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/