Bing-Rui WEI, Dian Francis SAVELLANO,Cui-Huan HU

School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

ABSTRCT

To date, there are no known specific antiviral medicines recommended for coronavirus disease 2019 (COVID-19). The treatment mainly focuses on the improvement of the immunity of the individual and the application of palliative treatment. A case of a patient diagnosed with mild COVID-19 and then later developed common COVID-19 which was treated and closely monitored at home will be presented.The patient was advised for self-quarantine with several prescribed medications.Nursing home and self-care advice were given to the patient, including a change of lifestyle for the duration of the isolation, medication advice, symptomatic care, change of diet, how to monitor the progress of the disease, psychological care, and follow-up instructions. During the course of the nursing plan, the patient showed significant improvements, and normal life functions were restored. On February 05, 2020, novel coronavirus nucleic acid test showed negative after re-examination; the patient was cured. Therefore, providing adequate nursing plan for home-based self-care treatment can effectively cure mild and common cases of COVID-19.

Keywords: 2019 novel coronavirus, home-based nursing care, mild and common coronavirus disease 2019

INTRODUCTION

According to the World Health Organization, the first case of coronavirus disease 2019 (COVID-19) was reported from Wuhan, China, on December 31, 2019.[1]On January 11, 2020, 41 patients were diagnosed to be infected with novel coronavirus.[2]On January 20, 2020, the National Health Committee of the People’s Republic of China classified COVID-19 as a Class B infectious disease.Class A management of the disease was implemented to control the situation.[3]As of February 15, 2020, there are 50,580 globally confirmed cases with 1524 deaths counts from China.[4]As of this time, there is no known medicine or vaccine to prevent this virus, and the only way to alleviate the situation is through improving the immunity of the patient and palliative treatment.It is infectious, but it has a low mortality rate.At the onset of the disease, patients reported to experience chills, fever, pharyngitis, weakness, myalgia, difficulty in breathing, and dry cough.There are also a few patients that reported to have gastrointestinal problems such as nausea, vomiting, and diarrhea.Proper home-based nursing management can definitely help improve the condition of COVID-19 patients, and we should be able to expect a positive patient outcome.With adequate application of nursing management, we should be able to improve the immune system and slow down the progress of the virus and finally achieve the desired outcome.In this study, we analyzed the data of a patient who was diagnosed with mild COVID-19 at the onset of the disease.The patient had undergone home nursing care and self-care methods since from January 21, 2020, until she was diagnosed free from the disease on February 07, 2020.The objective of this study is to understand if home-based nursing care can be utilized for patients diagnosed with mild symptoms and to offer the public an option and improve recovery rates.

CASE REPORT

The patient is female, 46-year-old and married.She felt dyspnea for 3 days and got an onset of fever at 38.5°C on January 20, 2020, which lasted for 1 week.She took antipyretic medication at home and dropped down successfully.After then, she came to the hospital and was given drugs and advised to isolate in the room.The doctor prescribed medicine for antivirus and anti-infection.Moxifloxacin hydrochloride tablets are for general bacterial infection; abidol tablets are for antivirus infection; indication of Eucalyptus Lemongrass Enteric Softgels is a mucolytic expectorant; and Oseltamivir Phosphate Softgels are effective in treating influenza A.Through the telephone, WeChat and other network media, the patient’s home care is remotely guided.On February 07, 2020, the patient was re-examined for novel coronavirus nucleic acid test, and the result showed negative, and the symptoms have improved significantly.

During the isolation, the computed tomography (CT) scans of the lungs were closely monitored.The summary reports of serial CT scans of the patient are shown in Figure 1.

Figure 1: Computed tomography scans of the chest of the patient

NURSING CARE

General nursing (daily life)

Rest

The patient was advised to have complete bed rest with bathroom privileges.Sufficient sleep and rest promote faster recovery.Reduced activity will promote further healing of the damaged tissues.With minimal movement, it will promote blood circulation that can supply oxygen to the affected areas, thus avoiding the development of ulcer.The environment is also kept quiet to promote the rest and comfort.[5]

Isolation

To prevent cross infection, the patient was prohibited to go to crowded places, strict isolation alone at home in a single bedroom to prevent the transmission of the virus to family members.

All visitations were halted and if not, minimized, to prevent further spread of the disease to others.The patient was advised to keep a distance of at least 1 m and to wear a mask when talking.The mask and the distance are important since the virus can be airborne and can be transmitted through the droplets.

The patient eats alone and was instructed to use disposable tableware.If the patient needs to use reusable wares, we advised that the utensils must be disinfected using boiling water for at least 15 min.

Disinfection

When cleaning furniture, objects were wiped using 75% alcohol or chlorine-based disinfectants; afterward, the surface is wiped with clean water.The room is also sterilized using ultraviolet light for at least once a day to disinfect the air and the room.The patient’s clothing are washed separately to avoid further transmission through droplets such as sweat, urine, and other human fluid wastes.

Hygiene

When moving around the isolated room, the patient is advised to wear a mask and she needs to wash her face; we advised her to use running water.When she needs to clean her nasal cavity, cotton swabs were advised.Cotton swabs promote the sterile technique.[5]

Normal saline is also recommended when rinsing the oral cavity.This can relieve the pain experienced at the pharynx area and promotes the constriction of the blood vessels to reduce the chances of the virus to spread out through the blood vessels.

Frequently washing hands with soap and water for at least 20 s is advised to prevent contact transmission.The specific correct operation is like this: soak hands under running water and take an appropriate amount of hand sanitizer or soap and apply it evenly to the entire palm, back of the hand, and fingers.Then, rub hands carefully for at least 20 s, from palms, dorsal and palmar fingers, to the back of fingers, thumb, fingertip, and wrist.Finally, wash your hands thoroughly under running water and dry hands with clean paper towel not clothes.In addition, hot baths are promoted to promote blood circulation.We advised the patient to wear something comfortable and breathable to promote comfort.

Environment

The patient’s room was kept clean and tidy, the warmer was turned on for a while to keep the room warm, but the central air-conditioning system was not suggested, for this will only promote the spread of the disease.With a temperature of 25°C and humidity of 50%-60%, the patient felt comfortable.Windows were open for 1-2 h to promote the ventilation and fresh air.However, if the direction of the air changes toward the room, the windows should be closed.[5]

Medication nursing

To date, there are no specific medicines or vaccines for the COVID-19.Moxifloxacin hydrochloride tablets (1 tablet/day), abidol tablets (2 tablets, 3 times/day), cherokee (1 tablet, 3 times/day), bicyclic alcohol tablets (1 tablet, 3 times/day), and Oseltamivir Phosphate softgels (1 tablet, 2 times/day) are taken orally.These medicines slow the erosion of the human body by the virus.

Five million IU of interferon-α was added to 2 mL normal saline was given twice a day through nebulization.Interferon-α is a potent drug that can combat viral infection.

Lianhua Qingwen granules, a traditional Chinese medicine drug, were also prescribed, 3 times/day, 1 bag per serving, taken like tea.This can relieve the symptoms of fever, colds, muscle soreness, nasal obstruction and runny nose, cough, headache, dry throat, and sore throat.According to the People’s Daily, for common patients, the medical team of Shandong adopted a method of the diagnosis and treatment of combining traditional Chinese medicine and Western medicine, achieving very significant results in early intervention of the disease.[6]

The patient was also informed the side effects of the said medicines.She was told to watch out gastrointestinal discomfort and signs of allergic reactions.

Symptomatic nursing care

Nursing for fever

Tepid sponge bath and cooling gel sheets were applied when the patient experience fever.If the temperature is high, antipyretic drugs (Ibuprofen) are given as per the doctor’s advice.Dehydration due to fever is also watched out; fluid intake is increased at the occurrence of fever.

Nursing for cough and sore throat

Compound methanamin capsules (Asmei) were taken according to the doctor’s advice to relieve cough.The patient needs to drink plenty of water and keep warm to avoid catching colds and sore throat, rinse mouth with light saline or mouthwash, and take oral lozenges.

Nursing for diarrhea

As per doctor’s advice, Berberine supplemental tablets were administered orally if the patient experience diarrhea.To avoid dehydration, oral rehydration salt was given.Semi-liquid food with low-residue, low-fat, easy-to-digest, and low-cellulose liquid food was given to the patient, raw and cold food was avoided to reduce intestinal peristalsis.At the same time, the patient’s abdomen was kept warm by hot compress to relieve diarrhea accompanied by abdominal pain.Because of frequent defecation that can lead to impaired perianal skin, gentle wiping of the anus with a soft-tissue paper every time after defecation and cleaning the perianal area with warm water is suggested.

Nursing of colds

Although having a runny nose happens due to several environmental factors, it is still a good idea to take precautionary measures.Whenever the patient has colds, we advised the patient to use paper towels to wipe her nose and throw the used towel properly to avoid further transmission.We also advised the patient to clear her nasal cavity every time she went out to make sure that the airway is clear - promoting optimum oxygen levels required the body to function.Dryness of the nasal area cannot be avoided.Vaseline was offered to make sure that the said area is well hydrated.

Dietary guidance

The metabolism of patients with pneumonia is increased, and maintaining adequate nutrition is important to self-care and treatment.The patient was advised to increase fluid intake, a semi-liquid diet with high protein, high caloric diet with enough vitamins, and oily food was avoided.[7]Fresh food was simply cooked according to the patient’s own preferences to enhance the patient’s appetite.Appropriate addition of meat, poultry, soybeans, fish, nonstarch vegetables, and other food rich in ketone was performed to enhance the body’s immunity; hot soup was advised to relieve inflammation of the airway.Food rich in Vitamin C, such as vegetables and fruits, especially tomatoes, apples, and oranges were suggested to eat; Vitamin C tablets and zinc oral tablets are also suggested.

Monitoring one’s illness

Body temperature was measured four times a day.Difficulty in breathing and chest tightness, hypoxemia, characteristics of the sputum, and consciousness were paid attention to.The patient is observed and treated properly using home-based nursing care for 10 days.If the prognosis of the patient changes from common to a severe case, she must be transferred to the hospital for treatment.

Psychological nursing

Since novel coronavirus is a new strain of the virus, with no known cure, which makes the infected patients prone to anxiety.Drug interactions will also cause discomfort.Isolation also affected the social well-being of the individual for they are prohibited to participate in social gatherings and activities, which make isolated patients feel loneliness and deserted.

It is a fact that having a positive attitude in battling illness has a positive effect (fast recovery).The awareness of the progress of the research and development of the cure regarding the disease will give hope to the patient and lessen the anxiety and eliminate uncertainty, boosting the positive attitude of the patient.

In this case, the patient and her family are given psychological comfort by providing positive news about the research and development of the cure.The patient and the family were also given assurance that as long as they follow the protocols and the doctor’s advice, the patient’s isolation can be shortened.

Follow-up care

The patient is instructed to religiously follow the given doctor’s and the medical team’s advice.She is instructed that if there are any inconveniences that arise regarding her medications, if her condition worsens and does not improve, she must go to the hospital right away for further diagnosis.

DISCUSSION

Home-based nursing care is an effective way of treatment for mild-to-common cases of COVID-19.It is characterized by reducing the probability of cross infection and risk of disease progression, and ultimately, an alternative way to take care of patients diagnosed with mild and common cases of COVID-19.It is proven to be an effective method of treatment for COVID-19, with the advantages of a high recovery rate and fewer complications.In conclusion, home-based nursing care is of great way to deal with mild and common cases of COVID-19.

To date, the treatment of COVID-19 using home-based nursing care is only applied to patients who are diagnosed with mild and common pneumonia.There are only a few cases when this is applied; therefore, there is a lack of data.

The success of this treatment depends on the environment and the willingness of the patient to cooperate with minimal supervision.The general public must be made aware of the current situation: advances in research, understanding on how the disease is transmitted, and how it came to be.If the public will be able to comprehend this disease, chances of survival will be higher, transmission will be less, and in the near future, this kind of disease will not occur again.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms.In the form, the patient has given her consent for her images and other clinical information to be reported in the journal.The patient understands that her name and initial will not be published, and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.