Mobility question from new covid nurse

[ClaraRedheart, BSN, RN]

Our unit was the last safe space from covid at my hospital. We’ve run out of space, so we’re getting them in non-negative pressure rooms. We also have patients in the hallways. 

Anyways, I’m a new covid nurse just now learning the markers (d-diner, Crp, Ferratin). And still learning how to treat these patients. Being med surg, we mobilize aggressively. This doesn’t seem to work with covid patients. I had a covid patient that seemed fine in the bed and complained that he hadn’t been out since Christmas Eve and I was happy to help him get up. His O2 went down to 85% and hung out there while he was up. I insisted that he go back to bed. I would have liked to increase the O2 just for the task so he could get a shower, but I’ve heard it can be bad to do that. I didn’t, I’m glad. A doctor the next day said that the goal with covid patients is to decrease the need for oxygen even if if means limiting mobility. So, chair is acceptable but no mobility if o2 sats decline on what is required at rest. Is this consistent with what you all are seeing?

[Corey Narry, MSN, RN, NP]

I think there are a lot of moving parts with COVID-19 management right now. I personally feel that the nursing management is pretty similar to any other types of viral pneumonia where a patient is admitted if they have an oxygen requirement.  I think we should allow patients to mobilize in their room and even take showers if their strength can tolerate but also balance that with the risk of desaturation and how long it takes for the individual to recover their sats.  There is a high degree of thrombogenicity in this population so I feel like mobility is important.  We also can't predict who develops ARDS and require high flow or intubation.

[herring_RN, ASN, BSN]

I posted this elsewhere in April. I gave a copy of the entire article to our primary physician. He said ER docs have it posted.

The Infection That’s Silently Killing Coronavirus Patients

April 20, 2020: This is what I learned during 10 days of treating Covid pneumonia at Bellevue Hospital. By Richard Levitan, an emergency doctor.

…    Covid pneumonia initially causes a form of oxygen deprivation we call “silent hypoxia” — “silent” because of its insidious, hard-to-detect nature.

Pneumonia is an infection of the lungs in which the air sacs fill with fluid or pus. Normally, patients develop chest discomfort, pain with breathing and other breathing problems. But when Covid pneumonia first strikes, patients don’t feel short of breath, even as their oxygen levels fall. And by the time they do, they have alarmingly low oxygen levels and moderate-to-severe pneumonia (as seen on chest X-rays). Normal oxygen saturation for most persons at sea level is 94 to 100 percent; Covid pneumonia patients I saw had oxygen saturations as low as 50 percent.

To my amazement, most patients I saw said they had been sick for a week or so with fever, cough, upset stomach and fatigue, but they only became short of breath the day they came to the hospital. Their pneumonia had clearly been going on for days, but by the time they felt they had to go to the hospital, they were often already in critical condition.

In emergency departments we insert breathing tubes in critically ill patients for a variety of reasons. In my 30 years of practice, however, most patients requiring emergency intubation are in shock, have altered mental status or are grunting to breathe. Patients requiring intubation because of acute hypoxia are often unconscious or using every muscle they can to take a breath. They are in extreme duress. Covid pneumonia cases are very different.

A vast majority of Covid pneumonia patients I met had remarkably low oxygen saturations at triage — seemingly incompatible with life — but they were using their cellphones as we put them on monitors. Although breathing fast, they had relatively minimal apparent distress, despite dangerously low oxygen levels and terrible pneumonia on chest X-rays.

We are only just beginning to understand why this is so. The coronavirus attacks lung cells that make surfactant. This substance helps the air sacs in the lungs stay open between breaths and is critical to normal lung function. As the inflammation from Covid pneumonia starts, it causes the air sacs to collapse, and oxygen levels fall. Yet the lungs initially remain “compliant,” not yet stiff or heavy with fluid. This means patients can still expel carbon dioxide — and without a buildup of carbon dioxide, patients do not feel short of breath...

https://www.nytimes.com/2020/04/20/opinion/Sunday/coronavirus-testing-pneumonia.html

[T-Bird78]

13 hours ago, herring_RN said:

I posted this elsewhere in April. I gave a copy of the entire article to our primary physician. He said ER docs have it posted.

The Infection That’s Silently Killing Coronavirus Patients

April 20, 2020: This is what I learned during 10 days of treating Covid pneumonia at Bellevue Hospital. By Richard Levitan, an emergency doctor.

…    Covid pneumonia initially causes a form of oxygen deprivation we call “silent hypoxia” — “silent” because of its insidious, hard-to-detect nature.

Pneumonia is an infection of the lungs in which the air sacs fill with fluid or pus. Normally, patients develop chest discomfort, pain with breathing and other breathing problems. But when Covid pneumonia first strikes, patients don’t feel short of breath, even as their oxygen levels fall. And by the time they do, they have alarmingly low oxygen levels and moderate-to-severe pneumonia (as seen on chest X-rays). Normal oxygen saturation for most persons at sea level is 94 to 100 percent; Covid pneumonia patients I saw had oxygen saturations as low as 50 percent.

To my amazement, most patients I saw said they had been sick for a week or so with fever, cough, upset stomach and fatigue, but they only became short of breath the day they came to the hospital. Their pneumonia had clearly been going on for days, but by the time they felt they had to go to the hospital, they were often already in critical condition.

In emergency departments we insert breathing tubes in critically ill patients for a variety of reasons. In my 30 years of practice, however, most patients requiring emergency intubation are in shock, have altered mental status or are grunting to breathe. Patients requiring intubation because of acute hypoxia are often unconscious or using every muscle they can to take a breath. They are in extreme duress. Covid pneumonia cases are very different.

A vast majority of Covid pneumonia patients I met had remarkably low oxygen saturations at triage — seemingly incompatible with life — but they were using their cellphones as we put them on monitors. Although breathing fast, they had relatively minimal apparent distress, despite dangerously low oxygen levels and terrible pneumonia on chest X-rays.

We are only just beginning to understand why this is so. The coronavirus attacks lung cells that make surfactant. This substance helps the air sacs in the lungs stay open between breaths and is critical to normal lung function. As the inflammation from Covid pneumonia starts, it causes the air sacs to collapse, and oxygen levels fall. Yet the lungs initially remain “compliant,” not yet stiff or heavy with fluid. This means patients can still expel carbon dioxide — and without a buildup of carbon dioxide, patients do not feel short of breath...

https://www.nytimes.com/2020/04/20/opinion/Sunday/coronavirus-testing-pneumonia.html

Herring, that is exactly what happened with my uncle. He’d had a “bad cold” and fever for a week, then was taken to u/c and sent straight to the hospital. His O2 was 74. 9 days later he was gone. 

[herring_RN, ASN, BSN]

6 hours ago, T-Bird78 said:

Herring, that is exactly what happened with my uncle. He’d had a “bad cold” and fever for a week, then was taken to u/c and sent straight to the hospital. His O2 was 74. 9 days later he was gone. 

I am so sorry. 

Last April when I read it I bought pulse oximeters for family members and sent them with a copy. I paid $19.99 each. Recently sent one to a nephew, who is a paramedic, and tested positive for the virus. He is feeling "Almost well" and so far reassured that his O2 sat is 96% or better as he quarantines at home.