James Patrick J.

Tadeo BSNIII-A02 / Group CA8 Severe Acute Respiratory Syndrome (SARS) Causative Agent:

Manila Tytana College

The causative of SARS is a coronavirus, called SARS associated coronavirus (SARS CoV). Coronavirus are a common cause of mild upper respiratory illness in humans. Mode of Transmission: SARS appears to spread by close person-to-person contact by respiratory droplets. It is spread most rapidly through droplet transmission in which the infected particles are large and can travel only about 3 feet. Also, when a person touches an object contaminated with infectious droplets and then touches his or her mouth, norse, or eyes. Examples of close contact include kissing or hugging, sharing eating or drinking utensils, talking to someone within 3 feet, and touching someone directly. Incubation Period: The incubation period is short, range from typically 2-7 days but may be as long as 10 days. Sign and Symptoms: Week 1 of illness Patients initially develop influenza-like prodromal symptoms. Presenting symptoms include fever (temperature >38C), malaise, myalgia, headache, and rigors. No individual symptom or cluster of symptoms has proven specific. Although history of fever is the most frequently reported symptom, it may be absent on initial measurement. Week 2 of illness Cough (initially dry and nonproductive), dyspnea and diarrhea may be present in the first week but more commonly reported in the second week of illness. Severe cases develop rapidly progressing respiratory distress and oxygen desaturation with about 20% requiring intensive care. Up to 70% of the patients develop diarrhoea which has been described as large volume and watery without blood or mucus. Transmission occurs mainly during the second week of illness. Confirmatory Laboratory: The following tests are recommended for the laboratory diagnosis of SARS. A single test result is insufficient for the definitive diagnosis of SARS-CoV infection because both false negative and false positive results are known to occur. Reverse transcription polymerase chain reaction (RT-PCR) Reverse transcription polymerase chain reaction (RT-PCR) test can detect genetic material of the SARS-CoV in specimens ranging from blood, sputum, tissue samples or stools. The RT-PCR test so far have proven to be very specific but not very sensitive.

 Seroconversion by ELISA ELISA (enzyme-linked immunosorbent assay) test detects antibodies to SARS reliably but only 21 days after onset of symptoms.

Medical / Surgical Treatment: All viral pneumonias and a number of bacterial pneumonias will not respond to standard antibiotic treatments. As yet there is no proven treatment for SARS; supportive measures are recommended.Treatment of SARS so far has been largely supportive with antipyretics, supplemental oxygen and ventilatory support as needed. Suspected cases of SARS must be isolated, preferably in negative pressure rooms, with complete barrier nursing precautions taken for any necessary contact with these patients.There was initially anecdotal support for steroids and the antiviral drug ribavirin, but no published evidence has supported this therapy. There is no known treatment directed at the SARS virus. The CDC recommends similar treatment as for other serious community-acquired atypical pneumonia. Anitiviral and antiretroviral medications as such as lopinavir, ritonavir, and ribavirin can be use.

Nursing Responsibility: Patients should be placed in an isolation unit. Strict respiratory and mucusol barrier nursing is recommended. It is very important that suspected cases are separated from other patients and placed in their own hospital room. Health care workers and visitors should wear efficient filter masks, goggles, aprons, head covers, and gloves when in close contact with the patient

Reference: Medical Surgical Nursing 12th edition by Brunner and Suddarth Medical Surgical Nursing 8th edition by Joyce M. Black Nursing Care Plans 6th edition by Gulanick and Myers Guidelines for surveillance of severe acute respiratory syndrome by WHO