Communicable Disease Nursing
Written Report
eCHOLE RAf Submitted to: Ms. Rowena Luce, RN Clinical Instructor San Lazaro Hospital
Submitted by:
Nicolas, Jean Therese P. BSN
104 B/ Grp. B3 Norzagaray College
Date Submitted: September 8, 2010
CHOLERA (EL TOR) Introduction
Cholera is an acute, bacterial, diarrheal disease with profuse watery stools, occasional vomiting, and rapid dehydration.
If untreated, circulatory collapse, renal failure and death may occur.
More than 50% of untreated people with severe cholera die.
It occurs worldwide, with periodic epidemics and pandemics.
The Philippines were infected in 1858.
The 1902-1904 cholera epidemic claimed 200,000 lives in the Philippines.
In the Philippines, there is an incidence rate of approximately one person in 86,241,697.
Etiologic agent
Certain biotypes of Vibrio cholerae serogroup 01 which are curved, Gramnegative bacilli that secrete an enterotoxin (a toxin that adversely affects cells in the intestinal tract) called choleragen. Other Vibrio spp. (Vibrio parahaemolyticus, Vibrio
ulnificus) also cause diarrheal diseases. Vibrios are halophilic and are thus found in marine
v
environments. Reservoirs and Mode of Transmission
Infected humans and aquatic reservoirs.
Transmission is via the fecal-oral route, contact with feces or vomitus of infected people, ingestion of fecally contaminated water and foods especially raw or undercooked shellfish and other seafood and flies.
Incubation Period
From few hours to 5 days; usually 1- 3 days CLINICAL MANIFESTATIONS Stage 1: Diarrheal Stage
Abrupt onset of painless, severe, watery diarrhea that is often voluminous, flecked with mucus and dead cells, and has a pale, milky appearance that resembles water in which rice has been rinsed (rice-watery stool)
Vomiting without nausea that may persist for hours at a time
Muscle cramps
Stage 2: Dehydration Stage
Dehydration
Irritability
Lethargy
Sunken eyes
Dry mouth
Extreme thirst
Dry, shriveled skin that's slow to bounce back when pinched into a fold (Washer Woman¶s Hands)
Little or no urine output
Low blood pressure
Irregular heartbeat (arrhythmia)
Shock
Pathognomonic Sign
RICE WATERY STOOL
y
Diagnosis Rectal swabs or stool specimens should be inoculated onto thio-sulfate-citrate-bile-sucrose (TCBS) agar; different Vibrio spp. produce different reactions on this medium. are used to identify the various species.
Biotyping
Biochemical
tests
is accomplished using commercially available
antisera. Laboratory Test:
darkfield/phase-contrast microscopy, which may yield a large quantity of curved bacilli on examination of saline suspensions from fresh stool samples. V cholerae are usually variable in size from 1 to
3
micrometres in length to 0.5 to 0.8 micrometres in diameter, with single
polar flagellum and typical shooting star motility.
Gram-stain examination of stool culture is cheap and widely available but not a particularly helpful subsequent laboratory test. Smears can demonstrate small, curved gram-negative rods.
Full blood count may show elevated haematocrit in non-anaemic patients as a result of volume depletion, and a high neutrophil count may be present in severe infection.
Blood
chemistry tests are important in assessing the degree of volume depletion; urea and
creatinine levels are frequently elevated due to volume depletion.
RISK FACTORS Precipitating factors:
Contaminated food and water (contact with flies, feces )
Raw or undercooked seafood (e.g., shellfish)
Poor hygiene and sanitation
Overcrowding(e.g., refugee camps, impoverished countries, and areas devastated by famine, war or natural disasters)
Poverty
Malnutrition
Compromised Immunity
Reduced or nonexistent stomach acid (hypochlorhydria or achlorhydria)
Predisposing factors:
Age: children and older adults People who have had gastric surgery, who have untreated Helicobacter pylori infection, or who are taking antacids, H-2 blockers or proton pump inhibitors for ulcers
Type O blood
Household exposure
International travel (Latin America, Africa, Asia, Gulf of Mexico, Middle East)
NURSING CARE MANAGEMENT
Assess severity, quality, region and time of muscle cramps.
Assess for signs of dehydration. Observe for excessively dry skin and mucous membranes, decreased skin turgor, slowed papillary refill.
Note number, color, amount, consistency and characteristic of stool and vomitus.
Note generalized muscle weakness or cardiac dysrhythmias.
Observe for overt bleeding and test stool daily for occult blood.
Monitor input and output strictly.
Monitor vital signs.
Weigh daily.
Increase fluid intake.
Estimate fluid volume losses like diaphoresis.
Measure urine specific gravity and observe for oliguria.
Maintain oral restrictions, bed rest and avoid exertion.
Provide bed pan or bedside commode.
Provide a bland diet.
Assist patient in ambulating to the bathroom.
Medical septic protective care must be provided.
Contact precautions must be observed.
A thorough and careful personal hygiene must be provided.
Stool, urine and other infected secretions must be properly disposed of.
Concurrent disinfection must be applied.
Food must be properly prepared.
Environmental sanitation must be observed.
Blood
pressure, pulse, respiration and temperature.
TREATMENT Cholera requires immediate treatment because the disease can cause death within hours.
Rehydration. The goal is to replace fluids and electrolytes lost through diarrhea using a simple rehydration solution, Oral Rehydration Salts (ORS), that contains specific proportions of water, salts and sugar. The ORS solution is available as a powder that can be reconstituted in boiled or bottled water. Without rehydration, approximately half the people with cholera die. With treatment, the number of fatalities drops to less than 1 percent.
Intravenous fluids. During a cholera epidemic, most people can be helped by oral rehydration alone, but severely dehydrated people may also need intravenous fluids.
Antibiotics. Recent studies show that a single dose of azithromycin (Zithromax, Zmax) in adults or children with severe cholera helps shorten diarrhea duration and decreases vomiting.
Zinc supplements. Research has shown that zinc may decrease and shorten the duration of diarrhea in children with cholera.
PREVENTION
Wash your hands. Frequent hand washing is the best way to control cholera infection. Wash your hands thoroughly with hot, soapy water, especially before eating or preparing food, after using the toilet, and when you return from public places. Carry an alcohol-based hand sanitizer for times when water isn't available.
Avoid untreated water. Contaminated drinking water is the most common source of cholera infection. For that reason, drink only bottled water or water you've boiled or disinfected yourself. Coffee, tea and other hot beverages, as well as bottled or canned soft drinks, wine and beer, are generally safe. Carefully wipe the outside of all bottles and cans before you open them and ask for drinks without ice..
Eat food that's completely cooked and hot. Cholera bacteria can survive on room temperature food for up to five days and aren't destroyed by freezing. It's best to avoid street vendor food, but if you do buy it, make sure your meal is cooked in your presence and served hot.
Avoid sushi. Don't eat raw or improperly cooked fish and seafood of any kind.
Be careful with fruits and vegetables. When you're traveling, make sure that all fruits and vegetables that you eat are cooked or have thick skins that you peel yourself. Avoid lettuce in particular because it may have been rinsed in contaminated water.
Be wary of dairy foods. Avoid ice cream, which is often contaminated, and unpasteurized milk.
Cholera vaccine.
Because
travelers have a low risk of contracting cholera and because the
traditional injected vaccine offers minimal protection, no cholera vaccine is currently available in the United States. A few countries offer two oral vaccines that may provide longer and better immunity than the older versions did. If you'd like more information about these vaccines, contact your doctor or local office of public health. Keep in mind that no country requires immunization against cholera as a condition for entry.
