Made by:- Rekha ladharB.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 pandemic form from saveral times

Epidemics of cholera creates public health problems as it spread fast and cause mortality.

Cholera is called as water borne.

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 deplition. ORCholera is an acute diarrrhoel illness caused by infection of intestine with bacteria v. cholerae.

FLUID LOSS IS FLUID LOSS IS 1-20%1-20% PER PER 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 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.

• The optimum ph for organism is 8.2.

• The organism is extreamly sensitive to acidic medium which kill it. (stomach)

2. 2. HOSTHOST FACTORFACTOR:-:-

AGEGENDERPHHYGIENE

HOST FACTORAGE;-

All ages in the endemic areas. It is more frequent in children who are living mostely in the unhygienic conditions.

GENDERGENDER::-

Cholera distributes equally in men as well as in women.

It is more severe in pregnancy in the endemic areas.

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).

RISK RISK FACTORSFACTORSPOOR SANITARY CONDITIONSRAW OR UNCOOKED FOODHYPOCHLORHYDIAMIGRATION.

PATHOPHYSIOLOGY

FLIW CHART FROM NET

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. Irregular heartbeat.

D. Metabolic acidosis.

CLINICAL MENIFESTATIONS

Metabolic acidosis is due to the acidosis is due to the excessive release/loss of bicarbonate ions.

STAGES

OF CHOLERA

STAGE 1STAGE 1 (stage of invasion)MalaiseHeadacheDiarrhoeaanorexia

Watery stool which appears like rice water

is ‘rice water stool’.

RICERICE WATER WATER DIARRHOEADIARRHOEA

STAGE 3STAGE 3 (stage of collapse)

Patient rapidly Patient rapidly developdevelop

a)a) DehydrationDehydration

b)b) Eyes are sunkenEyes are sunken

c)c) Skin become dry, Skin become dry, wrinkled and wrinkled and clammy.clammy.

d)d) Suppresssion of Suppresssion of urineurine

e)e) Decreased body Decreased body tempraturetemprature

f)f) Low blood pressureLow blood pressure

STAGE 4 (stage of reaction)

I. Death seems imminent.II.Surface temprature begins

to rise.III.Vommits

COMPLICATIONS;-

Severe dehydrations.Hypokalemia.HyponetremiaHypoglycemia.Renal failureShockdeath

LABLAB DIAGNOSISDIAGNOSIS1)SPECIMENS2)COLLECTION &

TRANSPORT3)CULTURE OTHERSI. COMPLETE BLOOD

COUNTII. GRAM STAINING

SPECSPECIIMENS:-MENS:-Stool examination;-

Rectal swabs Checking of water and food for v.

cholerae by taking sample of water and food for v. cholerae.

COLLECTCOLLECTIOION N AANDND

TRANTRANSPSPORTORT;-;-

Specimens should collected preferably prior to start of antibiotics.

They should not be collected from bedpans due to risk of contamination.

Specimens should send

immediately to

laboratory for

processing.

In case of delay stool

sampels may be

preserved in holding

media or cary blair

media.

3. CULTURE:-

PREVEPREVENTIONNTIONCholera 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.

TREATREATTMEMENTNT

1. EARLY DIAGNOSIS

(2)NOTIFICATION

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.

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.

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. HHYGYGIIENIC ENIC FOFOODOD

3. HANHAND WASD WASHINHINGG

4. DISINDISINFEFECTIOCTIONN

How water is disinfected???

• By adding chlorine drops in water

5. 5. SANITSANITAATIONTION

NURSINURSING NG 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 blood presssure.

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 forachieving prevention and

control. health education

regarding;- causessymptoms preventioncontrol of cholera

knowledge regarding symtoms also help to take the appropriate steps to control cholera

SUMMRISATIONINTRODUCTIONDEFINITIONEPIDDEMIOLOGICAL TRIADCOMPLICATIONMODES OF TRANAMISSONINCUBATION PERIODRISK FACTORSPAHOPHYSIOLOGY CLINICAL MENIFESTATIONSSTAGESCOMPLICATIONSLAB DIAGNOSISPREVENTION TREATMENTNURSING INTERVENTIONSHEALTH EDUCATION

RECAPTULISATION1) 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 water4) Incubation period for cholera is _________5) Metabolic acidosis is due to

_______________________

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.

HOW WE CAN DISINFECT WATER

WHICH MEDIA IS USED TO PRESERVE THE STOOL SAMPLES IN CASE OF DELAY

11%, 50%

2. 1-20% /day3. 10^3, 10^94. few hours to 5 days5. excessive release of bicarbonate ions in the

lumen6.stage 27. RL, ORS 8. Tetracyclin