Nursing Diagnosis

Hey m&m! Nursing diagnosis focuses on potential risks or actual conditions as a result of the related disease or symptoms. Below are a list of 5 nursing diagnosis related to Ebola. I choose one to go into detail (I have highlighted) about goals, outcomes, and interventions.

To understand a little bit about how Ebola works in the body I’ll give a short summer below. Also go back to my blog post “Ebola Treatment” and watch the video at the bottom of the post of how Ebola works in your body. Or click here to go directly to the video.

Ebola doesn’t stay at the initial place of infection; it migrates to nearby lymph nodes and then travels to the liver, spleen, and adrenal gland. Liver cells die off and clotting factors that help clot your blood so you don’t bleed out, become abnormal. This can cause prolonged or excess bleeding. Ebola can also result in Adrenocortical death which causes low blood pressure and makes it hard to make steroids. The Ebola virus also initiates a release of cytokines that are associated with inflammation which can cause impairment of clotting and result in multi-organ failure.  

Nursing Dianogsis

1. Risk for bleeding related to impaired clotting factors.
2. Risk for electrolyte imbalance related to decreased oral intake, vomiting and diarrhea.
3. Risk for shock related to progressive multi-organ failure.
4. Pain related to musculoskeletal and abdominal aches.   
5. Risk for fluid volume deficit related to restricted oral intake, bleeding, vomiting and diarrhea.  

Risk for fluid volume deficit related to restricted oral intake, bleeding, vomiting and diarrhea. 

Goal and outcomes: Patient will maintain fluid volume balance as evidenced by

• Normal skin turgor
• Weight stable at baseline
• Moist mucous membranes
• Heart rate within normal baseline
• Blood pressure within normal baseline
• Mental status within baseline
• Balanced intake and output

Assessment

• Check for tenting: decreased skin turgor (look to the figure at the right)
• A: pinching the skin
• B: skin remains elevated = dehydration 
• Sudden weight loss of at least 2%
• A low B/P or high B/P upon standing
• A rapid and weak pulse
• Change in mental status from baseline
• Decreased urine output

Implementations

• Administer prescribed anti nausea medications to reduce vomiting episodes
• Administer prescribed antidiarrheal medications to reduce watery stools
• Maintain fluid intake through IV if oral intake is contraindicated  
• Weigh patient daily to monitor for fluctuations

Resources:  

Chertow, D.S., Bray, M. (2015). UpToDate: clinical manifestations and diagnosis of Ebola virus disease. Wolters Kluwer. Retrieved May 20, 2015 from http://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-ebola-virus-disease 

Ebola (Ebola Virus Disease). (April 1, 2015). Retrieved May 20, 2015 from http://www.cdc.gov/vhf/ebola/healthcare-us/preparing/clinicians.html 

Nanda International (2015). Retrieved May 20, 2015 from http://www.nanda.org/nanda-international-nursing-diagnoses-defintions-and-classification-2015-17.html

Nursing Care for Patients with Ebola

Hi m&m! Remember when I took care of you when you were sick? I couldn’t do much to cure you but I helped soothe your symptoms. This is exactly the type of nursing care provided to patients with Ebola!

Ebola has NO cure, so as previously discussed in last week’s post the treatments and care provided treat the symptoms and help make the patients feel more comfortable.

When caring for patients with Ebola nurses make sure to follow the protocol involving protective measures to keep the patient, caregivers and other patients safe from transmission.

Nurses make sure that the patient is well hydrated

• They monitor IV fluids running
• Check hydration status through checking skin turgor (pinch the skin to see if it tents or remains flat)
• Monitor intake and output to make sure they are well balanced
• Manage diarrhea, nausea and vomiting to make sure the patient isn’t losing a lot of fluids

Nurses make sure the patient is receiving proper nutrition and hygienic care

• They perform good oral hygiene
• They may help feed the patient
• They help clean the patient to make sure the skin is intact and well cared for

Aside from specific patient care nurses also help educate the public about virus transmission

• They inform the public about transmission facts
• They raise awareness about the disease
• They defend rights of caregivers and nurses who care for patients with Ebola

**Educating the public is important in reducing fear and decreasing stigma or negative feelings attached to patients and caregivers who are diagnosed with Ebola

Click here, this is a great page with a table that summarizes CDC recommendations for infection prevention and control for hospitalized patients with Ebola

Check out this interesting video about patients with Ebola through a nurse’s eyes!

Resources:

Ebola (Ebola Virus Disease) (2015, February 12) Retrieved May 13, 2015, from http://www.cdc.gov/vhf/ebola/healthcare-us/hospitals/infection-control.html

Ebola Care is Nursing Care (2014, November 10). Retrieved May 13, 2015, from http://www.rwjf.org/en/library/articles-and-news/2014/11/_ebola-care-is-nursing-care.html

Ebola Treatment

Hey m&m! Remember how I treated your cold based on your symptoms and how they progressed? Well Ebola uses the same idea.

Ebola symptoms and related complications are treated as they appear and how they progress.

The following treatment interventions can greatly improve a person’s chances of survival when done early in the disease progression:

• Giving IV fluids and balancing electrolytes
• Maintaining good oxygen status and blood pressure
• Treating other infections as they appear

** There are no FDA-approved medications or vaccines for Ebola

• Experimental treatments are currently being developed but have not been appropriately tested in terms of safety or effectiveness

It is very important for the patient to have a strong immune system and to have great supportive care in order to recover. Once recovered antibodies will develop and last for a minimum of 10 years!

While recovery can be successful, some patients who have recovered have suffered from long-term complications.

As you can see there aren't a lot of treatment options for Ebola. The above interventions listed such as giving IV fluids and maintaining oxygen are the known and effective interventions to help a patient survive.

**Check out this video to understand how a your body fights for survival against Ebola!

You can also check out this link here for Q&A on developing Ebola vaccines and treatments! The audience for this information is intended for healthcare providers but you can scroll down to the prophylaxis and treatment section to read about Ebola complications and interventions.

Remember the ways to prevent Ebola infection - check out the blog post "What Causes Ebola?"

**But always remember to wash your hands! =) 

Resources: 

Ebola (Ebola Virus Disease): Treatment. (April 9, 2015 ). Retrieved May 9, 2015, from 

http://www.cdc.gov/vhf/ebola/treatment/

Signs and Symptoms of Ebola

Hey m&m! I know you've been sick recently. Some of your symptoms are similar to Ebola symptoms... but don't worry! This post will explain Ebola symptoms and how to differentiate between the flu. 

As previously shown in last week’s post, general signs and symptoms of early stage Ebola are similar to other diseases:

·         Fever

·         Fatigue

·         Malaise (feeling unwell) and weakness

·         Reddened eyes

·         Joint and muscle pain

·         Headache

·         Nausea and vomiting

Here are other signs and symptoms that include later stages of Ebola as well. 

This picture was found here, click to read for another general overview about Ebola transmission and symptom presentation.

As stated above, symptoms may appear anywhere from 2 to 21 days after exposure to Ebola.

The average number of days where symptoms appear is 8 to 10 days

**Remember! Humans are only infectious once symptoms start showing**

Initial symptoms of Ebola

• Fever
• Fatigue
• Muscle pain
• headache
• Sore throat

Late symptoms of Ebola 

• Vomiting
• Diarrhea
• Rash
• symptoms of impaired kidney and liver function
• Internal and external bleeding
• bleeding gums, blood in the stool 

Take a look at this graphic that summarizes Ebola symptoms and stages! 

Now that you've learned more about Ebola signs and symptoms click here for a great informational graphic about the difference between the flu and Ebola. 

Resources:

Ebola virus disease. (2014, September 1). Retrieved April 30, 2015, from http://www.who.int/mediacentre/factsheets/fs103/en/

Ebola (Ebola Virus Disease): Signs and Symptoms. (April 9, 2015 ). Retrieved April 30, 2015, from http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/distribution-map.html

How is Ebola Diagnosed?

Hey m&m! Cant’ wait to see you in a couple of hours =)

This entry will be about how Ebola is diagnosed. I will talk about what procedures or tests are done to confirm that someone has Ebola rather than something else. I’ll cover a little bit on signs and symptoms but I won’t go too much in detail because my next post will be all about Ebola signs and symptoms!

It is hard to diagnosis a newly infected individual because the early symptoms presented, such as fever, are seen in other more common diseases such as malaria and typhoid fever. Other common early symptoms include muscle pain, fatigue, headache and sore throat. See below for comparisons between Ebola and other diseases! (Hint: click to make bigger) 

If someone is presenting early symptoms of Ebola and has had known contact with body fluids of an infected person or objects that were contaminated by an infected person then it is recommended for them to be isolated until they can confirm or rule out Ebola.

 Blood samples are taken in order to perform diagnostic testing for the Ebola virus.

Below are lab tests used to detect Ebola virus in the blood.  The virus is only detected in the blood after symptoms start; it also may take a few days for the virus to reach levels that are high enough to be detected. (Hint: click to make bigger) 

Click here to read a nice one page handout with good visual aids and text information about Ebola virus testing!


Resources: 

Ebola virus disease. (2014, September 1). Retrieved April 4, 2015, from http://www.who.int/mediacentre/factsheets/fs103/en/

Ebola (Ebola Virus Disease): Diagnosis. (April 9, 2015 ). Retrieved April 11, 2015, from http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/distribution-map.html

What Causes Ebola?

Hey m&m, I’ll discuss what causes Ebola in humans, how someone can become infected, and prevention measures. 

As previously discussed in the initial overview, Ebola is caused by the Ebola virus. 

Animals it can be found in: 

• Fruit bats
• Chimpanzees, gorillas, monkeys
• Possibly other animals. 

It is transferred through contact with Infected animal’s secretions such as 

• Blood
• Organs
• Other bodily fluids

Humans transmit it directly to one another through infected blood, secretions, organs, and bodily fluids of infected people

This can also include: 

• Saliva, sweat, 
• Vomit, 
• Breast milk
• Semen
• Urine and feces
• Others 

This can be transferred through broken skin or mucous membranes such as eyes nose and mouth, and materials such as bedding, clothing, bandages, medical equipment and needles.

Check out these DOs and DO NOTs for a colorful graphic with great information about what to avoid! 

The graphic below has great facts to dissolve any myths about Ebola:

Who is at risk?

Health-care workers are at high risk when treating patients with suspected or confirmed Ebola Virus Disease. This is usually due to poor infection control precautions.

People at burial or funeral ceremonies that may make contact with the mourned may be at risk if the person was infected as well.

REMEMBER THIS

• ***As long as the blood contains the Ebola virus, people will remain infectious!
• **Someone cannot spread Ebola until they are showing symptoms.
• *There is not enough research to confirm or reject the idea of possible transmission of the virus through sexual activity.

Finally, just to bring the point home and just to give you more graphics since I know you like simple pictures... Check out below for 6 simple but effective ways for prevention! 

Resources:

Ebola virus disease. (2014, September 1). Retrieved April 4, 2015, from
 http://www.who.int/mediacentre/factsheets/fs103/en/

Ebola virus disease. (2014, Octover 10). Retrieved April 17, 2015, from

http://www.nlm.nih.gov/medlineplus/ency/article/001339.htm

What Populations are most affected?

Hi m&m! This post will be about Ebola’s origins and the recent outbreak cases so you know which populations are most affected and the most at risk. 

~Fun Facts~ 

• In 1976 Ebola was discovered by the Ebola River which is now known as the Democratic Republic of the Congo. Since its discovery Ebola has spread to many African countries.

• Since then we have learned that there are 5 Ebola virus species, 4 out of those 5 have caused disease in humans. 

The recent 2014 outbreak that you have been hearing about in West Africa is the biggest outbreak since Ebola’s first discovery. The number of cases and deaths in the recent outbreak has been much higher than all other previous outbreaks combined. 

Here is a map of the distribution of the 2014 outbreak in West Africa 
Hint: click on the image to make it bigger

Here is a CDC chart to show the recent 2014 outbreak reported Ebola cases in different countries and the affected areas

Of those countries in the previous chart, here are specific data about the number of cases and deaths per country 

If you want to learn more about the 4 cases in the United States you can click here and read about short detailed summaries of who was affected in each case! 

**As you can see, since you don’t travel to West Africa frequently and you aren't involved in healthcare, your everyday job as a tech geek keeps you relatively safe =) 

Resources: 

Ebola virus disease. (2014, September 1). Retrieved April 4, 2015, from
 http://www.who.int/mediacentre/factsheets/fs103/en/

2014 Ebola Outbreak in West Africa. (April 9, 2015 ). Retrieved April 11, 2015, from http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/distribution-map.html

What Is Ebola?

Mornings m&m, I hope you're enjoying the sunshine at the batting cages! 

I’m not sure how much you know already so I’m going to define Ebola in general and my future posts will go more into detail about causes, symptoms, treatments, and such.

For starters, Ebola is an infectious disease caused by the Ebola virus. Wild animals can spread this virus to people, and then people can spread it among each other. It is spread through contact with infected blood, secretions, or other bodily fluids of animals and humans. Transmission by humans can also occur through infected materials such as bedding. 

This is a great diagram to get a good visual, I know you like pictures rather than text! Hint: click on the graphic to make it bigger. 

The average Ebola virus disease case fatality rate is 50%; this means that it causes death in 50% of the people who contract the virus ...scary. The first outbreak of this disease was in small villages in Central Africa near tropical rainforests, and recently cases have occurred in major West African urban and rural areas. 

Right now there isn’t a treatment that can neutralize the virus and there are no current vaccines, BUT there are 2 vaccine candidates being evaluated right now, and there are treatment methods for symptoms that are shown to improve survival.

Here is a simple but very informational graphic about 10 things you should know about Ebola. Take a look! I know you will tell me you looked at it, but we both know all you do is glance things over in 3 seconds and pretend you looked in detail.  I WILL quiz you on it later, so if you don’t want to get in trouble take the time to read it over, it’s for your own benefit =) 

Resources:

About Ebola Virus Disease. (2014, December 8). Retrieved April 4, 2015, from http://www.cdc.gov/vhf/ebola/about.html

Ebola virus disease. (2014, September). Retrieved April 4, 2015, from http://www.who.int/mediacentre/factsheets/fs103/en/

My Blog Inspiration

Hey m&m,

I know you wanted to learn more about Ebola, as per your text:

“It’s mysterious and something that I've heard about recently”

So this blog post is dedicated to you.