EXTRACTED FROM THE CDC CENTERS FOR DISEASE CONTROL AND PREVENTION WEBSITE FOR HEALTHCARE PROFESSIONALS.
A: The clinical spectrum of COVID-19 ranges from mild disease with non-specific signs and symptoms of acute respiratory illness, to severe pneumonia with respiratory failure and septic shock. There have also been reports of asymptomatic infection with COVID-19. See also Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease 2019 (COVID-19).
A: Currently, those at greatest risk of infection are persons who have had prolonged, unprotected close contact with a patient with symptomatic, confirmed COVID-19 and those who live in or have recently been to areas with sustained transmission.
A: The available data are currently insufficient to identify risk factors for severe clinical outcomes. From the limited data that are available for COVID-19 infected patients, and for data from related coronaviruses such as SARS-CoV and MERS-CoV, it is possible that older adults, and persons who have underlying chronic medical conditions, such as immunocompromising conditions, may be at risk for more severe outcomes. See also Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease 2019 (COVID-19).
A: The onset and duration of viral shedding and period of infectiousness for COVID-19 are not yet known. It is possible that SARS-CoV-2 RNA may be detectable in the upper or lower respiratory tract for weeks after illness onset, similar to infection with MERS-CoV and SARS-CoV. However, detection of viral RNA does not necessarily mean that infectious virus is present. Asymptomatic infection with SARS-CoV-2 has been reported, but it is not yet known what role asymptomatic infection plays in transmission. Similarly, the role of pre-symptomatic transmission (infection detection during the incubation period prior to illness onset) is unknown. Existing literature regarding SARS-CoV-2 and other coronaviruses (e.g. MERS-CoV, SARS-CoV) suggest that the incubation period may range from 2–14 days.
A: Very limited data are available about detection of SARS-CoV-2 and infectious virus in clinical specimens. SARS-CoV-2 RNA has been detected from upper and lower respiratory tract specimens, and SARS-CoV-2 has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, but whether infectious virus is present in extrapulmonary specimens is currently unknown. The duration of SARS-CoV-2 RNA detection in upper and lower respiratory tract specimens and in extrapulmonary specimens is not yet known but may be several weeks or longer, which has been observed in cases of MERS-CoV or SARS-CoV infection. While viable, infectious SARS-CoV has been isolated from respiratory, blood, urine, and stool specimens, in contrast – viable, infectious MERS-CoV has only been isolated from respiratory tract specimens. It is not yet known whether other non-respiratory body fluids from an infected person including vomit, urine, breast milk, or semen can contain viable, infectious SARS-CoV-2
A: The immune response to COVID-19 is not yet understood. Patients with MERS-CoV infection are unlikely to be re-infected shortly after they recover, but it is not yet known whether similar immune protection will be observed for patients with COVID-19.
A: Although the transmission dynamics have yet to be determined, CDC currently recommends a cautious approach to persons under investigation (PUI) for COVID-19. Healthcare personnel evaluating PUI or providing care for patients with confirmed COVID-19 should use, Standard Transmission-based Precautions. See the Interim Infection Prevention and Control Recommendations for Patients with Known or Patients Under Investigation for Coronavirus Disease 2019 (COVID-19) in Healthcare Settings.
A: Patients should receive any interventions they would normally receive as standard of care. Patients with suspected or confirmed COVID-19 should be asked to wear a surgical mask as soon as they are identified and be evaluated in a private room with the door closed. Healthcare personnel entering the room should use Standard and Transmission-based Precautions.
A: Not all patients with COVID-19 will require medical supportive care. Clinical management for hospitalized patients with COVID-19 is focused on supportive care of complications, including advanced organ support for respiratory failure, septic shock, and multi-organ failure. Empiric testing and treatment for other viral or bacterial etiologies may be warranted. Corticosteroids are not routinely recommended for viral pneumonia or ARDS and should be avoided unless they are indicated for another reason (e.g., COPD exacerbation, refractory septic shock following Surviving Sepsis Campaign Guidelines).
There are currently no antiviral drugs licensed by the U.S. Food and Drug Administration (FDA) to treat COVID-19. Some in-vitro or in-vivo studies suggest potential therapeutic activity of some agents against related coronaviruses, but there are no available data from observational studies or randomized controlled trials in humans to support recommending any investigational therapeutics for patients with confirmed or suspected COVID-19 at this time. Remdesivir, an investigational antiviral drug, was reported to have in-vitro activity against COVID-19. A small number of patients with COVID-19 have received intravenous remdesivir for compassionate use outside of a clinical trial setting. A randomized placebo-controlled clinical trial of remdesivirexternal icon for treatment of hospitalized patients with COVID-19 respiratory disease has been implemented in China. A randomized open label trialexternal icon of combination lopinavir-ritonavir treatment has been also been conducted in patients with COVID-19 in China, but no results are available to date. trials of other potential therapeutics for COVID-19 are being planned. For information on specific clinical trials underway for treatment of patients with COVID-19 infection, see clinicaltrials.govexternal icon.
A: No. These multi-pathogen molecular assays can detect a number of human respiratory viruses, including other coronaviruses that can cause acute respiratory illness, but they do not detect COVID-19.
A: There is currently no FDA-approved post-exposure prophylaxis for people who may have been exposed to COVID-19. For more information on movement restrictions, monitoring for symptoms, and evaluation after possible exposure to COVID-19
See Interim US Guidance for Risk Assessment and Public Health Management of Persons with Potential Coronavirus Disease 2019 (COVID-19) Exposure in Travel-associated or Community Settings and Interim U.S Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease 2019 (COVID-19).
A: Healthcare providers should consult with local or state health departments to determine whether patients meet criteria for a Persons Under Investigation (PUI). Providers should immediately notify infection control personnel at their facility if they suspect COVID-19 in a patient.
A: Not all patients with COVID-19 require hospital admission. Patients whose clinical presentation warrants in-patient clinical management for supportive medical care should be admitted to the hospital under appropriate isolation precautions. Some patients with an initial mild clinical presentation may worsen in the second week of illness. The decision to monitor these patients in the inpatient or outpatient setting should be made on a case-by-case basis. This decision will depend not only on the clinical presentation, but also on the patient’s ability to engage in monitoring, the ability for safe isolation at home, and the risk of transmission in the patient’s home environment.
For more information, see Interim Infection Prevention and Control Recommendations for Patients with Known or Patients Under Investigation for Coronavirus Disease 2019 (COVID-19) in a Healthcare Setting and Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for Coronavirus Disease 2019 (COVID-19).
A: Patients can be discharged from the healthcare facility whenever clinically indicated. Isolation should be maintained at home if the patient returns home before the time period recommended for discontinuation of hospital Transmission-Based Precautions described below. Decisions to discontinue Transmission-Based Precautions or in-home isolation can be made on a case-by-case basis in consultation with clinicians, infection prevention and control specialists, and public health based upon multiple factors, including disease severity, illness signs and symptoms, and results of laboratory testing for COVID-19 in respiratory specimens.
Criteria to discontinue Transmission-Based Precautions can be found in: Interim Considerations for Disposition of Hospitalized Patients with COVID-19
I’ve heard people make the claim that nurses are superhuman. While it’s meant to be an empowering compliment, I think it actually does more harm than good.
I believe it removes the human factor from our role. It cultivates that mentality that nurses can’t make mistakes simply because they are nurses. That we can do anything in any situation.
I mean… You wouldn’t be able to get through nursing school if you messed up, right?
Turns out – nurses are human too. (Surprise, haha!) Just like anyone else, we make mistakes. Everyone does. Getting through nursing school, med school, pharmacy school, or physical therapy school, etc. doesn’t mean all of a sudden you’re above mistakes. The stakes are just higher.
Naturally, we don’t want to mess up and harm someone in the process. It makes sense. However, in this pursuit of avoiding error, we begin to set the bar at perfectionism. Somehow being perfect becomes the lowest acceptable standard.
Achieving this is impossible. When we inevitably mess up, either an identity crisis ensues, or we try to cover up our mistake because we couldn’t bare the thought of being one of “those nurses” who does something wrong. Nurses hide their mistakes out of fear of discipline and facing that realization that they are not the perfect nurse they thought they were.
It’s a pretty tough place to be, especially if you’ve made it a while without a mistake or if you’ve been hard on someone else who has.
Not only do patients suffer from mistakes themselves, but also from not reporting them. Processes can’t be perfected. Others may make the same mistakes but because no one is talking about it, the people in a position to address it are completely unaware.
A perfect track record does not mean someone is a successful nurse, much like growing in age does not mean someone has matured.
Honest nurse > “Perfect” nurse
You are not your mistakes. Mistakes are a byproduct of the learning process and being human. What matters more than the mistake itself is how you handle in the moment and how you view yourself going forward. Will you allow it to empower you to become better, or will it cripple you and break you down?
The beautiful thing is that we get to choose our response. We can say no to the negative thoughts that come up, allow the waves of emotions in the moment to calm, and intentionally choose how this situation will shape our character. We just need to own the narrative.
All the best,
Shared From Kati Fleber’s Blog FreshRN.com
Whether you are in Washington, Alaska, Vermont or North Dakota you are bound to encounter snow this winter. If you are coming from a warmer state that doesn’t experience snow, you may not be prepared. We have put together a small list of things you can do to help make your assignment in winter wonderland a little bit easier.
#1. Start your car before you leave
While you are getting ready, run out and start your car. Turn the defrost and heat on. This will help ensure you aren’t late to work. If you must scrape snow and ice off your windows, you could become late. Turning the defrost on early should help eliminate or greatly reduce that problem. Not only will you have clean windows, you will have a warm car to get into on the way to work. You don’t have to leave it running all morning, but 5-10 minutes before you leave will greatly help.
#2. Keep a spare pair of boots in your vehicle
If you are going to work, chances are you are wearing your work shoes. It is always a good idea to keep a spare pair of winter/rubber boots in your vehicle in case you may need them. You may need them walking from the parking lot into your building or if you were to get stuck somewhere. It never hurts to be over prepared!
#3 Don’t forget your winterwear
If you are coming from a state that doesn’t get cold very often it may be hard to find winterwear to pack. (Winterwear would be gloves, hats, jackets, etc.) If you are in that situation, you can order online or buy when you get to your destination. If you are able to shop before you leave, don’t forget to pack them!
There are many ways you can prepare for your winter assignment. We hope these tips will help make your assignment a little bit easier and don’t forget to enjoy your time in your new destination!