Cholera Eltor

A bunch of topic were selected for our subject Communicable Diseases, surprisingly I picked up "Cholera El tor"...
I have done enough research regarding this topic from Brunner and Suddarths MedSurg books and other resources. I collated the ideas and came up to this presentation...


Hope it will be able to help my colleagues, students and those people who needs to know the what, why's, and how of Cholera!


xoxo ^___^

1. CholeraCholera
EltorEltor
Prepared by:
Leancris A. Conde
BSN III-B
Bicol University College of Nursing

2. Cholera is a worldwide disease with an
estimated incidence of more than five
million cases per year, most of which occur
in Asia and Africa, with 8% of cases
requiring hospitalization. Cholera is a
devastating disease, the epidemics of
which, until 1992, were caused by Vibrio
cholerae serogroup O1 biotype classical or
El Tor. The classical biotype is believed to
have caused the first six pandemics, which
occurred in the Indian subcontinent and
subsequently in other areas of the world
between 1817 and 1923.

3. Definition
An 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

4. Etiologic Agent
Vibrio Cholera/ Vibrio Coma
1.the organism are slightly
curved rods (coma shaped),
gram negative(-)
motile with a single polar flagellum
2.Organism survive well at ordinary
temperature and can grow well in
temperature from
22-40 degrees centigrade

5. 3.They can survive well at ordinary
temperature and can survive longer in
refrigerated food
4.An enterotoxin, choleragen, is
elaborated by organisms as they
grow in intestinal tract

6. Electron Micrograph of Vibrio
cholerae
Description: Vibrio cholerae is a gram-negative, facultatively
anaerobic, curved (vibrio-shaped), rod prokaryote that
causes the disease cholera

7. The Vibrio cholerae bacterium
Description: The Vibrio cholerae bacterium under an electron
microscope. Color has been added to show the nucleic acid
(orange) and the flagellum (tail), which is used by the
bacterium to move.

8. Pathognomonic Sign
RICE-WATER
STOOL

9. Incubation Period
The incubation period ranges from
Few hours to five(5) days
Usually
One to three(3) days

10. Period of Communicability
The organism are communicable
during stool positive stage
few days after recovery
occasionally carrier may have the
organism for several months

11. Mode of Transmission
1.Fecal transmission passes via oral
route from contaminated water, milk,
and other foods
2.The organisms are transmitted
through ingestion of food or water
contaminated with stool or vomitus of
patient
3.Flies, soiled hands, and utensils also
serve to transmit the infection.

12. -
Patho
physiology

17. 1.There is an acute, profuse, watery
diarrhea with no tenesmus or intestinal
cramping
2.Initially, the stool is brown and contains
fecal materials, but soon becomes pale
gray, “rice-water” in appearance with an
inoffensive, slightly fishy odor.
3.Vomiting often occurs after diarrhea has
been established

18. 4. Diarrhea causes fluid loss amounting to 1 to 30
liters per day owing to subsequent dehydration
and electrolyte loss.
5. Tissue turgor is poor and eyes are sunken in the
orbit
6. The skin is cold, fingers and toes are wrinkled,
assuming the characteristic “washer-woman’s
hand.”
7.Radial pulses become imperceptible and blood
pressure unobtainable.
8.Cyanosis is present.

19. 9. The voice becomes hoarse and then,
is lost, so that the patient speaks in
whisper(aphonia).
10. Breathing is rapid and deep.
11. Despite marked diminished
peripheral circulation,
unconciousness is present.
12. Patient develops oliguria and may
even develop anuria.

20. 13. Temperature could be normal at the
onset of disease but becomes
subnormal in the later stage especially
if patient is in shock.
14. When patient is in deep shock, the
passage of diarrhea stops.
15. Death may occur as for hours after
onset, but usually occurs on the first
or second day if not properly treated.

21. Principal deficits:
1. Extra cellular volume in the loss of intestinal
fluid that can lead to:
a. severe dehydration with the appearance f
washer-woman’s hand”
b. circulatory collapse or shock
2. Metabolic acidosis is due to loss of large volume
of bicarbonate-rich stool that results in rapid
respiration with intervals of apnea.
3. Hypokalemia is due to massive loss of
potassium in stool. Patient may manifest
abdominal distention that could be attributed to
paralytic ileus.

22. A case of severe dehydration from cholera
Description: A child, lying on a cholera cot, showing typical signs of
severe dehydration from cholera. The patient has sunken eyes,
lethargic appearance, and poor skin turgor, but within 2h was sitting
up, alert, and eating normally

23. 1.Rectal Swab- is a
laboratory test to isolate
and identify organisms in
the rectum that can cause
gastrointestinal symptoms
and disease. Normally,
many organisms are
present in the lower
gastrointestinal (GI) tract,
but some can act as
pathogens (disease-causing
organisms) in the bowel.

24. 2. Stool Exam-It refers to a series of
laboratory tests done on fecal samples
to analyze the condition of a person's
digestive tract in general. Among
other things, a fecalysis is performed
to check for the presence of any
reducing substances such as white
blood cells (WBCs), sugars, or bile
and signs of poor absorption as well
as screen for colon cancer.

25. 3. Dark field or phase microscopy
Exam. of cholera stools by dark-field or phase-
contrast microscopy often shows the highly
motile vibrios darting through the field,
particularly when the concentrations of
vibrios are > 10(5) per ml of stool
Dark field and phase contrast microscopy have
been used to screen liquid or rice-water fecal
specimens for V. cholerae. Liquid stool or
enrichment broth is examined for the presence
of organisms with a darting or "shooting star"
motility.

26. Nursing
Management

27. HealthHistory
Ask the patient where did he go or if he recently
traveled
Know if the patient is treated with antibiotics
Ask the patient if he has been in close contact with
anyone who has recently with diarrheal disease
What the patient recently eaten. It is helpful to ask
the patient to list every food tasted
Know if they are employed in a food preparation
service

28. LOOK
CONDITI
ON
Well, AlertRestless,
Irritable*
Lethargic,
Unconsciou
s, Floppy
EYE Sunken Very Sunken
and Dry
TEARS Present Absent Absent
MOUTH
TONGUE
Moist Dry Very Dry
STOOL Loose Rice WateryRice Watery

29. FEEL
SKIN
PINCH
Goes Back
Quickly
Goes Back
Slowly
Goes Back
Very Slow
DECIDE
The patient
has no sign of
dehydration
If the patient
has two or
more signs,
including at
least one
sign, there is
moderate
dehydration
If the patient
has two or
more signs,
including at
least one
sign, there is
severe
dehydration

30. Presence of mucus or blood on stool
should be inspected and recorded
Measurement of intake and output is
vital in determining fluid balance
Liquid stool should be measured and
documented along with a record of the
frequency of stool
Note the consistency and form of the
stool as the key indicator of the type and
the severity of the diarrheal disease

31. Risk for fluid volume deficit r/t severe
diarrhea and vomiting
Hypothermia r/t hypovolemia
Potential for Impaired skin integrity r/t
dehydration
Deficient knowledge about the infection
and the risk of transmission to others
Metabolic Acidosis r/t bicarbonate,
sodium, potassium ions and other
electrolyte losses

32. To be able to maintain fluid and electrolyte
balance
To prevent further severe complications
To improve the knowledge of patient and
relatives about the disease and risk of
transmission

33. 1. Medical aseptic protective care must be
provided.
2. Enteric isolation must be observed
3. Vital signs must be recorded accurately
4. Intake and output must be accurately
measured
5. A thorough and careful personal hygiene
must be provided

34. 6. Excreta must be properly disposed
off.
7. Concurrent disinfection must be
applied
8. Food must be properly prepared.
9. Environmental sanitation must be
observed

35. Treatment of cholera consists in correcting the
basic abnormalities without delay– restoring
the circulating blood volume and blood
electrolytes to normal levels.
1. Intravenous treatment is achieved by rapid
intravenous infusion of alkaline saline
solution containing sodium, potassium,
chloride and bicarbonate ions in proportions
comparable to that in water-stool.

36. 2. Oral therapy rehydration can be
completed by oral route
(ORESOL,HYDRITES) unless
contraindicated or, if patient is not
vomiting.
3. Maintenance of the volume of fluid and
electrolyte lost after rehydration. This is
done by careful intake and output
measurement.

37. 4. Antibiotics:
a. Tetracycline 500 mg every 6 hrs. might be
administered to adults, and 125mg/kg body
weight for children every 6hrs. for 3days
b. Furazolidone 100mg for adults and
125mg/kg for children, might be given every
6hrs. For 3 days.
c. Chloramphenicol may also be given 500mg
for adults and 18mg/kg for children every 6hrs.
For 3days.
d. Cotrimoxazole can also be administered
8mg/kg for 3days.

38. Patient expected outcomes may consist of:
1. Attains fluid balance
2. Acquires knowledge and understanding
about infectious diarrhea and
transmission potential
3. There are no further complications

39. Prevention
and

Control

40. 1. Vaccination
2. Environmental sanitation
a.) Excreta disposal
b.) Water Supply Sanitation
c.) Food sanitation
d.) Fly control
e.) Disinfection
f.)Proper disposal of dead

41. Vaccination
Safe, highly protective
oral cholera vaccines
◙ Currently, internationally licensed oral cholera
vaccine can be used for preventive vaccination
campaigns.
◙ This vaccine has been deployed in a mass
vaccination campaign in a cholera-endemic area of
Mozambique and proved in principle that mass
cholera vaccine campaigns are feasible, safe and
protective.

42. In fact it is the only effective approach known
at present to the problem of control of
cholera and its eventual eradication.

43. a.) Excreta disposal
◙The safe disposal of excreta should be
ensured so that possible contamination
of water sources is prevented and there
is no exposure to flies.
◙Adequate use of powdered chlorine
should be made to sprinkle over excreta
and soiled surface in and around the
latrines.

44. Where pipe water
supplies are existing,
steps should be taken
to protect the water
sources from possible
contamination and to
promote operation of
water works at
maximum efficiency.

45. “ , ,
Boilit cookit peel
,
it orforgetit”
◙ Sale of exposed
prepared foods and cut
fruits sold by vendors
should not be allowed.
◙ Strict supervision of
sanitation of eating places
and hygiene of food
handlers is of importance.
◙ People may be
encouraged to eat cooked
and hot food.

46. ◙ Fly control campaign
is desirable in control of
cholera.
◙ The measures should
aim at elimination of
breeding places.
◙ Prompt collection and
disposal of garbage and
excreta in urban and
rural areas are essential
for effective fly control

47. Washing the hands thoroughly and properly
before handling foods should be done.

48. e.) Disinfection
Concurrent and terminal disinfection of infective
materials of each patient would prevent the
spread of vibrios.
Patients' stools and vomit should be disinfected
before their disposal. Chlorinated lime and Lysol
have been found very effective for the purpose.
In rural areas, it may be feasible to burn or bury
the excretal wastes.
Patients' clothes, linen, and utensils should be
boiled or dipped in 2% Lysol or chlorinated lime
solution. Contaminated floors, furniture, etc.,
may be scrubbed with either 2% Lysol or
chlorinated lime solution

49. f.)Disposal of Dead
Sanitary disposal of dead patients
with due respect to the religious
and social customs should be
ensured. The disposal of corpses
into the rivers, which is practiced in
some places, is dangerous and
should be prohibited.

50. ThAnk You!
Hope you
learned
something!