You need an account to save articles to your profile1 What the clinical picture of Covid-19 looks like 2 How Covid-19 is diagnosed 3 What the treatment of Covid-19 looks like 4 What the nursing points of attention are in Covid-19text article: Francine Aarts Photography: AdobeStock test: Anna-Marie MollinkCovid-19 (coronavirus disease 2019) is a disease resulting from infection with the human coronavirus SARS-CoV-2.In the majority of cases, the complaints are mild, in a smaller proportion severe to very severe.It concerns respiratory and sometimes gastrointestinal complaints:1,2In frail elderly people, covid-19, like other infections, can manifest itself in geriatric symptoms such as delirium, a fall, syncope (fainting), dehydration and acute loss of function.Often there are several geriatric complaints at the same time.The coronavirus is transmitted via droplet infection: via macro aerosols released by coughing and sneezing within a distance of 1.5 meters.It is also very likely that aerogenic spread (via micro-aerosols in the air) plays a relevant role in the spread of the virus.The virus can also be inhaled or enter the airway after touching the nose or mouth with contaminated hands.The eyes are also an entrance for the virus;the contaminated tear fluid can then end up in the throat via the tear duct.Certain actions release a lot of aerosols, such as intubation, non-invasive respiration and suctioning of the airways.1 That is why you must use the correct protective equipment during these actions and it is not recommended to use mouth-to-mouth or mouth-to-mask respiration. to suit patients with covid-19 or suspected covid-19.3Patients are contagious when they have symptoms (including mild symptoms), and perhaps 2 days before that.The incubation period is 2 to 14 days, on average 5-6 days.1Covid-19 causes mild to moderate complaints in the majority of positively tested patients.A small proportion are hospitalized.An even smaller group ends up in intensive care, part of which dies.Death rates increase as patients get older and have more underlying conditions.Entry into the body When a virus enters the body in the mouth-nasal cavity, it comes into contact with the nasal, throat and tongue tonsils.These together form Waldeyer's Ring;a ring of lymphatic tissue to keep infections out of the airways.The symptoms are still limited at this stage, for example cough and sore throat.The virus has not yet reached the alveoli (alveoli) and the gas exchange is still intact.6Pneumonitis When the virus penetrates to the lower respiratory tract and affects the alveoli, pneumonitis develops.7 An active inflammatory response occurs in the lungs.The walls of the alveoli swell and inflammatory fluid accumulates in the alveoli, along with necrotic epithelial cells and inflammatory cells.This restricts gas exchange and causes hypoxemia.6 There is also shunting: blood flows uselessly along the alveoli, which are not filled with air because they are full of inflammatory material.Pneumonitis in a severe form of Covid-19 is usually two-sided.This means that an even larger part of the gas exchange surface is affected.6 The oxygen saturation will decrease and symptoms such as dyspnoea and coughing may worsen.ARDS (shock lung) Pneumonitis can get worse quickly if ARDS occurs: acute respiratory distress syndrome, also called shock lung.There is then a hyperactive inflammatory reaction in which an enormous amount of inflammatory substances and inflammatory cells is released.This causes leakage of the lung capillaries and protein-rich fluid leaks from the capillaries into the alveoli.This further restricts gas exchange and the patient becomes critically ill with severe dyspnea and hypoxemia despite oxygen administration.Admission to the ICU and often prolonged ventilation is then necessary.The severely disrupted gas exchange can lead to multi-organ failure and death.6Erratic course What is striking about covid-19 is the erratic course.'Corona is the boss', says geriatrician Karen Keijsers.8 'It is very different from the diseases we already know: the picture can suddenly change.'And then both in the right and in the wrong direction: patients can suddenly get better or worsen a few days after admission.What causes this is not yet entirely clear.Researchers suspect that hyperinflammation of the lung plays a role, caused by its own immune response.9Rapid clinical deterioration may be associated with hypoxemia: the patient has a low saturation, but does not feel short of breath.How this is possible is not yet known.Keijsers: 'For example, a Covid-19 patient with a saturation of 79% can casually ask whether the oxygen cap can be taken off because it is annoying.'The course is therefore difficult to predict and treacherous.2In older patients, Covid-19 is more likely to have a severe course and a higher risk of death.This also applies to patients with underlying disease, such as lung disease (asthma, COPD), hypertension, chronic heart disease, diabetes mellitus, obesity, cancer and end-stage renal insufficiency.The same goes for immunocompromised patients.5The general practitioner or geriatric specialist assesses whether an assessment of the emergency department is necessary.This is done on the basis of risk factors and alarm signals such as a seriously ill impression, dyspnoea, low saturation, high respiratory rate and pulse, low blood pressure.2,10 The options for treatment and monitoring are better in the hospital, but there are also disadvantages: the The patient is not allowed to receive only limited visits, there is often little psychosocial support available, there is a risk of severe delirium (particularly in the frail elderly).10Covid patients can measure their saturation at home in more and more municipalities.As a result, they can stay at home longer or go home earlier.Also read: 6 questions about measuring saturation at home in covid-19.Notes (part 1: transmission and clinical picture) 1 Guideline COVID-19, National Coordination of Infectious Disease Control, consulted on 27 May 2021 2 Pocket card Basic knowledge of COVID-19, Jeroen Bosch Hospital, consulted on 27 May 2021 3 Corona: new advice for resuscitation in hospital .4 Death rate COVID-19 almost seven in a thousand, Medisch Contact, 2 April 2020 5 Internal medicine in times of COVID-19, e-learning Dutch Internists Association 6 Clinical reasoning COVID-19, video Amstel Academy VUmc 7 Pneumonitis is the name for inflamed lungs.The term pneumonia is often used with a bacterial infection.8 Webinar COVID-19, Jeroen Bosch Hospital, broadcast on March 31, 2020 9 Medicines for COVID-19, Dutch Journal of Medicine, March 25, 2020 10 Guideline Triage home treatment versus referring to hospital in elderly patients with (suspected) COVID-19 , Federation of Medical Specialists, consulted on 27 May 2021Covid-19 can be detected with laboratory research (PCR test or antigen test).The virus is better detected with a nasal swab (nasopharynx) than with a throat swab (oropharynx).It is best to take both, because sometimes only 1 of the 2 samples shows the virus.To save material, you can remove the nasal swab and the throat swab with 1 stick, or send 2 sticks in 1 tube.2In case of a negative nose/throat swab, if possible, also send in sputum, or possibly bronchoalveolar lavage (BAL, collected during a bronchoscopy).This makes it even easier to detect the virus than with a nose and throat swab.The corona test is not 100% watertight: a negative test result does not completely rule out infection.In the event of a negative test and a high suspicion of Covid-19, it is good to repeat the test.3The lab values ​​of the first 29 covid-19 patients were analyzed in the Amphia Hospital in Breda.A number of things stood out.60% of patients had lymphocytopenia (deficiency of lymphocytes).It is still unclear what causes this.The leukocyte count was often not abnormal.CRP (c-reactive protein, an important inflammatory parameter) was generally increased.Furthermore, the majority of patients had elevated AST (aspartate aminotransferase) and LDH (lactate dehydrogenase) levels, both indicative of organ damage.These findings are in line with what was found in Wuhan.4 (The last 2 values ​​are mainly measured on the IC.)In addition to the result of the nose/throat swab, the doctor may decide on a CT scan or at least a chest X-ray.Most hospital patients with Covid-19 complaints have an abnormal CT scan;however, in the early stages, CT scan and chest X-ray may look normal.3The CT scan often shows areas of frosted glass bilaterally, especially subpleural and peripheral (in the margins of the lung).Frosted glass in this case probably indicates alveolitis (pneumonitis).A chest X-ray can mainly show the bilateral consolidations (the alveoli are filled with fluid instead of air), especially peripheral.3Notes (part 2: diagnostics) 1 Respiratory complaints in times of corona, Dutch Journal of Medicine, 25 March 2020 2 Guideline COVID-19, National Coordination of Infectious Disease Control, consulted on 27 May 2021 3 Internal medicine in times of COVID-19, e-learning Dutch Internists Association 4 The first 29 COVID-19 patients in the clinic, Dutch Journal of Medicine, April 2, 2020Supportive (oxygen) therapy is the most important.1 This mainly concerns the administration of oxygen and, if necessary, artificial respiration.In addition, the patient may receive intravenous fluids in case of imminent dehydration due to persistent fever, and broad-spectrum antibiotics in critically ill patients.Although antibiotics do not help against the coronavirus, they are used preventively against possible bacterial super infections.The most recent medical treatment advice for covid-19 can be found on the website of the Antibiotic Policy Working Group (SWAB)1.Always follow the protocol of your hospital.Currently, the following drugs are described in the treatment recommendations of the SWAB.Corticosteroids – Dexamethasone The corticosteroid dexamethasone is indicated in covid patients who require oxygen administration or (especially) when oxygen therapy needs to be scaled up to Optiflow, NIV or mechanical ventilation.This concerns 6 mg per day or an equivalent dose of hydrocortisone/prednisone for a maximum of 10 days.1Remdesivir Remdesivir is an intravenous antiviral agent and is indicated for the treatment of covid-19.This concerns adults and adolescents (12 years and older with a body weight of at least 40 kg) with pneumonia that requires supplemental oxygen.The recommended duration of treatment is a minimum of 5 and a maximum of 10 days.1The combination of remdesivir and dexamethasone has not yet been studied.This combination may be effective in patients receiving oxygen who have not yet been admitted to the ICU.1IL6 inhibitors In patients who need to be admitted to the ICU, IL6 inhibitors can be administered in addition to corticosteroids.The timing of administration seems to be essential.1(Hydroxy)chloroquine, vitamin D etc Chloroquine and hydroxychloroquine are old antimalarial drugs, which were thought to be potentially effective against covid-19.Observational research and randomized studies show that this is not the case.1 Chloroquine has side effects (e.g. heart rhythm disturbances, nausea, anxiety) and interactions with other medications, such as domperidone and ondansetron.4 The SWAB guideline states: 'There is no place for off-label use of hydroxychloroquine, chloroquine or azithromycin, ivermectin and vitamins C/D.'NSAIDs There have been rumors that NSAIDs may be harmful to patients with Covid-19, but there is insufficient evidence to support this.As usual, paracetamol is preferred for fighting fever and pain.Patients who use NSAIDs for rheumatism, for example, should not stop taking them.4ACE inhibitors According to some theories from China, RAAS inhibitors (ACE inhibitors such as captopril, enalapril and lisinopril and ATII antagonists such as valsartan or losartan) would worsen Covid-19.However, there is no scientific evidence for this, and therefore no action is taken in the Netherlands.1Patients are intubated and ventilated on the IC in the event of respiratory deterioration.Patients are generally placed in the prone position for several hours a day. In the prone position, more blood goes to the lung tops and the ventral lung parts that are less affected.This improves gas exchange.The prone position can also be used in the nursing ward to reduce shortness of breath.The patient is generally turned twice a day, a risky procedure that usually requires 5 to 6 caregivers.Patients also often receive tube feeding and have a greatly increased energy requirement.In addition, patients are given fluids if necessary.Ventilation carries a high risk of a so-called barotrauma (damage to the alveoli).In addition, many complications can occur in the circulation, such as pulmonary embolisms.Ischemia of the heart muscle can also occur due to, for example, tachycardia, low saturation and dehydration.Furthermore, due to shock or damage to the kidney tubes, kidney problems can arise, which require hemodialysis.Notes (part 3: treatment) 1 Drug treatment options for patients with COVID-19, Stichting Werkgroep Antibioticsbeleid, consulted 27 May 2021 2 Internal medicine in times of COVID-19, e-learning Dutch Internists Association 3 Clinical reasoning COVID-19, video Amstel VUmc Academy 4 Medicines for COVID-19, Dutch Journal of Medicine, March 25, 2020 5 Guideline for COVID-19 in intensive care, no. 5, Dutch Association for Intensive Care, March 23, 2020It is known that patients with covid-19 can suddenly deteriorate sharply.Marc Bakker, nurse and clinical reasoning teacher*: 'The pneumonitis1 can suddenly worsen, or an ARDS or pulmonary embolism can occur.'The rapid deterioration may be accompanied by silent hypoxemia: the saturation is low, but the patient does not indicate that he is short of breath.'In patients with Covid-19 you actually take the standard measurements (see under 'assessment'), and you keep a close eye on the respiratory rate and saturation in particular,' Bakker explains.'On admission, a saturation lower than 95% is considered abnormal.If the saturation drops despite oxygen administration, that is a warning signal and a sign that you need to scale up the oxygen.'We are working out the nursing points of interest with a case about Mrs Bos*, recorded in the covid-19 nursing department.She indicates that every breath is 'a fight'.We discuss the case using the SBAR method (Situation – Background – Assessment – ​​Recommendation).Female, age 25, admitted 2 days ago, respiratory decline, tested positive for covid-19.We map the medical background with the AMPLE case history.Allergy: none Medication: oral contraception, 1000 mg paracetamol against fever via the GP Past illness: blank history Last meal: eaten less for several days due to sore throat.Still drinks well, especially cold drinks Event: came to the emergency room with fever, dyspnoea, cough and sore throat.Suspicion of covid-19, test taken.Complaints and symptoms;clinical picture Dry cough.Pain with deep inhalation and exhalation.Feeling as if lungs are on fire and unable to breathe properly, pain on collarbone and right next to right shoulder blade.Muscle pain throughout the body.Appears anxious due to shortness of breath;uses accessory respiratory muscles.Ms scored 9 points on the (M)EWS: 8 points (see above) plus 1 concern point from the nurse.Primary Covid isolation and oxygen administration via nasal goggles 5l/min.In case of deterioration, scale up via nasal mask to max. 15 l/min.In general, it is stated that with oxygen administration in which the oxygen follows the normal route through the nose, such as the nasal goggles, but also the oxygen mask, humidification of the air is in principle not necessary.Food and drink Energy needs are increased because the body fights against the infection, appetite is moderate due to shortness of breath.Food and drink as needed;preferably no IVs, probes or catheters.Each insertion opening forms an additional porte d'entrée for micro-organisms.Earn more points?Also make the other Nursing Challenge tests, you can find them via the Challenge page.Mobility and ADL Covid-19 patients are sick, tired, bedridden and unable to do much.They are often introverted, concentrating on their breathing.In addition, they are less mobile due to oxygen administration.Psychosocial counseling The isolation measures make psychosocial counseling more difficult.Patients have a great need for attention, but nurses suffer from fatigue and lack of time.Nurses often see this as a shortcoming in care.Mrs Bos was allowed to go home after a week in the covid department.Not much is known about the long-term effects of Covid-19.IC patients can suffer from post intensive care syndrome (PICS).A small proportion of patients develop and sustain lung damage in the form of pulmonary fibrosis.This causes complaints such as shortness of breath and fatigue.It is not yet known how many patients will be affected by this and how long the complaints will last.However, it seems to be a low percentage.Some covid patients in the Netherlands have now undergone a lung transplant because of lung fibrosis.* This patient's name and other details have been changed.Thanks to Marc Bakker for the case study.Notes (Part 4: Nursing points of interest) 1 Pneumonitis is the name for inflamed lungs.The term pneumonia is often used with a bacterial infection.2 AVPU: A(lert), V(erbal),P(ain), U(nresponsive) 3 MEWS: Modified Early Warning Score, set of vital parameters 4 These values ​​are retested if the situation calls for it.No follow-up values ​​are known for this patient.5 In principle, blood gas is only measured again after admission to the IC.Thanks to: – Frans Krouwels, lung specialist at the Spaarne Gasthuis in Haarlem – Marc Bakker, expert lecturer clinical reasoning at the Expertise Center ProActive Nursing of VUmc Amstel Academy/VUmc Academy in Amsterdam.– Dirk Van Renterghem, pulmonologist, Professional Association of Belgian Pulmonologists – Inez Bronsveld, pulmonologist at UMC Utrecht – Leon van den Toorn, pulmonologist, trainer and acting head of department of Pulmonary Diseases Erasmus MC.Chairman NVALT.Every month two articles are published in Nursing magazine and on Nursing.nl that are linked to a knowledge test: an article about a nursing topic and a medicine article.With the first test you earn 2 accreditation points and with the second 1. You can therefore earn 33 accreditation points per year (Nursing appears 11 times a year)All tests are online at www.​nursing.​nl/​challengeEvery month a goodie bag is raffled among all participantsAt the end of the year, the three best participants will win great prizesThe winners will be announced online every monthCovid-19 can cause serious illness and can deteriorate quickly if ARDS occurs: acute respiratory distress syndrome.There is then a hyperactive inflammatory response.What complicates gas exchange in ARDS?Give 2 answers.A Protein-rich fluid in the alveoli B Capillary leakage C Shock image D T cells adhering to the alveoliI can't take the covid-19 test, I get a message that I'm not a subscriber, even though I do have one.Dear Monique, it is best to submit your question to customerservice@bsl.nl.Greetings from the editorshi I can't do the challenge test about covid 19.I get a message that I don't have access, but I am a subscriber to Nursing Magazine and Challenge (full package).please help greetings RuthDear Ruth, it is best to submit your question to customerservice@bsl.nl.Greetings from the editorsThe oxygen sum is incorrect.There is not enough in the cylinder, so the answer must be no.The explanation is correct.I don't think the question about the tonsils is correct either, but I'm not familiar with that enough.Dear Mirjam, you are absolutely right.We've adjusted it.Thank you very much for your attention and for taking the time to report this!2 answers are incorrect.the question of oxygen.mw uses 300L oxygen and gets a bottle with converted 260L oxygen.so this is not enough for 20 minutes.answer explanation is good but yes must be no.in addition, question 7, there is 2 x the answer tonsilla pharyngealis, while here must be 1 tonsilla palatinae at number 4. Please adjust this 🙂Dear Joyce, you are absolutely right.We've adjusted it.Thank you very much for your attention and for taking the time to report this!My dear, something did indeed go wrong – but everything should work again now.Good luck!Same problem here, I don't think the button is there yet.Unfortunately I can't find the test.At 04-2020 I have a test about Hepatitis.Or should I be somewhere else?To respond, you must be logged in.If you don't have an account yet, create an account below.Also read the rules of the game.Bohn Stafleu van Loghum Walmolen 1, 3994 DL Houten PO Box 246, 3990 GA HoutenContact usSign up for the newsletter