What is the initial treatment plan for a 63-year-old patient with nasal congestion, chest congestion, and a positive COVID-19 test, who also has a history of Hypertension (HTN)?

Treatment Plan for a 63-Year-Old COVID-Positive Patient with Nasal and Chest Congestion and HTN

For a 63-year-old patient with nasal congestion, chest congestion, and a positive COVID-19 test who has hypertension, the initial treatment should focus on supportive care including rest, adequate hydration, over-the-counter expectorants like guaifenesin for chest congestion, and continued use of their regular antihypertensive medications.

Initial Assessment and Management

• The patient should rest in bed with monitoring of vital signs including heart rate, pulse oxygen saturation, respiratory rate, and blood pressure 1
• Ensure sufficient energy intake and maintain balance of water, electrolytes, and acid-base levels 1
• Continue all previously prescribed antihypertensive medications, including ACE inhibitors and ARBs, as evidence shows no increased risk of COVID-19 infection or worse outcomes with these medications 1, 2
• For nasal and chest congestion, guaifenesin (100 mg/5 mL) can be used as an expectorant to loosen and relieve chest congestion 3

Respiratory Support

• For patients with mild symptoms (as in this case with only congestion), supplemental oxygen is not required unless oxygen saturation falls below 92% 1
• If oxygen is needed, start with nasal cannula at 5 L/min and titrate to maintain SpO2 92-97% 1, 4
• Monitor for signs of respiratory deterioration including increased work of breathing, decreasing oxygen saturation, or development of shortness of breath 5

Monitoring and Follow-up

• Regular monitoring of temperature, respiratory rate, heart rate, blood pressure, and oxygen saturation is recommended 1
• Consider laboratory tests including complete blood count, CRP, and organ function tests if symptoms worsen 1
• Chest imaging should be considered if respiratory symptoms worsen 1
• Implement telemedicine-based home blood pressure monitoring to maintain good blood pressure control while maintaining social distancing 2

Warning Signs Requiring Medical Attention

• Development of shortness of breath or difficulty breathing 6
• Persistent chest pain or pressure 6
• Oxygen saturation below 92% on room air 5
• Confusion or inability to stay awake 6
• Worsening of symptoms after initial improvement 7

Special Considerations for Hypertension

• Hypertension has been identified as a common comorbidity in COVID-19 patients and may be associated with worse outcomes 8
• Blood pressure should be closely monitored as COVID-19 can affect cardiovascular function 2
• There is strong evidence supporting the continuation of ACE inhibitors and ARBs in patients with COVID-19 and hypertension 1
• Avoid NSAIDs if possible as they may worsen hypertension control and potentially affect COVID-19 outcomes 2

Prevention of Transmission

• The patient should isolate from others to prevent transmission 1
• Household members should practice hand hygiene, wear masks, and maintain physical distancing 1
• Frequently touched surfaces should be disinfected regularly 1

When to Consider Hospitalization

• Development of hypoxemia (SpO2 <92%) despite supplemental oxygen 5, 7
• Signs of severe respiratory distress or rapid deterioration 7
• Inability to maintain oral hydration 6
• Significant comorbidities that increase risk (age >65, hypertension, etc.) with worsening symptoms 8

This treatment plan prioritizes supportive care while monitoring for signs of deterioration, which is appropriate for a patient with mild COVID-19 symptoms and hypertension as a comorbidity.