Communicable Disease

CHOLERA
BORJA – CABAGAN – DE LUNA – DIVINO
FRANCISCO – GARDANOZO
MAGLALANG – MATIAS – SICAT
VALMORES
BSN III – B (GROUP B1)
 CASE SCENARIO
A patient 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

SLIDESMANIA

bowel as a result of the large volume of intestinal secretions. Fever is typically absent
 CASE SCENARIO
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
SLIDESMANIA

days he was passing persistently watery diarrhea.

 CASE SCENARIO
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
SLIDESMANIA

 Foods are bought in the Carinderia nearby and water supply from water pump being used by
the whole Barangay.
 CASE SCENARIO
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

SLIDESMANIA

 Temperature: 36.1 ⁰C
 CASE SCENARIO
EXAMINATION/ASSESSMENT

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:

SLIDESMANIA

Guarding and tenderness noted in the left iliac fossa and hypogastrium.
Abdominal X-ray:
 No toxic megacolon
 CASE SCENARIO
EXAMINATION/ASSESSMENT
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 twice a-day, and

Flygal (Metronidazole) 400 mg twice-a-day and a rehydration solution (ORS).

SLIDESMANIA

 Intravenous Fluid to treat dehydration (Volume per Volume)

 
INTRODUCTION
According to the Centers for Disease Control and Prevention (2020),
cholera is an acute, diarrheal illness caused by infection of the intestine
with the toxigenic bacterium Vibrio cholerae serogroup O1 or O139. It
is endemic in South-East Asia, the Middle East, parts of Africa and
most of Central and South America. Cholera appears to be increasing
worldwide in terms of both the number of cases and their distribution.
V. cholerae causes infections only in humans, with symptomatic and
asymptomatic carriers being reservoirs of infection. Cholera is spread
by the fecal–oral route through contaminated water or food. The
organism produces an enterotoxin, enzymes and other substances
affecting the entire small intestine.
INTRODUCTION
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 hypokalemia may also develop. 
 STATISTICS
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.

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

 To accurately present a thorough general assessment

of the client which includes physical assessment and
family history taking.

 To understand the pathophysiology and etiology of

the disease.

 To determine the contributing factors in the

development of the diagnosis.

 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.-

OBJECTIVES  To provide accurate and effective documentation to

ensure continuity of care and prevent duplication or
error in the patient's care.
 ASSESSMENT
Nursing Process
 Patient 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
 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
Environmental
Status
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 and the life there is quite hard and
poor
 He stated that his apartment is made of cement
and wood which is also sturdy enough for him to
live in and it is ventilated enough for him. When it
comes to the ceiling, there are some parts that is Environmental
broken already, and he cannot manage to fix it due Status
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 his 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 transmission are
Environmental
walking, tricycle, jeep and sometimes buses. Garbage
Status
collection trucks by the city collects their waste every
Friday to be properly disposed but there were times that
he cannot comes it out because by the time the garbage
collectors came, he already asleep because he is unable
to sleep every night because of his products (paninda).
 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 that, his
Lifestyle everyday routine was, leave his house and go to the
market at exactly 7:00 pm in the evening, by that 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
Lifestyle sells as he stated that “no one touched it therefore no need to wash it”, and whenever his
products sold quickly he used to came 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, then he easily fell asleep because he’s 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
Lifestyle 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.
Family history
 HISTORY OF PAST
ILLNESS

Patient A 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. According to him, he completes his
immunization during his childhood. His usual illness was
just cough and cold and use paracetamol as medication or
drinking herbal medicine such as lagundi.
 HISTORY OF
PRESENT ILLNESS
Two days prior to admission the patient A
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.
 HISTORY OF PRESENT
ILLNESS
Two days prior to admission the patient A 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 A 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.
 HISTORY OF PRESENT
ILLNESS
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.

 HISTORY OF PRESENT
ILLNESS
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
 Mental Status
Appearance and Movement

During the first day of hospitalization, patient is neat Norms:

wearing appropriate clothing according to the weather, he
was appeared lethargic and anorexic. Thin ill looking male The client should be able to stand still, have smooth and

patient, conscious and in obvious discomfort. coordinate movement (Jensen, 2019).

Upon arriving at the hospital, Patient A had difficulty

Analysis:
in moving due to abdominal pain. He also stated that he
does not move around often because of abdominal pain and The client has a difficulty to move around because of the

the intense urge to pass stool. He was walking slowly and pain he felt on the abdomen and vomiting. This pain and
slightly bowed while guarding his stomach with his two
feeling of weakness restrain his movement and/or daily
hands.
physical activities.
 Emotional Status
Norms:

During the interview, the Patient is in pain yet able to A person expresses himself as an optimistic and positive thinker in

tolerate it and we asked how he is feeling today? If there is life. There should be no presence of fear, anxiety, grieving etc. the

something bothering him? And he told us that “nag aalala patient should have the ability to manage stress and to express emotions

appropriately. It also involves the ability to recognize, accept and express

ako sa kalagayan ko, bakit ako nagkakaganito. Paano ako
feelings and to accept one’s limitations (Kozier & Erb’s, 2015).
makakabayad dito sa hospital?”
Analysis:

The patient is anxious about his condition and about the hospital

bills.
 Motor Status
Norms:
Patient A experienced body malaise. He was unable to stand
Normal motor stability includes the ability to perform
upright properly due to abdominal pain and weakness with
different activities. (Estes, 2011)
presence of abdominal guarding especially before admission
Analysis:
to the hospital.

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.

 Temperature

Norms:
Date Assessed Time Temperature Analysis
The normal body temperature of a person is within 36.4

06/21/21 7:30 am 36.1 C Below Celsius to 37.4 Celsius. (Estes, 2011)

normal
Analysis:
06/22 /21 7:30 am 36.7 C Normal
Upon admission the temperature of patient on his right

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

 Respiratory Status
Norms:

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

Date Assessed Time Breaths Analysis sounds are classified as tracheal, bronchial, bronchovesicular, and
vesicular sounds. In normal breathing at rest, there are small in breaths
06/21/21 7:30 am 24 cpm Above
(inhalation) followed by the out breaths (exhalation). The out breath is
normal 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
06/22/21 7:30 am 21 cpm Above
the diaphragm, the main breathing muscle. (Kozier, Fundamental of
normal Nursing. 7th Edition)

06/23/21 8:00 am 16 cpm normal 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.
 Circulatory Status

Date Assessed Time Blood Pressure Pulse Rate Analysis

06/21/2021 7:30 am 90/50 mmHg Low 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
 Respiratory Status

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.
 Nutritional Status

Nutritional Parameters
Patient A states that he just ate twice a day;
breakfast and lunch only, without eating snacks. Parameter Norms Analysis
He also said that he loves to eat seafoods like
Height: <16=Malnourished  
kilawin/kinilaw (raw seafood dish) and ate raw
vegetables and fruits after eating. He has 168 cm 16-19=Underweight Underweight

inadequate water intake with the unusual range Weight: 20-25=Normal

between 4-5 glasses of water a day, also stated he 48 kg 26-39=Moderate to severe
does not like the taste of mineral water instead he
BMI: obesity
preferred drinking from the water pump.
17 kg/m2 40 and above=Morbidly

obese (Fundamentals of

Nursing by Kozeir, et al.)

 Nutritional Status

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.
 Elimination Status
Norms:

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

Upon the assessment, patient presented a rice-watery
voiding in 3 to 4 times a day with an output of 1200 to 1500 ml a day. A
stool that is not malodorous. He added that this is the
normal stool is brown in color and well formed, urine is clear to yellowish
first time he experiencing this kind of stool. Currently in color. (Fundamentals of Nursing, kozier, 2007)

on the day of admission, patient is passing 6 stools Analysis:

over the 8 hours of student nurse’s duty. Vomitus was Patient’s elimination status is not normal due to the characteristics of his

also complaint of the patient. On the other hand, 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..
patient stated that he also has problem on voiding
Moreover, his voiding pattern also have a problem with a urine of 120-
pattern. He stated that he only voids twice a day with a
150ml in each urination and a dark in color but as the treatment goes by
120-150 ml of urine in each urination since the disease voiding were slowly going back to normal. On the other hand over the

occured. period of 3 days treatment, patient stool and vomiting decreases.

 Sleep – Rest Pattern

According to the patient his sleep rest pattern Norms:

is disturbed since the first time he experience 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
the diarrhea brought by cholera. He also
in adults. Maintaining a regular sleep-wake rhythm is more
added tha he’s sleep hours is inadequate
important than the number of hours slept. (Kozier et. al.,
since he only slept for 3-4 hours. Fundamentals of Nursing 7th edition)

Analysis:

Patient X sleep-rest pattern is not normal. 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.

 State of Skin Appendages
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

Student nurses on duty inspected the skin 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

appendages of the patient beginning at the crown
in anemia. No skin lesson should be present. Normally, the skin is dry with a
of the head, parting the hair to visualize the scalp, 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.
and progressing caudally to feet. It was seen that
Estes, Health Assessment and Physical Examination 3rd. edition). The normal
hair is equally distributed, no lice was shown, Capillary Refill Time (CRT) is <2 seconds; a CRT of >2 seconds suggests poor

pigmentation is consistent throughout the body. No peripheral perfusion and may be an early sign of shock (Hernández et al, 2020).

Analysis:
lesions, inflamation, vascular or other
Patient A skin is tan and the color of hair upon the assessment is black. No presence
miscellaneous lesions observed. Patient has no
of infestation, infections and wounds. However, skin is shriveled and dry on the
wounds. Skin’s color and characteristics also upper extremities including abdomen that is pale. Moreover, capillary refill time

shows aberration with 3 seconds due to severe dehydration.

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

Abdominal X-Ray June 21, Non-invasive test used to Normal: As per patient’s Abdominal X- Before:
2021, assess potential problems (-) Ascites ray result, there was no organ  
12:25 pm in the abdominal cavity,   enlargenment, ascites and no Explained the procedure to the patient and its purpose.
stomach, and No organ toxic megacolon was detected.  
intestines. The doctor enlargement. Instructed the patient to remove some of his clothes and
ordered the test for   wear gown.
possible result of toxic Patient’s stool  
megacolon. (Holm, G., analysis: Instructed the patient to remove any jewelries or metal
2017).   objects that might interfere with the result.
  (-) Ascites  
    Assessed if the patient has undergone any invasive
No organ procedure involving placement of metal inside the body. 
enlargement. Advised the patient to empty your bladder before the test.
  Instructed the patient to lie down flat on his back and stay still during
No toxic the procedure.
megacolon
After:
Instructed the patient to change into normal clothes.
(Acr, R. A.,2019).
PATHOPHYSIOLOGY
THANK
YOU!