1. Made by:- Rekha ladhar
B.sc nursing 2nd
yr
Dayanand medical college of ludhiana ..

2. 
INTRODINTRODUCTION:UCTION:--
Cholera is responsible for about
5-10% of all acute diarrhoeal
illness.
It occurs in pandemic form
from saveral times

3. Epidemics of cholera creates
public health problems as it spread
fast and cause mortality.
Cholera is called as water
borne.

4. GI infection is caused by
gram negative rod of v.
cholerae.

5. DEFINITION:-Cholera is an infectious disease
characterised by vomiting and severe
diarrhoea with fluid and electrolyte
deplition.
OR
Cholera is an acute diarrrhoel illness
caused by infection of intestine with
bacteria v. cholerae.

6.  FLUID LOSS ISFLUID LOSS IS 1-20%1-20% PERPER
DAY IN CHOLERA.DAY IN CHOLERA.

7. EPIDEMIOLOGICALEPIDEMIOLOGICAL TRIADTRIAD;-
AGENT
HOST
ENVIRONMENT

8. EPIDEMIOLOGICAL TRIAD:-
AGENT;-v .cholerae.
HOST;-all ages(both sexes)
ENVIRONMENT;-
contaminated water and
food.

9. 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.

10. • The optimum ph for
organism is 8.2.
• The organism is
extreamly sensitive
to acidic medium
which kill it.
(stomach)

11. 2.2. HOSTHOST FACTORFACTOR:-:-
AGE
GENDER
PH
HYGIENE

12. HOST FACTOR
AGE;-
All ages in the
endemic areas. It is
more frequent in
children who are living
mostely in the
unhygienic conditions.

13. 
GENDERGENDER::-
Cholera distributes equally in men as
well as in women.
It is more severe in pregnancy in the
endemic areas.

14. PH:-PH:-
it is most common among those who
reduced the gastric acidity.
 ph:8.2 (7.35-745) i.e alkaline
medium.

15. 
HYGIENEHYGIENE::
It is most commonly
occurs in the among
the unhygienic
conditions or the
poor sanitary
conditions.

16. 3.3. ENVIRONMENTENVIRONMENT FACTORSFACTORS
1)POOR
ENVIRONMENT
SANITATION

17. 2)CONTAMINATED
WATER.

18. 3.CONTAMINATED
FOOD.

19. 4.HUMAN
HABITS
FAVOURING
SOIL AND
WATER
POLLUTION.

20. 4. Poor personal
hygiene.
5. Poor quality of
life.
5. Lack of
education.

21. 5F
 FOOD
 FINGER
 FLIES
 FILTHS
 FOMITES

22. 1.FOOD

23. 2.FINGER

24. 3. FLIES

25. 4. FILTH
5. FOMITES

26. From few hours to 5 days.
(Commonly last for 2 days).

27. RISKRISK FACTORSFACTORS
POOR SANITARY CONDITIONS
RAW OR UNCOOKED FOOD
HYPOCHLORHYDIA
MIGRATION.

31. PATHOPHYSIOLOGY
FLIW CHART FROM NET

32. 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. Irregularheartbeat.
D. Metabolic acidosis.
CLINICAL MENIFESTATIONS

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

34. STAGES
OF
CHOLERA

35. STAGE 1STAGE 1 (stageof invasion)
Malaise
Headache
Diarrhoea
anorexia

36.  Watery stool
which appears like rice water is
‘rice water stool’.

37. RICERICE WATERWATER DIARRHOEADIARRHOEA

38. STAGE 3STAGE 3 (stage of collapse)
Patient rapidly developPatient rapidly develop
a)a) DehydrationDehydration
b)b) Eyes are sunkenEyes are sunken
c)c) Skin become dry,Skin become dry,
wrinkled and clammy.wrinkled and clammy.
d)d) Suppresssion of urineSuppresssion of urine
e)e) Decreased bodyDecreased body
tempraturetemprature
f)f) Low blood pressureLow blood pressure

39. STAGE 4 (stage of reaction)
I.Death seems imminent.
II.Surface temprature begins to
rise.
III.Vommits

40. COMPLICATIONS;-
 Severe dehydrations.
 Hypokalemia.
 Hyponetremia
 Hypoglycemia.
 Renal failure
 Shock
 death

42. LABLAB DIAGNOSISDIAGNOSIS
1)SPECIMENS
2)COLLECTION &
TRANSPORT
3)CULTURE
OTHERS
I. COMPLETE BLOOD
COUNT
II.GRAM STAINING

43. SPECSPECIIMENS:-MENS:-
Stool examination;-
Rectal swabs
 Checking of water and food for v.
cholerae by taking sample of water and
food for v. cholerae.

44. COLLECTCOLLECTIOIONN AANDND
TRANTRANSPSPORTORT;-;-
Specimens should collected
preferably prior to start of
antibiotics.
They should not be collected
from bedpans due to risk of
contamination.

45. Specimens should send
immediately to laboratory
for processing.
In case of delay stool
sampels may be preserved
in holding media or cary
blair media.

46. 3. CULTURE:-

47. PREVEPREVENTIONNTION
Cholera 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.

48. TREATREATTMEMENTNT
1. EARLY DIAGNOSIS

49. (2)NOTIFICATION

50. 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.

51. 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.

52. 1.MILD DEHYDRATION:-

53. (A)(A) ORALORAL REHYDRAREHYDRATIONTION
SOSOLUTILUTIONON

54. 2.Severe
dehydration

55. (B)(B) RINGERRINGER LACTATELACTATE SOLUTIONSOLUTION

56. ANTIBIANTIBIOOTICSTICS:-:-

58. Remember
• Tetracycline is
contraindicated in pregnancy

59. 11. GENERAL
MEASURES

60. Purification of
water

61. Better provision
for sewage
disposal.

62. 2. HHYGYGIIENICENIC FOFOODOD

63. 3. HANHAND WASD WASHINHINGG

64. 4. DISINDISINFEFECTIOCTIONN

65. How water is disinfected???
• By adding chlorine drops in
water

66. 5.5. SANITSANITAATIONTION

71. NURSINURSINGNG IINTERVENTIONSNTERVENTIONS;-;-

72. 1. During the acute
phase of cholera,
provide enteric
precautions and
supportive care
and closely
observe the
patient.

73. 2. Accurately
measure intake
and output and
assess the
patient for other
signs of fluid
loss.

74. 3.monitor result of
serum electrolyte and
glucose tests.
administer replacement
fluids and electrolytes
as ordered.

75.  4.During therapy,
continue to evaluate
peripheral pulses and
central pulses, central
venous pressure and
orthostatic blood
presssure.

76.  5. Carefully observe
neck veins and
auscultate the lungs
for indications of
fluid overload from
cardiac failure.

78. HEALTHHEALTH EDUCATIONEDUCATION
It is an preventive effective
measure for
achieving prevention and control.
health education regarding;-
 causes
symptoms
prevention
control of cholera
knowledge regarding symtoms also
help to take the appropriate
steps to control cholera

79. SUMMRISATIONINTRODUCTION
DEFINITION
EPIDDEMIOLOGICAL TRIAD
COMPLICATION
MODES OF TRANAMISSON
INCUBATION PERIOD
RISK FACTORS
PAHOPHYSIOLOGY
CLINICAL MENIFESTATIONS
STAGES
COMPLICATIONS
LAB DIAGNOSIS
PREVENTION
TREATMENT
NURSING INTERVENTIONS
HEALTH EDUCATION

80. RECAPTULISATION
1) 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 water
4) Incubation period for cholera is
_________
5) Metabolic acidosis is due to
_______________________

81.  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.

82. HOW WE CAN DISINFECT
WATER
 WHICH MEDIA IS USED TO
PRESERVE THE STOOL SAMPLES IN
CASE OF DELAY

83. 11%, 50%
2. 1-20% /day
3. 10^3, 10^9
4. few hours to 5 days
5. excessive release of bicarbonate ions in the lumen
6.stage 2
7. RL, ORS
8. Tetracyclin