Working on Covid Units - Tips, Tricks, Advice, Encouragement

[violet87, BSN, RN]

Hey everyone, just thought I'd make an educational thread about how everyone is handling taking care of their covid patients in the hospital for some shared knowledge.

What are some tips you have on getting and staying as ahead of the game as possible? And for staying prepared when anything can happen and your patient ratio is practically impossible?

Any tips on keeping your patients saturation up?

For me, I collect and give all meds with my first assessment. I also place the next up oxygen level in the patients room if possible (unless next is intubation ofcourse). Not groundbreaking. Anyone have any other tips on preparedness and time management?

When my patients are desatting, I've found laying anyone and everyone on their belly to be helpful. I haven't found chest PT very helpful though. How about you? Anything else you try?

What kind of focused assessments are you doing? I've found it helpful adding a rating system for shortness of breath, and asking them to rate every time I'm in the room. Any other things you're assessing that you don't normally do with your usual patient population?

Also, what treatments are your hospitals using?

Mine is giving remdesivir, and I've been giving a lot of Q4 albuterol asthma inhalers. I'm unsure if either is working because I'll only have a patient once and never see them again due to rotations, but we do have only a few ICU acuity out of 70 covid patients so it may be working, although I'm not sure if that's why. 

Any other advice or words of encouragement? 

These are definitely tough times, hitting us yet again, and too soon. We were hit hard in March with almost 200 covid at our peak, but most were ICU acuity. I'm use to either a max of 3 burn patients or a max of 3 ICU patients (during crisis), and now I'm being thrown into med-surg and step down with 6 and up to potentially 8 sick patients at a time. We're all being faced with coming out of our comfort zones so any and every word of advice or different perspective is appreciated.

Thank you all in advance and good luck out there!

[NurseLy, BSN, RN]

Proning patients as you said. A lot of studies show this is really helpful in increasing oxygenation and preventing people from progressing to needing more oxygen. So even a patient on only 3-4L still benefits from proning. Patients who can not tolerate proning benefit from hard side lying positions too.

Our patients are getting convalescent plasma, remdesivir, and decadron. The antibodies in the plasma from people who have recovered from covid seems to help the most. 

We monitor lab trends— ferritin, crp, d dimer. When the ferritin and crp and trending up patients are often getting sicker. The d dimer we watch because these patients have been developing PEs and DVTs. We repeat the chest CTA if continue to be unable to wean oxygen to ensure no PE. 

Patients with high respiratory rate, use of accessory muscles, etc (even with SpO2 > 90, check an ABG. These patients often need HFNC for the pressure, helps decrease the work of breathing. 
 

Have a non rebreather stocked in every room. Put it on in addition to whatever oxygen they are on if acute desaturations. Sometimes this is needed with any exertion if they can’t tolerate it. We also will pre oxygenate with NRB if a person has been desating with exertion. 

The term “happy hypoxic” ... some of these patients desat with absolutely no signs or symptoms. Keeping them on continuous pulse ox monitoring. 

And just learning the signs of a patient going bad. It seems when they tank they tank quickly. When someone progresses from room air to 10L in just a few hours they are likely one who will end up needing HFNC quickly.