NURSING CARE PLAN CUES

Subjective: - General feeling of discomfort - Body aches - Headache - exposure to person with SARS Objective: - Temperature greater than 38C 2 to 3 days - Chills - Diarrhea - Dry nonproductive cough 2 to 7 days - hypoxia - positive diagnostic test

NURSING DIAGNOSIS
Infection related to failure to avoid pathogen secondary to exposure to SARS-CoV

RATIONALE
Coronavirus are a common cause of mild upper respiratory illness in humans. SARS appears to spread by close person-to-person contact by respiratory droplets, or when a person touches an object contamindated with infectious droplets and then touches his or her mouth, norse, or eyes. The illness usually begins with an elevated high temperature, chilss, and headache. Reference: Nursing Care Plans 6th edition

GOALS AND OBJECTIVES

Short term: After 8 hours of nursing intervention, the patient will be able to: - maintain a normal body temperature of 36.5 to 37.5 C - reduce the respiratory symptoms Long term: After 3-5 days of nursing intervention, the patient will be able to: - reduce the risk to spread of infection - maintain absence of respiratory symptoms

NURSING INTERVENTION
Independent: - Monitor temperature. - Monitor lung sounds and cough.

RATIONALE
- SARS usually begins with a high temperature and chills. - Bronchial lung soounds are evident in areas of lung consolidation. A dry, nonproductive cough is common. - Respiratory compromise results in hypoxia. - SARS spreads by close contace as do other respiratory ilnesses. It is spread most rapidly through droplet transmission in which the infected particles are large and can travel only about 3 feet. But the virus can also spread by touching a surface contaminated by the droplets, and then touching ones mouth, nose, or eyes.

EVALUATION
- Patient exhibits absence of of fever and absence of respiratory symptoms. - Risk of spread of infection is reduced. The goal was partially met.

- Monitor oxygen saturation. - Maintain respiratory isolation. Keep tissues at the patients bedide. Dispose secretions properly. Have the patient cover mouth when coughing or sneezing. Use masks (particulate N95 mask is preferred). Have anyone entering the patients room wear a mask. Keep door closed at all times and place respiratory isolation sign where visible. If the patient is transported out of the room, have him or her wear a mask.

by Gulanick/Myers page 515

Place respiratory stickers on chart, linens, and so on. Assist visitors to follow appropriate isolation techniques. - Teach the patient to wash hands after coughing. - Use appropriate therapy for elevated temperature. - Encourage the patient to cough unless the cough is nonproductive. - For patients with reduced energy, pace activities. - Provide a high protein, high calorie, increased fluid diet in small frequent servings. Dependent: - Administer anitiviral and antiretroviral medications as ordered: such as lopinavir, ritonavir, and ribavirin. Collaborative: - Consult a respiratory therapist for chest physiotherapy and nebulizer treatments, as ordered. - Collect and monitor diagnostic results.

- Friction and running water effectively remove organisms. - This maintains normothermia and reduces metabolic needs. - Frequent nonproductive coughing results to hypoxemia. - Coughing is hard work and may exhaust an already compromised patient. - This maintains nutritional status while reducing risk for nausea and vomiting.

- There is no known treatment directed at the SARS virus. The CDC recommends similar treatment as for other serious community-acquired atypical pneumonia. - Chest physiotherapist includes techniques of postural drainage and chest percussion. - No specific clinical laboratory findings can distinguish SARS.

CUES
Subjective: - Questioning members of health care team - lack of questions about SARS - verbalizing inaaccurate information Objective: - unaware of proper prevention methods - denial need to learn

NURSING DIAGNOSIS
Deficient knowledge related to unfamiliarity with disease transmission information

RATIONALE
The lack of cognitive information or psychomotor skills required for health recovery, maintenance, or health promotion. The lack of information about a disease process leads to development and acquiring of the disease. Reference: Nursing Care Plans 6th edition by Gulanick/Myers page 116

GOALS AND OBJECTIVES

After 2 hours of nursing intervention, the patient will be able to: - verbalize the disease process, transmission, treatment, and complications of SARS.

NURSING INTERVENTION
Independent: - Provide information on disease transmision. SARS is spread predominantly by droplet transmission or when a person touches an object contaminated with infectious droplets and then touches his or her own mouth, nose, or eyes. Person are infectious mostly when they have symptoms such as fever or cough most commonly during the second week of illness. All current laboratory confirmed SARS cases were acquired after travel to areas where SARSCoV transmission was occurring. - Provide information on diagnostic testing. Reverse-transcription polymerase chain reaction (RT-PCR) test using secretions from nose, blood, stool Blood and viral cultures Radiographic testing (chest computed tomography or CT scan

RATIONALE
The CDS and WHO websited provided updated guidelines on SARS. The incubation period for SARS is typically 2 to 7 days but may be as long as 10 days.

EVALUATION
After 2 hours of nursing intervention, the patient was able to: - verbalized the disease process, transmission, treatment, and complications of SARS. The goal was met.

These includes testing for the presence of antibodies to SARS-associated coronavirus. They are more likely detected by the end of the second week of illness.

and chest x-ray) - Provide information on disease process / complications. The illness usually begins with elevated temperature, chills, and other flulike symptoms. Mild respiratory symptoms predominated and progress to hypoxia and often pneumonia, with some requiring mechanical ventilation. - Provide information on treatment. Strict respiratory isolation is paramount. Antiviral and antiretroviral medications are ordered. Supportive care is offered. Intubation and mechanical ventilation may be required. - Provide information on general protection from SARS. Apply general principles such as frequent hand wasing. Inform yourself about the latest SARS status of countries being visited.

Information enables individuals to take control of the situation. The sooner symptoms are recognized, the sooner treatment can begin.

There is no known treatment directed at the SARS virus. The CDS recommends similar treatments as for other serious community-acquired atypical pneumonia.

These are effective agains the spread of infection. Is is the best to get needed shots 4 to 6 weeks before travel.