TARLAC STATE UNIVERSITY

COLLEGE OF SCIENCE
DEPARTMENT OF NURSING
Awarded Level III Status by the Accrediting Agency of Chartered Colleges and
Universities in the Philippines

A Clinical Case Study Presented to the Faculty of the

Department of Nursing
In Partial Fulfillment
Of the Requirement of the
Subject NCM 112 RLE
Communicable Disease

Cholera

Presented by:
BORJA, Richelle Ann
CABAGAN, Alicia Dianne
DE LUNA, Raquel Mae
DIVINO, Denisse Diane
FRANCISCO, Krisianne Mae
GARDANOZO, Rachel Ann
MAGLALANG, Rujmina
MATIAS, Daisybelle
SICAT, Kenneth
VALMORES, Ranford

Mr. Jomer Manalang, RN, MAN

Clinical Instructor

July 2021
CASE SCENARIO:

PATIENT PRESENTATION

Client is 27 years old. He was infected with a bacteria V. cholerae (Cholera is

caused by the bacterium V. cholerae. (This bacterium is Gram stain-negative), by

eating contaminated food and water or uncooked food and fruits. After a 24–48 hours,

some symptoms begin with the sudden onset of painless watery diarrhea that quickly

become voluminous and is often followed by vomiting. Its main symptoms are

vomiting and diarrhea, because of these, severe dehydration can occur.

He vomits every time he eats or drinks anything. After a day, his color become

pale yellow and he became weak due to dehydration by loose motions and vomiting.

In the first day of infection, he drank some rehydration solutions, but no improvement

observed. He also felt severe abdominal pain.

He experienced accompanying abdominal cramps, probably from distention of

loops of small bowel because of the large volume of intestinal secretions. Fever is

typically absent.

DIAGNOSIS

He went to a hospital where proper check-ups were performed. The Physician

advised him for few tests (CBC+ESR, Rapid stool test to identify cholera bacteria).

Thus, confirms cholera by identifying bacteria in a stool sample. He was then

admitted for treatment and management.

HISTORY

Two Days ago: Symptoms began with abdominal cramps and an intense urge

to pass stool after every meal. His symptoms started to appear after eating his dinner
bought in the Carinderia and rapidly worsened with passage of stool becoming more

frequent. Within two days he was passing persistently watery diarrhea.

One Day ago: Symptoms persisted, and he experienced diarrhea and vomiting

after eating or drinking, which lasted for 48 hours. He was admitted to hospital for

rehydration and further investigations. No conclusive diagnosis was made.

Currently: Client is passing 8-10 liquid stools per day. Diarrhea is watery.

Occurs day and night. Client complains of malaise, lethargy and anorexia. He has lost

5 kg in the past 2-3 days. No past surgical history, and no significant medical history

FAMILY HISTORY:

• Mother – type 2 Diabetes Mellitus

• No other family members with chronic disease

• No known allergies

• Foods are bought in the Carinderia nearby and water supply from water pump

being used by the whole Barangay.

EXAMINATION/ASSESSMENT

• Thin ill looking male, conscious, and alert, in obvious discomfort.

• The Nurse weighed him and recorded 48 kgs only at that time. He became

bluish and weak due to loss of water causing dehydration.

Other findings include:

Vital Signs:

• Blood Pressure: 90/50

• Cardiac Rate: 122bpm

• Respiratory Rate: 28cpm

• Temperature: 36.1 ⁰C

General Appearance:
• Weak, and pale looking, Eyes were sunken and with observable discomfort.

• Lack of sweat production, Sunken eyes, Shriveled skin, with Dark urine

Neurological:

• Verbalized stress and worrying at time.

Cardiovascular:

• Slight Tachycardia

• Complaining of heart beats faster, increasing heart rate and causing to feel

palpitations at times.

Abdominal examination:

• Guarding and tenderness noted in the left iliac fossa and hypogastrium.

Abdominal X-ray:

• No toxic megacolon

Gastroscopy Report:

Esophagus and gastro- esophageal junction were normal. Stomach mucosa

was intact and normal. No gastritis, ulceration or blood was noted. Cardia

was normal. Pylorus and duodenum normal.

MANAGEMENT

• After checking all aspects, the Physician ordered the following:

• Dimenhydrinate tablets for vomiting twice-a-day before the meal.

• Antibacterial Medication: gramicidin, neomycin sulfate, ciprofloxacin 500

mg twicea-day, and Flygal (Metronidazole) 400 mg twice-a-day and a

rehydration solution (ORS).

• Intravenous Fluid to treat dehydration (Volume per Volume)

INTRODUCTION

Cholera is an acute, diarrheal illness caused by infection of the intestine with

the toxigenic bacterium Vibrio cholerae serogroup O1 or O139. In fact, about 1 in 10

people infected with this type of bacteria experience severe, life-threatening illness,

and both serogroups can cause widespread epidemics. Also, it is endemic in South-

East Asia, the Middle East, parts of Africa and most of Central and South America

(CDC,2020).

V. cholerae causes infections only in humans, with symptomatic and

asymptomatic carriers being reservoirs of infection. The organism produces

enterotoxin, enzymes and other substances affecting the entire small intestine. The

cholera toxin increases the levels of cyclic adenosine monophospate (AMP) in

intestinal epithelial cells, resulting in a massive outflow of water and electrolytes into

the bowel lumen (Lemone, 2017). Its incubation period ranges from a few hours to

five days, usually one to three days with people living in places with unsafe drinking

water, poor sanitation, and inadequate hygiene being the most affected and at risk

(Navales, 2010).

Cholera ranges in severity from very mild, with few or no manifestations, to

acute and fulminant. Its onset is typically abrupt, with severe, frequent, watery

diarrhea. Up to 30 L of stool may be passed in a day, rapidly depleting fluid volume.

Stool is often described as ‘rice-water stool’, characteristically grey and cloudy, with

no fecal odor, blood, or pus. Vomiting may accompany the diarrhea. Other

manifestations related to the loss of fluid and electrolytes include thirst, oliguria,

muscle cramps, weakness, and significant signs of dehydration. Metabolic acidosis

and hyperkalemia may also develop. Fecal to oral route is the transmission of cholera
through contaminated water or food when ingested. Flies, soiled hands, and utensils

also serve to transmit the infection (WHO, 2021).

Cholera remains a global threat to public health and an indicator of inequity

and lack of social development. Researchers have estimated that every year, there are

roughly 1.3 to 4.0 million cases, and 21 000 to 143 000 deaths worldwide due to

cholera ((WHO,2020).

In the Philippines, a total of 2,856 reported cases of cholera in the year of

2019. 1, 431 were males and 1,425 were females. Children with the age of 1 to 4

years were the most affected group (DOH, 2019).

GENERAL OBJECTIVES

The objective of making this case study is to identify the problem of our

patient and to determine the factors that contribute to this kind of disease so that

specific actions should be done and rendered to our patient.

SPECIFIC OBJECTIVES

To the future nursing students, this case study will be of help as it presents the

following:

1. To accurately present a thorough general assessment of the client which

includes physical assessment and family history taking.

2. To understand the pathophysiology and etiology of the disease.

3. To determine the contributing factors in the development of the diagnosis.

4. To provide appropriate and proper nursing diagnosis in line with the

client’s medical condition, hence, formulation of nursing care plan for the

problems identified.

5. To provide accurate and effective documentation to ensure continuity of

care and prevent duplication or error in the patient's care.

II. NURSING PROCESS

PATIENT’S PROFILE

Name: Patient A

Age: 27 years old

Gender: Male

Date of Birth: January 21, 1994

Birthplace: Tarlac City

Civil Status: Single

Occupation: Vendor

Nationality: Filipino

Chief of Complain: Sudden onset of painless watery diarrhea that

quickly become

voluminous and is often

followed by vomiting.

Date of admission: June 21, 2021

Time of admission: 7:00 AM

Admitting Diagnosis: Cholera

Final Diagnosis: Cholera

Environmental Status

Patient A currently living alone in his apartment located in Carangian Tarlac

City on the river side five (5) years from now, he is a vendor in public market of

Tarlac. His place is quite spot of traffic especially in the morning and rush hours, as

he mentioned they used to call his place as little tondo because the houses are just

wall apart therefore, the life there is quite hard and poor. He stated that his apartment
is made of cement and wood which is also sturdy and ventilated enough for him to

live in. When it comes to the ceiling, there are some parts that is broken already, and

he cannot manage to fix it due to his everyday work as a vendor. According to him, he

has own toilet facility inside his apartment wherein sometimes his neighborhood

engaging to used it whenever he is around. He prefers to get his drinking water from

water pump, that is 20 meters far from his apartment and refill it every five (5) days to

one (1) week. His electricity is supplied by the city and his mode of transportation are

walking, tricycle, jeep and sometimes buses. Garbage collection trucks by the city

collects their waste every Friday to be properly disposed but there were times that he

is unable to put his garbage out because he is asleep whenever the garbage collectors

arrive in their area.

Lifestyle
The patient is currently living in his own, he moved out from their house and

rent an apartment and live his life alone for about five (5) years now. As he stated, his

everyday routine was, leave his house and go to the market at exactly 7:00 pm in the

evening, he used to eat in the Carinderia found in the roadside near at irrigation in

Carangian Tarlac City while waiting for his co-vendor (kumpare). Afterwards, around

8:00 pm he exactly went to the Market and fix his products (paninda) which are fish,

some vegetable and fruits and he stated that whenever his product is slacken they used

to drink alcohol and their pulutan sometimes was his product with a half cook mode

together with the vegetables and fruits that he basically sells as he stated that “no one

touched it therefore no need to wash it”, and whenever his products sold quickly he

used to go home early but before that he will go around to the different canteen in the

Market and look what he wanted to eat because he don’t usually cook for his self

since he’s just alone in his apartment, then upon arriving at home he will just go to the
bed without washing his hands or taking a bath even, due to tiredness and laziness

sometimes. He easily fell asleep because he is awake the whole night. He will wake

up around 3:00 pm to 4:00 pm in the afternoon and then making some stuff such as

having an entertainment like, watching on YouTube, checking his Facebook etc.

afterwards, he will stand and get water from water pump at least 3 pails for about 20

meters far from his apartment and he will lift it from the location of the water pump

up to his apartment without covering it. The one pail serves as his drinking water for

about a week and the other remaining two serves as his water to use for his taking a

bath for the specific day, and the day same goes around.
 1. HISTORY OF PAST ILLNESS

Patient X has no known allergy to any foods, medications, animals and any

other environmental agents. He stated that he does not have previous surgery and no

known history of cholera. He stated that he usually bought meals in the Carinderia

near his house after his work because no one could prepare his meals. He also stated

that their water supply is from water pump being used by the whole Barangay.

2. HISTORY OF PRESENT ILLNESS

Two days prior to admission the patient X experienced symptoms with

abdominal cramps and an intense urge to pass stool after every meal. His symptoms

started to appear after eating his dinner bought in the Carinderia and rapidly worsened

with passage of stool becoming more frequent. Within two days he was passing

persistently watery diarrhea.

One day prior to admission he stated that symptoms persisted, and he

experienced diarrhea and vomiting after eating or drinking, which lasted for 48 hours.

On June 21, 2021 the patient X decided for consultation hence admitted at the

hospital for rehydration and further investigations. No conclusive diagnosis was made.

Currently, patient is passing 8-10 liquid stools per day. Diarrhea is watery. Occurs day

and night.

He also complains of malaise, lethargy and anorexia. He has lost 5 kg in the past

2-3 days. Upon examination he is thin ill looking male patient, conscious and alert, in

obvious discomfort. His weight was recorded for 48 kgs only at that time. He became

bluish and weak due to loss of water causing dehydration.

The Physician advised him for few tests (CBC+ESR, Rapid stool test to identify

cholera bacteria). Thus, confirms cholera by identifying bacteria in a stool sample. He

was then admitted for treatment and management.

Vital Signs:

Blood Pressure: 90/50mmHg

Cardiac Rate: 122bpm

Respiratory Rate: 28cpm

Temperature: 36.1 *C

13 AREAS OF ASSESSMENT

I. Social Status

Patient A is a 27-year-old male, born on March 07, 1994 and currently

residing in Tarlac City he is away from his family since pandemic started

because he is working as a construction worker. According to the patient, he

misses his family especially his wife because he cannot be able to see them in

almost a year, he stated that they usually talk using video call every night to see

her and their 3-year-old child he also said that he was excited be back on their

hometown to see them next month.

Upon interview, patient A is having discomfort because of his condition

however he classified himself as jolly person since we can able to joke around

despite of his feelings because according to him, he is the clown on their team or

work as he usually tell funny stories, through this their work seems to be easy,

and he also stated that they treat each other as family or brothers by sharing what

they have and help each other at time of crisis.

Norms:

The ability to interact successfully with the people and within the environment

of which each person is a part, to develop and maintain intimacy with significant

others, and to develop respect and tolerance for those with different opinions and

beliefs. (Fundamentals of Nursing: Concepts, Process, and Practice, 7th Edition).

Analysis:

Patient A social status is normal despite of his condition. As he interacts

successfully with the people around him within health care team and his environment.

He also has a good relationship with people as they maintain intimacy.

II. Mental Status

Level of Consciousness

During our assessment, Patient A was awake but lethargic and able to have an

eye-to-eye contact when he responds to the student nurse’s questions despite of

having discomfort.

Norms:

The clients must be alert and awake with eyes open and looking at the

examiner and able to respond appropriately. (Kelley & Weber, 2018)

Analysis:

Based on the norms, patient A level of consciousness was normal because he

was awake but lethargic and able to have an eye-to-eye contact when he answered to

the student nurse’s questions despite of having discomfort.

Appearance and Movement

During the first day of hospitalization, patient is neat wearing appropriate

clothing according to the weather, he was appeared lethargic and anorexic. Thin ill

looking male patient, conscious and in obvious discomfort.

Upon arriving at the hospital, Patient A had difficulty in moving due to

abdominal pain. He also stated that he does not move around often because of
abdominal pain and the intense urge to pass stool. He was walking slowly and slightly

bowed while guarding his stomach with his two hands.

Norms:

The client should be able to stand still, have smooth and coordinate movement

(Jensen, 2019).

Analysis:

The client has a difficulty to move around due because of the pain he felt on

the abdomen and vomiting. This pain and feeling of weakness restrain his movement

and/or daily physical activities.

Orientation

The patient was oriented to current time and place when we asked questions

like “Nasaan po kayo ngayon?” and “Anong petsa na po?’ he answered it right and

responded “Nasa hospital ako” on place and “June 21,2021 na” on the date.

Norms:

A person is normally aware to self, others, place, time, and address. (Weber,

2018)

Analysis:

Patient A was in a good level of orientation as he correctly stated the time,

date, and place.

Speech

During the assessment and interview, the patient was lethargic but can respond

to the student nurses, he was having a difficulty in stating a complete sentence and in

speaking due to pain, weakness, and malaise.

Norms:
 Speech should be clear and moderate pace. It should be exerted effortlessly.

(Jensen, 2019).

Analysis:

The patient was lethargic and has a difficulty in speaking due to pain,

weakness, and body malaise.

Intellectual Function

Despite having difficulties in verbalizing his answers, he was able to answer

coherently and was able to recall past events when we asked questions like “Ano pong

kinain ninyo kanina?” and “saan po kayo madalas kumakain?’ he answered it right

and responded “Hindi ako makakain” on the first question and “sa may carenderia” on

the second question.

Norms:

A person should respond normally and appropriately to topics discussed.

Express full and free-flowing thought during the interview and listen and responds

with full thought. (Jensen, 2019)

Analysis:

The patient was able to remember past events which indicate good intellectual

function.

III. Emotional Status

During the interview, the Patient is in pain yet able to tolerate it and we asked

how he is feeling today? If there is something bothering him? And he told us that “nag

aalala ako sa kalagayan ko, bakit ako nagkakaganito. Paano ako makakabayad dito sa

hospital?”

Norms:
 A person expresses himself as an optimistic and positive thinker in life. There

should be no presence of fear, anxiety, grieving etc. the patient should have the ability

to manage stress and to express emotions appropriately. It also involves the ability to

recognize, accept and express feelings and to accept one’s limitations (Kozier & Erb’s,

2015).

Analysis:

The patient is anxious about his condition and about the hospital bills.

IV. Sensory Perception

Sense of Sight

During the interview with the patient, we inspect and assess the eyes of the

patient with the use of penlight. We obtain the following information: sclera is white,

the conjunctiva is pale in color and pupils are equal round and reactive to light. We

also performed an eye test that assesses the 6 ocular movements. The patient's eyes

are round, moving symmetrically and his iris is dark brown, we also use Snellen’s

chart to check for the visual acuity and result in vision of 20/20.

Norms:

Normal vision of a person is 20/20 in 20 feet without wearing or using

eyeglasses or corrective grade lenses. (Estes, 2011)

Analysis:

Upon assessment of the patient’s sense of sight is normal.

Sense of Touch

During the interview we asked for permission from the Patient to assess his

sense of touch. We did some tests wherein we use a cotton wool to touch some parts

of the body and locate where it was being felt, and we are also his pain wherein we

must use some pin that is slightly sharp objects, and the patient must say if it hurts or
if he could feel something. For his temperature we grab some ice and a heat compress

to specifically know whether it is cold or hot.

Norms:

The skin contains receptors for pain, touch, pressure, and temperature. Sensory

signals that help to determine precise locations on the skin are transmitted along rapid

sensory pathways and less distance signals such as pressure or poorly located touch

are sent via slower or sensory pathways. (Estes, 2011)

Analysis:

Based on the assessment, the patient's sense of touch is normal. He was able to

portray the location where we tested his pain, temperature, and touch. The assessment

shows in light touch where in a particular area using gentle contact with a fingertip or

a wisp of cotton wool and it was being felt.

Sense of Taste:

We asked our patient to close his eyes and describe the taste of the calamansi,

apple juice and a pinch of coffee that was being given to him, to assess if there is a

change on his taste buds. We also assess the mouth of our patient if there is a presence

of swelling or bleeding and perform a gag reflex.

Norms:

A person can identify the taste of bitter, sweet, and sour. (Estes, 2011)

Analysis:

Upon assessing the patient's sense of taste, wherein specifically we asked him

to describe and give him each food first to test the taste of the calamansi and the next

one is apple, he verbally told us that the given foods taste and normal and he easily

identified the taste.

Sense of Hearing
 During the interview with patient, we assess his sense of hearing with Rinne

test wherein we place the base of a struck tuning fork on the mastoid bone behind the

ear. Have the patient indicate when sound is no longer heard. Move the fork beside

the ear and ask if it is audible. For the Weber test we place the base of a struck tuning

fork on the bridge of the forehead, nose, or teeth. We did these tests to specifically

know if the patient has hearing problems. Additionally, symmetrical ear was noted

upon assessment.

Norms:

Patient should be able to repeat the words whispered from 2 feet. (Estes, 2011)

Analysis:

Upon doing the Rinne test to the patient, he reported that sound is still heard

when the tuning fork is moved to air near the ear air conduction or AC indicating that

AC is equal or greater than bone conduction or BC. He participated well and

performed normally. However, on doing the Weber’s test, patients also reported

sound heard equally on both sides. We also assessed the ear, and it is symmetrical.

Sense of Smell

During the interview with the patient, we assess the sense of smell and give

him two objects, vinegar, and fish sauce. But before we assess, we asked him to

identify these two objects with his eyes closed to check if there is an alteration on the

patient's sense of smell. First, we hand over the vinegar, next the fish sauce.

Norms:

The nose must be symmetrical and along the middle of the face. Nostrils must

be patent and able to recognize the smell of different objects. (Estes, 2011)

Analysis:
 During the interview, the patient’s sense of smell is normal. We gave two

objects (vinegar and fish sauce). Upon giving the vinegar, he was able to determine

and describe what was given to him. After that, we handed over the fish sauce and the

patient answered correctly. Therefore, the patient’s sense of smell is normal.

V. Motor Status

Patient A experienced body malaise. He was unable to stand upright properly

due to abdominal pain and weakness with presence of abdominal guarding especially

before admission to the hospital.

Norms:

Normal motor stability includes the ability to perform different activities.

(Estes, 2011)

Analysis:

Upon assessing the patient motor status, the patient shows not normal. The

dehydration of the patient is making him weak due to electrolytes loss and unable to

stand upright due to abdominal pain.

VI. Temperature

Date Assessed Time Temperature Analysis

06/21/21 7:30 am 36.1 C Below normal

06/22 /21 7:30 am 36.7 C Normal

06/23/21 8:00 am 37.2 C Normal

06/24/21 8:30 am 37.0 C Normal

Norms:
 The normal body temperature of a person is within 36.4 Celsius to 37.4

Celsius. (Estes, 2011)

Analysis:

Upon admission the temperature of patient on his right axillary is lower than

the normal range, experiencing hypothermia shivering from being cold and pale in

appearance. The next day, it became normal until the patient has been discharged.

VII. Respiratory Status

Respiratory Rate

Date Assessed Time Breaths Analysis

06/21/21 7:30 am 24 cpm Above normal

06/22/21 7:30 am 21 cpm Above normal

06/23/21 8:00 am 16 cpm normal

06/24/21 8:30 am 13 cpm normal

Norms:

A normal respiratory rate ranges from 12-20 CPM. Normal breath sounds are

classified as tracheal, bronchial, bronchovesicular, and vesicular sounds. In normal

breathing at rest, there are small in breaths (inhalation) followed by the out breaths

(exhalation). The out breath is followed by an automatic pause (or period of no

breathing) for about 1 to 2 seconds. Most of the work of inhalation when we are at

rest is done by the diaphragm, the main breathing muscle. (Kozier, Fundamental of

Nursing. 7th Edition)

Analysis:
 Patient’s respiratory rate during the first and second day upon admission is

above normal. The patient experienced tachypnea for two days. Poor perfusion of

body tissue can result in lactic acidosis, thereby causing hyperventilation and

Kussmaul breathing.

VIII. Circulatory Status

Date Assessed Time Blood Pressure Pulse Rate Analysis

06/21/2021 7:30 am 90/50 mmHg High blood pressure

122 bpm Increased pulse rate

06/22/2021 7:30 am 90/60 mmHg Normal blood pressure

100 bpm Normal pulse rate

06/23/2021 8:00 am 100/70 mmHg Normal blood pressure

95 bpm Normal pulse rate

06/24/2021 8:30 am 120/80 mmHg Normal blood pressure

96 bpm Normal pulse rate

Norms:

An adult’s blood pressure tends to rise with advancing age. The optimal blood

pressure for a healthy, middle- age adult is less than 120/80 mmHg. Systolic blood

pressure values of 120-139 and Diastolic blood pressure value of 80/89 mmHg are

considered prehypertension. Some medications directly or indirectly affect blood

pressure. Blood pressure is not measured on the client's limb if is injured or diseased,

has an intravenous infusion or blood transfusion. The pulse is the palpable bounding

of blood flow noted at various points of the body. The normal adult pulse rate is 80
 (60–100) beats per minute. It must have a regular beat and not bounding nor weak.

(Potter, et al, 2021)

Analysis:

The patient's blood pressure on his 1st day of admission is low significantly the

diastolic. The patient experienced hypotension upon admission. The capillary refill

took three seconds and nails are bluish in color. These results from the rapid loss of

salts such as sodium, chloride, and potassium. Shock. This is one of the most serious

complications of dehydration. It occurs when low blood volume causes a drop in

blood pressure and a drop in the amount of oxygen in the body.

IX. Nutritional Status

Patient A states that he just ate twice a day; breakfast and lunch only, without

eating snacks. He also said that he loves to eat seafoods like kilawin/kinilaw (raw

seafood dish) and ate raw vegetables and fruits after eating. He has inadequate water

intake with the unusual range between 4-5 glasses of water a day, also stated he does

not like the taste of mineral water instead he preferred drinking from the water pump.

Nutritional Parameters

Parameter Norms Analysis

Height: <16=Malnourished

168 cm 16-19=Underweight Underweight

Weight: 20-25=Normal

48 kg 26-39=Moderate to severe obesity

BMI: 40 and above=Morbidly obese (Fundamentals of Nursing by Kozeir, et

17 kg/m2 al.)
Norms:

According to the Health Asian Diet Pyramid, there should be a daily intake of

rice, grains, bread, fruit, and vegetables; optional daily for fish, shellfish, and dairy

products; weekly for sweets, eggs and poultry, and monthly for meat. There should be

an increase intake of a wide variety of fruits and vegetables. Include in the diet foods

higher in vitamins C and E, and omega-3 fatty acid rich foods. (www.webmd.com)

Fluid intake is on the average of 8-10 glasses per day (Mohan, 2002). BMI is a

measurement that indicates body composition. The degree of overweight or obesity as

well as the degree of underweight can be determined using BMI. The normal BMI

ranges from 18 to 22. (Mary Ellen Zator Estes, Health Assessment, 2006)

Analysis:

The eating behavior of Patient A is not normal, he only ate twice a day instead

of thrice. Patient A preferred to drink that comes from the water pump and loves to

eat spicy seafoods which may be the cause of her diarrhea. Moreover, Due to

persistent watery diarrhea and vomiting Patient A had loss of fluid and sudden weight

loss that caused the client’s BMI to become underweight or below the normal weight ,

BMI is 17 kg/m2.

X. Elimination Status

STOOL
DATE TIME VOLUME
June 19, 2021 7:00 AM 100ml
June 19, 2021 12:30 PM 130ml
June 19, 2021 8:30 PM 140ml
June 20, 2021 7:10 AM 80 ml
June 20, 2021 12:15 PM 125 ml
June 20, 2021 3:00 PM 95 ml
June 20, 2021 7:30 PM 100 ml

VOMITUS
DATE TIME VOLUME
June 20, 2021 9:00 AM 80 ml
June 20, 2021 5:00 PM 50 ml
 June 20, 2021 8:00 PM 65 ml

Currently
DAY 1: DATE ADMITTED
STOOL
DATE ASSESSED TIME VOLUME
June 21, 2021 7 AM 80ml
June 21, 2021 8:15 AM 70 ml
June 21, 2021 9:00 AM 65 ml
June 21, 2021 9:15 AM 100 ml
June 21, 2021 11:00 AM 83 ml
June 21, 2021 11:50 AM 80 ml
June 21, 2021 12:55 PM 60 ml
June 21, 2021 2:00 PM 50 ml

VOMITUS
DATE ASSESSED TIME VOLUME
June 21, 2021 9:00 AM 50 ml
June 21, 2021 5:00 PM 30 ml

VOIDING
DATE ASSESSED TIME VOLUME
June 21, 2021 10:00 AM 135 ml
June 21, 2021 7:00 PM 120 ml

DAY 2
STOOL
DATE ASSESSED TIME VOLUME
June 22, 2021 2: 00 AM 50 ml
June 22, 2021 6: 00 AM 50 ml
June 22, 2021 12: 00 NN 45 ml
June 22, 2021 5:00 PM 43 ml
June 22, 2021 11:00 PM 40 ml

VOMITUS
DATE ASSESSED TIME VOLUME
June 22, 2021 9:00 AM 20 ml
June 22, 2021 8 PM 15 ml

VOIDING
DATE ASSESSED TIME VOLUME
June 22, 2021 10:00 AM 150ml
June 22, 2021 12:00 NN 170 ml
June 22, 2021 2:00 PM 180 ml
June 22, 2021 7: 00 PM 185 ml
 DAY 3
STOOL
DATE ASSESSED TIME VOLUME
June 23, 2021 5: 00 AM 25 ml
June 23, 2021 12: 00 NN 23 ml

VOMITUS
DATE ASSESSED TIME VOLUME
June 23, 2021 9:00 AM 5 ml

VOIDING
DATE ASSESSED TIME VOLUME
June 23, 2021 7:00 AM 150ml
June 23, 2021 9:00 AM 180 ml
June 23 2021 11:00 AM 140 ml
June 23, 2021 1: 30 PM 125 ml
June 23, 2021 5:00 PM 150 ml
June 23, 2021 7:00 PM 90 ml

Upon the assessment, patient presented a rice-watery stool that is not

malodorous. He added that this is the first time he experiencing this kind of stool.

Currently on the day of admission, patient is passing 6 stools over the 8 hours of

student nurse’s duty. Vomitus was also complain of the patient. On the other hand,

patient stated that he also has problem on voiding pattern. He stated that he only voids

twice a day with a 120-150 ml of urine in each urination since the disease occured.

Norms:

Normal bowel movement of a person must be 1 to 2 times a day and voiding

in 3 to 4 times a day with an output of 1200 to 1500 ml a day. A normal stool is

brown in color and well formed, urine is clear to yellowish in color. (Fundamentals of

Nursing, kozier, 2007)

Analysis:

Patient’s elimination status is not normal due to the characteristics of his stool

which is rice – watery and also the consistency of his elimination, wherein he was

passing 6 stools over the 8 hours of student nurse’s duty.. Moreover, his voiding

pattern also have a problem with a urine of 120-150ml in each urination and a dark in
color but as the treatment goes by voiding were slowly going back to normal. On the

other hand over the period of 3 days treatment, patient stool and vomiting decreases.

XI. Reproductive Status

Patient A reported that he notices changes in his voice at the age of 13 and his

height also increased at the same age. Facial hairs grew at around 17 years old. His

last intercourse with his wife was around 5 months ago. On the day of the assessment

it was seen that the genital hair is well distrbuted. Penis’ surface characteristics, color,

lesions and discharge is also clear. Scrotum, sacrococcygeal areas, perineal area and

inguinal region and femoral areas also clear and shows no masses or bulges being

found.

Norms:

Examination of the penis includes the skin, corporal erectile bodies, and

urethral meatus. It should be noted whether the patient is circumcised or

uncircumcised. The ease with which a redundant prepuce is retracted is assessed. The

entire penile skin, including that beneath the prepuce, should be examined for ulcers,

warts, rashes, or other lesions. The size and position of any skin lesion should be

described along with the degree of tenderness to palpation and fixation to

subcutaneous tissue. If penile skin lesions are found, correlation of palpable deep or

superficial inguinal adenopathy should be made at that time. Examination for urethral

discharge or urethral mucosal lesions near the meatus should also be carried out by

everting the lips of the meatus. (Maxwell White, Clinical Methods: The history,

Physical, and Laboratory Examination. 3rd edition.)

Analysis:
 Reproductive status of the client is normal. On the scrotum the anterior and

posterior scrotal skin appears darker in pigmentation with rugous or wrinkled surface.

Cacrococcygeal areas skin is clear and smooth with no palpable mass being detected.

Perineal area skin surrounding the anus is coarse with darker pigmentation. Anal

sphincter is closed.

XII. Sleep – Rest Pattern

According to the patient his sleep rest pattern is disturbed since the first time

he experience the diarrhea brought by cholera. He also added tha he’s sleep hours is

inadequate since he only slept for 3-4 hours.

Norms:

Adults generally sleep 6-8 hours per night. About 20% of sleep is rapid eye

movement. The complete sleep cycle is about 1.5 hours in adults. Maintaining a

regular sleep-wake rhythm is more important than the number of hours slept. (Kozier

et. al., Fundamentals of Nursing 7th edition)

Analysis:

Patient X sleep-rest pattern is abnormal. Due to the abdominal cramps he

experiencing he can not complete the supposed to be right amount of hours that he

needs according to his age.

XIII. State of Skin Aappendages

Student nurses on duty inspected the skin appendages of the patient beginning

at the crown of the head, parting the hair to visualize the scalp, and progressing

caudally to feet. It was seen that hair is equally distributed, no lice was shown,

pigmentation is consistent throughout the body. No lesions, inflamation, vascular or

other miscellaneous lesions observed. Patient has no wounds. Skin’s color and

characteristics also assessed.

Norms:

Normal skin is a uniform whitish pink or brown color, depending on the

patient’s race. Pallor is due to decreased visibility of the normal oxyhemoglobin. This

can occur when the patient has a decreased blood flow in the superficial vessels, as in

shock or syncope, or when there is a decreased amount of serum oxyhemoglobin as in

anemia. No skin lesson should be present. Normally, the skin is dry with a minimum

respiration. It should be smooth, even and firm except when there is a significant hair

growth. It should return to its original contour when pinched. (M.E.Z. Estes, Health

Assessment and Physical Examination 3rd. edition). The normal Capillary Refill Time

(CRT) is <2 seconds; a CRT of >2 seconds suggests poor peripheral perfusion and

may be an early sign of shock (Hernández et al, 2020).

Analysis:

Patient A skin is tan and the color of hair upon the assessment is black. No

presence of infestation, infections and wounds. However, skin is shriveled and dry on

the upper extremities including abdomen that is pale. Moreover, capillary refill time

shows aberration with 3 seconds due to severe dehydration.

Laboratory and Diagnostic procedures
Diagnostic/laboratory Date Indication/Purposes
procedure ordered
Rapid Stool Test June 21, It is a test done on
2021, a stool (feces) sample to
11:30 am help diagnose certain
conditions affecting the
gastrointestinal tract. It is
also commonly use to
confirm cholera by
identifying the bacteria
present in the stool
sample. (Stool Analysis |
Michigan Medicine,2021)
Result Analysis and Nursing responsibilities
interpretation of prior to, during and after
results the procedure
Normal: As per patient’s Before:
Color-brown stool analysis,
Consistency- soft, well- Vibrio cholerae Explain to the patient the
formed was found in the purpose of the procedure.
(-) Pus stool sample, and
(-) Blood was confirmed to Assessed the patient’s level
(-) Mucus have cholera. of comfort.
No harmful bacteria Asked the patient if he has
found in the stool. taken any dark colored
foods.
Patient’s stool analysis:
Color- Transparent Assessed if the patient has
Consistency- Rice watery taken any laxatives for the
(-) Pus past few days.
(-) Blood
(-) Mucus Encouraged the patient to
(+) Vibrio cholerae urinate before collecting the
stool to avoid contaminating
the stool sample.
Demonstrated to the patient
the proper hand washing
technique and instructed the
patient to perform it after
using the toilet.

Demonstrated to the patient

how to properly collect the
stool.

After:

Labeled the cup of the stool

sample appropriately.

Delivered the stool sample in

the laboratory immediately
for stool analysis (Martin, P.
B., 2019).
Diagnostic/laboratory Date Indication/Purposes Result Analysis and Nursing responsibilities
procedure ordered interpretation of prior to, during and after
results the procedure
Abdominal X-Ray June 21, Non-invasive test used to Normal: As per patient’s Before:
2021, assess potential problems (-) Ascites Abdominal X-ray
12:25 pm in the abdominal cavity, result, there was Explained the procedure to
stomach, and No organ enlargement. no organ the patient and its purpose.
intestines. The doctor enlargenment,
ordered the test for Patient’s stool analysis: ascites and no Instructed the patient to
possible result of toxic toxic megacolon remove some of his clothes
megacolon. (Holm, G., (-) Ascites was detected. and wear gown.
2017).
No organ enlargement. Instructed the patient to
remove any jewelries or
No toxic megacolon metal objects that might
interfere with the result.

Assessed if the patient has

undergone any invasive
procedure involving
placement of metal inside
the body.

Advised the patient to

empty your bladder before
the test.

Instructed the patient to lie

down flat on his back and
stay still during the
procedure.

After:

Instructed the patient to

change into normal clothes.

(Acr, R. A.,2019).
 DIGESTIVE SYSTEM ANATOMY AND PHYSIOLOGY

The digestive system breaks down the food into

nutrients needed in the metabolic processes such as

making ATP and rids the body of materials that

cannot be used, such as fiber. It is essential for

providing the body with the energy and building

blocks it requires to maintain life.

The digestive system is to divide its organs into

two main categories. The first group is the organs

that make up the alimentary canal. Accessory

digestive organs comprise the second group and are critical for orchestrating the breakdown of

food and the assimilation of its nutrients into the body. Accessory digestive organs, despite their

name, are critical to the function of the digestive system.

Alimentary Canal Organs

Also called the gastrointestinal (GI) tract or

gut, the alimentary canal (aliment- = “to

nourish”) is a one-way tube about 7.62

meters (25 feet) in length during life and

closer to 10.67 meters (35 feet) in length

when measured after death once smooth

muscle tone is lost. The main function of

the organs of the alimentary canal is to

nourish the body. This tube begins at the

mouth and terminates at the anus. Between those two points, the canal is modified as the pharynx,
esophagus, stomach, and small and large intestines to fit the functional needs of the body. Both

the mouth and anus are open to the external environment; thus, food and wastes within the

alimentary canal are technically considered to be outside the body. Only through the process of

absorption do the nutrients in food enter and nourish the body’s “inner space.”

Accessory Canal Organs

Each accessory digestive organ aids in the

breakdown of food. Within the mouth, the teeth and

tongue begin mechanical digestion, whereas the

salivary glands begin chemical digestion. Once food

products enter the small intestine, the gallbladder,

liver, and pancreas release secretions—such as bile

and enzymes—essential for digestion to continue.

Together, these are called accessory organs because

they sprout from the lining cells of the developing gut

(mucosa) and augment its function; indeed, you could

not live without their vital contributions, and many

significant diseases result from their malfunction.

Even after development is complete, they maintain a

connection to the gut by way of ducts.

8. Pathophysiology (book based)
Name: Patient A Nursing Diagnosis: Fluid volume deficit related to excessive fluid loss through the stool
Age: 27 years old or emesis as evidenced by low blood pressure, dyspnea,
Gender: Male tachycardia, and slow capillary refill.
NURSING CARE PLAN #1

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE Fluid volume deficit Short term INDEPENDENT Short term

“Tatlong araw na pong related to excessive fluid
basa young idinudumi ko”, loss through the stool or
as verbalized by the client. emesis as evidenced by
low blood pressure,
OBJECTIVE dyspnea, tachycardia, and
- Weakness slow capillary refill.
- Sunken eyes
- Shriveled skin RATIONALE
- Dry skin This is the 1st prioritized
- Dry lips nursing diagnosis.
- Slow capillary refill because:
with 3 seconds
- Cyanotic - Maslow stated in the
- Pale skin color hierarchy of needs that
- Dark urine physiological needs
- Lethargic
should be initially
- Malaise
prioritized for survival
Vital Signs: these needs include
- BP: 90/50 mmHg fluid, which should be
- Cardiac Rate: 122bpm maintained to survive
- Respiratory Rate: (Nursing Theories and
28cpm their works, Martha
- Temperature: 36.1 ℃
Raile Alligood, 8th ed.,
2014).
- According to
Abdellah’s typology of
21 nursing problems, it
After 8 hours of
rendering nursing
intervention,
client’s vital sign
will improve and
will demonstrate behaviors
to monitor and correct
deficit.
Long term
After 3 days of
rendering nursing
intervention, the client will
maintain normal fluid
volume as evidenced by
good skin turgor, moist
mucous membrane, and
normal capillary refill.
- Weigh patient daily. - Daily weight is an
indicator of overall
fluid and nutritional
status.
- Monitor intake and - Measurements of
output. intake and output
provide useful data for
comparison.
- Monitor vital signs. - To determining the
Observe for degree of fluid deficit
temperature elevation and response to
and orthostatic replacement therapy.
hypotension.
- Provide adequate fluid - Increased fluid intake
intake. replaces fluid lost in
the liquid stools.
- Reposition the patient - To prevent tissue
frequently, gently breakdown.
massage skin, and
protect bony
prominence.
- Provide safety - Decreased cerebral
precautions, as perfusion frequently
indicated, such as the results in changes in
use of side rails when mentation or altered
appropriate, bed in low thought process,
After 8 hours of
rendering nursing
intervention, client’s
vital signs improved as
evidence by:
- BP: 90/50mmHg
- HR: 122 bpm
Client also verbalized
behaviors to monitor and
correct deficit as
evidence by: “opo,
umiinom po ako ng tubig
gaya po ng sinabi ninyo
para mapalitan din iyong
inilalabas ko”.
Long term
After 3 days of
rendering nursing
intervention, the
client attained normal fluid
volume:
- BP: 120/90
mmHg
- Good skin
turgor
- Moist mucous
Membrane
is necessary to manage position, frequent requiring protective - Normal capillary refill
the maintenance of observation. measures to prevent
fluid and electrolyte client injury.
balance (Nursing
- Provide mouth care, - To manage skin
Theories and their sponge bath, and apply dryness.
works, Martha Raile lotion if indicated.
Alligood, 8th ed.,
2014). - Place the patient in - Helps to manage low
Trendelenburg’s blood pressure.
position.

DEPENDENT
Saline IV + Potassium - For fluid replacement
Chloride rate of 15 to manage dehydration
mEq/hr (Volume per due to severe fluid
loss.
volume) and Oral
hydration solution as
ordered.
- To treat vomiting.
- Administer
dimenhydrinate 100
mg PO twice a day as
prescribed.
- To treat infection

- Administer
metronidazole 400 mg
twice a day as
prescribed.
 COLLABORATIVE

Along with the dietician,

educate the and family
members about the
following dietary measures - These dietary changes
to control diarrhea: can slow the passage
- Avoid spicy, fatty of stool through the
foods, alcohol, and colon and reduce or
caffeine. Boil foods; eliminate diarrhea.
avoid frying.

‘
 Name: Patient A Nursing Diagnosis: Acute pain related to inflammation of intestinal lining as
Age: 27 years old evidenced by verbalization of pain.
Gender: Male
NURSING CARE PLAN #2

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective
“sobrang sakit po ng tiyan ko.”
as verbalized by the client.
Objective
- Facial grimace
- Arms against the
stomach
- Heartburn
- Nausea
- Malaise
- Weakness
- abdominal pain with
pain scale of 5/10
Vital Signs:
- BP: 90/50 mmHg
- Cardiac Rate: 122bpm
- Respiratory Rate: 28cpm
- Temperature: 36.1 ℃
Acute pain related to After 2 hours of nursing INDEPENDENT After 2 hours of nursing
inflammation of interventions, the patient - Position the patient in a - May help to promote interventions, the patient
intestinal lining as will verbalize relief from comfortable position. comfort to the patient. verbalized relief from pain
evidenced by pain and rate it as 2/10 and rate it as 2/10 from
verbalization of pain. from 5/10. 5/10.
RATIONALE
This is the 2nd - Monitor intake and - Measurements of
prioritized nursing output. intake and output
diagnosis because: provide useful data for
comparison.
According to Maslow’s - Provide cognitive-
hierarchy of needs, one behavioral therapy for
of the basic non-pharmacological
physiological needs is pain management such
homeostasis and it must as:
be attained. Pain can ✓ Provide patient - This technique
cause changes in some distraction involves heightening
homeostasis and can such as reading, one’s concentration
affect the client’s watching TV, upon non-painful
behavioral status. playing video stimuli to decrease
Therefore, to achieve games, guided one’s awareness and
Maslow’s hierarchy of imagery. experience of pain.
needs, an
individual must be ✓ Eliciting the - Eliciting a relaxation
capable of doing things Relaxation response decreases the
without alteration or Response such effects of stress on
pain. (Nursing Theories as music therapy pain.
and their works, Martha and deep
Raile Alligood, 8th ed., breathing.
2014).
- Provide comfort - To interrupt the patient
measures such as back from the pain.
rub.

- Provide patient - To promote relaxation

adequate rest. measure to the client
which may help to
minimize pain.

- Provide pleasant,
relaxing environment.

DEPENDENT

- Administer Paracetamol - To help relief

600 Ampule IVP q4h, abdominal pain
PRN for pain
 Name: Patient A Nursing Diagnosis: Imbalanced Nutrition: less than body requirements related to severe fluid
Age: 27 years old loss as evidenced by diarrhea, vomiting, abdominal cramps, hyperactive bowel sound
Gender: Male
NURSING CARE PLAN #3

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE Imbalanced Nutrition: less Short-Term INDEPENDENT Short-Term

“Nasa walo o sampung beses
po ako tumatae ng apat na
araw”, as verbalized by the
client.
OBJECTIVE
- Abdominal cramps
- 8-10 liquid stools per day
- Hyperactive bowel sound
at left upper quadrant
upon auscultation.
- Anorexia
- Weakness
- Weight loss of 5kg in the
past 2-3days.
Vital Signs:
- BP: 90/50 mmHg
- Cardiac Rate: 122bpm
- Respiratory Rate: 28cpm
- Temperature: 36.1 ℃
Height: 168 cm
Weight: 48 kg
BMI: 17 kg/m2
than body requirements related - Weigh patient daily. - Daily weight is an
to severe fluid loss as After 8 hours of nursing indicator of overall fluid After 8 hours of nursing
evidenced by diarrhea, interventions, the client will and nutritional status. interventions, the client
vomiting, abdominal cramps,
demonstrate behaviors to demonstrated behaviors to
hyperactive bowel sound.
regain appropriate weight as - Measurements of intake regain appropriate weight as
- Monitor intake and
RATIONALE evidenced by eating the output. and output provide useful evidenced by verbalized
appropriate diet data for comparison. restricting the intake of
6th of Abdellah’s 21 recommended by the caffeine, milk, and dairy
dietician. - Provide patient a small, - To digest food easily. products; and eating bland
typology of Nursing
Problems is the maintenance frequent meals and foods diet as recommended.
of nutrition for Long-Term that can easily digest.
Long-Term
all body cells(Nursing - To prevent transmission
After 2 weeks of nursing - Wash hands before and
Theories and their works, after rendering nursing of infection.
th interventions, the client will After 2 weeks of nursing
Martha Raile Alligood, 8 care.
ed., 2014. demonstrate progressive interventions, the client
weight gain at least 10% of - Encourage the client to - These food items can demonstrated progressive
the ideal weight. restrict the intake of irritate the lining of the weight gain as evidenced by
caffeine, milk, and dairy stomach, hence may Weight gain of at least 10%
products. worsen diarrhea. of the ideal weight (60 kg).
- Provide patient adequate - To regain patient’s
rest. energy.
- Provide pleasant, relaxing - May help to enhance food
environment. intake.

DEPENDENT
Saline IV + Potassium
Chloride rate of 15 - For fluid replacement to
manage dehydration due
mEq/hr (Volume per to severe fluid loss.
 volume) and Oral
hydration solution as
ordered.

- Administer - To treat vomiting.

dimenhydrinate 100 mg
PO twice a day as
prescribed.

- Administer - For cholera infection

metronidazole 400 mg. medical management and
twice a day as treat diarrhea.
prescribed.

COLLABORATIVE - Patient with diarrhea

- Collaborate with the should eat bland diet such
dietician for the as banana and rice.
appropriate diet for the
patient.

- Demonstrate and - To control infection

encourage the patient transmission.
with the family members
the proper hand washing
with soap and water.
 Name: Patient A Nursing Diagnosis: Anxiety related to threat and alteration in health status as evidenced by teary eyed and verbalization of
Age: 27 years old anxiety.

NURSING CARE PLAN #4

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

SUBJECTIVE
“nag aalala ako sa kalagayan
ko, bakit ako nagkakaganito.
Paano ako makakabayad dito
sa hospital?”
OBJECTIVE
- Teary eyed
- Quivering voice
- Weakness
- Pale
Vital Signs:
- BP: 90/50 mmHg
- Cardiac Rate: 122bpm
- Respiratory Rate: 28cpm
- Temperature: 36.1 ℃
Anxiety related to threat and
alteration in health status as
evidenced by teary eyed and
verbalization of anxiety.
RATIONALE
This is the 4 th prioritized
nursing diagnosis because:
According to Maslow’s
hierarchy of needs, the second
tier represents the safety needs
and the needs in this tier
include freedom from anxiety
(Nursing Theories and their
works, Martha Raile
Alligood, 8th ed., 2014).
After 8 hours of nursing
intervention, the client will
be able to appear relaxed
and demonstrate reduced
anxiety as evidenced by
verbalization of relief
INDEPENDENT After 8 hours of nursing
- Establish therapeutic - To build trust and intervention, the client was
nurse – client facilitate sharing of able to appear relaxed and
demonstrated reduced
relationship. information.
anxiety as evidenced by
verbalization of relief as he
- Encourage client to - To help release his stated that “Ang mahalaga
acknowledge and emotions. ay maging Mabuti ang
kalagayan ko at maitaguyod
express feelings.
ko pa ang aking pamilya”
- Demonstrate and - To help the client relax
encourage the client to
perform deep breathing
exercise.
- Be available to the - To show concern and
client for listening and support to the client
talking and show
empathy.

- Provide accurate - To help the client

information about the identify what is reality
situation and avoid based.
false reassurances.
- Provide comfort - To help soothe fears
measures such as calm and divert focus of
environment and music. attention.

- Assist the client in in - To help provide variety

developing new anxiety of coping methods to
reducing skills. manage anxiety.

- Provide patient - To promote relaxation

adequate rest. and reduce stress and
anxiety.
- Provide pleasant, - To promote relaxation
relaxing environment. and reduce stress and
anxiety.
C. IMPLEMENTATION

1. DRUGS

Name of the drug Date Dosage, route, Mechanism of action Indication Patient’s Response Nursing responsibilities
ordered frequency
Generic name: June 21, 50mg oral q 4- 6 Dimenhydrinate acts as Used to prevent and The client shows relief Prior
Dimenhydrinate 2021 hours an inverse agonist at the treat nausea, vomiting, of nausea and
H1 receptor, thereby and dizziness caused vomiting. • Check the doctor’s
Brand name: reversing effects of by motion sickness. order.
Draminate histamine on capillaries, • Observe for the 12 rights
reducing allergic reaction of drug administration.
Pharmacologic class: symptoms, acts as an • Check if patient has high
Antihistamines intracellular sodium blood pressure,
channel blocker, resulting stenosing peptic ulcer.
in local anesthetic blockage of the urinary
properties. bladder. enlarged
prostate, they should not
take dimenhydrinate.

During
• First dose should be
taken 30 minutes to 1
hour before you travel or
begin motion activity.
• Instruct to take by mouth
with or without food.

After
• Advise to avoid
consuming alcohol or
alcohol-containing
products while taking
this medication.
• Advise patient that they
might experience
drowsiness, constipation,
blurred vision, or dry
 mouth/nose/throat. If any
of these effects persist or
worsen, instruct them to
report.

Name of the drug Date Dosage, route, Mechanism of action Indication Patient’s Response Nursing responsibilities
ordered frequency
Generic name: June 21, 500mg oral BID Neomycin is bactericidal Used to prevent or treat Repeat rapid stool test Prior
Neomycin sulfate 2021 in action. Like other skin infections caused showed that the
aminoglycosides, it by bacteria. It is not bacteria V. cholerae • Check the doctor’s
Brand name: inhibits bacterial protein effective against fungal decreased in number. order.
Nivemycin synthesis through or viral infections. • Observe for the 12
irreversible binding to the rights of drug
Pharmacologic class: 30 S ribosomal subunit of administration.
Aminoglycoside antibiotics susceptible bacteria • Check if patient has
known allergy to the
drug.
• Instruct that it can be
taken on a full or
empty stomach.

During
• After taking an
antibiotic you may
need to wait for up to
3 hours before eating
or drinking any dairy
products. Dairy
products include milk
as well as butter,
yogurt, and cheese.

After
• Monitor the patient
receiving
aminoglycosides for
 signs of decreased
renal function such as
declining urine output
and increasing blood
urea nitrogen (BUN),
creatinine, and
declining glomerular
filtration rate (GFR).
• Advise patient that
they might experience
adverse reactions to
oral neomycin sulfate
like nausea, vomiting
and diarrhea.
 Name of the drug Date Dosage, route, Mechanism of action Indication Patient’s Response Nursing responsibilities
ordered frequency
Generic name: June 21, 500mg oral BID Ciprofloxacin is a Infections of the Repeat rapid stool test Prior
Ciprofloxacin 2021 bactericidal antibiotic of gastro-intestinal tract showed that the
the fluoroquinolone drug and intra-abdominal bacteria V. cholerae • Check the doctor’s
Brand name: class. It inhibits DNA infections decreased in number. order.
Cipro replication by inhibiting • Observe for the 12
bacterial DNA rights of drug
Pharmacologic class: topoisomerase and DNA- administration.
Fluoroquinolones gyrase. • Check if patient has
known allergy to
drug.
• Instruct to take
ciprofloxacin before
or after meals. Try to
space out doses take a
dose every 12 hours.

During
• Instruct to drink
several glasses of
water during the day.
• Do not drink or eat a
lot of caffeine-
containing products
such as coffee, tea,
energy drinks, cola, or
chocolate.

After
• Report if there is pain,
burning, tingling,
numbness, weakness.
Symptoms affecting
tendons, muscles, and
joints, including
swelling, pain, and
tendon rupture.
 Name of the drug Date Dosage, route, Mechanism of action Indication Patient’s Response Nursing responsibilities
Ordered frequency

Generic name: June 21, 400mg oral BID Metronidazole diffuses Treatment of anaerobic Repeat rapid stool test Prior
Metronidazole 2021 into the organism, bacterial infections, showed that the • Check the doctor’s
inhibits protein synthesis protozoal infections, and bacteria V. cholerae order.
Brand name: by interacting with DNA microaerophilic bacterial decreased in number. • Observe for the 12
Flagyl and causing a loss of infections. rights of drug
helical DNA structure administration.
Pharmacologic class: and strand breakage. • Check if patient has
Antibiotic Therefore, it causes cell known allergy to drug.
death in susceptible
organisms. During
• Administer with food
or milk. Do not skip
doses or double up on
missed doses.
• Do not drink alcohol or
consume food or
medicines that contain
propylene glycol while
you are taking
metronidazole.

After
• Discontinue therapy
immediately if
symptoms of CNS
toxicity
 Name of the drug Date Dosage, route, Mechanism of action Indication Patient’s Response Nursing responsibilities
Ordered frequency

Generic name: June 21, Paracetamol 600 mg Exhibits analgesic action Treatment for pain. Relief from pain and Prior
Paracetamol 2021 ampule IVP q4h, by peripheral blockage of rate it as 2/10 from • Check the doctor’s
PRN. pain impulse generation. 5/10. order.
• Observe for the 12
Pharmacologic class: No adverse effects rights of drug
Analgesic, antipyretic noted. administration.
• Assess onset, type,
location, duration of
pain.

During
• Administer the drug
for at least 5- 10
minutes via IV push.

After
• Assess for clinical
improvement and relief
of pain.

Patient Education:
• Instruct patient to sit or
stand up slowly.
• Advise client to not eat
food containing caffeine
such as coffee
2. Medical Management

Medical Date Performed General Description Indication/Purpose Client’s Reaction to

management/treatment
Saline IV + Potassium
Chloride rate of 15 mEq/hr
June 21, 2021 Saline used in I.V therapy
intravenously supplying extra
water to rehydrate people or
supplying the daily water/salt
needs. Potassium Chloride is
used to treat low blood levels
of potassium.
treatment
Used because it improves The patient was able to tolerate
circulatory volume and tissue the treatment.
perfusion, reducing blood
glucose and serum osmolality
toward normal levels, clearing
ketones from serum and urine
at a steady rate, correcting
electrolyte imbalances and
identifying precipitating
factors.
 CHARTING #2

S: “Sobrang sakit po ng tiyan ko.” as verbalized by the client.

O:
- Facial grimace
- Arms against the stomach
- Heartburn
- Nausea
- Malaise
- Weakness
- abdominal pain with pain scale of 5/10

Vital Signs:
- BP: 90/50 mmHg
- Cardiac Rate: 122bpm
- Respiratory Rate: 28cpm’
- Temperature: 36.1 ℃

A: Acute pain related to inflammation of intestinal lining as evidenced by verbalization of pain.

P: After 2 hours of nursing interventions, the patient will verbalize relief from pain and rate it as

2/10 from 5/10.

I:

- Done positioning the patient in a comfortable position that may help to promote comfort to

the patient.

- Monitored intake and output.

- Provided cognitive-behavioral therapy for non-pharmacological pain management such as:

✓ Provide patient some distraction such as reading, watching TV, playing video games,

guided imagery.

✓ Eliciting the Relaxation Response such as music therapy and deep breathing.

- Provided comfort measures such as back rub.

- Wash hands before and after rendering nursing care.

- Provided patient adequate rest.

- Provided pleasant, relaxing environment.

- Administered Administer Paracetamol 600 Ampule IVP q4h, PRN for pain as ordered.

E: After 2 hours of nursing interventions, the patient verbalized relief from pain and rate it as

2/10 from 5/10

 CHARTING #3

S: “Nasa walo o sampung beses po ako tumatae ng apat na araw”, as verbalized by the client.

O:
- Abdominal cramps
- 8-10 liquid stools per day
- Hyperactive bowel sound at left upper quadrant upon auscultation.
- Anorexia
- Weakness
- Weight loss of 5kg in the past 2-3days.

Vital Signs:
- BP: 90/50 mmHg
- Cardiac Rate: 122bpm
- Respiratory Rate: 28cpm
- Temperature: 36.1 ℃

A: Imbalanced Nutrition: less than body requirements related to severe fluid loss as evidenced

by diarrhea, vomiting, abdominal cramps, hyperactive bowel sound.

P:

Short term: After 8 hours of nursing interventions, the client will demonstrate behaviors to

regain appropriate weight as evidenced by eating the appropriate diet recommended by the

dietician.

Long term: After 2 weeks of nursing interventions, the client will demonstrate progressive

weight gain at least 10% of the ideal weight.

I:

- Done weighing the patient daily to monitor nutritional status.

- Monitored intake and output.

- Provided patient a small, frequent meals and foods that can easily digest.

- Wash hands before and after rendering nursing care to prevent transmission of infection.

- Encourage the client to restrict the intake of caffeine, milk, and dairy products because these

food items can irritate the lining of the stomach, hence may worsen diarrhea.

- Provided patient adequate rest to allow patient to regain his energy.

- Provided pleasant, relaxing environment because calm and relaxing environment may help

to enhance patient appetite.

Administered the following as ordered:

- Saline IV + Potassium Chloride rate of 15 mEq/hr (Volume per volume) and Oral hydration

solution

- Dimenhydrinate tablets for vomiting twice-a-day before the meal.

- Antibacterial Medication: gramicidin, neomycin sulfate, ciprofloxacin 500 mg

- Collaborated with the dietician for the appropriate diet for the patient. Patient with diarrhea

should eat bland diet such as banana and rice.

- Demonstrated and encouraged the patient with the family members the proper hand washing

with soap and water to control the transmission of the infection.

E: Short-Term: After 8 hours of nursing interventions, the client demonstrated behaviors to

regain appropriate weight as evidenced by verbalized restricting the intake of caffeine, milk, and

dairy products; and eating bland diet as recommended.

Long-Term: After 2 weeks of nursing interventions, the client demonstrated progressive weight

gain as evidenced by Weight gain of at least 10% of the ideal weight (60 kg).
 CHARTING #4

S: “nag aalala ako sa kalagayan ko, bakit ako nagkakaganito. Paano ako makakabayad dito sa

hospital?”

O:

- Teary eyed
- Quivering voice
- Weakness
- Pale
Vital Signs:
- BP: 90/50 mmHg
- Cardiac Rate: 122bpm
- Respiratory Rate: 28cpm
- Temperature: 36.1 ℃

A: Anxiety related to threat and alteration in health status as evidenced by teary eyed and

verbalization of anxiety.

P: After 8 hours of nursing intervention, the client will be able to appear relaxed and

demonstrate reduced anxiety as evidenced by verbalization of relief

I:

- Established therapeutic nurse – client relationship.

- Encouraged client to acknowledge and express feelings.

- Demonstrated and encouraged the client to perform deep breathing exercise.

- Attended available to the client for listening and talking and show empathy.

- Provided accurate information about the situation and avoid false reassurances.

- Provided comfort measures such as calm environment and music.

- Assisted the client in in developing new anxiety reducing skills.

- Provide patient adequate rest.

- Provided pleasant, relaxing environment.

E: After 8 hours of nursing intervention, the client was able to appear relaxed and

demonstrated reduced anxiety as evidenced by verbalization of relief as he stated that

“Ang mahalaga ay maging Mabuti ang kalagayan ko at maitaguyod ko pa ang aking

pamilya”
Evaluation

A. General Condition Upon Discharge:

Upon discharge, the patient improves his condition after several days of treating

bacteria V. cholerae and watery diarrhea that can lead to dehydration. His weight was

also improving. But according to him, he likely feel weak and tired so he was advised to

have a plenty of rest at home. He was given take home medication to continue treatments

at home. Therefore, he was discharged and instructed to watch closely for unusual feeling

and symptoms of reoccurring of the disease.

Discharge Plan Method:

Advised the patient and relatives to continue prescribed medications for

Medication post-operative management

• Dimenhydrinate 50mg oral q 4- 6 hours

• Neomycin sulfate 500mg oral BID

• Metronidazole 400mg oral BID

• Oral Hydration Solution 30-45 ml q 5-10 minutes.

1. Instructed the patient to do light walking every day for 10-15

Exercise minutes and gradually add distance or to the length of time to

walk.

2. Advise patient to try to move a little a day or after discharge,

gradually increasing daily activity.

3. Get back on usual routine as best as you can.

Treatment 4. Instructed the patient to comply on prescribed medications and

follow up schedules.

5. Demonstrated how to prepare ORS, how much to give and

when. (1L boiled water then cooled. Add six (6) level teaspoon

sugar then add half (1/2) level teaspoon salt .

6. Explained to the patient that ORS serves to replace fluid.

7. Advised the patient to the following:

 - Maintain healthy body weight.

- Follow healthy lifestyle.

8. Advised the patient to comply with the treatment regimen

ordered by the doctor.

9. Avoid taking herbal supplements and remedies, unless

prescribed.

10. Consult to dietician for meal plans and diet modifications.

Heath The patient was instructed to drink boiled water or purified, wash hands

Teaching several time each day. Wash hands after using bathroom, before and

after preparing food. Demonstrated the proper hand washing technique

and use hand sanitizer that contains alcohol if soap and water are not

available. Specified to not to touch eyes, nose or mouth without washing

hands first. Also advise patient to maintain hygienic environment.

OPD The patient should attend his follow-up checkup, one week after the

discharge to monitor the progress and educate for additional instruction

on what to do to continue health improvement. Advise patient to return

to the emergency department is symptoms come back.

Diet Instructed the patient to:

11. Drink enough water (mainly ORS) and stay hydrated.

12. Plenty of fluids like fruit juices.

13. Lemon juice either sweet or salted can help. The juice of this

fruit can help kill cholera bacilli within a very short time.

14. Eat properly cooked food.

15. Follow diet modifications such as:

- Avoiding solid and uncooked foods and uncooked vegetables

until there is a complete recovery.

- Avoid eating sea foods specially fish and shellfish.

16. Avoid unpasteurized milk and milk products.

 I. Conclusion

Patient A is 27 years old Male was infected with bacteria V. cholerae by eating

contaminated food. He was treated based on his presenting clinical manifestation such as

watery diarrhea followed by vomiting. Treating the underlying causes may prevent

further complications. Patient reported faster recovery with rehydration, proper nutrition

and medication prescribed.

II. Recommendation

We recommend that the patient need to comply on prescribed medications and

follow up schedules. Take medication as prescribed most specially antibiotics. Instruct

the patient not to stop taking medication just because he feels better. Advise patient to

talk to the physician regarding medication. ORS must be prepared with safe water and

should be made fresh daily. Provide a clear instruction for care. ORS should be given

after each loose stool and immediately come back if the patient’s condition deteriorates

such as repeated vomiting, number of stools increased or the patient is drinking or eating

poorly.

Review of Related Literature

Foreign

A Cholera Outbreak in a Rural North Central Nigerian Community: An

Unmatched Case-Control Study
Chioma Cindy Dan-Nwafor, Uzoma Ogbonna, Pamela Onyiah, Saheed Gidado,
Bashorun Adebobola, Patrick Nguku, Peter Nsubuga
Published on 25 January 2019

Cholera remains a global threat to public health and a key indicator of lack of

social development. Cholera, an acute diarrheal disease caused by gram-negative bacillus

Vibrio cholerae of serogroup 01 and 0139 is associated with high morbidity and mortality

The onset of cholera often starts with stomach cramps, vomiting and diarrhoea,

and if left untreated may progress to fluid losses of up to 1 litre per hour, resulting in

severe dehydration and metabolic acidosis, and consequently kidney failure, shock, coma,
and death. About 50% of cholera cases are asymptomatic. Asymptomatic cases shed

vibrios in their stools and serve as a potential source of infection to others. Symptomatic

patients may also shed vibrios before the onset of illness and will continue to shed the

organisms for about 1 to 2 weeks.

Cholera is transmitted through the fecal-oral route via contaminated food, carriers

and unsanitary environmental conditions. Cholera outbreaks tend to occur as a result of

contamination of food or water with Vibrio cholera organisms due to poor personal

hygiene, unsafe environmental sanitation conditions compounded by lack of potable

water supply. Internal displacement of persons by natural and man-made disasters leading

to unstable living conditions with contamination of food and water sources have also

been reported to cause cholera outbreaks.

LOCAL

Lopez and Macasaet, (2015) stated to their study entitled "Epidemiology of

cholera in the Philippines" that knowing the factors that leads to the occurrence of

cholera may help to plan appropriate preventive measures to eradicate the disease. The

study identified that the epidemiology of cholera in the Philippines including spatial log

recession, poor access to improve sanitation and water pollution.

The outbreak of cholera has been declared in North Cotabato. There have been

nine deaths since the outbreak and there are hundreds of patients being treated. This

disease affects the intestines when food or water is contaminated that may cause common

symptoms to occur such as watery diarrhea or vomiting within a day. As an action, the

World Health Organization (WHO) continue to train health professionals to enhance the

Philippine Integrated Disease and Surveillance System Response to detect and respond to

these kinds of outbreaks such as cholera. With the help of Philippine Department of

Health (DOH), they are ensuring that the infected patients are treated properly, and the

information needed are distributed and spread amongst the local communities in the

Philippines for them to be aware and avoid the rapid spreading of cholera (WHO, 2017).
According to Logan, (2016) Areas with poor sanitation and water contamination brought

by heavy rains are most likely to be affected of cholera disease. The municipalities must

provide a proper conduction of health awareness with the process of chlorination of water

sources and monitor watery diarrhea to stop the growing rate of the disease.
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World Health Organization. (2021). Cholera. Retrieved from

https://www.who.int/news-room/fact-sheets/detail/cholera.

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