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Use of Psychotropic Drugs in Juvenile

Behavior Modification.

By: Dr. Betrand N. Okwesili, NP; MSc; M.B.B.Ch; BSc; CM/DM

Psychotropic substances are chemicals that affect the function, behavior, or experience of the mind. Although their exact mechanism of action is still subject to controversy, they are thought to act upon the biochemistry of the brain through the various neurotransmitters of the brain and hence, affect thinking mechanisms, emotional control, and other behavioral processes. These chemical substances include; Neuroleptics such as Haldol, Anti-psychotics such as Zyprexa, antidepressants such as Prozac, stimulants such as Ritalin, anti-anxiety such as Buspar, and so forth.

Emotional and Behavioral Problems among Children

  • Attention Deficit Hyperactivity Disorder (ADHD) and Learning Disability (LD) – ADHD refers to the developmentally inappropriate degree of inattention, impulsiveness, and hyperactivity. While an LD refers to the heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, mathematical abilities, or social skills. ADHD and LD conditions affect every aspect of a child’s life but are most obvious in the classroom. Early identification of affected children is very important since the characteristics of the disorder significantly interfere with the normal course of emotional and psychological development. Many children develop maladaptive behavior patterns that impede psycho-social adjustments while they try to cope with cognitive dysfunction. 1Their behavior evokes negative responses from others, and repeated exposure to negative feedback adversely affects their self-perception, scholastic competence, social acceptance, and behavioral conduct in children with ADHD.
  • Conduct Disorder or Oppositional Defiant Disorder – This affects 1-4% of 9-17 year-olds. Children with a conduct disorder act out their feelings or impulses in destructive ways, including aggression, lying, theft, setting fires, and vandalism; the degree of offense growing more serious over time.
  • Post-Traumatic Stress Disorder (PTSD) – this refers to the development of characteristic symptoms following exposure to an extremely traumatic experience or catastrophic event. An accident, assault, natural disaster, sexual abuse, or witnessing violence can lead to PTSD. Children with PTSD tend to relive or visualize traumatic experiences for years and retain some fear specific to the event.
  • Depression – before puberty, boys and girls are at equal risk for depression; after puberty onset, the rate of depression is twice as high for girls. Childhood depression is often difficult to detect. Children may be unable to express their feeling and tend to act out their problems and concerns.
  • Substance Abuse – Drug abuse is the regular use of drugs other than the accepted medical purposes and to the extent that it results in physical or psychological harm to the user and/ or is detrimental to society. Drug abuse, misuse, and addiction are culturally defined and are voluntary behaviors. Drug tolerance and physical dependence are involuntary physiological responses to the pharmacologic characteristics of drugs. Most drugs that young people use induces changes in perception, feelings of well-being, a sense of closeness, and a feeling of happiness. In the majority of cases, drug use among children begins with experimentation. The individual may try a drug only once, may use it occasionally or may make it an integral part of a drug centered lifestyle. For many young people, drugs produce a dreamy state of altered consciousness or a feeling of power, excitement, heightened acuity, or confidence. Others seek visual hallucinatory experiences and sexual sensation. Many youngsters use drugs not only for perceptual and sensory experiences but also for social aspects. They use drugs because their peers use them and because they want to “belong”. Any drug can be abused and the chemically active substances most frequently abused are caffeine and theobromines contained in chocolate, tea, coffee, and colas. Ethyl alcohol and nicotine are other substances that although recognized as drugs, are sanctioned by society. These drugs can produce mild to moderate euphoric and/ or stimulant effects and can lead to physical and psychic dependence. Alcohol, a socially accepted depressant, is responsible for the acts of violence, suicide, accidental injury, and death among youngsters. The most remarkable effects of alcohol are on the central nervous system, evidence by lack of coordination, marked mood changes, impaired judgment, impaired memory, and impaired perception. Youngsters often rely on alcohol as a defense against depression, anxiety, fear, or anger. Not all of these signs may be present, but if some are evident, the youngster should be considered at risk and detoxification therapy initiated to ensure safe and complete withdrawal from the drug. Other drugs abused by children include Cocaine (Crack), although pharmacologically not a narcotic but legally categorized as one. Cocaine induces a sense of euphoria and/ or indefinable high. Withdrawal symptoms from cocaine are as dramatic as observed in withdrawal from other substances. Effects include depression, lack of energy and motivation, irritability, appetite changes, psychomotor retardation, and irregular sleep patterns. Other serious symptoms include cardiovascular manifestations and seizures. Narcotics include opiates such as heroin, morphine, meperidine hydrochloride (Demerol), Fentanyl, Hydromorphone (Dilaudid) and codeine. They produce euphoria by removing painful feelings and creating a pleasurable experience, and a sense of success accompanied by clouding of consciousness and a dreamlike state. Signs of narcotic abuse include constricted pupils, respiratory depression, and often cyanosis. Withdrawal from opiates is extremely unpleasant unless controlled with supervised substitutions of Methadone. The use of narcotics has brought many youngsters brouhaha with the legal system. Health problems resulting from self-neglect of physical needs (nutrition, cleanliness and dental care) overdose, contamination, and infection, including HIV infection and Hepatitis B can not be overemphasized. Marijuana – this is a green, brown, or gray mixture of dried, shredded leaves, stems, seeds, and flowers of the hemp plant. Marijuana has many street names including pot, herb, weed, grass, boom, gangster, Mary Jane, or chronic. Other marijuana street names include; sinsemilla, hashish, Indian-hemp, smoke, catch a fire, stone, Igbo, ganja, g-force and so forth. All forms of marijuana are mind-altering. They change how the brain works. They all contain δ-9-THC (Delta-9-Tetrahydrocannabinol), the main active ingredient in marijuana. They also contain more than four hundred other chemicals. Marijuana’s effects on the user depend on its strength or potency, which is directly related to the amount of δ-9-THC it contains. The short term effects of marijuana include; problems with memory and learning, distorted perception (sight, sound, time, touch); trouble with thinking and problem-solving, loss of motor coordination, and increases in heart rate. These effects are even greater when other drugs are mixed with Marijuana. Marijuana can mess up a youngsters schooling, sports activities or clubs, or with the youngster’s friendships with others. If one is high on Marijuana, one is more likely to make mistakes that could embarrass or hurt the individual or others. Individuals who use Marijuana may lose interest in how they look and how they are getting along at work or school and may lead to risky sexual behavior, resulting in possible exposure to sexually transmitted diseases like Human Immunodeficiency Virus (HIV), the virus that causes AIDS.
  • Suicide – this is the act of intentionally killing one’s self. Suicide is the third leading cause of death during the teenage years, surpassed only by death from injury or homicide. Suicide ideation involves a preoccupation with thoughts of committing suicide and maybe a precursor to suicide. Suicide attempt (parasuicide) is intended to cause injury or death. The term parasuicide is used to refer to all behaviors ranging from gestures to serious attempts to kill one’s self. The term does not include intent or motivation. For many adolescents, the motivation for a suicidal gesture or attempt may be obscure, complex, and difficult to articulate. However, all suicidal activity should be taken seriously and should not be taken lying low.
  • Eating disorders – Obesity is defined as an increase in body weight, resulting from an excessive accumulation of body fat relative to lean body mass. Children are considered obese when their weight exceeds the 95th percentile for their age, gender, and height, on the NCHS growth charts. Anorexia Nervosa (AN) is an eating disorder characterized by a refusal to maintain minimally normal body weight and by severe weight loss in the absence of obvious physical causes. It occurs predominantly in adolescent or young adult females, and the incidence is increasing. Bulimia – This is an eating disorder characterized by binge eating. This consists of secretive, frenzied consumption of a large number of high caloric foods during a brief period. The disorder is observed more frequently in older adolescent girls and young women.

Psychotropic drugs that may be encountered in juvenile behavior modification

Medication – Ritalin, Concerta

Indications/ Symptoms – ADHD, LD, Inattention, Distractability, agitation, behavior problems.

What nurse should watch out for – Nervousness, insomnia, decreased appetite, weight loss, headaches, skin rash, jitteriness, and social withdrawal.

Medication – Prozac

Indications/ Symptoms – Depression, obsessive disorder, panic disorder, bulimia nervosa, anorexia nervosa.

What nurse should watch out for – Anxiety, nervousness, insomnia, mania, agitation, decreased appetite, rash or hives, thoughts of suicide, attempted suicide, or actual suicide in rare cases, seizure.

Medication – Depakote, Lithium CO3

Indications/ Symptoms – Severe change in mood, hypersexuality, overly inflated self-esteem, increased energy.

What nurse should watch out for – Nausea, drowsiness, dizziness, vomiting, abdominal pain, headache, tremor, severe pancreatitis, and liver disease.

Medication – Risperdal, clozaril, zyprexa, seroquel.

Indications/ Symptoms – Schizophrenia, Bi-polar disorder, mania.

What nurse should watch out for – Hyperglycemia, diabetes mellitus, hypertension, cognitive or motor impairments. Rare: serious cardiac and neuromuscular effects.

Medication – Wellbutrin, Buproprion, Propranolol, buspirone.

Indications/ Symptoms – Anxiety, shakiness, jumpiness, trembling, tension, muscle aches, fatigability, inability to relax, twitching, depression, panic attacks, aggressive behavior.

What nurse should watch out for – Dizziness, nausea, headache, nervousness, light handedness, excitement, slowness, or sedative effects. Agitation. anxiety, insomnia, hypertension, possible hallucinations, or delusions, weight loss, dose-related risk of seizure, excessive tiredness, upset stomach, vomiting, rash, diarrhea, difficulty breathing, sore throat, unusual bleeding, swelling of feet or hands, low heartbeat, chest pain fever, and depression.

Medication – Paxil, Zoloft, Celexa, Anafranil.

Indications/ Symptoms – Depression, obsessive-compulsive disorder, panic disorder.

What nurse should watch out for – Anxiety, nervousness, insomnia, mania, agitation, decreased appetite, rash or hives, thoughts of suicide, attempted, or actual suicide.

Medication – Remeron

Indications/ Symptoms – Depression.

What nurse should watch out for – Drowsiness, weakness, dizziness, dry mouth, increased appetite, weight gain, constipation.

Medication – Trazodone

Indications/ Symptoms – Depression, anxiety disorder, sleeplessness.

What nurse should watch out for – Drowsiness, weakness, dizziness, dry mouth, increased appetite, weight gain, constipation.

Medication – Trileptal

Indications/ Symptoms – Convulsion, seizure

What nurse should watch out for – Drowsiness, dizziness, dry mouth, constipation, nausea, vomiting, headache, rash, and fatigue.

Medication – Lexapro

Indications/ Symptoms – Depression, generalized anxiety disorderse

What nurse should watch out for – Nausea, vomiting, diarrhea, constipation, upset stomach, loss of appetite, drowsiness, dizziness, dry mouth, trouble sleeping, back pain.

Due to the controversy surrounding the use of psychotropic drugs in children, it is the responsibility of the nurse to monitor, document, and report to the appropriate prescribing individual the presence of any side effects of these medications on the child involved. In many institutions, the trough level of these medications is obtained from time to time to monitor the toxicity level of the medication.

1 Dumas and Pelletier, 1999

2 Keller & Stevens, 1996

REFERENCES:

  1. The center for health and health care in schools. The School of Public Health & Health Services, the George Washington University: Psychotropic Drugs and Children. Reversed in 2004. Accessed at www.healthinschools.org.
  2. Wong, D. L; et al; Wongs Essentials of Pediatric Nursing, 6th Ed. MI; Mosby, Inc; 2001
  3. National Institute on Drug Abuse. Marijuana: Facts for Teens. Reversed in 2005. Accessed at http://www.nida.nih.gov/marjbroch/teenpg7-8.html.
  4. The Columbia Encyclopedia, 6th Ed. 2006. Columbia University Press. Accessed at http://yahooligans.yahoo.com/reference/encyclopedia/entry/depressa.

Respiratory Syncytial Virus (RSV), Nursing Intervention and Prevention.

By: Dr. Betrand N. Okwesili, NP; MSc; M.B.B.Ch; BSc; CM/DM

Respiratory Syncytial Virus (RSV) is the leading cause of lower respiratory tract infections in infants and young children. RSV is implicated in Bronchiolitis, which is an acute viral infection with maximum effect at the bronchiolar level. The infection occurs primarily during the winter and spring of the year and is rare in children over two years of age. Adeno viruses and parainfluenza viruses may also cause acute bronchiolitis. Infection begins in the fall, reached a peak during the winter, and decreases in Spring. It is easily spread from hand to eye, nose, or other mucous membranes. It is a suspected cause of fatal respiratory diseases in infants and can cause serious illness in immuno-compromised adults, institutionalized elderly persons, and patients with underlying cardiopulmonary disease.

PATHOPHYSIOLOGY

In RSV infection, the virus attaches to cells, eventually resulting in necrosis of the bronchiolar epithelium. The mucosa of the Bronchiole is swollen, resulting in the lumina filled with mucus and exudate, these attract inflammatory cells resulting in peribronchiolar interstitial pneumonitis. The variable degrees of obstruction produced in small air passages by these changes lead to hyperinflation, obstructive emphysema resulting from partial obstruction, and patchy areas of atelectasis. Dilation of bronchial passage on inspiration allows sufficient space for the intake of air, but a narrowing of the passages on expiration prevents air from leaving the lungs. This air is trapped distal to the obstruction and causes progressive overinflation with the result being emphysema.

SIGNS AND SYMPTOMS OF RSV

Initial

  • Rhinorrhea (running or watery nose)
  • Pharyngitis
  • Coughing/sneezing
  • Wheezing
  • Possible ear or eye drainage
  • Fever

With the progression of an illness

  • Increased coughing and wheezing
  • Air hunger
  • Tachypnea and retractions of intercostal cartilages
  • Cyanosis

Severe illness

  • Tachypnea, >70 breath per minute
  • Listlessness
  • Apneic spells
  • Poor air exchange, poor breath sounds

COMPLICATIONS OF RSV

  • Pneumonia and progressive pneumonia
  • Bronchiolitis
  • Croup
  • Otitis media
  • Respiratory failure
  • Sudden Infant Death Syndrome (SIDS)
  • Residual lung damage

NURSING ASSESSMENT

History

  • Nasal congestion
  • Coughing
  • Wheezing
  • Malaise
  • Sore throat
  • Earache
  • Dyspnea
  • Fever

Physical findings

  • Nasal and pharyngeal inflammation
  • Otitis media
  • Severe respiratory distress marked by nasal flaring, retraction of intercoastal cartilages, cyanosis, and tachypnea
  • Wheezes, rhonchi, and crackles
  • Apnea may be the first recognized indicator of RSV infection in very young infants

LABORATORY EVALUATION

  • Syncytial virus
  • Elevated serum respiratory syncytial virus antibodies titers
  • Arterial blood gas values showing hyponatremia
  • Elevated blood urea nitrogen in dehydration

TREATMENT

  • Respiratory support is very important
  • The importance of adequate nutrition in RSV infection can not be overemphasized.
  • Overhydration of an RSV individual should be avoided.
  • Rest is very important when fatigued during the period of infection.
  • Medication includes the use of Ribavirin.
  • Tracheostomy is a possible surgical intervention.

NURSING DIAGNOSIS

  • Activity intolerance, impaired gas exchange related to bronchiolar edema and increased mucus production.
  • The risk for fluid volume deficit related to increased water loss through inhalation and decreased fluid intake.
  • Hyperthermia related to infection.
  • Social isolation, related to isolation precautions.
  • Fatigued related to respiratory distress.
  • Altered nutrition, less than body requirements related to lack of knowledge about the child’s condition.
  • Knowledge deficit related to home care.

EXPECTED OUTCOME

  • The child will have improved gas exchange as evidenced by ease of respiration and pinkish skin.
  • The child will maintain fluid balance as evidenced by urine output of 1 to 2ml/kg/hr and good skin turgor.
  • The child will maintain a body temperature of less than 1000F ((38.70C).
  • The child will demonstrate effective social interactions in both one-on-one and group settings.
  • The child will rest at least one hour in the morning and afternoon.
  • The child has improved nutritional intake as evidenced by consuming at least 80% of each meal.
  • The child and parents will be less anxious as evidenced by expressing an understanding of home care instructions.

NURSING INTERVENTIONS AND RATIONALE

  • Provide a high-humidity environment by placing the child in a mist tent or cool humidification device; the cool mist from a mist tent helps liquefy secretions and decreases bronchial edema.
  • Administer oxygen by face mask, nasal cannula, or oxygen tent, as ordered, because oxygen helps relieve the restlessness associated with respiratory distress and hypoxia.
  • Position the child with his / her head and chest elevated and neck slightly extended because this position maintains an open airway and eases respiration by decreasing pressure on the diaphragm.
  • Administer bronchodilator as ordered.
  • Suction the child as ordered to remove secretions.
  • Administer antiviral agents as ordered.
  • Promote adequate rest by decreasing noise and lights, and providing warmth and comfort.
  • Assess the child’s respiratory rate and rhythm hourly.
  • Teach the parent(s) and child (if appropriate) how and when to administer medication, including dosage details and adverse reactions.
  • Explain the signs and symptoms of respiratory distress and infection, including fever, dyspnea, a change in sputum color and wheezing.
  • Explain the importance of adequate rest for the child to the parent(s), and to the child (if appropriate).

PREVENTION OF RSV

There are two drugs used for the prevention of RSV infections is recommended and approved by the American Academy of Pediatrics (AAP) and the Federal Drug Administration (FDA). These drugs include; RSV immune globulin (RSV-IGIV or Respigam) and Monoclonal antibody, palivizumab (Synagis.) By the year 2000, the AAP had set up specific standards for who should receive the drugs and specified instruction for their use. Most patients receive the shot throughout the RSV season.

Presently, Global Medical and Health Services, Baltimore is undergoing seasonal RSV prevention by prophylactically using the Synagis every month for our high-risk clients. This is on-going and will continue throughout the RSV season. Each year, 125,000 infants in the United State are hospitalized with severe RSV infections, the leading cause of infant hospitalization, and severe RSV infections cause up to 500 deaths annually (MedImmune, 2005).

WAYS TO HELP PREVENT THE SPREAD OF RSV

RSV is easily spread by physical contact. Touching, kissing, and shaking hands with an infected person can spread RSV. It is also spread by coughing or sneezing and can live up to six hours on countertops and for several hours on used tissue. RSV usually spreads very quickly. Nearly all babies get RSV by the age of two. Here are some ways you can help prevent the spread of RSV:

  • Wash your hands before touching a baby and ask others to do the same.
  • Keep babies away from crowds, especially other young children during the period of the RSV infection outbreak (winter periods).
  • Keep people with colds away from infants in your care
  • Wash the baby’s toys and bedding (share this information with the primary caregiver)
  • Do not smoke near your client and do not let others smoke near your client. Exposure to tobacco smoke increases the risk of RSV.

PROTECT OUR PEDIATRIC CLIENTS TO BE HEALTHY TODAY, FOR A HEALTHIER TOMORROW!!!!

REFERENCES:

  • Kathleen, MS. Pediatric Care Planning, 3rd ed. Pennsylvania; Springhouse Corp. 1999.
  • Lippincott Williams & Wilkins. Nurse’s three-minute clinical reference, ed. PA., 2003
  • Wong, D.L., et., Wong’s Essentials of Pediatric Nursing, 6th ed. MI; Mosby, Inc., 2001
  • MedImmune 2005. Avoiding the spread of RSV-RSV protection.

SEASONAL ALLERGY, PREVENTION, AND NURSING CONSIDERATIONS

By: Dr. Betrand N. Okwesili, NP; MSc; M.B.B.Ch; BSc; CM/DM

An allergy is an abnormal or pathological reaction to environmental substances such as pollen, food, dust, or microorganisms, while allergic reactions or hypersensitivity reactions are the inappropriate immune responses to a normally harmless substance. Two out of every ten (10) people suffer from some form of allergy arising from a hyperactive immune system (Hypersensitivity). People who are not hypersensitive can breathe, taste, and touch things that are a normal part of the environment without suffering. The unlucky few percentages of hypersensitive people have immune systems that overreact to one or more things. Their immune systems are too vigorous in defending the body against certain foreign invaders. The normal immune system includes antibodies, white blood cells, mast cells, complement proteins and other substances (called antigens). In susceptible people, the immune system can overreact to certain antigens (called allergens) which are harmless in most people. the result is an allergic reaction. Some people are allergic to one substance, others are allergic to many. A seasonal allergy is a result of the exposure to airborne substances (such as pollens) that appear only during certain times of the year. A seasonal allergy (commonly called “hay fever”), occurs only during certain times of the year particularly the Spring, Summer, or Fall, depending on what the person is allergic to. The term “hey fever” commonly associated with the seasonal allergy is a misnomer because any fever associated with a seasonal allergy should not be taken with a pinch of salt. A seasonal allergy or “hay fever” is usually a reaction to pollens and grasses. Different parts of the globe have very different seasons and so also different parts of the United States have very different pollen seasons. People may react to one or more pollens, so a person’s pollen allergy season may be from early Spring to late Fall. Seasonal allergies are also caused by mold spores, which can be airborne for long periods during the Spring, Summer, and Fall. Other causes include animal dander, house dust, and dust mites. Primarily the part of the body affected by the pollen, which comes in contact with them in allergic reactions includes; nurse and the doctorsthe membrane lining of the nose, causing allergic rhinitis or the membrane lining of the eyelids and covering the whites of the eyes (conjunctiva) causing allergic conjunctivitis. Rhinitis and conjunctivitis may be caused by other disorders. A seasonal allergy may trigger off an asthmatic attack in an asthmatic individual, causing bronchial constriction with resultant dyspnoea and wheezing respiratory sounds.

Pathophysiology

Allergen may cause an allergic reaction when they land on skin or in the eye, are inhaled, are eaten, or are injected. An allergic reaction can occur as part of a seasonal allergy (such as hey fever) caused by exposure to such substances as grass or pollen, breathing in dust, or animal dander. When exposed to an allergen, the immune system produces a type of antibody called immunoglobulin E (IgE). This binds to the white blood cell basophil in the bloodstream and the mast cells in the tissues. The individual becomes sensitized on first exposure, the cells that have IgE on their surface release substances such as histamine, prostaglandin, and leukotrienes. These substances cause inflammation in the surrounding tissues resulting in swelling. These substances begin a cascade of reactions that continue to irritate and harm tissues; these may range from mild to severe reactions.

Signs and Symptoms

  • Itching – Seasonal allergy can cause itching of the nose, the roof of the mouth, back of the throat and eyes. Itching may start gradually or abruptly. The itching is sometimes severe that individual causes breakage of the membrane during vigorous itching, which results in infection. Itching, skin rashes, including hives, are also common.
  • Rhinorrhea – Due to the inflamed nasal mucosa (rhinitis) the nose runs, producing a clear, watery discharge and may become stuffy. Clear watery discharge from the nose and itching are pathognomonic of seasonal allergy in the absence of other upper respiratory tract infections.
  • Sneezing – This is very common in seasonal allergy due to the continual irritation of the cilia mucosal lining of the nose and upper respiratory tracts.
  • Conjunctivitis – Allergic conjunctivitis may result when airborne substances, such as pollens, contact the eyes directly causing profuse itching, tearing, and the whites of the eyes and the eyelids may become red and swollen. Wearing contact lenses can irritate the eyes further.
  • Anosmia – Loss of smell may result in the inflammation of the olfactory bulb in the nasal mucosa.
  • Other symptoms include headache, coughing, wheezing, and irritability.
  • More rarely, depression, loss of appetite, and insomnia may develop.

Treatment

Antihistamines – They competitively block the effects of histamine at peripheral H1 receptor sites. They also have anticholinergic (atropine-like) and antipruritic effects. These include;

  • Diphenhydramine
  • Brompheniramine maleate
  • Chlorpheniramine maleate,

as ordered by the physician.

Nasal Decongestant – Such as pseudoephedrine to help relieve a stuffy nose. Antihistamine and nasal decongestants may come in combination as a single tablet. Also, non-prescription nasal decongestant sprays are available; but these sprays should not be used more than a few days at a time, as prolonged use may worsen or prolong nasal congestion. cromolyn, which is available as a non-prescription nasal spray may be useful. Corticosteroid nasal spray may be prescribed by the physician if the above non-prescription medications are not effective.

Artificial tears – Can be used to wash the eye in allergic conjunctivitis to help reduce irritation. Other eye drops are also available depending on the physician’s discretion. Prolong use of eye drops containing vasoconstrictors to relieve the redness of the eyes can worsen conjunctivitis. Corticosteroid use for a long period may predispose the individual to glaucoma, hence regular check of intra-ocular pressure is recommended.

Prevention and Nursing Considerations

Avoiding an allergen if possible is the best approach. The way to protect one from an allergic reaction is to know what one is allergic to and to avoid the allergen whenever possible. At present, various tests are available that detects the specific pollen origin that causes individuals allergic reaction. Your physician will assist you to determine which test is appropriate and how to go about it. If your allergy is to certain grasses or trees; pay attention to the cycle of pollination where you live. Staying in an air-conditioned building will help. Be sure that air filters are kept clean. An electronic filter incorporated in a central heating and air-conditioning system will help. If mold or fungi are implicated in allergy, they can be especially heavy around grains, trees, and other plants. Cottages that have been closed for Winter can be full of mold. When in contact with such areas, a protective mask may be of help. All individuals on corticosteroid therapy must be observed for infections as corticosteroid suppresses immunity and may make the individual susceptible to opportunistic infections. When an infection is suspected, this should be reported appropriately to the physician’s concern. Check for a rise in ocular pressure regularly for individuals on prolonged use of corticosteroid eye drop preparations. If no particular pollen grain is known as the cause of the seasonal allergy, it might be suggested that individuals should wear a protective breathing mask when outside during periods of pollination cycle to avoid inhalation of pollen grains, abundant in the air at that particular period.

REFERENCES:

  • Friedlander, Mark P., Et al. The Immune System, Your Body’s Disease Fighting Army, Lerner Publication Company, Minneapolis.
  • Mark H. Beers Et Al. The Merck Manual of Medical Information. 2nd Home Edition; Merck Research Laboratories; White House Station, NJ 2003
  • Lawrence M. Tierney, Jr. Et. Al. 2005 Lange Current Medical Diagnosis & Treatment, 44th Edition. McGraw-Hill Companies, Inc; NY
  • Amy M. Karch; Lippincott’s Nursing drug guide 2005; Lippincott Williams & Wilkins, Philadelphia.

Coronavirus Disease (COVID-19) Outbreak, Spread, and Prevention Based on CDC and WHO Perspectives.

Dr. Betrand N. Okwesili, NP; MSc; M.B.B.Ch; BSc; CM/DN

President/ CEO
GMHS, LLC & GMHSB, Inc
Asst. Professor of Human Anatomy & Physiology
Adjunct Faculty
BCCC.

Coronavirus occurs as a big family of Viruses that produce ailment varying from the common cold to farther critical illnesses such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). Coronaviruses are zoonotic, indicating that they are transmitted between animals and people. The novel coronavirus (nCoV) is a new strain that has not been previously identified in humans (World Health Organization [WHO], 2020).

The outbreak of respiratory disease caused by the novel (new) coronavirus that was first detected in Wuhan City, Hubei Province, China has now been detected in 37 locations internationally, including the United States. The virus which has been named “SARS-CoV-2” is responsible for causing the coronavirus disease 2019 (COVID-19). The International Health Regulations Emergency Committee of the WHO declared the outbreak a “public health emergency of international concern” (PHEIC). The Secretary of the US Health and Human Services declared a public health emergency (PHE) for the United States to aid the nation’s healthcare community in responding to COVID-19 (Centers for Disease Control and Prevention [CDC], 2020).
According to the CDC, 2020 the source and spread of the viruses common in many different species of animals include bats, cattle, cats, and camels. According to CDC, 2020; although rarely, animal coronaviruses can infect people and then spread between people such as with MERS-CoV, SARS-CoV, and now with this new virus (named SARS-CoV-2). The SARS-CoV-2 virus is a betacoronavirus, in the same way as MERS-CoV and SARS-CoV. All these viruses, according to CDC, 2020 have their pedigrees in bats. The progressions from U.S. patients are like the ones that China primarily displayed, indicating a possible single, recent development of this virus from an animal pool (CDC, 2020). In the beginning, several of the patients in the COVID-19 eruption in Wuhan, China had a certain relation to significant seafood and live animal arcade, insinuating animal-to-person spread. Soon, a rising figure of patients who did not have contact with animal arcades, signifying person-to-person disseminate. Person-to-person spread has been reported outside China, including in the United States and other locations (CDC, 2020).
Current understanding about how the virus COVID-19 spreads is largely based on what is known about similar coronaviruses. As indicated by the CDC, 2020, the virus is thought to spread mainly from:
Person-to-person: Between people who are in close contact with one another (within about 6 feet). Via respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.
Spread from contact with infected surfaces or objects: It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.
For substantiated COVID-19 cases, as noted by CDC, 2020; reported infections have varied from mild symptoms to severe illness and even death. Symptoms can include:

  • Fever
  • Cough
  • Shortness of breath

CDC believes at this time that symptoms of COVID-19 may appear in as few as 2 days or up to 14 days after exposure. This is based on what has been seen previously as the incubation period of MERS-CoV viruses (CDC, 2020).
There is currently no vaccine to prevent COVID-19. The best way, as has always been to prevent illness is to avoid being exposed to this virus. CDC as usual, recommends everyday preventive actions to help prevent the spread of respiratory diseases. Management of Global Medical & Health Services, LLC always implores its healthcare personnel to be proactive in not only preventing infection and spread of diseases but to also educate our numerous patients and families on how to do the same to stay healthy. GMHS, LLC follows the CDC recommendations in preventing infection and spread of disease by adhering to the following:

  • It’s currently flu and respiratory disease season and CDC recommends getting a flu vaccine, taking everyday preventive actions to help stop the spread of germs, and taking flu antivirals if prescribed. GMHS, LLC health care providers must ensure that their flu shots records are up to date.
  • Avoid close contact with people who are sick.
  • Avoid touching your eyes, nose, and mouth.
  • Stay home when you are sick.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
  • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
  • Follow CDC’s recommendations for using a facemask.
  • CDC does not recommend that people who are well wearing a facemask to protect themselves from respiratory diseases, including COVID-19.
  • Facemasks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to others. The use of facemasks is also crucial for health workers and people who are taking care of someone in close settings (at home or in a health care facility).
  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.
  • If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.

For information about handwashing, see GMHS, LLC’s Handwashing policy and procedure manual, and GMHS, LLC Handwashing Technique.
For information specific to healthcare, see CDC’s Hand Hygiene in Healthcare Settings, and the GMHS, LLC Handwashing Technique.
These are everyday habits that can help prevent the spread of several viruses. CDC does have specific guidance for travelers, endeavor to consult their website for such information as pertains to traveling. The above are informational and are based strictly on CDC recommendations and suggestions. The outbreak of COVID-19 in the USA is seriously being anticipated with great anxiety. “It is not so much a question of if this will happen anymore, but more really a question of when it will happen – and how many people in this country (USA) will have a severe illness.” – Dr. Nancy Messonnier – CDC. (Stein & Wamsley, 2020). The management of GMHS, LLC advises all its numerous health care providers, patients, and families to be very alert for further information and instructions as may be released by the CDC, as we embrace the anticipated scourge.

REFERENCES:

GMHS, LLC Update on COVID-19 and CMS Memorandum

Dr. Betrand N. Okwesili, NP; MSc; M.B.B.Ch; BSc; CM/DM
President/ CEO
GMHS, LLC, GMHSB, Inc and OGMHL
Asst. Professor of Anatomy & Physiology
Adjunct Faculty – BCCC

Date: 03/10/2020

The World Health Organization (WHO), through its Director-General, Dr. Tedros Adhanam Ghebreyesus, declared the global coronavirus (COVID-19) crisis a “pandemic” crisis. A pandemic outbreak of disease implies an outbreak occurring over a wide geographic area and affects an exceptionally high proportion of the population. Based on the COVID-19 more than 118,000 cases, seen in more than 110 countries and territories all over the globe, with great anxiety on the persistent rising threat regarding the extent of global spread; hence the characterization of it spread like a pandemic. The implication of these universally is that the continuous spread of the virus is likely hence should be prepared for the possibility of extensive community infestation of the disease.

The international travel ban is already in place in the USA. The Chief State Executive of the State of Maryland has directed the Maryland Emergency Management Agency to move to its highest activation level, and he has enacted an executive order to activate the National Guard. He also directed the closure of all the public schools in the state. Additionally, the governor ordered that social, community, religious, recreational, or sports gatherings or events of more than 250 people are prohibited. The governor ordered that hospitals must put visitation restrictions in place.

Global Medical & Health Services, LLC (GMHS, LLC), is following all the modalities and instructions as stated and outlined by both the Center for Disease Control and Prevention (CDC), and the World Health Organization (WHO). GMHS, LLC follows the State of Maryland’s plans and precautionary efforts in containing the COVID-19 scourge and spread in the State. GMHS, LLC is committed to protecting its patients, families, and staff by ensuring that we have and provide up-to-date information to adequately respond to COVID-19 appropriately. GMHS, LLC is also following the Center for Clinical Standards and Quality/Quality, Safety & Oversight Group of the Department of Health & Human Services, Centers for Medicare & Medicaid Services Guidance for Infection Control and Prevention Concerning Coronavirus disease 2019 (COVID-19) in Home Health Agencies (HHAs). They provided the following HHA guidance for admitting and treating patients with known or suspected COVID-19:

At risk for severe disease for COVID-19 – Based on the CDC data, these include elder adults or those with an underlying chronic medical condition that may be most at risk for severe outcomes.

Screening patients for COVID-19 – During home visits, patients at risk for COVID-19 should be identified before or immediately upon arrival to the home by asking the following: international travel within the last 14 days to countries with sustained community transmission. Signs and symptoms of respiratory infection including fever, cough, and sore throat. Inquire contact with someone with or COVID-19 or are ill with respiratory illness in the last 14 days. Residing in a community where the community-based spread of COVID-19 is occurring.

For ill patients with COVID-19 – Implement source control measures by placing a face mask over the patients’ nose and mouth if that has not been done already. The clinical case manager, local and state public health authorities should be informed about the presence of a person under investigation (PUI) for COVID-19.

Health care providers (HCP) who have signs and symptoms of respiratory infection should not report to work. Any staff that develops signs and symptoms of a respiratory infection while on-the-job, should: Immediately stop work, put on a facemask, and self-isolate at home; Inform the HHA clinical manager on individuals, equipment, and locations the person came in contact with; and contact and follow the local health department recommendations for next steps e.g., testing, locations for treatment.

Where to get the COVID-19 test? – Enter your zip code to find out the nearest COVID-19 test from the US HRSA.gov website; https://findahealthcenter.hrsa.gov/

HHAs should contact their local health department for questions, and frequently review the CDC website dedicated to COVID-19 for health care professionals @ http://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-home-care.html

What are recommended infection prevention and control practices, including considerations for family member exposure, when evaluating and caring for patients with known or suspected COVID-19?– The CDC advises the patient to stay home except to get medical care, separate yourself from other people and animals in the home as much as possible (in a separate room with the door closed), call ahead before visiting your doctor, and wear a facemask in the presence of others when out of the patient room. For everyone in the home, CDC advises covering coughs and sneezes followed by hand washing or using an alcohol-based hand rub, not sharing personal items (dishes, eating utensils, bedding) with individuals with known or suspected COVID-19, cleaning all “high-touch” surfaces daily, and monitoring for symptoms. GMHS, LLC ask patients and families to share additional information as contained in https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-preventspread.html%20and%20https://www.cdc.gov/coronavirus/2019-ncov/community/home/index.html

What Personal Protective Equipment (PPE) should home care staff routinely use when visiting the home of a patient suspected of COVID-19 exposure or confirmed exposure? – If care to patients with respiratory or gastrointestinal symptoms who are confirmed or presumed to be COVID-19 positive is anticipated, then HHAs should refer to the Interim Guidance for Public Health Personnel Evaluating Persons Under Investigation (PUIs) and Asymptomatic Close Contacts of Confirmed Cases at Their Home or Non-Home Residential Settings: https://www.cdc.gov/coronavirus/2019-ncov/php/guidance-evaluating-pui.html

Hand hygiene should be performed before putting on and after removing PPE using an alcohol-based hand sanitizer that contains 60 to 95% alcohol.
PPE should ideally be put on outside of the home prior to entry into the home. If unable to put on all PPE outside of the home, it is still preferred that face protection (i.e., respiratory and eye protection) be put on before entering the home. Alert persons within the home that the public health personnel will be entering the home and ask them to move to a different room, if possible, or keep a 6-foot distance in the same room. Once the entry area is clear, enter the home and put on a gown and gloves.
Ask the person being tested if an external trash can is present at the home, or if one can be left outside for the disposal of PPE. PPE should ideally be removed outside of the home and discarded by placing in the external trash can before departing location. PPE should not be taken from the home of the person being tested in public health personnel’s vehicle.

If unable to remove all PPE outside of the home, it is still preferred that face protection (i.e., respiratory and eye protection) be removed after exiting the home. If gown and gloves must be removed in the home, ask persons within the home to move to a different room, if possible, or keep a 6-foot distance in the same room. Once the entry area is clear, remove the gown and gloves and exit the home. Once outside the home, perform hand hygiene with alcohol-based hand sanitizer that contains 60 to 95% alcohol, remove face protection and discard PPE by placing in the external trash can before departing location. Perform hand hygiene again.

When is it safe to discontinue transmission-based precautions for home care patients with COVID-19?
– The decision to discontinue transmission-based Precautions for home care patients with COVID-19 should be made in consultation with clinicians, infection prevention and control specialists, and public health officials. This decision should consider disease severity, illness signs and symptoms, and results of laboratory testing for COVID-19 in respiratory specimens. For more details, please refer to https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-inhome-patients.html

Considerations to discontinue in-home isolation include all the following:

  • Resolution of fever, without the use of antipyretic medication
  • Improvement in illness signs and symptoms
  • Negative results of an FDA Emergency Use Authorized molecular assay for COVID-19 from at least two consecutive sets of paired nasopharyngeal and throat swabs specimens collected ≥24 hours apart* (total of four negative specimens— two nasopharyngeal and two throats). See Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Patients Under Investigation (PUIs) for 2019 Novel Coronavirus (2019-nCoV) for specimen collection guidance.

*Initial guidance is based upon limited information and is subject to change as more information becomes available. In persons with a persistent productive cough, SARS-CoV-2-RNA might be detected for longer periods in sputum specimens than in the upper respiratory tract (nasopharyngeal swab and throat swab) specimens.

Protocols for Coordination and Investigation of Home Health Agencies with Actual or Suspected COVID-19 Cases– During a home health agency survey, when a COVID-19 confirmed case or suspected case (including PUI) is identified, the surveyors will confirm that the agency has reported the case to public health officials as required by state law and will work with the agency to review infection prevention and education practices. Confirm that the HHA has the most recent information provided by the CDC.

Based on the above, GMHS, LLC is imploring its patients and families to call and report to GMHS, LLC if the patient or any member of the family has symptoms or is diagnosed with COVID-19 or is a PUI.

GMHS, LLC is making every effort to ensure that our patients, their families, and our staff are safe and protected against this pandemic outbreak. We encourage all to continue with the maintenance and practice of proper hand hygiene as has always been reiterated by the GMHS, LLC policy on universal precautions. Handwashing with plain soap and water for about 20 seconds or use of alcohol 60% and above-based hand sanitizer remain the mainstay of prevention of viral and other germs infection/ spread. Proper wiping of surfaces with household antiseptic wipes should be practiced frequently in homes around patient care. All equipment should be properly sanitized using the appropriate sanitizing antiseptics. Please consult our policy on handwashing and technique for handwashing. For questions and clarifications, please call our corporate office at 410 486 0516 during the office hours or 443 657 3723 for after-hours calls.

REFERENCES:

  • Center for Disease Control and Prevention [CDC] (2020). Interim Guidance for Public Health Personnel Evaluating Persons Under Investigation (PUIs) and Asymptomatic Close Contacts of Confirmed Cases at Their Home or Non-Home Residential Settings. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/php/guidance-evaluating-pui.html
  • Department of Health & Human Services (2020). Guidance for Infection Control and Prevention Concerning Coronavirus Disease 2019 (COVID-19) in Home Health Agencies (HHAs). Center for Medicare & Medicaid Services (CMS). Center for Clinical Standards and Quality, Safety & Oversight Group. 7500 Security Boulevard, Mail Stop C2-21-16. Baltimore, MD 21244-1850.
  • U.S. Department of Health & Human Services (nd). COVID-19 Notice. HRSA Data Warehouse. Find a Health Center. Retrieved from: https://findahealthcenter.hrsa.gov/

Coronavirus Disease 2019 (COVID-19) Pandemic Outbreak: Get Your Home Ready

Dr. Betrand N. Okwesili, NP; MSc; M.B.B.Ch; BSc; CM/DN.
President/ CEO
GMHS, LLC, GMHSB, INC & OGMHL
Asst. Professor of Human Anatomy & Physiology
Adjunct Faculty
BCCC; MD – USA.

03/16/2020

This interim guidance is based on what is currently known about the Coronavirus Disease 2019 (COVID-19), as enumerated by the Center for Diseases Control and Prevention (CDC). The center will continue to update the guidance as needed, and we at Global Medical & Health Services, LLC (GMHS, LLC) will provide the information when available to our numerous patients, families, health care providers, and staff members respectively.

COVID-19 is caused by a new virus (Center for Disease Control & Prevention (CDC) [2020]). There is much to learn about its transmissibility, severity, and other features of the disease. We at GMHS, LLC will endeavor to create awareness to everyone to prepare to respond to this public health threat.

Before a COVID-19 outbreak occurs in your community: Plan

A COVID-19 outbreak could last for a long time when it hits our community. Depending on the severity of the outbreak, public health officials may recommend community actions designed to help keep people healthy, reduce exposures to COVID-19, and slow the spread of the disease. Local public health officials may make recommendations appropriate to your local situation. Creating a household plan can help protect your health and the health of those you care about in the event of an outbreak of COVID-19 in your community. You should base the details of your household plan on the needs and daily routine of your household members.

Create a household plan of action:

Talk with the people who need to be included in your plan. Meet with household members, other relatives, and friends to discuss what to do if a COVID-19 outbreak occurs in your community and what the needs of each person will be.

Plan ways to care for those who might be at greater risk for serious complications.From the data that are available for COVID-19 patients, and from data for related coronaviruses such as SARS-CoV and MERS-CoV, it is possible that older adults and persons who have underlying chronic medical conditions may be at risk for more serious complications. Early data suggest older people are more likely to have serious COVID-19 illness. If you or your household members are at increased risk for COVID-19 complications, please consult with your health care provider for more information about monitoring your health for symptoms suggestive of COVID-19. CDC will recommend actions to help keep people at high risk for complications healthy if a COVID-19 outbreak occurs in your community.

Identify aid organizations in your community.Create a list of local organizations that you and your household can contact in the event you need access to information, health care services, support, and resources. Consider including organizations that provide mental health or counseling services, food, and other supplies.

Create an emergency contact list.Ensure your household has a current list of emergency contacts for family, friends, neighbors, carpool drivers, health care providers, teachers, employers, the local public health department, and other community resources.

Practice good personal health habits and plan for home-based actions.Practice everyday preventive actions now. Remind everyone in your household of the importance of practicing everyday preventive actions that can help prevent the spread of respiratory illnesses:

  • Avoid close contact with people who are sick.
  • Stay home when you are sick, except to get medical care.
  • Cover your coughs and sneezes with a tissue.
  • Clean frequently touched surfaces and objects daily (e.g., tables, countertops, light switches, doorknobs, and cabinet handles) using regular household detergent and water or disinfectant spray.
  • If surfaces are dirty, they should be cleaned using a detergent and water prior to disinfection. For disinfection, a list of products with Environmental Protection Agency (EPA)-approved emerging viral pathogens claims, maintained by the American Chemistry Council Center for Biocide Chemistries (CBC), is available at Novel Coronavirus (COVID-19) Fighting Products @ https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf
  • Always follow the manufacturer’s instructions for all cleaning and disinfection products.
  • Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing. If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Always wash your hands with soap and water if your hands are visibly dirty.
  • Choose a room in your home that can be used to separate sick household members from those who are healthy. Identify a separate bathroom for the sick person to use, if possible. Plan to clean these rooms, as needed, when someone is sick. Learn how to care for someone with COVID-19 at home.

Be prepared if your child’s school or childcare facility is temporarily closed.

Learn about the emergency operations plan at your child’s school or childcare facility. During a COVID-19 outbreak in our community, as is now, the local public health department through the governor of the State of Maryland ordered the closure of all public schools in the State to help slow the spread of illness. Understand the plan for continuing education and social services (such as student meal programs) during school closure. If your child attends a college or university, encourage them to learn about the school’s plan for a COVID-19 outbreak.
Plan for potential changes at your workplace.

Learn about your employer’s emergency operations plan. Discuss sick-leave policies and telework options for workers who are sick or who need to stay home to care for sick household members. Learn how businesses and employers can plan for and respond to COVID-19.
During a COVID-19 outbreak in your community: Act

During an outbreak in your community, protect yourself and others by:

  • Staying home from work, school, and all activities when you are sick with COVID-19 symptoms, which may include fever, cough, and difficulty breathing.
  • Keeping away from others who are sick.
  • Limiting close contact with others as much as possible (about 6 feet).
  • Put your household plan into action

Stay informed about the local COVID-19 situation. Get up-to-date information about local COVID-19 activity from public health officials of the State of Maryland.
Be aware of school closure in your area, as this may affect your household’s daily routine.
Stay home if you are sick. Stay home if you have COVID-19 symptoms. If a member of your household is sick, stay home from school and work to avoid spreading COVID-19 to others.
Patients and families are encouraged to maintain a 30-day supply of medications and medical supplies as well as a two-week supply of non-perishable food and water.
If your children are in the care of others, urge caregivers to watch for COVID-19 symptoms.
Continue practicing everyday preventive actions. Cover coughs and sneezes with a tissue and wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use a hand sanitizer that contains 60% alcohol. Clean frequently touched surfaces and objects daily using regular household detergent and water.
Use the separate room and bathroom you prepared for sick household members (if possible). Learn how to care for someone with COVID-19 at home. Avoid sharing personal items like food and drinks. Provide your sick household member with clean disposable facemasks to wear at home, if available, to help prevent spreading COVID-19 to others. Clean the sick room and bathroom, as needed, to avoid unnecessary contact with the sick person.
If surfaces are dirty, they should be cleaned using a detergent and water prior to disinfection. For disinfection, a list of products with EPA-approved emerging viral pathogens claims, maintained by the CBC, is available at Novel Coronavirus (COVID-19) Fighting Products @ https://www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf. Always follow the manufacturer’s instructions for all cleaning and disinfection products.
Stay in touch with others by phone or email. If you live alone and become sick during a COVID-19 outbreak, you may need help. If you have a chronic medical condition and live alone, ask family, friends, and health care providers to check on you during an outbreak. Stay in touch with family and friends with chronic medical conditions.
Take care of the emotional health of your household members. Outbreaks can be stressful for adults and children. Children respond differently to stressful situations than adults. Talk with your children about the outbreak, try to stay calm, and reassure them that they are safe.
Take the following steps to help protect your children during an outbreak

If your child/children who are under the care of GMHS, LLC becomes sick with COVID-19, or a member of the family is involved, please follow the CDC guide by making sure that the child puts on a face mask immediately. Notify GMHS, LLC immediately. This is very important because the healthcare provider caring for the child must be well protected by wearing personal protective equipment (PPE) to avoid being infected and spreading the infection further. GMHS, LLC has very limited reusable PPEs for its health care providers in preparation in case they have to care for any of our patients diagnosed with COVID-19. GMHS, LLC encourages families with the at-risk patient to ask for PPE from their Durable Medical Equipment (DME) supply providers, for their own use in caring for any child or member of the family that came down with COVID-19. Our health care providers are independent contractors, hence are supposed to provide their own PPE. We encourage them to have their own PPE in case of such a pandemic outbreak. Although GMHS, LLC has them in a very limited amount to augment the situation. Put the affected child in the previously suggested room, in isolation from others, and the door of the room must always be closed. Do not share any utensil with other children and family members that are well. Before going for any appointment or hospital visit, call in advance and the individual must be on the face mask. Keep pets and other well individuals away from the infected child. Discourage children and teens from gathering in other public places while school is closed to help slow the spread of COVID-19 in the community.

REFERENCES:

GMHS Seq For Putting on PPE

GMHS, LLC: Use of Face Mask in COVID-19 Pandemic Outbreak, Including COVID-19 Pandemic Updates.

Dr. Betrand N. Okwesili, NP; MSc; M.B.B.Ch; BSc; CM/DN
President/ CEO
GMHS, LLC, GMHSB, INC & OGMHL
Asst. Professor of Human Anatomy & Physiology
Adjunct Faculty
BCCC; MD – USA.

04/10/2020

We are witnessing a substantial increase in the number of infections with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that caused coronavirus disease 2019 (COVID-19), in Maryland. The disease was first noticed in China from where it spreads to other parts of the globe in pandemic proportions. In response to this, the authorities have imposed drastic restrictions on the everyday life of Marylanders, in a move to slow down any further spread of the virus. Following the Director-General of WHO declaration of the spate of infections caused by COVID-19 a pandemic, the use of face masks by the general public has become controversial and a subject of discussion. The management of Global Medical & Health Services, LLC (GMHS, LLC) will continue to update its health care providers workforce, families/ patients and the entire public on the current measures to stay safe, in this pandemic. The World Health Organization [WHO] (2020), advised that, if you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection; wear a mask if you are coughing or sneezing; and that masks are effective only when used in combination with frequent hand-cleaning with alcohol-based hand rub or soap and water. The caveat here is that a healthy individual does not require to wear a mask in public. This also was supported based on the fact that if masks are worn by the general public, there will be a shortage of masks for the frontline health care workers who are more exposed to COVID-19 in their efforts to care and treat patients. US Surgeon General advised against buying masks for use by healthy people, again his reason being to preserve limited supplies for professional use in health-care settings (Feng, S., Shen, C., … Cowling, B. J., 2020). Universal face mask use in the community has also been discouraged with the argument that face masks provide no effective protection against coronavirus infection (Feng, S. et al., 2020).

In a recent publication, the Center for Disease Control and Prevention [CDC] (2020) reiterated that; the best way to prevent illness is to avoid being exposed to this virus. The virus is thought to spread mainly from person-to-person. Between people who are in close contact with one another (within about 6 feet). Through respiratory droplets produced when an infected person coughs, sneezes or talks. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs (CDC, 2020). Some recent studies have suggested that COVID-19 may be spread by people who are not showing symptoms (CDC, 2020). The CDC continues to reiterate that, cleaning by washing the hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing, remains the mainstay. If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol.

ghms hand sanitizer
ghms hand sanitizer

GMHS, LLC Hand Sanitizer Spray and Rub; compounded based on WHO recommendations.

Cover all surfaces of your hands and rub them together until they feel dry. Avoid touching your eyes, nose, and mouth with unwashed hands. Avoid close contact and avoid close contact with people who are sick. Stay home as much as possible. Put distance between yourself and other people. Remember that some people without symptoms may be able to spread the virus. Keeping distance from others is especially important for people who are at higher risk of getting very sick. Cover your mouth and nose with a cloth face cover when around others. You could spread COVID-19 to others even if you do not feel sick. Everyone should wear a cloth face cover when they must go out in public, for example to the grocery store or to pick up other necessities (CDC, 2020). Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance. The cloth face cover is meant to protect other people in case you are infected. Do NOT use a facemask meant for a healthcare worker. Continue to keep about 6 feet between yourself and others. The cloth face cover is not a substitute for social distancing.

face mask
face mask

GMHS, LLC Face Mask

When having respiratory symptoms, wear a surgical mask, refrain from work or attending class at school, avoid going to crowded places and seek medical advice promptly. N95 respirators are generally not recommended for use by the general public in community settings because special training is required for proper wearing and removal of the mask (Center for Health Protection, 2020). Otherwise, the infective risk due to inadequate protection and contamination may be ironically increased. Avoid going to crowded places with poor ventilation if you are feeling unwell. Maintenance of good personal hygiene, maintenance of good environmental hygiene, and maintaining of a healthy lifestyle cannot be overemphasized. Building up good body resistance and maintenance a healthy lifestyle, can be achieved through a balanced diet, regular exercise, and adequate rest. Do not smoke and avoid alcohol consumption.

Also, GMHS, LLC’s health care providers are reinforced to continue to make use of telehealth appropriately. This includes but not limited to continue triaging patients and families for fever, any symptoms of cough, sneezing, difficulty breathing, any history of returning from a recent journey; before heading for a home visit. The GMHS, LLC’s health care providers are also reminded that they should not go to work if they notice any symptoms of COVID-19, and should immediately report the same to the GMHS, LLC’s on-call.

REFERENCES: