Response: Patients With Ebola Virus Disease (EVD) Should Not Receive CPR.

Ebola Virus
The 2014 Ebola virus outbreak was centered in three West African countries: Guinea, Liberia, and Sierra Leone.
In humans, the virus is transmitted through direct contact with blood or body fluids from an infected or deceased patient. The body fluids include: blood, emesis, urine, stool, sweat, semen, saliva, and other fluids. One can also become infected by direct contact with objects contaminated with the virus. These objects include: needles and medical equipment. It is important to note that the infectiousness of body fluids increases as the patient becomes more ill.
Once infected, the symptoms may appear from 2 to 21 days after exposure to the virus. The symptoms of Ebola include: fever, headache, joint and muscle aches, nausea, vomiting, stomach pain, lack of appetite and bleeding.
Laboratory findings:
•Thrombocytopenia (decreased platelet count)
•Leukopenia (decreased white blood cell count)
•Elevation of the liver enzyme serum aspirate amino transferase (AST)
•Electrolyte abnormalities
•Prolonged PT/PTT
•Increased creatinine
There are no Federal Drug Administration (FDA) approved treatments for the Ebola virus. Instead clinical management of the Ebola virus is supportive and aggressive:
•Hypovolemia – is treated with intravenous fluid resuscitation and hemodynamic support with vasopressors (medications to increase blood pressure) and critical care management.
•Electrolyte and acid-base abnormalities – are treated with aggressive repletion of electrolytes and correction of acid-base abnormalities with sodium bicarbonate (NaHCO3).
•Management of fever and gastrointestinal symptoms. NSAIDS must be avoided.
•Multi-system organ failure – the patient may require intubation and mechanical ventilation, correction of coagulopathy with transfusions of packed red blood cells (PRBC’s), Platelets, Fresh Frozen Plasma (FFP), and Cryoprecipitate. The patient may require renal replacement therapy (CRRT) for renal failure.
Recovery from Ebola depends on supportive care and the patient’s immune response. Those patients, who survive, show clinical signs of improvement by the second week of the illness. People who recover from the Ebola virus will develop antibodies that last for at least 10 years, possibly longer. It is not known if people who recover are immune for life (http:// cdc.gov/vhf/ebola/treatment/index.html).
The Center of Disease Control and Prevention (CDC) has tightened infection control guidelines for healthcare workers caring for patients infected with the Ebola virus. Personal Protective Equipment (PPE) must be worn properly to prevent contamination. Healthcare workers must understand the importance of following basic principles to ensure safe and effective PPE use, which includes the skin NOT being exposed while working in PPE:
Donning:
•It is recommended that healthcare workers wear 2 pairs of gloves when caring for patients infected with the Ebola virus . Double gloving provides an extra layer of safety during direct patient care and during the PPE removal process.
•PPE must be donned correctly in proper order before entry into the patient care area and not be modified while in the patient care area.
During Patient Care:
•PPE must remain in place and be worn correctly for the duration of exposure to potentially contaminated areas. PPE should not be adjusted during patient care.
•Healthcare workers should perform frequent disinfection of gloved hands using an alcohol based hand rinse, particularly after handling body fluids.
•If during patient care a partial or total breach in PPE (e.g., gloves separate from sleeves leaving exposed skin, a tear develops in an outer glove, a needle stick) occurs, the healthcare worker must move immediately to the doffing area to assess the exposure. Implement the facility exposure plan, if indicated by assessment.
Doffing:
•The removal of used PPE is a high-risk process that requires a structured procedure. There should be a designated area, such as an anti-room, for removal to ensure protection.
•PPE must be removed slowly and deliberately in the correct sequence to reduce the possibility of self-contamination or other exposure to the Ebola virus.
(http://www(dot)cdc(dot)gov/vhf/ebola/hcp/procedures-for-ppe.html)
The CDC reminds healthcare workers to “Think Ebola” and to “Care Carefully.” Healthcare workers should take a detailed travel and exposure history with patients who exhibit fever, severe headache, muscle pain, weakness, diarrhea, vomiting, stomach pain, unexplained hemorrhage. If the patient is under investigation for Ebola, healthcare workers should activate the hospital preparedness plan for Ebola; isolate the patient in a separate room with a private bathroom and ensure standardized protocols are in place for PPE use and disposal. Healthcare workers should not have physical contact with the patient without putting on appropriate PPE.
Zika Virus
The Zika virus is transmitted to people through the bite of an infected mosquito, Aedes aegyptu, in tropical regions. This is the same mosquito that transmits yellow fever.
The symptoms of Zika virus disease include fever, skin rashes, conjunctivitis, muscle and joint pain, malaise and headache. These symptoms are usually mild and last for 2 to 7 days.
Infection with the Zika virus is suspected based on symptoms and history of recent travel or living in an area where the Zika virus is known to be present. Blood, urine and saliva can be tested for the presence of Zika virus RNA.
There is no specific treatment for Zika virus disease. Persons sick with Zika virus should get rest, drink fluids and manage pain and fever with over the counter medications.
Prevention and control of the Zika virus relies on reducing the mosquito population through removal and modification of mosquito breeding sites and reducing contact between mosquitoes and people.
Potential complications of Zika virus disease include Guillain-Barre syndrome and an increase in the number of infants born with microcephaly.
World Health Organization. (2016). Zika virus. Retrieved from http://www(dot)who(dot)int/mediacentre/factsheets/zika/en/
Patients with Ebola virus disease (EVD) should not receive CPR.
For this activity, you will weigh in on the RN’s ethical obligation when providing care to patients with EVD and the performance of CPR.
Initial Discussion Post:
•Address the ethical and potential safety issues.
•Justify and cite your work from current resources.