2. Introduction
Worldwide, cholera affects 3-5 million
people and causes 100,000-130,000
deaths a year as of 2010.
Due to severe dehydration, fatality rates
are high when untreated, especially
among children and infants.
Death can occur in otherwise healthy
adults within hours.
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3. General objective
At the end of the lecture the student
nurses should be able to acquire
knowledge on cholera and its
management.
MWENYA EVANS 3
4. Specific objectives
At the end of the lesson the student
nurses should be able to
1. Define cholera.
2. Mention the causative agent of cholera.
3. Mention the mode of transmission.
4. Describe the pathogenesis of cholera.
MWENYA EVANS
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5. Specific objectives cont..
5. State the clinical pathological features.
6. Describe the management of cholera.
7. Outline the complications of cholera.
8. Outline the preventive measures of
cholera.
EVANS
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6. Definition
Cholera is an acute diarrhoeal infection
caused by ingestion of food or water
contaminated with the bacterium Vibrio
cholera and is characterized by severe
vomiting, explosive diarrhea and severe
dehydration
EVANS 6
9. Characteristics of vibro cholerae
1. Comma shaped
2. Aerobic organism
3. Gram negative and non spore forming
4. Motile organism
5. Killed by heat at 55 degrees C for 15m and by
phenolic and hypochlorite disinfectants.
6. Can survive aquatic environment for
extended periods in a dormant state.
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10. Oral fecal route
Cholera is transmitted through ingesting
food or drinking water contaminated with
faeces containing organism vibrio
cholerae.
Mode of transmission
EVANS
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12. Pathophysiology
Firstly vibrio cholera enters the body in
contaminated food and water.
After passage through the stomach the
number of microbes is reduced by the
stomach acid.
However some will survive and use their
flagellum to move to the small intestine.
This greatly increases the infectious dose
of vibrio cholera.
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13. Pathophysiology cont..
The organism adheres to the intestinal
mucosa of the small intestine and
multiplies rapidly.
It does not penetrate the mucosa nor
invade blood vessels but it secretes a toxin
called choleragen.
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14. Pathophysiology cont..
The toxin acts by disrupting the normal
intestinal cell physiology.
The toxin binds to intestinal receptors
where they start causing inflammation
This cause active secretion of an isotonic
fluid (chloride) resulting in profuse watery
diarrhea, extreme loss of fluid and
electrolytes, and dehydration and collapse.
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15. Pathophysiology cont...
And there is impairment of absorption of
sodium by villus cells.
Water moves with the electrolytes and
leads to profuse water loss
Dehydration leads to a decrease of blood
volume, acidosis (loss of bicarbonate),
muscle cramps due to loss of potassium
and sometimes coma and convulsions.
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16. Clinical features
Very rapid onset diarrhoea (rice water type) >3
times a day. Due to accumulation of fluids in the
intestines.
Profuse vomiting due to accumulation of fluids in
the intestines
Severe de-hydration- Due to rapid loss of fluids up
to 20 liters daily.
Low pulse, undetectable blood pressure due to
loss of fluids.
Rapid weight loss due to loss of fluids.
Fever due to infection.
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17. Clinical features
Sunken eyes, wrinkled hands and feet due
to dehydration as a result of loss of fluids.
Slow recovery of shape after depression of
skin
Anuria (No urine output) due to severe
dehydration.
Muscle cramps due to loss of potassium
Shock occurs as a result of collapse of the
circulatory system.
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18. Evacuation phase
There is abrupt painless profuse diarrhea
with flecks of mucous known as rice water
stool with fishy odor.
Sudden effortless, uncontrolled projectile
vomiting and nausea which may last for
more than 3 or 4 days.
Signs and symptoms in phases
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19. • .
Dehydration marked by, sunken eyes, loss
of skin turgor, pale face and weakness.
Anxiety and restlessness but patient
remains mentally clear.
Signs and symptoms in
phases
Evacuation phase cont..
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20. Muscle cramps due to loss of electrolytes
Metabolic acidosis indicated by signs of air
hunger with deep sometimes rapid breathing
as a result of loss of bicarbonates
Hypovoleamic shock due to vascular
depletion leading to vascular collapse
detected by hypotension, tachycardia, and
pulse may be impalpable at the wrist, cold
clammy skin, oliguria.
If no intervention shock can complicate into
acute renal failure and death
Collapse phase
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22. Medical management
Aims
To restore normal hydration status, this
should take no more than 4 hours.
To maintain the nutritional status of the
patient
To prevent complications like renal failure,
or hypovolemic shock
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23. Investigations
History of being at an endemic area
Clinical features eg rice watery stool,
severe dehydration.
Stool for microscopy will detect the typical
cholera vibrio.
Stool for culture will isolate the organism
and determine the serological
characteristics.
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24. Treatment
Oral rehydration therapy- sugar and salt
solution can be taken by mouth.
Intravenous fluid ringers lactate to replace
the lost fluids.
Antibiotic therapy
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25. Patients with mild to moderate
dehydration can be given appropriate
oral rehydration salt solution(ORS)who
formula that contain a proper balanced
electrolytes for rehydration
Patients with severe dehydration or
severe vomiting need intravenous fluids
such as Ringers lactate which should be
given quickly to restore adequate
circulation
Fluids replacement
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26. For patients older than 1 year, give
100ml/ kg intravenously fluids in
3hrs(30mls/kg rapidly within 30mins then
70mls/kg in the next 2hrs and 30 min
For patients younger than 1 year,
administer 100mls/kg intravenously for
6hrs(30mls/kg in the first hour then 70mls
in the next 5hrs
Fluids replacement
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27. The patient's level of dehydration will be
re assessed frequently by checking skin
turgor and sunken eyes.
Give ORS as soon as patient can drink.
If patient still dehydrated and can not
tolerate oral fluids after rehydration and
reassesment
Continue iv rehydration till condition
improves
Fluids replacement
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28. Antibiotic therapy
Antimicrobial therapy is an adjunct
(supplement) to fluid therapy of cholera
and is not an essential component.
However, it reduces diarrhea volume and
duration by approximately 50%.
Doxycycline
2 mg/kg bid on day 1; then 2 mg/kg qid
on days 2 and 3; not to exceed 100
mg/dose
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29. Tetracycline
40 mg/kg/d divided qid for 3 d; not to
exceed 2 g/dose
Ciprofloxacin
30 mg/kg/day divided 12h for 3 days; not
to exceed 2 g/dose
Ampicillin
50 mg/kg/day divided qid for 3 days; not
to exceed 2 g/dose.
Erythromycin
40 mg/kg/day erythromycin base divided
tid for 3 days; not to exceed 1 g/dose. 29
30. Aims
To restore normal hydration status, this
should take no more than 4 hours.
To maintain the nutritional status of the
patient
To prevent complications like renal failure
and hypovolemic shock.
Nursing care
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31. Environment
The patient will be admitted to a cholera
camp to prevent transmission of the
disease to others.
The room will be well ventilated.
Acute patients are treated on specialised
beds that allow for efficient excreta
disposal via a hole for the passage of
excreta into a bucket below.
Provide a buckets are also provided beside
the bed for patients who are vomiting.
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34. Allow the patient to express his /her fear
or worries about the disease and answer
him accordingly or refer to appropriate
people in case you fail to answer.
Explain all the procedures done on him
and why he is isolated in a cholera camp
that the disease is very infectious and can
easily spread to other people.
Psychological care
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35. Explain the disease process that it is
curable as long as they adhere to
treatment and infection prevention
measures.
Update relatives on the patients condition
and why he is isolated.
Psychological care
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36. Observations
Vital signs should be checked every
2hours (TPR, BP) to monitor the condition
of the patient whether improving or
deteriorating.
Monitor the IVF ,the rate of flow to
prevent overhydrate the patient assess
the hydration status.
Observe the nature of stool and vomitus ,
amount, consistency, colour, smell.
Observe the urine output an record as the
patient is likely to have anuria
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37. Hygiene
Encourage frequent hand washing with
disinfectant
All waste must be incinerated and/or
buried in a pit to control the spread of
cholera
Any fecal waste should be discarded in
the toilet to prevent the spread of cholera.
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39. Anyone who enters the Cholera treatment
centre must walks through a basin of
chlorinated water to disinfect the feet.
Hands must also be washed
Their clothes are laundered in a chlorine
solution, and if a shower is available they
may wash their body after receiving
treatment
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41. Diet and fluids
Resume feeding with a normal diet when
vomiting has stopped.
Continue breastfeeding infants and young
children.
A clean water supply is essential as
treatment involves rehydrating patients
The water supply is chlorinated to ensure
that bacteria levels are safe for human
consumption.
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42. Diet and fluids
Give the patient frequent sips of water or
orange drink.
Meals must be well balanced but rich in
proteins, vitamins to aid in tissue repair.
Give the meals in small amounts to ensure
retention.
Patient must have their own utensils for
eating and these must be disinfected.
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43. Elimination
Follow enteric isolation technique when
dealing with patient excreta and it must
be safely handled.
The volume of stool is measured every 2-4
hours, and the volume of fluid
administered is adjusted accordingly.
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45. Risk factors
1.Being in a cloudy place.
2.Not washing hands with soup after using the
toilet.
3. Drinking and eating contaminated foods.
4. Leaving foods exposed to flies to settle on.
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46. Prevention
Use only clean, treated or boiled water.
Wash all raw food with clean, treated or
boiled water
Wash your hands before handling or
eating food
Wash food utensils in clean, treated or
boiled water
Protect food from fly contamination and
prevent fly contamination in your homes
Use proper toilet facilities only and wash
hands after use.
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47. Prevention
Do not allow children to play in dirty
pools, or dirty water or sewer area
Do not contaminate rivers or leave sewage
where it can be washed into a river by
rain.
Proper sewage disposal and water
purification are important.
Avoid gathering at funeral houses of
somebody suspected to have died from
cholera.
Corpses must be disposed off in deep 47
