cholera new adited

8/9/2019 Cholera New Adited

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UPHUPH--DJGTMUDJGTMU

College of NursingCollege of Nursing

UPHUPH--DJGTMUDJGTMU

College of NursingCollege of Nursing

|CHOLERA}|CHOLERA}

PREPARED BY:PREPARED BY:

dela Pea, Maria Cristina C.dela Pea, Maria Cristina C.

Group 4Group 4


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CholeraCholera(El tor)(El tor)

is an severe and acute bacterial entericis an severe and acute bacterial enteric

disease of the GIT characterized bydisease of the GIT characterized by

profuse diarrhea, vomiting, massive loss ofprofuse diarrhea, vomiting, massive loss of

fluid and electrolytes that could result tofluid and electrolytes that could result tohypovolemic shock, acidosis, and death.hypovolemic shock, acidosis, and death.


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EtiologicEtiologic AgentAgent::EtiologicEtiologic AgentAgent::

VibrioVibrio CholeraeCholerae// VibrioVibrio ComaComa This organism survive well atThis organism survive well at

ordinary temperature and canordinary temperature and can

grow well at cold temperaturegrow well at cold temperature(20(20--40 C)40 C)

Vibrio Cholerae/ Vibrio Coma

This organism survive well

at ordinary temperature and

can grow well at cold

temperature

(20-40 C)

Etiologic Agent:


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Incubation Period:Incubation Period:

Few hours to 5 daysFew hours to 5 days

Usually 1Usually 1--3 days3 days


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Period of CommunicabilityPeriod of Communicability

The organisms are communicable duringThe organisms are communicable during

stool positive stage.stool positive stage.

Usually 4 days after recovery, however theUsually 4 days after recovery, however thecarrier may have the organism for severalcarrier may have the organism for several

months.months.


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Mode of TransmissionMode of Transmission

Fecal oral route from contaminated water,Fecal oral route from contaminated water,

milk and other foods.milk and other foods.

Ingestion of contaminated food and waterIngestion of contaminated food and water

with stool and vomitus of patient.with stool and vomitus of patient.

flies, soiled hands and utensils also serveflies, soiled hands and utensils also serve

to transmit the infection.to transmit the infection.


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PathophysiologyPathophysiology

Ingestion of contaminated food and water

With Presence of vibreo cholerae

Few bacteria conserve energy and stored

nutrients during passage through the stomach

shutting down much protein production

Surviving bacteria exit the stomach and reach the

small intestine


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They propel through the thick mucus that lines

the small intestine

V. C. bacteria start up production of hollow

cylindrical protein flagellin to make flagella.

Bacteria reach the intestinal wall

Stops flagella to move

Conserving of energy and nutrients by

changing mix protein


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Start producing toxic protein

Watery diarrhea

VomitingRapid and severe dehydration

Fluid and Electrolytes loss

Cholera

They pump chloride ions

Creating ionic pressure

Prevent sodium ion s from entering the cell


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Main symptoms:Main symptoms:

Profuse water diarrheaProfuse water diarrhea

VomitingVomiting


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Pathognomonic sign:Pathognomonic sign:

RiceRice--water stoolwater stool


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Other clinical manifestation:Other clinical manifestation:

Abdominal painAbdominal pain

Poor skin turgurPoor skin turgur

Sunken eyeballSunken eyeball Skin is coldSkin is cold

Finger and toes are wrinkled like washerFinger and toes are wrinkled like washer--

womanswomans--hand.hand. Radial pulse become imperceptibleRadial pulse become imperceptible

Blood pressure unobtainableBlood pressure unobtainable


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TachypneaTachypnea

Diminished peripheral circulationDiminished peripheral circulation

CyanosisCyanosis

Horseness of voiceHorseness of voice

AphoniaAphonia

Oliguria and anuriaOliguria and anuria

Temp. could be normal at the onset of theTemp. could be normal at the onset of the

disease but became subnormal in laterdisease but became subnormal in later

stage especially if the patient is in shock.stage especially if the patient is in shock.


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Principal DeficitsPrincipal Deficits

Extracellular volume in the loss of

intestinal fluid that can lead to:

a. severe dehydration with the

appearance of washer-woman's

hand, restlessness, excessive thirst

b. circulatory collapse or shock


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Metabolic acidosis

Hypokalemia

Renal failure

Convulsion ortetany Hypoglycemia

Corneal scaring

Acute pulmonary edema


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Diagnostic Exams

1. Rectal swab2. Darkfield or phase microscopy

3. Stool exam


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Modalities of treatment

Intravenous treatment containing Na+, K+,

Cl+, bicarbonate ions in proportions

comparable to that in water-stool.

ORS (ORESOL, HYDRITES)

Maintenance of the volume of fluid and

electrolytes


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Antibiotics

* tetracycline

* furazolidone

* chlorampenicol

* cotrimoxazole


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Nursing Management

1. Hand washing before food item is

handled

2. Enteric isolation3. Vital signs

4. I & O must be measured accurately

5. Personal hygiene must be provided6. Excreta must be properly disposed of


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7. Proper food preparation

8. Environmental sanitation

9. Weight the patient

10. Appropriate diet is given according to the

stage of recovery


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Prevention

Health teaching must be provided

Sterilization

-proper disposal of all contaminatedmaterials

-sterilized the materials that come in

contact with cholera patient bywashing in hot water using a chlorine

bleach.


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Water purification

-all water should be sterilized by either

boiling, chlorination, ozone water

treatment, ultra-violet light sterilization,

or anti microbial filtration in any area

where cholera is present.

Milk should be pasteurized

Sanitary supervision is important


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Vaccine for cholera is available in some

countries

Dokoral (brand name)- newer

vaccine, orally administered

inactivated whole cell vaccine.


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Prevention is

better than cure

Thank you!

cholera new adited

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