Glyn Villegas Critical Care Nursing 11 / 16 / 2020

Ms. Nessa Librando Instructor

Cholera Assignment

Cholera is an acute diarrheal illness caused by gram-negative bacterium Vibrio - Cholerai. It is

endemic in parts of Asia Middle east and Africa. Cholera is spread through fecal-oral route or oral-fecal
through contaminated water or food. Route of transmission of disease, when pathogens in fecal
particles pass from one person or animal to the mouth of another person. These organisms produces
enterotoxins, enzymes, and other substances that affect the entire small intestine. Water and
electrolytes are secreted into the bowel lumen in response to the toxin.
Some causes of fecal-oral transmission includes; inadequate sanitation such as open defecation,
infected water supply, and improper hand washing especially after defecating,or changing baby’s
diapers. Five F’s to watch for, to avoid fecal-oral transmitted diseases. Fingers, Flies, Fields, Fluids, and
Food.
Cholera ranges in severity from mild with few or no manifestations, to sudden, acute and severe.
Its onset is abrupt with severe, frequent, watery diarrhea. Up to 1 Liter of watery stool may be passed in
an hour. Rapidly depleting a person’s fluid volume causing severe dehydration, if left untreated. Stool is
described as rice water stool. Gray and cloudy in color. Vomiting may accompany the diarrhea. No fecal
odor nor blood or pus.
Modern sewage and water treatment have virtually eliminated cholera in industrialized countries.
But still exist in Africa, Southeast Asia and Haiti.

Manifestations of Cholera:
Severe watery diarrhea and vomiting - primary symptoms triggered by the bacterial infection.
Oliguria - urine less than normal.
Less than 1 ml/kg/hr in infants
Less than 0.5 ml/kg/hr in children
Less than 30 ml/hr in adults
Thirst, Muscle cramps, Weakness

Complications may include:

Metabolic acidosis R/T severe diarrhea. Lost of bicarbonate from GI tract.
Metabolic alkalosis ( could also happen during repetitive vomiting. When fluids instead of
being absorved going down to the GI tract. It goes out with vomitus
Normal ABG pH 7.35 - 7.45. Below 7.35 acidosis. Above 7.45 alkalosis.
Hypokalemia ( potassium is the most common and dangerous electrolyte excreted
with fluids and feces) Normal is 3.5 to 5.3 meq/L
Hyponatremia ( loss of sodium R/T diarrhea and vomiting.) Normal 135 - 145 meq/L
Vascular collapse
Acute Renal Failure
Dehydration

Management:
With prompt and adequate fluid replacement, mortality is less than 1 %. Recovery could occur within 3
to 6 days.
Oral or intravenous rehydration
Antimicrobial therapy:
Doxycycline - indicated for bacterial, protozoal, and fungal infections
Ciprofloxacin - indicated for bone and joint infections, bacterial gastroenteritis,
intra-abdominal infections, and urethral infections

Examples of Nursing Diagnosis.

For diarrhea and vomiting.

Nursing dx: Risk for fluid volume deficit R/T severe diarrhea
Planning/Goal: Client will show no S/S of fluid volume deficit.
Nsg Intervention: Assess V/S and monitor I&O.
Rationale: To provide means of evaluating the status of the client.
Maintain IV fluid therapy as ordered.
Rationale: To prevent further fluid imbalance.
Offer ice chips or sips of clear fluids as tolerated per MD order.
Rationale: Gradually helps to re-establish oral intake.
Assess skin turgor
Rationale: Poor skin turgor could be an indication of dehydration.
Lab works as ordered.
Rationale: Lab tests results are reliable indicators of fluid imbalance.
Evaluation: V/S are within normal limits at this time. Urine output is approximately
350 ml in 8 hrs. with amber color. Skin returns quickly in less than 2 mins.
Laboratory results are within acceptable levels at this time.
Goal is met.