COVID-19 is associated with a plethora of complications for those who suffer from both mild and severe forms of the disease. Although research is ongoing, it’s known that those who suffer from COVID-19 require interventions that target the respiratory, cardiovascular, neurological system, and renal systems.

Below is information designed to help nurses working in the outpatient and home health settings develop care plans that meet the needs of patients suffering from mild to moderate symptoms of COVID-19. An effective care plan may help reduce mortality.

Respiratory

COVID-19 particularly affects the respiratory system. Complications include chronic cough, fibrotic lung disease, bronchiectasis, and pulmonary vascular diseases. This mirrors other coronavirus diseases such as SARS and MERS, which both also cause long-term lung damage. A nurse who is planning care for a patient with COVID-19 should focus on the respiratory system as the primary body system of concern. Interventions include:

• incentive spirometry
• teaching breathing techniques
• moisture and heat to increasing respiratory secretions
• oral hygiene for the prevention of thrush
• teaching oxygen safety and management for patients on oxygen
• teaching patients how to monitor their oxygen saturation levels
• teaching related to emergency procedures for increases in shortness of breath and chest pain.

Cardiovascular

Patients who suffer from COVID-19 disease often develop clotting disorders that can lead to myocardial or neurological injury. Patients also are at risk for venous thromboembolism after a long hospital stay during which they are quarantined in their rooms. In the outpatient setting, the following interventions can help prevent cardiovascular complications:

• encouraging mobility
• involving physical and occupational therapists, as indicated
• using compression stockings or a compression device until the patient returns to normal activity level.
• teaching related to emergency management for severe leg pain and chest pain
• teaching signs and symptoms of stroke and the importance of early intervention
• monitoring for neurological symptoms.

Renal

Renal complications are attributed to decreased hydration and nutrition. One of the most commonly reported symptoms of COVID-19 is lack of taste and smell. This places patients at risk for renal complications if their intake is not sufficient. Nursing interventions include:

• teaching the importance of eating and drinking sufficient fluids
• teaching caregivers and patients to monitor intake and output
• teaching caregivers and patients when to call their primary care provider when their intake is not sufficient.

Although COVID-19 is a new disease, emerging literature suggests the importance of preventative nursing interventions in managing mild and moderate forms of the disease. Nurses who are tasked with caring for patients in outpatient settings can use the information outlined here as a guide to plan care, thereby helping to reduce the risk of complications and mortality.

Bridget Seelinger is an RN from Atlanta, Georgia. She is a PhD student at East Tennessee State University.

References

Katz JM, Libman RB, Wang JJ, et al. Cerebrovascular complications of COVID-19. Stroke. 2020;51(9):e227-e231.

Kunutsor SK, Laukkanen JA. Renal complications in COVID-19: A systematic review and meta-analysis. Ann Med. 2020;52(7):345-53.

Long B, Brady WJ, Koyfman A, Gottlieb M. Cardiovascular complications in COVID-19. Am J Emerg Med. 2020;38(7):1504-07.

Terpos E, Ntanasis‐Stathopoulos I, Elalamy I, et al. Hematological findings and complications of COVID‐19. Am J Hematol. 2020;95(7):834-47.