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Made by:- Rekha ladhar
B.sc nursing 2nd
yr
Dayanand medical college of ludhiana ..

INTRODINTRODUCTION:UCTION:--
Cholera is responsible for about
5-10% of all acute diarrhoeal
illness.
It occurs in pand...
Epidemics of cholera creates
public health problems as it spread
fast and cause mortality.
Cholera is called as water
bo...
GI infection is caused by
gram negative rod of v.
cholerae.
DEFINITION:-Cholera is an infectious disease
characterised by vomiting and severe
diarrhoea with fluid and electrolyte
dep...
 FLUID LOSS ISFLUID LOSS IS 1-20%1-20% PERPER
DAY IN CHOLERA.DAY IN CHOLERA.
EPIDEMIOLOGICALEPIDEMIOLOGICAL TRIADTRIAD;-
AGENT
HOST
ENVIRONMENT
EPIDEMIOLOGICAL TRIAD:-
AGENT;-v .cholerae.
HOST;-all ages(both sexes)
ENVIRONMENT;-
contaminated water and
food.
1. AGENTAGENT
• The causitive agent for cholera is
vibrio cholerae.
• The causitive organism is present
in stool and vomit...
• The optimum ph for
organism is 8.2.
• The organism is
extreamly sensitive
to acidic medium
which kill it.
(stomach)
2.2. HOSTHOST FACTORFACTOR:-:-
AGE
GENDER
PH
HYGIENE
HOST FACTOR
AGE;-
All ages in the
endemic areas. It is
more frequent in
children who are living
mostely in the
unhygienic...

GENDERGENDER::-
Cholera distributes equally in men as
well as in women.
It is more severe in pregnancy in the
endemic ...
PH:-PH:-
it is most common among those who
reduced the gastric acidity.
 ph:8.2 (7.35-745) i.e alkaline
medium.

HYGIENEHYGIENE::
It is most commonly
occurs in the among
the unhygienic
conditions or the
poor sanitary
conditions.
3.3. ENVIRONMENTENVIRONMENT FACTORSFACTORS
1)POOR
ENVIRONMENT
SANITATION
2)CONTAMINATED
WATER.
3.CONTAMINATED
FOOD.
4.HUMAN
HABITS
FAVOURING
SOIL AND
WATER
POLLUTION.
4. Poor personal
hygiene.
5. Poor quality of
life.
5. Lack of
education.
5F
 FOOD
 FINGER
 FLIES
 FILTHS
 FOMITES
1.FOOD
2.FINGER
3. FLIES
4. FILTH
5. FOMITES
From few hours to 5 days.
(Commonly last for 2 days).
RISKRISK FACTORSFACTORS
POOR SANITARY CONDITIONS
RAW OR UNCOOKED FOOD
HYPOCHLORHYDIA
MIGRATION.
PATHOPHYSIOLOGY
FLIW CHART FROM NET
1. Painless watery
diarrhea.
2. Nausea/vomiting.
3. Loss of skin
elasticity.
4. Dry mucous
membrane.
5. Abdominal cramps.
...
 Metabolic acidosis is due to the
acidosis is due to the excessive
release/loss of bicarbonate ions.
STAGES
OF
CHOLERA
STAGE 1STAGE 1 (stageof invasion)
Malaise
Headache
Diarrhoea
anorexia
 Watery stool
which appears like rice water is
‘rice water stool’.
RICERICE WATERWATER DIARRHOEADIARRHOEA
STAGE 3STAGE 3 (stage of collapse)
Patient rapidly developPatient rapidly develop
a)a) DehydrationDehydration
b)b) Eyes ar...
STAGE 4 (stage of reaction)
I.Death seems imminent.
II.Surface temprature begins to
rise.
III.Vommits
COMPLICATIONS;-
 Severe dehydrations.
 Hypokalemia.
 Hyponetremia
 Hypoglycemia.
 Renal failure
 Shock
 death
LABLAB DIAGNOSISDIAGNOSIS
1)SPECIMENS
2)COLLECTION &
TRANSPORT
3)CULTURE
OTHERS
I. COMPLETE BLOOD
COUNT
II.GRAM STAINING
SPECSPECIIMENS:-MENS:-
Stool examination;-
Rectal swabs
 Checking of water and food for v.
cholerae by taking sample of...
COLLECTCOLLECTIOIONN AANDND
TRANTRANSPSPORTORT;-;-
Specimens should collected
preferably prior to start of
antibiotics.
...
Specimens should send
immediately to laboratory
for processing.
In case of delay stool
sampels may be preserved
in holdi...
3. CULTURE:-
PREVEPREVENTIONNTION
Cholera is an disease of five f or the
unhygienic conditions.so people must
keep their house and sur...
TREATREATTMEMENTNT
1. EARLY DIAGNOSIS
(2)NOTIFICATION
TREATMENT;-
Mild dehydration
 Patiet will alert, restless and
thirsty.
 Radial pulse will be normal
in rate and volume.
...
Contd…
Mild dehydration
 Skin will retract easily if
pinched.
 ORS solution is required
 Solution can be prepared
at ho...
1.MILD DEHYDRATION:-
(A)(A) ORALORAL REHYDRAREHYDRATIONTION
SOSOLUTILUTIONON
2.Severe
dehydration
(B)(B) RINGERRINGER LACTATELACTATE SOLUTIONSOLUTION
ANTIBIANTIBIOOTICSTICS:-:-
Remember
• Tetracycline is
contraindicated in pregnancy
11. GENERAL
MEASURES
Purification of
water
Better provision
for sewage
disposal.
2. HHYGYGIIENICENIC FOFOODOD
3. HANHAND WASD WASHINHINGG
4. DISINDISINFEFECTIOCTIONN
How water is disinfected???
• By adding chlorine drops in
water
5.5. SANITSANITAATIONTION
NURSINURSINGNG IINTERVENTIONSNTERVENTIONS;-;-
1. During the acute
phase of cholera,
provide enteric
precautions and
supportive care
and closely
observe the
patient.
2. Accurately
measure intake
and output and
assess the
patient for other
signs of fluid
loss.
3.monitor result of
serum electrolyte and
glucose tests.
administer replacement
fluids and electrolytes
as ordered.
 4.During therapy,
continue to evaluate
peripheral pulses and
central pulses, central
venous pressure and
orthostatic blo...
 5. Carefully observe
neck veins and
auscultate the lungs
for indications of
fluid overload from
cardiac failure.
HEALTHHEALTH EDUCATIONEDUCATION
It is an preventive effective
measure for
achieving prevention and control.
health educati...
SUMMRISATIONINTRODUCTION
DEFINITION
EPIDDEMIOLOGICAL TRIAD
COMPLICATION
MODES OF TRANAMISSON
INCUBATION PERIOD
RISK...
RECAPTULISATION
1) Mortality rate is ___in treated cases
while ____in untreated ones.
2) Fluid loss is _______ in cholera....
 6) rice watery diarrhoea seems in _______
stage of cholera
 7) In the treatment of cholera
 _______ is used in severe ...
HOW WE CAN DISINFECT
WATER
 WHICH MEDIA IS USED TO
PRESERVE THE STOOL SAMPLES IN
CASE OF DELAY
11%, 50%
2. 1-20% /day
3. 10^3, 10^9
4. few hours to 5 days
5. excessive release of bicarbonate ions in the lumen
6.stage ...
CHOLERA PPTS....BY REKHA
CHOLERA PPTS....BY REKHA
CHOLERA PPTS....BY REKHA
CHOLERA PPTS....BY REKHA
CHOLERA PPTS....BY REKHA
CHOLERA PPTS....BY REKHA
CHOLERA PPTS....BY REKHA
CHOLERA PPTS....BY REKHA
CHOLERA PPTS....BY REKHA
CHOLERA PPTS....BY REKHA
CHOLERA PPTS....BY REKHA
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CHOLERA PPTS....BY REKHA

  1. 1. Made by:- Rekha ladhar B.sc nursing 2nd yr Dayanand medical college of ludhiana ..
  2. 2.  INTRODINTRODUCTION:UCTION:-- Cholera is responsible for about 5-10% of all acute diarrhoeal illness. It occurs in pandemic form from saveral times
  3. 3. Epidemics of cholera creates public health problems as it spread fast and cause mortality. Cholera is called as water borne.
  4. 4. GI infection is caused by gram negative rod of v. cholerae.
  5. 5. DEFINITION:-Cholera is an infectious disease characterised by vomiting and severe diarrhoea with fluid and electrolyte deplition. OR Cholera is an acute diarrrhoel illness caused by infection of intestine with bacteria v. cholerae.
  6. 6.  FLUID LOSS ISFLUID LOSS IS 1-20%1-20% PERPER DAY IN CHOLERA.DAY IN CHOLERA.
  7. 7. EPIDEMIOLOGICALEPIDEMIOLOGICAL TRIADTRIAD;- AGENT HOST ENVIRONMENT
  8. 8. EPIDEMIOLOGICAL TRIAD:- AGENT;-v .cholerae. HOST;-all ages(both sexes) ENVIRONMENT;- contaminated water and food.
  9. 9. 1. AGENTAGENT • The causitive agent for cholera is vibrio cholerae. • The causitive organism is present in stool and vomits of cases and carriers. • The cholera occurs when vibrio cholerae exceed (10^9) in water. (10^3) in food. i.e.high doses of cholera produce clinical symptoms.
  10. 10. • The optimum ph for organism is 8.2. • The organism is extreamly sensitive to acidic medium which kill it. (stomach)
  11. 11. 2.2. HOSTHOST FACTORFACTOR:-:- AGE GENDER PH HYGIENE
  12. 12. HOST FACTOR AGE;- All ages in the endemic areas. It is more frequent in children who are living mostely in the unhygienic conditions.
  13. 13.  GENDERGENDER::- Cholera distributes equally in men as well as in women. It is more severe in pregnancy in the endemic areas.
  14. 14. PH:-PH:- it is most common among those who reduced the gastric acidity.  ph:8.2 (7.35-745) i.e alkaline medium.
  15. 15.  HYGIENEHYGIENE:: It is most commonly occurs in the among the unhygienic conditions or the poor sanitary conditions.
  16. 16. 3.3. ENVIRONMENTENVIRONMENT FACTORSFACTORS 1)POOR ENVIRONMENT SANITATION
  17. 17. 2)CONTAMINATED WATER.
  18. 18. 3.CONTAMINATED FOOD.
  19. 19. 4.HUMAN HABITS FAVOURING SOIL AND WATER POLLUTION.
  20. 20. 4. Poor personal hygiene. 5. Poor quality of life. 5. Lack of education.
  21. 21. 5F  FOOD  FINGER  FLIES  FILTHS  FOMITES
  22. 22. 1.FOOD
  23. 23. 2.FINGER
  24. 24. 3. FLIES
  25. 25. 4. FILTH 5. FOMITES
  26. 26. From few hours to 5 days. (Commonly last for 2 days).
  27. 27. RISKRISK FACTORSFACTORS POOR SANITARY CONDITIONS RAW OR UNCOOKED FOOD HYPOCHLORHYDIA MIGRATION.
  28. 28. PATHOPHYSIOLOGY FLIW CHART FROM NET
  29. 29. 1. Painless watery diarrhea. 2. Nausea/vomiting. 3. Loss of skin elasticity. 4. Dry mucous membrane. 5. Abdominal cramps. 6. Sunken eyes/cheeks A. Oligourea/anurea. B. low blood pressure. C. Irregularheartbeat. D. Metabolic acidosis. CLINICAL MENIFESTATIONS
  30. 30.  Metabolic acidosis is due to the acidosis is due to the excessive release/loss of bicarbonate ions.
  31. 31. STAGES OF CHOLERA
  32. 32. STAGE 1STAGE 1 (stageof invasion) Malaise Headache Diarrhoea anorexia
  33. 33.  Watery stool which appears like rice water is ‘rice water stool’.
  34. 34. RICERICE WATERWATER DIARRHOEADIARRHOEA
  35. 35. STAGE 3STAGE 3 (stage of collapse) Patient rapidly developPatient rapidly develop a)a) DehydrationDehydration b)b) Eyes are sunkenEyes are sunken c)c) Skin become dry,Skin become dry, wrinkled and clammy.wrinkled and clammy. d)d) Suppresssion of urineSuppresssion of urine e)e) Decreased bodyDecreased body tempraturetemprature f)f) Low blood pressureLow blood pressure
  36. 36. STAGE 4 (stage of reaction) I.Death seems imminent. II.Surface temprature begins to rise. III.Vommits
  37. 37. COMPLICATIONS;-  Severe dehydrations.  Hypokalemia.  Hyponetremia  Hypoglycemia.  Renal failure  Shock  death
  38. 38. LABLAB DIAGNOSISDIAGNOSIS 1)SPECIMENS 2)COLLECTION & TRANSPORT 3)CULTURE OTHERS I. COMPLETE BLOOD COUNT II.GRAM STAINING
  39. 39. SPECSPECIIMENS:-MENS:- Stool examination;- Rectal swabs  Checking of water and food for v. cholerae by taking sample of water and food for v. cholerae.
  40. 40. COLLECTCOLLECTIOIONN AANDND TRANTRANSPSPORTORT;-;- Specimens should collected preferably prior to start of antibiotics. They should not be collected from bedpans due to risk of contamination.
  41. 41. Specimens should send immediately to laboratory for processing. In case of delay stool sampels may be preserved in holding media or cary blair media.
  42. 42. 3. CULTURE:-
  43. 43. PREVEPREVENTIONNTION Cholera is an disease of five f or the unhygienic conditions.so people must keep their house and surrounding absolutely clean and free from flies. Educate the people about the dangers of five f Educate people to wash their hands before food and after defecation.
  44. 44. TREATREATTMEMENTNT 1. EARLY DIAGNOSIS
  45. 45. (2)NOTIFICATION
  46. 46. TREATMENT;- Mild dehydration  Patiet will alert, restless and thirsty.  Radial pulse will be normal in rate and volume.  Blood pressure will be normal.  No change in the urine output.  Tongue will be moist. Severe dehydration  Patient will appear drowsy,cold or comma.  Pulse will feeble or sometimes not palpable.  Blood pressure will be lower due to loss of potassium.  Tongue will be dry.
  47. 47. Contd… Mild dehydration  Skin will retract easily if pinched.  ORS solution is required  Solution can be prepared at home. Severe dehydration  Skin elasticity will be decreased .  On pinch skin will retract very slowly.  RINGER LACTATE is required .  It requires hospitilization.
  48. 48. 1.MILD DEHYDRATION:-
  49. 49. (A)(A) ORALORAL REHYDRAREHYDRATIONTION SOSOLUTILUTIONON
  50. 50. 2.Severe dehydration
  51. 51. (B)(B) RINGERRINGER LACTATELACTATE SOLUTIONSOLUTION
  52. 52. ANTIBIANTIBIOOTICSTICS:-:-
  53. 53. Remember • Tetracycline is contraindicated in pregnancy
  54. 54. 11. GENERAL MEASURES
  55. 55. Purification of water
  56. 56. Better provision for sewage disposal.
  57. 57. 2. HHYGYGIIENICENIC FOFOODOD
  58. 58. 3. HANHAND WASD WASHINHINGG
  59. 59. 4. DISINDISINFEFECTIOCTIONN
  60. 60. How water is disinfected??? • By adding chlorine drops in water
  61. 61. 5.5. SANITSANITAATIONTION
  62. 62. NURSINURSINGNG IINTERVENTIONSNTERVENTIONS;-;-
  63. 63. 1. During the acute phase of cholera, provide enteric precautions and supportive care and closely observe the patient.
  64. 64. 2. Accurately measure intake and output and assess the patient for other signs of fluid loss.
  65. 65. 3.monitor result of serum electrolyte and glucose tests. administer replacement fluids and electrolytes as ordered.
  66. 66.  4.During therapy, continue to evaluate peripheral pulses and central pulses, central venous pressure and orthostatic blood presssure.
  67. 67.  5. Carefully observe neck veins and auscultate the lungs for indications of fluid overload from cardiac failure.
  68. 68. HEALTHHEALTH EDUCATIONEDUCATION It is an preventive effective measure for achieving prevention and control. health education regarding;-  causes symptoms prevention control of cholera knowledge regarding symtoms also help to take the appropriate steps to control cholera
  69. 69. SUMMRISATIONINTRODUCTION DEFINITION EPIDDEMIOLOGICAL TRIAD COMPLICATION MODES OF TRANAMISSON INCUBATION PERIOD RISK FACTORS PAHOPHYSIOLOGY CLINICAL MENIFESTATIONS STAGES COMPLICATIONS LAB DIAGNOSIS PREVENTION TREATMENT NURSING INTERVENTIONS HEALTH EDUCATION
  70. 70. RECAPTULISATION 1) Mortality rate is ___in treated cases while ____in untreated ones. 2) Fluid loss is _______ in cholera. 3) Cholera occurs when v.cholerae exceeds ________ in food ______ in water 4) Incubation period for cholera is _________ 5) Metabolic acidosis is due to _______________________
  71. 71.  6) rice watery diarrhoea seems in _______ stage of cholera  7) In the treatment of cholera  _______ is used in severe dehydration  _______ is used in mild dehydration  8) ________ is contraindicated in pregnancy.
  72. 72. HOW WE CAN DISINFECT WATER  WHICH MEDIA IS USED TO PRESERVE THE STOOL SAMPLES IN CASE OF DELAY
  73. 73. 11%, 50% 2. 1-20% /day 3. 10^3, 10^9 4. few hours to 5 days 5. excessive release of bicarbonate ions in the lumen 6.stage 2 7. RL, ORS 8. Tetracyclin
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