Cholera
Written by Abena Odeibea, RN in 2015
In Ghana, Cholera is predominant during the rainy season. This can be chiefly attributed to our poor drainage system, and refuse and sewage disposal culture. As we enter the rainy season, it will be prudent for us as nurses to recap the management of this fatal disease.
Cholera is an infectious disease caused by the bacterium Vibrio cholera. Patients suffering from Cholera are normally rushed to the hospital presenting with severe watery diarrhoea, vomiting and abdominal cramps. This normally leads to dehydration causing low blood pressure, rapid heart rate, thirst and muscle cramps. This can results to acute renal failure and coma.
In most cases on the ward, Cholera is mostly diagnosed by the history taken from the patient. Patients usually report with passing frequent loose stools (normally described as rice water stools), vomiting or abdominal cramps.
Rectal swabs or samples of fresh stools can be taken for microscopy.
Management
The goal of treatment of Cholera treatment is to first prevent hypovolemic shock and also to treat any infections; thus the administration of fluid and appropriate antibiotics.
The nurse must first assess the state of dehydration and quickly secure IV line as quickly as possible. Intravenous fluids are administered based on doctor’s directives, however, Ringer’s Lactate or 5:4:1 is mostly preferred. Care must be taken to ensure that the patient is not overhydrated. The nurse must therefore assess for signs of over hydration.
Rectal swabs or stool samples are then taken for laboratory investigations. Blood samples are also taken for investigation.
Antibiotic treatment can be commenced whiles awaiting laboratory results. The preferred antibiotics for hospitals include any of the following or combination of Tetracycline, Doxycycline or Ciprofloxacin. For pregnant women and children under the age of 12years, Co-trimoxazole is used.
Oral intake is usually restricted when patient is vomiting but ORS and oral fluid is started immediately patient can tolerate.
Cholera is highly preventable. Establishment of the appropriate measures to prevent the ingestion of faeces containing the cholera bacterium such as washing of hand before eating and before and after visiting the toilet.
I would like to use this opportunity to encourage all nurses to join the National Sanitation day coming on this Saturday, 4th July, 2015 right in your locality. Let not forget that a clean environment will help clean Cholera away. We stand for cleanliness.
