NP's how are you these days?

Specialties NP

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Just checking in to see how everyone is doing in the NP world amidst this COVID19 pandemic. We in Acute/Critical Care for sure are on high alert...mandated work hours if a surge happens. We've had patients with the disease of course but not to the point of shortages of supplies, equipment or healthcare worker fatigue. The daily emails and updates can be overwhelming though. I'm sure those in primary care are inundated with requests for testing.

Specializes in ICU, LTACH, Internal Medicine.

Acute care/hospital:

- ER is somewhat calmer. People seem to finally get that it is not the best time to go there for bumped toes and back pains x10 years. But quite possibly it is calm before the storm surge. That's what we're getting ready for mentally. Currently, the hospital is eerily quiet and empty

- for a while, till testing guidelines were straightened and enforced, there was surge of frequent fliers with the same story instead of tried and true "chest pain" and "shortness of breath": one dude I am really close with just came back from cruise/Cali/Ore and now coughs as mad and sick as a dog... (counting that for approximately 48 h they could count for a bed, sum'witch and maybe some pain pills. Then test turnover became quicker and testing guidelines stricter)

- TREMENDOUS pressure from floor nurses to test everyone. For a reason or without. Literally, for one time cough or sneeze.

- we have all necessary PPE so far. Asked not to discard N95s. Fitted for alternative models of them.

- everybody is on high alert. Daily emails and updates from "command center" are overwhelming at times

- there are conscious and palpable efforts to disperse providers from places they are used to gather, to train nurses, to keep people informed. Everybody is "screened" before coming to work (I.e. made read screening questions and say "no"). There are talks about termometry starting soon.

- lisinopril is not first choice for HTN anymore. Solumedrol for "shortness of breath" of any possible cause and 2000 cc bolus "for hydration" in ER are likewise no more ordered automatically even by ER veterans.

- patients finally can use standard albuterol inhalers, as RRTs needed in ICU and neb machines make aerosol.

- elective surgeries are stopped, but pretty much only elective ortho and plastics are considered as such. Cancer, elective AAAs, CEAs, hearts, etc. are all go on as scheduled

- no visitors for a while unless "extenuous circumstances" and kids (max 2 at a time). Guilty, very guilty... pleasure. More parking spots. Less lines in cafeteria. No calls about family very concerned about something very minor and requesting to "see someone right now".

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Specializes in Psych/Mental Health.
19 minutes ago, KatieMI said:

- lisinopril is not first choice for HTN any more

? Do they have more than association and/or theoretical evidence for this? There could be serious implications if there's a link because so many people (including me) are on an ACEI or ARB. I was wondering why HTN is one of the risk factors, but it makes sense to me now.

I haven't heard from my doc about this at all...wondering if I should ask and switch med.

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Specializes in ICU, LTACH, Internal Medicine.
9 minutes ago, umbdude said:

? Do they have more than causal and/or theoretical evidence for this? There could be serious implications if there's a link because so many people (including me) are on an ACEI or ARB. I was wondering why HTN is one of the risk factors, but it makes sense to me now.

I haven't heard from my doc about this at all...wondering if I should ask and switch med.

https://www.acc.org/latest-in-cardiology/articles/2020/03/17/08/59/hfsa-acc-aha-statement-addresses-concerns-re-using-raas-antagonists-in-covid-19

Evidence so far is more theoretical but it says "do not add or stop any RAAS - related treatments"

In other words, if you are on them/your patient is on them, keep on unless otherwise contraindicated. If you want to start them AND have other choice, go for that other choice first.

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Specializes in Psych/Mental Health.
4 minutes ago, KatieMI said:

https://www.acc.org/latest-in-cardiology/articles/2020/03/17/08/59/hfsa-acc-aha-statement-addresses-concerns-re-using-raas-antagonists-in-covid-19

Evidence so far is more theoretical but it says "do not add or stop any RAAS - related treatments"

In other words, if you are on them, stay on them unless otherwise contraindicated. If you want to start them AND have other choice, go for that other choice first.

Thanks. It's good to know...still it's a bit anxiety provoking.

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Specializes in ICU, LTACH, Internal Medicine.
Just now, umbdude said:

Thanks. It's good to know...still it's a bit anxiety provoking.

Is there anything around nowadays that doesn't provoke anxiety? Just wondering ?

Healthy anxiety coping skills can be no less valuable than "social distansing" in the process of living through this epidemy. I found myself compulsively re-reading "Decameron" for two weeks, especially the first chapter ?

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Specializes in Cardiology, Research, Family Practice.

primary care here - not sure about my colleagues, but I, too, am not initiating prescriptions for ACE's. Still giving ARBs as I haven't seen them specifically called out in the literature, and besides there's no lung conversion (same reason they don't cause cough, right?). Also, giving far fewer corticosteroids.

Did my first telemedicine visit on Friday for med refills. Suspect this will become the new norm. Not sure I like it.

Oh yeah, still re-using the same surgical mask which I had to provide for myself.

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Specializes in Psych/Mental Health.
3 minutes ago, GoodNP said:

Oh yeah, still re-using the same surgical mask which I had to provide for myself.

oh goodness...?

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Specializes in ACNP-BC, Adult Critical Care, Cardiology.

Has anyone used any of the investigational treatments? we have started Remdesivir for compassionate use but it took days for the drug to reach us after the request was made (even if Gilead, the manufacturer was located just south of us).

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Specializes in Psychiatric and Mental Health NP (PMHNP).
1 hour ago, umbdude said:

? Do they have more than association and/or theoretical evidence for this? There could be serious implications if there's a link because so many people (including me) are on an ACEI or ARB. I was wondering why HTN is one of the risk factors, but it makes sense to me now.

I haven't heard from my doc about this at all...wondering if I should ask and switch med.

Cough is a known side effect of lisinopril.

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Specializes in ICU, LTACH, Internal Medicine.
13 minutes ago, juan de la cruz said:

Has anyone used any of the investigational treatments? we have started Remdesivir for compassionate use but it took days for the drug to reach us after the request was made (even if Gilead, the manufacturer was located just south of us).

Powers that are think about remdesivir and chloroquine, with or without azithromycin (the latter one being used anyway for ICU patients with COVID19). Unfortunately, things still need to go through some protocols before getting started and this takes few weeks.

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1 hour ago, juan de la cruz said:

Has anyone used any of the investigational treatments? we have started Remdesivir for compassionate use but it took days for the drug to reach us after the request was made (even if Gilead, the manufacturer was located just south of us).

We are using Remdesivir in trial. Most of our other patients are getting Hydroxychloroquine (dosing 400 mg PO 12h x 2 doses, then 200 mg PO q12h x 5-10 days (tablets can be crushed & dispersed in water; preferred to remove film coat w/ alcohol before crushing)

We are usually adding Azithromycin to Hydroxychloroquine. Watch the QTc on these. Kaletra is an option but I haven't seen anyone getting it, especially with the negative trial.

ID is seeing all these patients. Everyone understands these are all theoretical. The Chinese recommendations should be released this week which will be interesting.

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I am a newly graduated FNP who is still working in the ED as an RN while trying to find a job. No one has time to train a new graduate and I still have to eat, so it is the front lines here with a surgical mask, eye shield and the n-95 in a paper bag we keep with us if we are swabbing a suspected COVID patient. I came to allnurses to feel some camaraderie during this time of craziness and stress as my fellow RNs do not understand why I am still working the ED with the lack of PPE and have the option to go be a FNP not understanding that it is not that simple. I can at least now tell them the primary care side is in the same boat with lack of PPE.

Stay safe everyone! Hope to be on your side of the grass someday soon!

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