NCM 112: MIDDLE EAST RESPIRATORY SYNDROME Assessment and Diagnostic Findings

• rRT-PCR assay.
(MERS‐CoV)
o FDA approved
o Methods of collecting and diagnosing MERS-
• MERS or Middle East respiratory syndrome is a zoonotic CoV
disease (spreads from animals to people) that can cause o Realt time reverse transcription – PCR assay
severe respiratory illness. It was first identified in Saudi • Serology.
Arabia in 2012 and has infected more than 2,000
o Examination of blood serum and other body fluids
individuals worldwide.
• Laboratory studies. (lab findings include leukopenia,
o Caused by novel corona virus
lymphopenia, thrombocytopenia, and elevated lactate
o First known case occurred in Jordan, April 2012
dehydrogenase )
o May have originated in bats then transmitted to
• Imaging studies.
camels
− Chest imaging findings are abnormal in more than
o Large outbreak occurred in South Korea in 2015
80% of MERS cases;
− ground-glass opacity (GGO) is found in over 60% of
Pathophysiology
chest radiographs, with about 20% incidence of
• Compared with severe acute respiratory syndrome
consolidation;
coronavirus (SARS-Cov), MERSCoV can establish infection in
− some infiltrates may be nodular.
monocyte-derived macrophages (MDMs) and
macrophages.
Medical Management
• The virus induces the release of proinflammatory
• Management of the Middle East respiratory syndrome
cytokines, leading to severe inflammation and tissue
(MERS) coronavirus (MERS-CoV) infection is supportive; this
damage, which may manifest clinically as severe
includes hydration, antipyretic, analgesics, respiratory
pneumonia and respiratory failure.
support, and antibiotics if needed for bacterial
• Vascular endothelial cells located in the pulmonary
superinfection.
interstitium may also be infected by MERS-CoV, and,
• Consultations
because MERS-CoV receptor DPP4 is expressed in
o upon suspicion of MERS, the patient should be
different human cells and tissues, dissemination of the
placed in an airborne infection isolation room with
infection may occur.
a minimum of 12 air exchanges/hr
• Interestingly, lymphopenia has been noted in most
o use gown, gloves, goggles, and N-95 respirator
patients infected with MERSCoV, as was noted in SARS
mask
infections.
• Medical Care
• This is due to cytokine-induced immune cell sequestration
• Prevention
and release and induction of monocyte chemotactic
protein-1 (MCP-1) and interferon-gammainducible protein-
Pharmacologic Management
10 (IP-10), which suppresses the proliferation of human
• No medications have been approved for the treatment of
myeloid progenitor cells.
coronavirus infections. Clinical trials are needed to establish
any benefit from ribavirin and/or interferon alfa.
Causes
• Coronaviruses are the largest of all RNA viruses, with
Nursing Management
positive-sense single-stranded RNA genomes of 26-32 kb.
Nursing Assessment
• Betacoronavirus
• History. (travel exposure – Arabian Peninsula)
• Dromedary camels
o 14 days incubation period
o Urine as well as consumption of undercooked
• Physical exam. (may range from no symptoms to rapidly
meat or pasteurized dairy product
progressive multiorgan failure and death)

Clinical Manifestations
Nursing Diagnosis
Physical examination findings associated with MERS-CoV
• Infection related to failure to avoid pathogen secondary
infection are similar to those presenting with any flu-like
to exposure to MERS-CoV.
symptoms, including the following:
• Deficient knowledge related to unfamiliarity with
• Fever
disease transmission information.
• Rhinorrhea (clear runny nose)
• Hyperthermia related to increase in metabolic rate.
• Pulmonary findings (hypoxemia, rhonchi, and rales)
• Ineffective airway clearance related to excessive
• Tachycardia
production of pulmonary secretions.
• Hypotension (occur with severe illness)

MRPP © 2022 l NOTES BY: JAN FAITH RAMOS 15

Nursing Goals
• Prevent the spread of infection.
• Learn more about the disease and its management.
• Reduce increase in temperature.
• Provide a patent airway.
• Reduce anxiety.

Nursing Interventions
• Monitor vital signs. Monitor the patient’s temperature;
monitor the respiratory rate of the patient
• Educate the patient and folks. (Patients and Folks –
Objectives, goals of learning, and disease process)
• Reduce increase in temperature.
• Ensure patent airway. (Teach the patient the proper
ways of coughing and breathing) (e.g., take a deep breath,
hold for 2 seconds, and cough two or three times in
succession); position: upright; increase fluid intake 3L/day)
• Reduce anxiety. Use presence, touch (with permission),
verbalization.

MRPP © 2022 l NOTES BY: JAN FAITH RAMOS 16