cholera nursing management picture

The acute enteric infection that has caused several outbreaks worldwide in recent years is known as cholera, otherwise called as violent dysentery. It has widely affected those locations with a less potable supply of water, or those with inaccessible basic needs, and most especially those crowded places with lack of sanitation and hygiene practices.

Cholera is transmitted through fecal-oral route, more likely the ingestion of directly or indirectly fecal contaminated water or food by soiled hands, utensils, or mechanical carriers like flies. A person who is infected by this illness can transmit the organism through his feces or vomitus. So, obviously, the diagnosis for this enteric infection is through a fecal analysis. But, presently, the availability of the new rapid diagnostic test (RDT) is a promising way of early diagnosis. However, it is still being verified by the WHO to be utilized.

The extremely short incubation period of cholera pertaining to a few hours to five days with an average of 3 days has marked its deadly threat to those infected to it; considering that its mild form causes no symptoms at all. That is why it could result in severe dehydration, coma, and death if left untreated.

The initial clinical manifestations of an individual infected with cholera are

Later on, if not treated right away it could get worse to more profuse watery diarrhea (grayish-white or rice water colored stools), vomiting, and severe or violent leg cramps – leading to mild up to severe dehydration.

Symptoms of dehydration may be manifested by

Mild Dehydration Moderate Dehydration Severe Dehydration

Somewhat dry mucous membranes Pale, cool skin on arms & legs

Slight tachycardia

Increased capillary refill

Anxiety

Dry mucous membranes Poor skin turgor

Cool truncal skin

Sunken fontanel/eyes

Rapid, thread pulse

Supine hypotension

Increased thirst

Restlessness, confusion, or irritability

Dry, cracked mucous membranes Very poor skin turgor

Cold, mottled, or cyanotic skin

Sunken fontanel/ eyes

Marked tachycardia & hypotension

Narrowed pulse pressure

Delayed capillary refill

Unconsciousnes

 According to the World Health Organization, there are 48 countries that had been affected by cholera in the past 3 years. The continents of Africa, the Americas (Haiti), Asia, and Oceania were the ones that are mostly affected by this infection.  Nevertheless, it has occurred an overwhelming 52% increase in reported cases last 2009 to 2010 in the countries globally and which did not spare 45% of lives from 32 countries with reported cases of deaths.

In May 2011, the re-emergence of its cases pushed through more integrated and comprehensive management utilizing strong surveillance, early detection and control, and prevention strategies.

Prevention

  • Provision or assisting the community to access to potable and clean water resource i.e. boiling water if not sure to be clean
  • Teaching the community on proper sanitation practices, handling and preserving food
  • Educating them of the importance of hand washing before handling or eating food, and after defecating
  •  Proper detection of cases as part of rigid surveillance.

(WHO Standard case definition)Cholera case is suspected if:

  • in an area where the disease is not known to be present, a patient aged 5 years or more develops severe dehydration or dies from acute watery diarrhea;
  • in an area where there is a cholera epidemic, a patient aged 5 years or more develops acute watery diarrhea, with or without vomiting.

Cholera Nursing Management and Control

Infants

  • Emphasize to the mother to continue breastfeeding the baby
  • If the baby is exclusively breastfeeding, give ORS or 100 to 200ml clean water in addition to breast milk
  • If the baby is not exclusively breastfeeding, teach the mother to give food-based fluids like rice water and soups or ORS
  • Encourage the mother to give frequent small sips of clean water or ORS from a cup; the child vomits, tell to wait for at least 10 minutes and continue slowly
  • Rehydration is the main goal to compensate for the fluid loss from diarrhea and vomiting.
  • Clients are encouraged to take more fluids as much as possible or are given with ORS to replace electrolyte losses.
  • Children: 20ml/kg body weight per hour
  • Adult: 1000ml per hour, if necessary
  • If moderate to severe dehydration ensues, intravenous infusion with normal saline or Lactate ringer’s solution is the main priority.
  • The administration of antibiotics is done to reduce the volume and duration of diarrhea. Meanwhile, Zinc supplement is given to children to reduce the duration of diarrhea and to minimize its successive episodes.
  • Parenteral vaccines and mass chemoprophylaxis are not recommended by WHO for its high rates of severe adverse reactions. The available Oral Cholera Vaccine (OCV) in the market is only limited but best suitable for travelers aging 2 years old and above.

References:

  • Critical Care Nursing Made Incredibly Easy 3rd Edition. (2012). Lippincott Williams & Wilkins.National Center for Infectious Diseases, Center for Disease Control. Defeating Cholera: Clinical Presentation and Management. Retrieved last July 24, 2012, from www.cdc.gov  Health Organization.
  • Prevention and Control of Cholera Outbreaks: WHO Policy and Recommendations. Retrieved last July 24, 2012, from http://www.who.int

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