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Alyssa P. Bagaporo
AdU ± SN Batch 2012
CHOLERA - is an acute bacterial enteric disease of the GIT characterized by profuse diarrhea, vomiting, massive loss of fluid and electrolytes that could result to hypovolemic shock, acidosis, and death.
ETIOLOGIC AGENT Vibrio Cholerae/ Vibrio coma ± slightly curved rods (coma shaped), gram (-) and motile with a single polar flagellum.
. as they grow in the intestinal tract. ± develop an enterotoxin. choleragen. ± can survive longer in refrigerated foods.ETIOLOGIC AGENT ± survive well at ordinary temperature and can grow well in temperature ranging from 22-40oC.
usually 1 ± 3 days PERIOD OF COMMUNICABILITY ±communicable during stool positive stage. INCUBATION PERIOD ±2 hours to 5 days. few days after recovery ±Carrier may have the organism for several months .
The organisms are transmitted through ingestion of food or water contaminated with stool or vomitus of patient. Fecal transmission passes via oral route from contaminated water. . and other foods. soiled hands. milk. 3.MODE OF TRANSMISSION 1. Flies. 2. and utensils also serve to transmit the infection.
. The toxin stimulates adenylate cylase. 2. Fluid loss is attributed to the enterotoxin elaborated by the organism as they lie in opposition with the lining cells of the intestines.PATHOGENESIS AND PATHOLOGY 1. which results in the conversion of the adenosine triphosphate (ATP) to cyclic adesine monophosphate (CAMP).
4. associated with water and bicarbonate loss.PATHOGENESIS AND PATHOLOGY 3. thus. The toxin acts upon the intact epithelium on the vasculator of the bowel. The mucosal cell is stimulated to increase secretion of chloride. resulting in outpouring of intestinal fluids. .
acute renal failure and hypokalemia become secondary problems.PATHOGENESIS AND PATHOLOGY 5. Fluid loss of 5 ± 10% of the body weight resulting in dehydration and metabolic acidosis. . 6. If treatment is delayed or inadequate.
Vomiting . watery diarrhea 2.CLINICAL MANIFESTATIONS 1. profuse. Acute. pale gray (³rice-water´) stool with slightly fishy odor 3.
Cold skin. sunken eyes 6.CLINICAL MANIFESTATIONS 4.Diarrhea ± fluid loss: 1 ± 30 liters/day (dehydration and electrolyte loss) 5. wrinkled fingers and toes ³Washer-woman¶s-hand´ .Poor tissue turgor.
CLINICAL MANIFESTATIONS 7. Cyanosis 9. Aphonia (whisper voice) 10. 12.Rapid and deep breathing 11. Consciousness is still present. Hoarse voice. then anuria .Oliguria. Unobtainable BP 8.Diminished peripheral circulation. Imperceptible radial pulses.
Death ± may occur 4 hours after onset. Subnormal temperature in later stage.CLINICAL MANIFESTATIONS 13.Normal temperature at onset of disease. usually 1st or 2nd day if not properly treated . esp. when in shock 14.In deep shock ± diarrhea stops 15.
Circulatory collapse or shock . EXTRACELLULAR VOLUME IN THE LOSS OF INTESTINAL FLUID a. restlessness. Washer-woman¶s-hand.PRINCIPAL DEFICITS 1. & excessive thirst b.
METABOLIC ACIDOSIS ± due to loss of large volume of bicarbonate-rich stool that results in rapid respiration with intervals of apnea (Kussmaul respiration) .PRINCIPAL DEFICITS 2.
CONVULSIONS AND TETANY ± due to loss of Mg .PRINCIPAL DEFICITS 3. untreated shock or unrelieved hypokalemia 5. HYPOKALEMIA ± due to massive loss of K in stool. RENAL FAILURE ± due to prolonged. 4.
´ 8. HYPOGLYCEMIA ± due to untreated stupor for several days (in children) 7. CORNEAL SCARRING ± occur in stuporous patient who has lost the ³wink reflex.PRINCIPAL DEFICITS 6. ACUTE PULMONARY EDEMA may follow hydration in cases of uncorrected metabolic acidosis .
Dark field or phase microscopy 3. Stool exam . Rectal swab 2.DIAGNOSTIC EXAMS 1.
MODALITIES OF TREATMENT Correct basic abnormalities without delay: ± Restoring circulating blood volume and blood electrolytes to normal levels .
IV treatment: Rapid IV infusion of alkaline saline solution containing Na.MODALITIES OF TREATMENT 1. Cl. K. and CO3 ions in proportions comparable to that in water-stool .
HYDRITES (if pt is not vomiting) Maintenance of the volume of fluid and electrolyte lost after rehydration. 3. .MODALITIES OF TREATMENT 2. Oral therapy rehydration: ORESOL. Carefully note Intake & Output measurement.
Furazolidone: 100 mg for adults and 125 mg/kg for children given q 6hrs for 72hrs. Tetracycline: 500 mg q for adults and 125 mg/kg body weight q 6hrs for 72hrs for children b. .MODALITIES OF TREATMENT 4. Antibiotics a.
MODALITIES OF TREATMENT c. . d. Cotrimoxazole: 8mg/kg for 72hrs. Chloramphenicol: 500 mg for adults and 18 mg/kg for children q 6hrs for 72hrs.
Medical aseptic protective care must be provided. 5. Accurately measure I & O.NURSING MANAGEMENT 1. 3. 2. 4. Hand washing is imperative. Provide a thorough and careful personal hygiene. Enteric isolation must be observed. Accurately record v/s. . 6.
Properly prepare food. 12. . 10. Properly dispose excreta. 8.NURSING MANAGEMENT 7. Apply concurrent disinfection.Weigh the patient. 9.Observe environmental sanitation.Give appropriate diet according to stage of recovery. 11.
± food-preparation facilities that usually practice sanitary protocols. including cholera. and ± most people have access to toilets and handwashing facilities thus. preventing disease outbreaks.Can cholera be prevented? Developed countries have ± widespread water-treatment plants. .
Prevention hand washing avoiding areas and people with cholera drinking treated water or similar safe fluids eating cleaned and well-cooked food .
S. although they are not available in the U. and their effectiveness ranges from 50%-90% .Prevention There are vaccines available that can help prevent cholera.
Effective control measures rely on prevention. Up to 80% of cases can be successfully treated with oral rehydration salts. preparedness and response.KEY FACTS There are an estimated 3±5 million cholera cases and 100 000±120 000 deaths due to cholera every year. .
KEY FACTS Provision of safe water and sanitation is critical in reducing the impact of cholera and other waterborne diseases. but should not replace conventional control measures. . Oral cholera vaccines are considered an additional means to control cholera.
³People who are not in love fail to understand how an intelligent man can suffer because of a very ordinary woman.´ .The End. This is like being surprised that anyone should be stricken with cholera because of a creature so insignificant as the comma bacillus.
Bagaporo AdU ± SN Batch 2012 .BIRD¶S FLU Prepared by: Alyssa P.
.DEFINITION BIRD¶S FLU VIRUS ± Also known as Avian Influenza ± A type of influenza that was first identified in Italy in the early 1900s and is known to exist worldwide.
Etiologic Agent Avian influenza (AI) virus: genus of Orthomyxoviridae family. and segmented. negative-stranded. .
Cats ± possible infection vectors for H5N1 strains of avian flu .Mode of Transmission 1. and clothing 3. Contaminated feeds. In air and in manure 2. equipment. water.
Incubation Period: 3 ± 5 days .Avian Influenza in Humans Spreads rapidly among birds. these are capable of crossing the species barrier. No confirmed evidence of human-to-human transmission H5 and H7 ± out of 15 subtypes. but does not infect humans easily.
Signs and Symptoms Fever sore throat Cough Pneumonia (in severe cases) .
Antiviral drugs Vaccines ± taken at least 4 months to produce. prepared for each subtype.Prevention and Treatment Avian Influenza in human can be detected reliably with standard tests. .