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Diabetic RN with HTN working in the ER with Covid Patients

TT IS TT IS (New) New

As more data and studies come out on Covid-19 and those with underlying health issue emerge, is it wise for Healthcare workers who have pre-existing comorbidites to be taking care of Covid positive patients?

For example, a new RN hire in the ER I work at will be starting this upcoming week. I had a chance to orient him and he asked me about his thoughts on Healthcare workers with underlying conditions and caring for Covid patients. He told me he is a diabetic and also has HTN. I'm sure there are many other Healthcare workers with such conditions and are also caring for Covid patients

Is it wise that this new hire should resign, especially with the "twindemic" quickly approaching? He already accepted the position and signed all the HR paper work. I also figure if he were to resign during the first week of employment, that may also put him at risk for not being not eligible for rehire in the future.

Thoughts?

speedynurse, ADN, RN, EMT-P

Specializes in ER, Pre-Op, PACU.

There are plenty of us as nurses that have co-morbidities that place us at higher risk when working with covid patients. However, everyone has to make their choices in this field. I am one that can’t afford to go without a job. If there are others that are financially stable, then choosing to work in a different environment may be feasible.

Jedrnurse, BSN, RN

Specializes in school nurse.

With the different presentations (and non presentations) of coronavirus is there really any medical setting where a nurse could escape the possibility of exposure ? At least in the ED it's front-and-center in people's minds and hopefully precautions are at their best, which they might not be in other settings.

Is HTN in and of itself a predictor for a worse outcome? If so, does anyone know the patho behind it?

25 minutes ago, Jedrnurse said:

With the different presentations (and non presentations) of coronavirus is there really any medical setting where a nurse could escape the possibility of exposure ? At least in the ED it's front-and-center in people's minds and hopefully precautions are at their best, which they might not be in other settings.

Is HTN in and of itself a predictor for a worse outcome? If so, does anyone know the patho behind it?

True, I mean there are some settings that covid exposure is very minimal. For example, our GI Lab and our Outpatient Operating Room facility require all patients to get a covid test prior to the day of surgery. Any patient with a positive test are not brought in to the facility, they are contacted via phone and then rescheduled.

There's a few theories that point to HTN causing a higher affinity for Covid to bind to the ACE-2 receptor sites as well as higher ACE-2 expression. Other studies found that those with HTN have a hightened inflammatory response with covid compared to patients without HTN. One study found this (link at the end).

"patients with hypertension had significantly higher neutrophil counts, neutrophil-lymphocyte, alanine transaminase, creatinine and fibrinogen than those without hypertension. In addition, the activated partial prothrombin time in hypertensive patients is significantly lower than that in nonhypertensive patients. This data suggested that COVID-19 patients with hypertension tended to show more severe inflammation and organ damage than COVID-19 patients without hypertension, which may lead to a poor prognosis"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261650/

Edited by TT IS

I think a big part of this is not just his diagnoses, but how healthy he is overall. It is possible for one person who has both of these conditions to fare much better than another depending on other factors.

Ideally he is working on all of the controllable factors with an exercise plan, as sustainable diet, etc...

Plenty of nurses have risk factors. He is a nurse, what is his understanding of his health and his risks?

NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion.

With this pandemic, it's a false sense of security that preop patients testing negative means no disease. Asymptomatic spread -- could be exposed day of or day after testing negative and come up symptomatic or positive day after surgery, thus staff already exposed.

I was working 5yrs Resp./Telemetry unit at onset AIDS epidemic trached/vented patients--rarely got sick. Asked to work on Renal/dialysis floor for 3 months due to resignations -- got sick 3 weeks later --out a whole week due to URI/GI infection -- sickest ever been.

AS RN, germs are around us. HAND hygiene and masking crucial for its the unknown infection that usually affects us.

I know someone already said this but: High levels of community spread mean that every interaction is a potentially Covid+ one. If you have chronic medical conditions, see if you can find a job as a triage nurse that you can do from your home. Otherwise you will be exposed. Either from patients or from your coworkers.

I work in an FQHC and officially, nobody under suspicion is allowed in the building. But many, many of our staff have been ill with Covid. People who aren't working at all, but do grocery shop or put gas in their cars, are also at risk. So, no: In summation, ladies and gentlemen of the jury, I absolutely do not agree that people with risk factors shouldn't be working with Covid patients.

JVBT, ASN

Specializes in clinic nurse.

On 8/22/2020 at 1:46 PM, Jedrnurse said:

With the different presentations (and non presentations) of coronavirus is there really any medical setting where a nurse could escape the possibility of exposure ? At least in the ED it's front-and-center in people's minds and hopefully precautions are at their best, which they might not be in other settings.

Is HTN in and of itself a predictor for a worse outcome? If so, does anyone know the patho behind it?

Your point is spot on. Corona is everywhere, not just the hospitals. Everyone, not just HCWs, need to be wearing masks to their workplaces. This is not unique for HCWs. We all are dealing with coronavirus now.

From what I've heard, but by no means know with certainty, is that there is a strong association between HTN and pulmonary htn thereby leading to more severe complications should one become very sick. (There's much more to it than the weak way I am putting it, here, but I lack the knowledge to state it more clearly - apologies.)

I do not think one ought to exempt oneself from working in medsurg, the ED, the ICU due to diabetes or HTN, but to try to make sure those conditions are very well-managed and to try to limit stress as best one can when outside the work setting. I would say that such workers are almost pivotal in the future (and present) task of educating patients on the association between chronic diseases and Covid-19.

brandy1017, ASN, RN

Specializes in Critical Care.

I imagine the new hire was aware of the fact that he will be taking care of possible Corona patients and is OK with that.  The truth is we are all at risk.  Both at home, but esp in healthcare settings as we are standing close to patients to give them meds, assess them, turn, clean, and tend to wounds etc.

Not everyone is tested and there are also false negatives.  So even if a nurse was not directly working with Covid patients, there is still some risk, both from the patients and fellow coworkers.  Not to mention as others have said home, family, store,  and church for example.

At least now I think nurses are finally getting the TB masks and protection they didn't have in the beginning.  Also we know a little bit more about it and how to treat it and that plasma tx and remdesivir seem to help.

We each have to make our own personal choices re working in this pandemic.  He appears at peace with his choice to work in the ER.

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