UPH-DJGTMU

UPH-DJGTMU
College of Nursing
College of Nursing

“Cholera”
 Cholera
(El tor)
 Is an severe and acute bacterial enteric disease of
the GIT characterized by profuse diarrhea, vomiting,
massive loss of fluid and electrolytes that could
result to hypovolemic shock, acidosis, and death.
 EtiologicAgent:
Etiologic Agent:

Vibrio Cholerae/ Vibrio Coma

 Vibrio Cholerae/ Vibrio Coma
 This organism survive well at ordinary temperature and can grow

•This organism survive well

well at cold temperature
(20-40 C)

at ordinary temperature and

can grow well at cold
temperature
(20-40 C)
 Incubation Period:
Few hours to 5 days
Usually 1-3 days
 Period of Communicability
 The organisms are communicable during
stool positive stage.
 Usually 4 days after recovery, however the
carrier may have the organism for several
months.
 Mode of Transmission
 Fecal oral route from contaminated water,
milk and other foods.

 Ingestion of contaminated food and water

with stool and vomitus of patient.

 flies, soiled hands and utensils also serve

to transmit the infection.
 Main symptoms:
 Profuse water diarrhea
 Vomiting
Pathognomonic sign:
 Rice-water stool
 Other clinical manifestation:
 Abdominal pain
 Poor skin turgur
 Sunken eyeball
 Skin is cold
 Finger and toes are wrinkled like “washer-
woman’s-hand”.
 Radial pulse become impercible
 Blood pressure unobtainable
 Tachypnea
 Diminished peripheral circulation
 Cyanosis
 Horseness of voice
 Aphonia
 Oliguria and anuria
 Temp. could be normal at the onset of the
disease but became subnormal in later
stage especially if the patient is in shock.
 When the patient is in deep shock, the
passage of diarrhea stops.
 Death may occur as short as four hour
after onset, but usually occurs on the first
or on the second day if not properly
treated.
 Pathophysiology
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
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
 Start producing toxic protein

They pump chloride ions

Creating ionic pressure

Prevent sodium ion s from entering the cell

Watery diarrhea
Vomiting
Rapid and severe dehydration
Fluid and Electrolytes loss

Cholera
Principal 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
 Metabolic acidosis
 Hypokalemia
 Renal failure
 Convulsion or tetany
 Hypoglycemia
 Corneal scaring
 Acute pulmonary edema
 Diagnostic Exams

1. Rectal swab
2. Darkfield or phase microscopy
3. Stool exam
 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
•Antibiotics
* tetracycline
* furazolidone
* chlorampenicol
* cotrimoxazole
 Nursing Management
1. Hand washing before food item is
handled
2. Enteric isolation
3. Vital signs
4. I & O must be measured accurately
5. Personal hygiene must be provided
6. Excreta must be properly disposed of
7. Proper food preparation
8. Environmental sanitation
9. Weight the patient
10. Appropriate diet is given according to the
stage of recovery
 Prevention
 Health teaching must be provided
 Sterilization

-proper disposal of all contaminated

materials
-sterilized the materials that come in
contact with cholera patient by
washing in hot water using a chlorine
bleach.
 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
 Vaccine for cholera is available in some
countries
Dokoral (brand name)- newer
vaccine, orally administered
inactivated whole cell vaccine.
“Prevention is better than
cure”

Thank you! 