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My Experience With COVID-19 – An NP’s Perspective, Part 2

My Experience With COVID-19 – An NP’s Perspective, Part 2

In my previous post, I wrote about becoming ill with COVID-19 and how the initial symptoms impacted me. In this post, I'll be discussing home care tips that I figured out with the help of my healthcare colleagues.

Currently, there are no strong recommendations for home care for patients with moderate COVID-19; however, these are the things I did and will recommend to my patients in similar cases. Some of these are common sense, others I figured out, and still others were suggested by friends and colleagues.

Home Care for Patients:

  • Instruct them to get a pulse oximeter. If their oxygen saturation is sustained below 93%, they need to go to the emergency department. Patients should record their saturations three or more times per day so they can see how they are progressing.
  • Have them check their temperature twice a day and record it.
  • For cough: Have them use guaifenesin (Mucinex DM) every 12 hours and use an incentive spirometer to keep their airways open. Codeine cough syrup can be used at night if cough is interfering with sleep.
  • You may prescribe a combined long-acting beta agonist (LABA)/inhaled corticosteroid (ICS) inhaler to reduce inflammation and keep their airway open.
  • For fever: Have them use acetaminophen (up to 3 g daily). Low grade fevers can persist for a while, possibly from a persistent inflammatory response.
  • Definitely have them drink a lot of fluid, especially if experiencing fever and/or diarrhea. Gatorade or Pedialyte are good options, or low sugar Gatorade if diabetic. You can also have them add protein shakes when able if they are unable to eat a regular diet.
  • Recommend that they get up out of bed and walk for a few minutes every couple of hours to help prevent blood clots. Depending on their medical history, a baby aspirin may be considered.
  • When sleeping, recommend that they sleep prone or on their side. Proning is common in inpatient care, although more study is needed for patients at home.
  • Have them take vitamins D, C, and zinc daily.
  • If experiencing cough, honey and vaporizers can help relieve discomfort.

Advise patients to seek medical help if they have trouble breathing, persistent chest pain, new confusion, inability to stay awake, and/or bluish lips.

For many patients with moderate COVID-19, and certainly for me, recovery is NOT linear. As I write this, it has been 30 days since I tested positive. I’m still coughing, fatigued, and working on improving my endurance. It has been an agonizingly slow process. Explain to your patients that they may start to feel better and then have a day when they feel worse. Because of the non-linear recovery, it is a good idea to consider evaluating progress week by week, rather than day by day.

References
  • Name JJ, et al. Zinc, vitamin D and vitamin C: Perspectives for COVID-19 with a focus on physical tissue barrier integrity. Front Nutr. 2020;7:606398.
  • National Institute for Health and Care Excellence. Clinical guide for the management of critical care for adults with COVID-19 during the coronavirus pandemic. www.nice.org.uk/Media/Default/About/COVID-19/Specialty-guides/Specialty-guide_Adult-critical-care.pdf. Accessed February 2, 2021.
  • Paul IM, et al. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents.Arch Pediatr Adolesc Med. 2007;161:1140-1146.
  • Rao SSC, et al. Oral rehydration for viral gastroenteritis in adults: A randomized, controlled trial of 3 solutions. JPEN. 2006;30:433-439.
  • Shenoy N, et al. Considerations for target oxygen saturation in COVID-19 patients: are we under-shooting? BMC Medicine. 2020;18:260.
  • Simes J, et al. Aspirin for the prevention of recurrent venous thromboembolism. Circulation. 2014;130:1062-1071.

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Filed under: Infectious Diseases, NPs & PAs, Pulmonary Medicine

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