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Cuidados de enfermería en pacientes de 77 años con enfermedad pulmonar obstructiva crónica con covid-19.
| dc.contributor.advisor | Martínez Angulo, María Auxiliadora | |
| dc.contributor.author | Villegas Briones, Vilma Viviana | |
| dc.date.accessioned | 2021-06-11T17:11:39Z | |
| dc.date.available | 2021-06-11T17:11:39Z | |
| dc.date.issued | 2021 | |
| dc.identifier.uri | http://dspace.utb.edu.ec/handle/49000/9683 | |
| dc.description | The present clinical case includes a 77-year-old patient with a disorder whose fundamental characteristic is the reduction of the flow of oxygen that can be expelled when performing a maximum expiration. Various studies estimate that compliance with inhaler treatment in patients with COPD (chronic obstructive pulmonary disease) and covid does not exceed 50%. The TAI (Inhaler Adherence Test) questionnaire has proven to be a simple and useful tool to identify therapeutic non-compliance. The relationship between COPD and covid-19 is dual. It might be thought that, since COPD is a chronic respiratory disease and COVID-19 is a respiratory infection, COPD patients would have a higher risk of suffering from SARS-CoV-2 infection. However and surprisingly, the experience after these months of pandemic suggests the opposite: that COPD patients seem to have a lower risk of suffering from Covid-19. The answer is not entirely clear, but it could be due to several factors. COPD patients, aware that they suffer from a respiratory disease, may have been more strict with preventive measures against covid-19. In this way, they could have been more aware and paid more attention to recommendations such as confinement, the use of a mask, hand washing or maintaining social distance, among others. Now, what does seem to be clear is that, if a patient with COPD suffers from covid-19, her prognosis is worse. In this context, it is of interest to highlight a recent study. This shows that some underweight adults are not only at increased risk of COPD, but also severe covid-19. There are no data from clinical trials to conclude that COVID-19 treatment should be modified in COPD patients. Therefore, in this group of patients it is recommended to implement the same management as in the rest of COVID-19 cases, which includes systemic glucocorticoids and remdesivir. Markers linked to severe course of COVID-19 include, among others, lymphogen, thrombocytopenia, high levels of D-dimer, C-reactive protein, procalcitonin and creatinine, and increased activity of creatine kinase, liver enzymes and serum lactic dehydrogenase. SARS-CoV-2 infection multiplies the risk of deep vein thrombosis and pulmonary embolism by 2-4. In COPD patients, the risk of developing venous thromboembolic disease is also higher. Therefore, COPD patients admitted for COVID-19 require antithrombotic prophylaxis. Low molecular weight heparin (LMWH) is commonly used. In some centers, a medium intensity treatment is given (LMWH is given twice a day) or in therapeutic doses. However, it should be remembered that the American College of Chest Physicians guidelines recommend administering LMWH in prophylactic doses in patients with COVID-19; It is a strong recommendation in hospitalized patients and a weak recommendation in critically ill patients. | es_ES |
| dc.description | The present clinical case includes a 77-year-old patient with a disorder whose fundamental characteristic is the reduction of the flow of oxygen that can be expelled when performing a maximum expiration. Various studies estimate that compliance with inhaler treatment in patients with COPD (chronic obstructive pulmonary disease) and covid does not exceed 50%. The TAI (Inhaler Adherence Test) questionnaire has proven to be a simple and useful tool to identify therapeutic non-compliance. The relationship between COPD and covid-19 is dual. It might be thought that, since COPD is a chronic respiratory disease and COVID-19 is a respiratory infection, COPD patients would have a higher risk of suffering from SARS-CoV-2 infection. However and surprisingly, the experience after these months of pandemic suggests the opposite: that COPD patients seem to have a lower risk of suffering from Covid-19. The answer is not entirely clear, but it could be due to several factors. COPD patients, aware that they suffer from a respiratory disease, may have been more strict with preventive measures against covid-19. In this way, they could have been more aware and paid more attention to recommendations such as confinement, the use of a mask, hand washing or maintaining social distance, among others. Now, what does seem to be clear is that, if a patient with COPD suffers from covid-19, her prognosis is worse. In this context, it is of interest to highlight a recent study. This shows that some underweight adults are not only at increased risk of COPD, but also severe covid-19. There are no data from clinical trials to conclude that COVID-19 treatment should be modified in COPD patients. Therefore, in this group of patients it is recommended to implement the same management as in the rest of COVID-19 cases, which includes systemic glucocorticoids and remdesivir. Markers linked to severe course of COVID-19 include, among others, lymphogen, thrombocytopenia, high levels of D-dimer, C-reactive protein, procalcitonin and creatinine, and increased activity of creatine kinase, liver enzymes and serum lactic dehydrogenase. SARS-CoV-2 infection multiplies the risk of deep vein thrombosis and pulmonary embolism by 2-4. In COPD patients, the risk of developing venous thromboembolic disease is also higher. Therefore, COPD patients admitted for COVID-19 require antithrombotic prophylaxis. Low molecular weight heparin (LMWH) is commonly used. In some centers, a medium intensity treatment is given (LMWH is given twice a day) or in therapeutic doses. However, it should be remembered that the American College of Chest Physicians guidelines recommend administering LMWH in prophylactic doses in patients with COVID-19; It is a strong recommendation in hospitalized patients and a weak recommendation in critically ill patients. | es_ES |
| dc.description.abstract | El presente caso clínico comprende al paciente de 77 años de edad con un trastorno cuya característica fundamental es la reducción del flujo de oxigeno que puede expulsarse al realizar una expiración máxima. Diversos estudios estiman que el cumplimiento del tratamiento de inhalador en pacientes con EPOC (enfermedad pulmonar obstructiva crónica) y covid no pasa del 50 %. El cuestionario TAI (Test de Adherencia a Inhaladores) ha mostrado ser una herramienta sencilla y útil para identificar el incumplimiento terapéutico. La relación entre EPOC y covid-19 es dual. Podría pensarse que, al ser la EPOC una enfermedad respiratoria crónica y la covid-19 una infección respiratoria, los pacientes con EPOC tendrían mayor riesgo de sufrir la infección por SARS-CoV-2. Sin embargo y sorprendentemente, la experiencia tras estos meses de pandemia sugiere lo contrario: que los pacientes con EPOC parecen tener menor riesgo de sufrir covid-19. La respuesta no está del todo clara, pero podría deberse a varios factores. Los pacientes con EPOC, conscientes de que sufren una enfermedad respiratoria, pueden haber sido más estrictos con las medidas de prevención ante la covid-19. De esta manera, podrían haber sido más conscientes y haber prestado más atención a recomendaciones como el confinamiento, el uso de mascarilla, el lavado de manos o el mantenimiento de la distancia social, entre otras. Ahora bien, lo que sí parece estar claro es que, si un paciente con EPOC sufre covid-19, su pronóstico es peor. En este contexto, es de interés resaltar un estudio reciente. Esta muestra que algunos adultos de adulta que nacieron con bajo peso no solo tienen más riesgo de sufrir EPOC, también covid-19 grave. No hay datos de ensayos clínicos que permitan concluir que en los pacientes con EPOC se deba modificar el tratamiento de la COVID-19. Por lo tanto, en este grupo de pacientes se recomienda implementar el mismo manejo que en el resto de casos de COVID-19, lo cual incluye los glucocorticoides sistémicos y el remdesivir. Los marcadores ligados a la COVID-19 de curso grave son, entre otros, la linfógena, la trombocitopenia, las concentraciones elevadas de dímero D, proteína C-reactiva, procalcitonina y creatinina, y el aumento de actividad de la creatina-cinasa, las enzimas hepáticas y la deshidrogenasa láctica en suero. La infección por SARS-CoV-2 multiplica por 2-4 el riesgo de trombosis venosa profunda y embolismo pulmonar. En los pacientes con EPOC, el riesgo de desarrollar una enfermedad tromboembólica venosa también es mayor. Por lo tanto, los pacientes con EPOC ingresados por COVID-19 precisan de profilaxis antitrombótica. Normalmente se utiliza heparina de bajo peso molecular (HBPM). En algunos centros, se administra un tratamiento de intensidad media (se administra HBPM 2 veces al día) o en dosis terapéuticas. No obstante, conviene recordar que las guías del American College of Chest Physicians recomiendan administrar HBPM en dosis profilácticas en los pacientes con COVID-19; se trata de una recomendación fuerte en los pacientes hospitalizados y débil en los pacientes en estado crítico. | es_ES |
| dc.format.extent | 50 p | es_ES |
| dc.language.iso | es | es_ES |
| dc.publisher | Babahoyo: UTB-FCS, 2021 | es_ES |
| dc.rights | Atribución-NoComercial-SinDerivadas 3.0 Ecuador | * |
| dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/3.0/ec/ | * |
| dc.subject | Enfermedad Pulmonar Obstructiva Crónica | es_ES |
| dc.subject | Cuidado de Enfermería | es_ES |
| dc.subject | Covid-19 | es_ES |
| dc.title | Cuidados de enfermería en pacientes de 77 años con enfermedad pulmonar obstructiva crónica con covid-19. | es_ES |
| dc.type | bachelorThesis | es_ES |
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