Nursing care for the sars?

As a nurse, you're on the front lines. Assessing patients, you could be the first health care professional to recognize that a patient has signs and symptoms of SARS. In SARS with moderate respiratory illness, you'll note a fever higher than 100.4掳 F (38掳 C) and one or more of the following symptoms: cough, shortness of breath, difficulty breathing, or hypoxia.

In SARS with severe symptoms of respiratory illness, you'll find a temperature greater than 100.4掳 F, one or more of the previously mentioned clinical signs and symptoms, and a chest X-ray that reveals pneumonia or acute respiratory distress syndrome (ARDS). The chest X-ray may be normal at first, but changes may appear 3 or 4 days following infection, particularly in the lung bases.

If your patient has some or all of these suspicious signs and symptoms, take a detailed medical and travel history to determine his risk of exposure to SARS. Suspect SARS if he reports either of the following circumstances within 10 days of symptom onset:

* travel to an area with a known or suspected SARS outbreak. Just passing through the airport counts. The CDC Web site (httpV/www.cdc.gov/ ncidod/sars/casedefinition.htm) can tell you which areas qualify

* close contact with someone known or suspected to have SARS.

If you work in a primary care provider's office and suspect that a patient has SARS, contact the hospital before sending the patient there, so that hospital staff can make arrangements to prevent transmission of SARS to others in the facility.

If you suspect SARS...

Immediately have your patient put on a surgical face mask and make arrangements to isolate him, ideally in a negative-pressure isolation room. Protect yourself by donning an N95 disposable paniculate respirator or surgical mask, gown, gloves, and eye protection and observing meticulous hand hygiene.

The World Health Organization (WHO) recommends that any health care provider caring for a patient with a suspected case of SARS notify local public health authorities as soon as possible, so the patient's close contacts can be tracked and monitored. (Health Canada recommends similar management strategies.)

Diagnostic tests for SARS

The SARS virus may be detected in a patient's nasopharyngeal or oropharyngeal secretions, blood serum, or stool. The CDC, as well as many state public health labs, can process specimens. Three types of diagnostic tests are used for SARS:

* a reverse transcription polymerase chain reaction test to detect RNA of SARS-CoV Two tests on two different specimens must be positive to confirm SARS.

* serum tests to detect antibodies IgM (gamma M immunoglobulin) and IgG (gamma G immunoglobulin). The test result is negative if no SARS-CoV antibodies are found in serum obtained more than 28 days after symptom onset.

* a viral cell culture test to detect SARS-CoV

In September 2003, a 15-minute, palm-sized SARS detection kit was developed by Genelabs Diagnostics and the Institute of Molecular and Cell Biology, both of Singapore. This test generates accurate results with just a drop of serum, plasma, or blood and is designed to be used by people without special training in locations (such as airports) where lab facilities aren't available. The test is expected to be available to hospitals soon.

Other helpful tests

Along with baseline vital signs, chest X-rays, and the diagnostic tests listed above, tests that may help confirm or rule out SARS include a complete blood cell count, arterial blood gas analysis and pulse oximetry values, clotting profile, respiratory viral panel for influenza A and B and respiratory syncytial viruses, metabolic profile, examination of bronchoalveolar lavage from the lower respiratory tract, C-reactive protein test, and Legionella and pneumococcal urinary antigen testing.

Patients with SARS may have lymphopenia and mild thrombocytopenia. Activated partial thromboplastin time is prolonged, but prothrombin time is normal. Liver function tests are difficult to interpret because of various drug effects, but a slight increase in alanine aminotransferase is consistent with SARS.

How do you know if s not SARS?

A SARS diagnosis can be ruled out if:

* another diagnosis can fully account for the patient's illness

* he tests negative for SARS-CoV serum antibodies more than 28 days after symptom onset

* he was in contact with a person thought to have SARS who was later excluded, and he hasn't traveled to an area of SARS outbreak.

You've probably already seen patients with respiratory symptoms who fear they may have SARS. Providing them with a fact sheet and telling them what symptoms to watch for may help ease their anxiety.

Asymptomatic but at risk

For asymptomatic patients with probable exposure to SARS, voluntary quarantine at home has been suggested and, in some countries, including Canada, enforced to protect the public. In the United States, health authorities recommend instead that such a person simply monitor his temperature and health status closely for 10 days, while following precautions against transmitting the virus, such as frequent hand washing and covering the mouth and nose when coughing or sneezing. If he develops a fever or respiratory symptoms, he should notify his health care provider immediately.

In Canada, home temperature monitoring for 14 days was suggested for close contacts in certain cases.

If a health care worker has an unprotected exposure to SARS during a high-risk patient-care procedure, such as intubation, nebulizer treatment, or suctioning, U.S. health authorities recommend a voluntary home quarantine of 10 days, with daily temperature measurement and monitoring by a health care provider.

what are the sars?