Question Answered step-by-step Case Analysis Immunological System INSTRUCTIONS: All questions… Case AnalysisImmunological System INSTRUCTIONS: All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several answers, they should be listed in order of priority or significance. Scenario: A 48-year old-man, of Chinese origin, who had travelled to France from China around mid-January, 2020 was admitted to the Emergency room. He was then transferred to the ICU due to chest tightness, difficulty breathing, hypoxemia, sore throat, fever and severe dry cough. Initial orders include a STAT Chest X-ray, arterial blood gases and oxygen at 4L/min via Venturi mask. A respiratory viral panel and COVID-19 nasopharyngeal swab was ordered. Blood, urine and stool samples for viral loading were also ordered for 3 consecutive days. All samples were refrigerated and shipped to laboratories in the National Reference Center for Respiratory in Lyon, France, where RNA extraction, real-time RT-PCR, and virus isolation and titration procedures were done. The chest X-ray revealed hazy opacity in the lobes and the physician makes an initial diagnosis of pneumonia in both lower lobes. ABG show: PaO2 68mmHg, PaCO2 32mmHg and pH 7.53. 1. What is a respiratory viral panel and what does it cover? When is it usually ordered? 2. What other assessments should be done by the admitting nurse? What does the ABG of the patient suggest? Correlate it to her condition 3. What interventions should be implemented based on the laboratory results? After 24hours, he tested positive for COVID-19 and his illness was classified as severe. Treatment with antiviral and corticosteroid therapies were started but did not fully resolve his symptoms. On the second day in the hospital, a chest CT scan showed that the patient had ground glass opacities in his lungs, which are characteristic of pneumonia. His levels of interleukin-6 (IL-6), a pro-inflammatory cytokine, were high. His symptoms are rapidly evolving to multi-organ failure with persistent high viral load in lower and upper respiratory tract with systemic virus dissemination and virus detection in plasma. 4. COVID-19 has been proven to trigger “cytokine storm” or acute severe inflammatory response (ASIR). Why does this happen to patients with COVID-19? 5. What is ground glass opacity of the lungs? Explain. 6. Explain the possible pathophysiology of COVID-19 based on the symptoms manifested by the patient. Please use the format for the pathophysiology. DISEASE PROCESS – will indicate mode of entry (if applicable), organs involve or affected; described in diagram and narrative form the pathogenesis of a disease, the biological mechanism (or mechanisms) progress of disease showing its morphological features or that leads to the diseased state. SYMPTOMATOLOGY – can be multiple. Should include the positive and negative pertinent findings.Each sign and symptom should yield to a specific assessment/diagnostics and possibly management. DIAGNOSTICS/ LABORATORY CONFIRMATORY TEST – should be based on the signs and symptoms and the specific stage of disease process, and this will include a. Physical Assessment of the affected system. b. Medical Diagnostics may include IDEAL or potential diagnostic procedures. c. Nursing Diagnosis (NANDA) MANAGEMENT a. Medical – includes procedures ( ex. NGT, intubation, suctioning, BT,etc.) and drugs (including IV, parenteral feeding, ) b. Surgical – if there is c. Nursing – nursing interventions based on the formulated nursing diagnosis PROGNOSIS The predicted outcome of a disease and the chance of recovery if treatment is applied and if no treatment has been initiated to the patient. On the 3rd day, the patient demonstrated hyperpnea, grunting respirations, cyanosis, pallor, intercostal and substernal retractions with a change of mental status. The nurse suspects the patient is going into respiratory failure. The nurse informed the physician and he ordered the patient to be intubated and placed on mechanical ventilation because of progressing hypoxia. The patient was then placed on a combination of anti-viral agents, antibiotics and systemic corticosteroids. Intravenous immunoglobulin was also started. 7. Why is the patient being placed on a mechanical ventilator for COVID-19? Provide the rationale8. Explain the rationale for the use of antiviral, antibiotics, corticosteroids and immunoglobulins for the management of the patient with COVID-19. Since management for COVID-19 is not yet fully understood, one of the possible treatments being considered is the infusion of convalescent plasma, also called passive antibody therapy, which is a type of passive immunity. 9. Explain the rationale for this possible management being considered for COVID-19 infection. Health Science Science Nursing Share QuestionEmailCopy link Comments (0)
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