Covid-19 rapid guidelines (continued..)

5. Managing fever:

• Patients are advised to drink fluids (not more than 2 liters per day) on regular basis so as to avoid dehydration.
• In order to reduce body temperature, use of antipyretics should be prohibited.
• Remember, on an average usually the fever is most common 5 days after the exposure to the infection.
• Treatment for both adults and children is present. Adults from 18 years and over can be advised to take paracetamol and ibuprofen; paracetamol dosage could be 0.5 gram to 1 gram every 4 to 6 hours and a maximum of 4 gram per day, ibuprofen dosage should be 400 mg three times a day. Also, the children and young people over 1 month and under 18 years are recommended to have paracetamol or ibuprofen at a specific dose suggested by BNF for children.

6. Managing breathlessness:

• Beware severe breathless is always followed by the anxiety which leads to increase the breathlessness even more.
• Encourage relaxation and breathing techniques which includes body positioning, pursed –lip breathing, breathing exercises and coordinated breathing training.
• Well ventilation should be there for the patients who are self isolating all alone.
• To improve breathlessness, consider a trial of oxygen therapy.
• Identify the causes of breathlessness like pulmonary oedema.
• Treatments in the last days and hours of life for managing breathlessness for patients aged 18 years and over. Opioid dosage could be morphine sulphate 10 mg over 24 hours via a syringe driver. Benzodiazepine is used if required in addition to opioid, midazolam 10 mg over 24 hours via the syringe drivers. Addition of both parental morphine or midazolam is also recommended; morphine sulphate: 2.5 mg to 5 mg, midazolam 2.5 mg.

7. Managing anxiety, delirium and agitation:

• Treat reversible causes of anxiety or delirium, with or without agitation, for example hypoxia, urinary retention and constipation.
• Address reversible causes of anxiety, delirium and agitation first by: exploring the patient's concerns and anxieties, ensuring effective communication and orientation (for example explaining where the patient is, who they are, and what your role is), ensuring adequate lighting, explaining to those providing care how they can help.
• Try benzodiazepine to manage anxiety or agitation.

8. Managing medicines for patients:

• Follow UK government legislation on prescribing, ordering, supplying, transporting, storing and disposing of medicines.
• When returning medicines from a patient with COVID-19 or symptoms of COVID-19, tell the community pharmacy staff so that infection prevention and control precautions can be taken.
• Make sure social care is maintained in the processes for ordering and supplying medicines and transporting, storing and disposing of medicines.
• When prescribing, handling, administering and disposing of medicines in care homes and hospices, one must read about COVID-19 standard operating procedure for running a medicines re-use scheme in a care home or hospice setting.

9. Prescribing anticipatory medicines for patients with COVID-19:

• When prescribing and supplying anticipatory medicines at the end of life: Take into account potential waste, medicines shortages and lack of administration equipment by prescribing smaller quantities or by prescribing a different medicine, formulation or route of administration when appropriate. If there are fewer health and care staff you may need to prescribe subcutaneous, rectal or long-acting formulations, and carers or family members may need to administer them.
• Consider different routes for administering medicines if the patient is unable to take or tolerate oral medicines, such as sublingual or rectal routes, or subcutaneous injections.

10. Healthcare workers:

• All health care workers involved in receiving, assessing and caring for patients who have known or suspected or COVID‑19 should follow UK government guidance for infection prevention and control.
• It would help to provide information on using personal protective equipment (PPE), including visual and quick guides for putting on and taking off PPE.

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