced 15,310 new cases.

The Philippines had a slightly lower testing capacity than its neighbors in Southeast
Asia during the first months of the pandemic in the country. COVID-19 tests had to be
taken outside the country due to the lack of testing kits. This also has led to a
controversy that involved several government officials who were reported to have
undergone COVID-19 tests without qualifying to the DOH's triage algorithm. By the end
of January 2020, the Research Institute for Tropical Medicine (RITM) in Muntinlupa,
Metro Manila began its testing operations and became the country's first subnational
laboratory. Several laboratories have been accredited by the DOH since then. As of
April 25, the country has 249 subnational laboratories capable of detecting the SARS-
CoV-2 virus and has conducted a total of 11,581,020 tests from more than 10,882,337
unique individuals.

https://en.wikipedia.org/wiki/COVID-19_pandemic_in_the_Philippines

The world is in the midst of a COVID-19 pandemic. As WHO and partners work together
on the response -- tracking the pandemic, advising on critical interventions, distributing
vital medical supplies to those in need--- they are racing to develop and deploy safe and
effective vaccines.

Vaccines save millions of lives each year. Vaccines work by training and preparing the
body’s natural defences – the immune system – to recognize and fight off the viruses
and bacteria they target. After vaccination, if the body is later exposed to those disease-
causing germs, the body is immediately ready to destroy them, preventing illness.

As of 18 February 2021, at least seven different vaccines across three platforms have
been rolled out in countries. Vulnerable populations in all countries are the highest
priority for vaccination.

At the same time, more than 200 additional vaccine candidates are in development, of
which more than 60 are in clinical development. COVAX is part of the ACT Accelerator,
which WHO launched with partners in 2020. COVAX, the vaccines pillar of ACT
Accelerator, convened by CEPI, Gavi and WHO, aims to end the acute phase of the
COVID-19 pandemic by: speeding up the development of safe and effective vaccines
against COVID-19; supporting the building of manufacturing capabilities; and working
with governments and manufacturers to ensure fair and equitable allocation of the
vaccines for all countries – the only global initiative to do so.
Vaccines are a critical new tool in the battle against COVID-19 and it is hugely
encouraging to see so many vaccines proving successful and going into development.
Working as quickly as they can, scientists from across the world are collaborating and
innovating to bring us tests, treatments and vaccines that will collectively save lives and
end this pandemic.

Safe and effective vaccines will be a gamechanger: but for the foreseeable future we
must continue wearing masks, physically distancing and avoiding crowds. Being
vaccinated does not mean that we can throw caution to the wind and put ourselves and
others at risk, particularly because it is still not clear the degree to which the vaccines
can protect not only against disease but also against infection and transmission.
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/covid-19-vaccines