Norovirus is a contagious disorder that causes vomiting and diarrhea. Children and older patients have hard time as it affects them in much larger extent than the younger adults. This assignment would be mainly describing the viral infection in details and will show how older patients need to be cared when affected by the disorder (Petrignani et al., 2015). The care should not only evidence based but should also ensure following a person centered approach by professionals. It will also show the precautionary measures that need to be taken when such outbreaks occur in aged care facilities.
Norovirus are a group of related, non-enveloped, single-stranded RNA. This virus is highly contagious and spread through food and water that had been contaminated during preparation and through contaminated surfaces. Diarrhea, vomiting and abdominal pain typically begin 12 to 48 hours after exposure to the infection (Kambhampati et al., 2015). The symptoms mainly last for one to three days and most of the people recover completely without treatments. However, for specific cohorts of people like infants, people with underlying disorders and older adults, this infection takes a toll on their health. In their cases, diarrhea and vomiting results in severe dehydration and therefore require medical attention. Some of the other symptoms are abdominal cramps, malaise, and muscle pain as well as low grade fever. The patient named Mr. Abeo Okafor had similar complains of abdominal pain and diarrhea. Another patient complained of suffering from abdominal pain and vomiting.
Norovirus mainly spread in public spaces like that of hospitals, schools, and even nursing homes and aged care facilities. Small particles from vomit or the feces from the infected person have the ability to infect a healthy individual. This infection may spread through close contact with someone who are infected with Norovirus The virus can survive outside the body for several days and therefore when a healthy individual touches contaminated surfaces and objects, he or she might get affected with the infection (Lindsay et al., 2015). Moreover, eating contaminated food by the healthy individuals might lead to infection as well.
Older adults seem to suffer more in comparison to that of the younger cohorts of people when they get infected by Norovirus. The former suffer from a longer duration of diarrhea ranging from 3 days to 9 days Therefore, Mr. Okafor might have to suffer because of this infection in similar ways. Moreover, it results in even slower recovery from this infection in the older cohort of people. Many of the studies have shown that older people have increased susceptibility to the virus mainly due to age-related changes in B-cell as well as in T-cell function (Metzelthin et al., 2017). They also have d immune-senescence or underlying chronic conditions and co morbidities that make the older people vulnerable to more suffering. Therefore, healthcare professionals need to plan a proper evidence based care to ensure person centered care service to Okafor and help him get well soon.
Studies have found out important factors that explain why norovirus causes challenging situations in nursing homes, aged care facilities and similar healthcare centers. The infectious dose of norovirus is very low and this virus has multiple routes of transmission. Hence, they can affect patients in various ways. Variety of norovirus is present and hence infection with one strain does not confer immunity from other strains (Chen, Hall, & Kirk, 2017). They can survive on any surface for days that even includes exposed and even wrapped food items. Person to person outbreaks can take place in different types of semi-closed setting. However, they are very difficult to control. This might be because the infectious dose of Norovirus is small, or because that the infected patients excrete huge amount of viable virus particles and even because of the widespread environmental contamination that take place. Therefore, controlling the disorder in nursing homes and aged care facilities is very difficult.
Hand hygiene is the appropriate method of preventing spread of the virus. Cross contamination by hands result in further propagation of the norovirus outbreak in nursing homes and aged care facilities (Rajagopalan et al., 2016). Hence, hand hygiene needs to be maintained by staff professionals. Nurses caring for Mr. Okafor need to maintain hand hygiene before touching a patient, before a procedure, after touching a patient, after touching patients’ surroundings and after a procedure or body fluid exposure risk are necessary.
Personal protective equipments should be used in the nursing home and aged care facilities settings, as it would help in minimizing the infection risk. Splashing of feces or aerosols from vomited particles has the potential for suspending the virus in the air and thereby falling on food particles and surfaces. Hand hygiene needs to be carried after removing PPE to reduce spread of virus. Disposable gloves, ace-shields or goggles, (surgical type, fluid repellent paper filter mask) masks, and protective impermeable gowns or plastic aprons need to be worn (Temime et al., 2018). These PPE can reduce the spread and hence Nurses caring for Mr. Okafor need to utilize PPE and adopt the practice in their aged care setting as well. All these will protect skin and clothing from being contaminated and thereby prevent further spread.
Exclusion can reduce the chances of spread of infection to other patient in the nursing homes and aged care facilities as it would reduce chances of sharing common bathrooms, infecting common spaces and objects in the environment used or touched by many, infecting food of healthy patients and others. Nurses caring for Mr. Okafor need to transfer him to a separate room to reduce chances of affecting other asymptomatic patients. Environmental cleaning with chemical agents, sterilizing cleaning equipments and agents, environmental surfaces in the nursing home and aged care facilities are important to kill virus that may survive on the surface of objects (McIntosh et al., 2018). Carpets, soft furnishings, and laundries need to be properly disinfected.
Mr. Okafor is quite aged and he might have limited mobility and restrictions in movement. This results in risks of pressure ulcers when he is admitted to the ward. Nurses need to identify the “at risk” patients and try to evaluate the ability of the patient in repositioning himself on bed. Nurses attending Mr Okafor can utilize the risk assessment tool of pressure ulcer namely Waterloo pressure ulcer prevention/treatment policy (White et al., 2016). According to the score, they can identify the status and ability of the patient, accordingly develop interventions, and care plans. This would include repositioning him timely, proper mattress selection, assessing his nutritional status, maintaining correct moisture level of skin and others.
Mr. Okafor had three episodes of diarrhea and therefore there may be high chance that he might suffer from dehydration. Moreover, age related changes in the body’s ability for balancing water and sodium might increase the danger (Pringle et al., 2015). Therefore, nurses need to help the patient drink at least 6.5 liters of fluid every 24 hours to patients like Okafor who have increased risk for becoming dehydrated after diarrhea. Fluid balance chart needs to be maintained so as to assess whether management of dehydration was done successfully or not.
Me.Okafor is quite old for about 88 years and he might face issues with activities of daily living. Therefore, nurses caring for him need to use different assessment tools to assess his capability in completing his activities of daily living and develop care plans accordingly. They need to consider six important areas – movement in bed, transfers, locomotion, dressing, person hygiene and feeding (Jump et al., 2018). They need to assess his capabilities on these arenas and accordingly provide him services
Dietician is one of the professional who has the responsibility of working collaboratively with the healthcare team members It has been found that the patient had several episodes of diarrhea resulting in loss of water and nutritional constituents from the body. Hence, the dietician will advise the patient to drink lots of water that should be of the optimum amount set for the patient and should be neither hot nor icy. He should advise the patient to take clear liquids for the rest 10 to 24 hours as this helps the bowel to rest and replace the important fluids lost during diarrhea. The dietician would offer him some good choices of food like rice, potatoes, farina or wheat of cream, egg, white bread, canned peeled fruits as well as well-cooked vegetables. He should be advised to prevent including foods like fatty or fried foods, raw vegetables, and vegetables with lots of fiber like cabbage, peas, dried beans and broccoli and others (Aliabadi et al., 2015
0).
The medical practitioner needs to work collaboratively with the nursing professionals and act as the case manager for the patient named Okafor. He would continue assessing the health of the patient from time to time ensuring his gradual recovery from the infection of Norovirus (Temime et al., 2018). Accordingly, assessing the patient, identifying his altered requirements from time to time would be his main responsibility. Moreover, guiding the nursing professionals regarding the infection-control management-systems would be his responsibility (Pringle et al., 2015).
In summary, it becomes clear that norovirus is a contagious viral infection. Patients suffer from vomiting, diarrhea, dehydration, abdominal pain and many others. Children and older patients suffer massively when infected. Different important precautionary measures need to be taken by healthcare professionals once the outbreak takes place like maintaining proper hand hygiene, personal protective equipments, excluding the patients into separate rooms, environmental cleansing and others. The infection spreads through oral and rectal routes and even through contamination of surfaces and food materials. Older patients need to be assessed for their pressure ulcer status, fluid balance status, activities of daily living and cultural aspects before developing the care plans. Social workers are helpful for older patients in such scenario and help the aged care facility staffs and the patient to great extent.
References:
Aliabadi, N., Lopman, B. A., Parashar, U. D., & Hall, A. J. (2015). Progress toward norovirus vaccines: considerations for further development and implementation in potential target populations. Expert review of vaccines, 14(9), 1241-1253. https://doi.org/10.1586/14760584.2015.1073110
Chen, Y., Hall, A. & Kirk, M., (2017). Paper four: Norovirus disease in older adults living in long-term care facilities: strategies for management. Understanding Gastroenteritis in Middle-aged and Older Australians, p.97. https://openresearch-repository.anu.edu.au/bitstream/1885/133678/1/Chen%20Thesis%202017.pdf#page=106
Jump, R. L., Crnich, C. J., Mody, L., Bradley, S. F., Nicolle, L. E., & Yoshikawa, T. T. (2018). Infectious Diseases in Older Adults of Long?Term Care Facilities: Update on Approach to Diagnosis and Management. Journal of the American Geriatrics Society, 66(4), 789-803. https://doi.org/10.1111/jgs.15248
Kambhampati, A., Koopmans, M., & Lopman, B. A. (2015). Burden of norovirus in healthcare facilities and strategies for outbreak control. Journal of Hospital Infection, 89(4), 296-301. https://doi.org/10.1016/j.jhin.2015.01.011
Lindsay, L., Wolter, J., De Coster, I., Van Damme, P., & Verstraeten, T. (2015). A decade of norovirus disease risk among older adults in upper-middle and high income countries: a systematic review. BMC infectious diseases, 15(1), 425. https://doi.org/10.1186/s12879-015-1168-5
McIntosh, T., Williamson, L., & Boehm, H. (2018). Implementation of a Comprehensive Infection Control Program at a Behavioral Health Facility after a Norovirus Outbreak. American Journal of Infection Control, 46(6), S106. https://doi.org/10.1016/j.ajic.2018.04.183
Metzelthin, S., Zijlstra, G., de Man-van Ginkel, J., van Rossum, E., & Kempen, G. (2017). Doing With… Rather Than Doing For… Older Adults: The Stay Active At Home Program. Innovation in Aging, 1(suppl_1), 648-649. https://doi.org/10.1093/geroni/igx004.2300
Petrignani, M., van Beek, J., Borsboom, G., Richardus, J. H., & Koopmans, M. (2015). Norovirus introduction routes into nursing homes and risk factors for spread: a systematic review and meta-analysis of observational studies. Journal of Hospital Infection, 89(3), 163-178. https://doi.org/10.1016/j.jhin.2014.11.015
Pringle, K., Lopman, B., Vega, E., Vinje, J., Parashar, U. D., & Hall, A. J. (2015). Noroviruses: epidemiology, immunity and prospects for prevention. Future microbiology, 10(1), 53-67. https://www.futuremedicine.com/doi/abs/10.2217/fmb.14.102
Rajagopalan, S., & Yoshikawa, T. T. (2016). Norovirus infections in long?term care facilities. Journal of the American Geriatrics Society, 64(5), 1097-1103. https://doi.org/10.1111/jgs.14085
Temime, L., Cohen, N., Ait-Bouziad, K., Denormandie, P., Dab, W., & Hocine, M. N. (2018). Impact of a multicomponent hand hygiene–related intervention on the infectious risk in nursing homes: A cluster randomized trial. American journal of infection control, 46(2), 173-179. https://doi.org/10.1016/j.ajic.2017.08.030
White, M. B., Rajagopalan, S., & Yoshikawa, T. T. (2016). Infectious diarrhea: norovirus and Clostridium difficile in older adults. Clinics in geriatric medicine, 32(3), 509-522. https://doi.org/10.1016/j.cger.2016.02.008
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