486
Unit V Promoting Health in Patients With Oxygenation Disorders
Susceptible individual
Droplet nuclei
Airborne
Infected individual
Droplets
Droplets
Direct contact
Indirect contact
FIGURE 24.2 Transmission of COVID-19.
community and hospitalized patients with goals of early recognition of COVID-19 infection and mitigating viral exposure and spread. When there is significant community spread , all new respiratory symptoms should be treated as COVID-19. Inquiry about close contact with sick indi- viduals or recent travel to known “hot spots” should be part of the initial interview. Treatment for other possible etiologies should not be delayed, but isolation precautions should be initiated immediately due to high level of infec- tiousness. Since a significant percentage of cases remain mild, the burden on healthcare systems can be avoided. Initial guidance consists of the following: l Maintaining high index of suspicion for COVID-19 infection in those presenting with respiratory symptoms. l Identifying close contact with known or suspected case of COVID-19. l Awareness of current “hot spots” for infection. l Timely COVID-19 testing and workup to confirm COVID positivity consisting of a comprehensive phys- ical examination, careful history taking, chest imaging, and laboratory testing. l Additionally, suspected and/or confirmed cases of COVID-19 should be managed by a continuum of care program that includes patient self-assessment tools, telephone triage, risk stratification, in-person outreach if necessary, and quarantine. Individuals who are exhibiting mild upper respiratory symptoms or who have a positive COVID-19 test should quarantine (self-isolate) for 5 days, maintain physical distance from others in the home environment, wear a well-fitting mask or double-layered face covering (if dis- tancing from others is not possible), practice good hand washing, frequently clean shared surfaces, and avoid travel. Self-isolation may be discontinued after the 5-day period
Table 24.5 Classification of COVID-19 Disease
Asymptomatic
COVID nucleic acid test positive No clinical signs/symptoms if illness Normal chest imaging Signs/symptoms of acute upper res- piratory illness (fever, myalgias, cough, rhinorrhea, sneezing, sore throat) and/or gastrointestinal symptoms (nausea, vomit- ing, diarrhea) Pneumonia symptoms (fever, chest congestion, cough, tachypnea, dyspnea, fatigue) No oxygen requirement (SpO 2 ≥ 94% on room air) Abnormal chest imaging (<50% infiltrates) Pneumonia with evidence of hypoxemia (SpO 2 <92% on room air, respiratory rate >30 breaths per minute, PaO 2 /FiO 2 <300 mm/Hg) New or escalating oxygen requirement Chest imaging with >50% infiltrates Acute respiratory distress syndrome (ARDS) Shock state (septic shock that may rep- resent virus-induced distributive shock, cardiac dysfunction, an exaggerated inflammatory response, and/or exacerba- tion of underlying comorbidities). Cardiac, hepatic, renal, central nervous system, or thrombotic disease.
Mild
Moderate
Severe
Critical
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