-THIS ESSAY IS IN REGARDS OF COVID

-THIS ESSAY IS IN REGARDS OF COVID AND THE COMMON MEDICATION THAT IS TAKEN -PLEASE HELP PROVIDE A THROUGH CONSTRUCTIVE, CRITIQUE OF WHAT WAS DONE WELL AND WHAT IMPROVMENT NEEDS TO BE DONE AS WELL -PROVIDE DIRECTIONS TO ADDITIONAL RESOURCES FOR CONSIDERATION WHEN NECESSARY -THANK YOU!! COVID-19 was introduced to the world in 2019. It was found in a tiny village in China. Many myths have come out regarding how this specific virus came to be, but what is known is that COVID-19 originated from the small village of Wuhan in China. After spreading through Asia and Europe, it reached the United States, affecting Americans lungs along the way and killing hundreds of thousands. According to a report published by the National Center of Biotechnology Information in December of 2021, “Infected epithelial cells at the site of infection secrete chemokines that recruit and activate various immune cell populations. In patients with moderate-severe COVID-19, secretory cells show a significantly increased expression of the chemokines promoting the recruitment of macrophages, T cells and mast cells.” In otherwards, COVID-19 infects cells, starts an inflammatory response, and replicates very quickly. This replication occurs most commonly in the upper respiratory tract. Inevitably, this leads to aspiration of the virus into the lungs where COVID-19 becomes the debilitating disease we are all to aware of. Although COVID-19’s pathophysiology is the same, there are comorbidities that can increase the risk of developing a more severe case of the disease. Any person that may have heart failure, diabetes mellitus, cystic fibrosis, cancer, and/or any person that is immunocompromised. These are just a few of the conditions that can put a person at greater risk of contracting COVID-19 and needing to be hospitalized and even worse, being intubated and possibly dying. The even more disturbing statistic when discussing risk factors for contracting COVID-19, are individuals that have disabilities, people that live in poverty, or the geriatric population. The Mayo Clinic reported that “81% of deaths from the disease have been in people aged 65 years or older. Risks are even higher in older people that have other health conditions.” As far as the population that live in poverty, they usually live in crowded homes that are prone to respiratory diseases and often do not have access to or can not afford higher quality health care. This increases these individuals risks factors exponentially. For the reasons named above and the increasingly dangerous amounts of hospitalizations, the U.S. government used special privileges to fund and release vaccines (Pfizer) in November/December of 2020. Many were hesitant to get vaccinated due to possible side effects and a knowledge deficit on the reasons why one should get vaccinated. Many studies were conducted, and the risk vs reward was determined it was better to get vaccinated than to not, especially if you fell into one of those “at greatest risks” groups. Fast forward to November of 2021 and the United States used emergency use for a pill form of treatment for COVID-19. This medication was a named Paxlovid and was produced by the Pfizer Corporation. Paxlovid is a combination medication. Meaning, it is two medications in one. The Department of Health and Human Resources (HHS) described Paxlovid as a mixture of nirmatrelvir and ritonavir. These are both under the classification of an antiviral medication. After researching these medications, it was determined that they work synergistically. In terms better understood by the general public, these two medications help one another to work better against COVID-19 than if used separately. A report published on the HHS website, Nirmatrelvir is a peptidomimetic inhibitor. Without getting into detail, this medication disturbs the polyprotein precursor, thus rendering the virus incapable of replication. As described earlier, COVID-19 is so devastating due to its ability to replicate quickly. Ritonavir is a HIV protease inhibitor but does not work directly on the COVID-19 virus. What ritonavir does is increase the plasma concentrations of nirmatrelvir, thus weakening COVID’s ability to reproduce itself. With any new medication, time is the greatest adversary. Only with time, and guided clinical studies will the positive and negative effects of the medication become more apparent. With that said, some adverse effects have already been distinguished. According to Yale Medicine.org, hives, dyspnea and dysphagia, hoarseness, and skin reactions can occur. These are more commonly distinguished as allergic reactions and require immediate notification of a health care provider (HCP). Yale Medicine, and more specifically Erol Fikrig MD, BA, an internal medicine and infectious disease doctor, determined that other side effects to be aware of were as followed: altered sense of taste, diarrhea, hypertension, muscle aches, abdominal pain, nausea and a “general feeling of unwellness.” Dr. Fikrig went on to say that any client taking Paxlovid should be aware of needed dosage adjustments due to this medication being cleared by the kidneys. In otherwards, if a client has any renal impairment, taking this medication should be closely monitored. Along with the adverse effects of this medication, one needs to be just as aware of the interactions between medications. The National Institute of Health (NIH) states that, “Many commonly used medications can be safely co-administered” such as omeprazole, azithromycin, Aspirin or furosemide, metformin, sumatriptan, and any lipid modifiers like pravastatin. Additionally, some immunosuppressants like prednisone or methotrexate and anti-psychotics like lorazepam or amitriptyline can be safely administered while using Paxlovid. With any new medication, notifying your HCP if you are taking over the counter (OTC) drugs due to the possibility of adverse interactions between the two. Paxlovid is such a new medication these interactions are still being determined and official results may be years in the making. As reported by Kidney.org, St. John’s Wort, ginkgo, ginseng, and ginger can put an individual at a high risk of adverse reactions leading to more damage of an already failing kidney. Kidney.org continued to say, “Some herbal supplements that act like a diuretic may cause kidney irritation or damage.” Specifically named were bucha leaves, juniper berries, Uva Ursi, and parsley. Equally important are the interventions medical professionals need to be aware of when administering Paxlovid. Assess the clients baseline blood urea nitrogen (BUN) and creatinine levels due to Paxlovid being excreted by the kidneys. Asses the client’s level of consciousness (LOC) so that changes may be recognized. A complete blood count (CBC) can be ordered for a baseline count of hemoglobin and hematocrit, along with white blood cell (WBC) counts. A CBC with differential can be ordered to have specific counts of neutrophils and eosinophils. Elevated eosinophils can determine if an allergic reaction is occurring. The nurse should verify that all bedside emergency equipment is functioning properly. Because this Paxlovid is such a new drug on the market, being very aware of any subtle changes in the client’s condition. Teaching the client of how to recognize these changes is just as important. The signs and symptoms they themselves will observe before any nurse does is vital to there safety. Patient Education Report any signs of difficulty breathing and or swallowing Hoarseness of their voice Abnormal swelling of their face Any rash that may appear Report any abdominal pain Educate the client on the use of the call light Head of bed (HOB) to be maintained at 30 degrees Reposition the client q2hr to prevent pressure wounds Keep bed locked and in lowest position Ambulate the client as tolerated Use the teach back method to identify any lack of education the client has as it pertains to what he was taught. Patient education is one of the more important, and often overlooked, strategies that can prevent any further injury to the client while simultaneously saving the heath care facility vital funds needed to continue providing services that save lives. From a small village in Wuhan, China to the doorsteps of people across the world, COVID-19 has ravaged life as we know it and has impacted the medical community forever. Scientists have worked tirelessly to find creative ways to combat this virus. From creating a vaccine in record time, to Paxlovid, the first oral tablet of its kind. It is up to medical professionals to properly administer this medication and follow the guidelines set forth by all evidence-based practice in the future. The hope is to stop the progression of moderate cases of COVID-19 from reaching the severe stage and the need for hospitalization, thus reducing the death rate. References Katella, K., & Fikrig, E. (2022, August 11). 13 things to know about paxlovid, the latest COVID-19 Pill. Yale Medicine. Retrieved November 4, 2022, from https://www.yalemedicine.org/news/13-things-to-know-paxlovid-covid-19 Marik, P. E., Iglesias, J., Varon, J., & Kory, P. (2021, September 26). A scoping review of the pathophysiology of covid-19. International journal of immunopathology and pharmacology. Retrieved November 4, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8477699/ Staff. (2021, December). Paxlovid. Paxlovid | HHS/ASPR. Retrieved November 4, 2022, from https://aspr.hhs.gov/COVID-19/Therapeutics/Products/Paxlovid/Pages/default.aspx Staff. (2022). Tracking the COVID-19 economy’s effects on food, housing, and employment hardships. Center on Budget and Policy Priorities. Retrieved November 4, 2022, from https://www.cbpp.org/research/poverty-and-inequality/tracking-the-covid-19-economys-effects-on-food-housing-and Staff. (2022, October 19). People with certain medical conditions. Centers for Disease Control and Prevention. Retrieved November 4, 2022, from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html#:~:text=Having%20heart%20conditions%20such%20as,American%20Heart%20Association%3A%20COVID%2D19 Staff. (2022, October 21). Herbal supplements and kidney disease. National Kidney Foundation. Retrieved November 4, 2022, from https://www.kidney.org/atoz/content/herbalsupp#:~:text=Some%20herbal%20supplements%20that%20act,also%20have%20bad%%20effects. SCIENCE HEALTH SCIENCE NURSING NURS 110

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