This study guide will enable you to learn more about cholera, its risk factors, clinical manifestation, treatment, nursing diagnosis, nursing interventions, and nursing management.

Cholera which continues to be a threat to public health, usually affects individuals who has travel to or live in places with poor sanitation and lack of safe drinking water. This disease is also closely related with poverty, overpopulation, lack of safe disposal of excreta, and unhygienic practices during food preparation, handling and storage.

What is Cholera?

Cholera is an acute diarrhoeal disease caused by Vibrio cholerae.

• Records from Hippocrates (460-377 BCE) and the Indian peninsula describe an illness that might have been cholera.
• Although not the first description, the discovery of the cholera organism is credited to German bacteriologist Robert Koch, who independently identified V cholerae in 1883 during an outbreak in Egypt; the genus name refers to the fact that the organism appears to vibrate when moving.
• The hallmark of the disease is profuse secretory diarrhea.
• Cholera can be endemic, epidemic, or pandemic.

Pathophysiology

Cholera, caused by the bacteria Vibrio cholerae, is a comma-shaped, gram-negative aerobic or facultatively anaerobic bacillus that varies in size from 1-3 µm in length by 0.5-0.8 µm in diameter.

• Currently, the El Tor biotype of V cholerae O1 is the predominant cholera pathogen; organisms in both the classical and the El Tor biotypes are subdivided into serotypes according to the structure of the O antigen.
• The clinical and epidemiologic features of disease caused by V cholerae O139 are indistinguishable from those of disease caused by O1 strains; both serogroups cause clinical disease by producing an enterotoxin that promotes the secretion of fluid and electrolytes into the lumen of the small intestine.
• To reach the small intestine, however, the organism has to negotiate the normal defense mechanisms of the GI tract; because the organism is not acid-resistant, it depends on its large inoculum size to withstand gastric acidity.
• The use of antacids, histamine receptor blockers, and proton pump inhibitors increases the risk of cholera infection and predisposes patients to more severe disease as a result of reduced gastric acidity.
• Fluid loss originates in the duodenum and upper jejunum; the ileum is less affected.
• The colon is usually in a state of absorption because it is relatively insensitive to the toxin; however, the large volume of fluid produced in the upper intestine overwhelms the absorptive capacity of the lower bowel, resulting in severe diarrhea.
• Unless the lost fluid and electrolytes are replaced adequately, the infected person may develop shock from profound dehydration and acidosis from loss of bicarbonate.
• The enterotoxin acts locally and does not invade the intestinal wall. As a result, few neutrophils are found in the stool.

Causes

Cholera can be an endemic, epidemic, or a pandemic disease.

• Environmental factors. Primary infection in humans is incidentally acquired. Risk of primary infection is facilitated by seasonal increases in the number of organisms, possibly associated with changes in water temperature and algal blooms; secondary transmission occurs through fecal-oral spread of the organism through person-to-person contact or through contaminated water and food.
• Host factors. Malnutrition increases susceptibility to cholera. Because gastric acid can quickly render an inoculum of V cholerae noninfectious before it reaches the site of colonization in the small bowel, hydrochlorhydria or achlorhydria of any cause (including Helicobacter pylori infection, gastric surgery, vagotomy, use of H2 blockers for ulcer disease) increases susceptibility; infection rates of household contacts of cholera patients range from 20-50%. Rates are lower in areas where infection is endemic and individuals, especially adults, may have preexisting vibriocidal antibodies from previous encounters with the organism.

Statistics and Incidences

In the United States, cholera has virtually been eliminated because of improved hygiene and sanitation systems.

• The frequency of cholera among international travelers returning to the United States has averaged 1 case per 500,000 population, with a range of 0.05-3.7 cases per 100,000 population, depending on the countries visited.
• Between January 1, 1995, and December 31, 2000, 61 cases of cholera were reported in 18 states and 2 US territories.
• In 1990, fewer than 30,000 cases were reported to the WHO.
• From 2005 to 2008, 178,000-237,000 cases and 4000-6300 deaths were reported annually worldwide.
• In nonendemic areas, the incidence of infection is similar in all age groups, although adults are less likely to become symptomatic than children.

Clinical Manifestations

After a 24- to 48-hour incubation period, symptoms begin with the sudden onset of painless watery diarrhea that may quickly become voluminous and is often followed by vomiting.

• Diarrhea. Profuse watery diarrhea is a hallmark of cholera; cholera should be suspected when a patient older than 5 years develops severe dehydration from acute, severe, watery diarrhea (usually without vomiting) or in any patient older than 2 years who has acute watery diarrhea and is in an area where an outbreak of cholera has occurred.
• Vomiting. Vomiting, although a prominent manifestation, may not always be present; early in the course of the disease, vomiting is caused by decreased gastric and intestinal motility; later in the course of the disease it is more likely to result from acidemia.
• Dehydration. If untreated, the diarrhea and vomiting lead to isotonic dehydration, which can lead to acute tubular necrosis and renal failure; because the dehydration is isotonic, water loss is proportional between 3 body compartments, intracellular, intravascular, and interstitial.

Assessment and Diagnostic Findings

Definitive diagnosis is not a prerequisite for the treatment of patients with cholera.

• Stool examination. Although observed as a gram-negative organism, the characteristic motility of Vibrio species cannot be identified on a Gram stain, but it is easily seen on direct dark-field examination of the stool.
• Stool culture. V cholerae is not fastidious in nutritional requirements for growth; however, it does need an adequate buffering system if fermentable carbohydrate is present because viability is severely compromised if the pH is less than 6, often resulting in autosterilization of the culture.
• Serotyping and biotyping. Specific antisera can be used in immobilization tests; a positive immobilization test result (ie, cessation of motility of the organism) is produced only if the antiserum is specific for the Vibrio type present; the second antiserum serves as a negative control.
• Hematologic tests. Hematocrit, serum-specific gravity, and serum protein are elevated in dehydrated patients because of resulting hemoconcentration; when patients are first observed, they generally have a leukocytosis without a left shift.
• Metabolic panel. Serum sodium is usually 130-135 mmol/L, reflecting the substantial loss of sodium in the stool; serum potassium usually is normal in the acute phase of the illness, reflecting the exchange of intracellular potassium for extracellular hydrogen ion in an effort to correct the acidosis; hyperglycemia may be present, secondary to systemic release of epinephrine, glucagon, and cortisol due to hypovolemia; patients have elevated blood urea nitrogen and creatinine levels consistent with prerenal azotemia.

Medical Management

Rehydration is the first priority in the treatment of cholera. Rehydration is accomplished in 2 phases: rehydration and maintenance.

• Rehydration phase. The goal of the rehydration phase is to restore normal hydration status, which should take no more than 4 hours; set the rate of intravenous infusion in severely dehydrated patients at 50-100 mL/kg/hr; Lactated Ringer solution is preferred over isotonic sodium chloride solution because saline does not correct metabolic acidosis.
• Maintenance phase. The goal of the maintenance phase is to maintain normal hydration status by replacing ongoing losses; the oral route is preferred, and the use of oral rehydration solution (ORS) at a rate of 500-1000 mL/hr is recommended.
• Cholera cots. In areas where cholera is endemic, cholera cots have been used to assess the volume of ongoing stool losses; a cholera cot is a cot covered by a plastic sheet with a hole in the center to allow the stool to collect in a calibrated bucket underneath.
• Diet. Resume feeding with a normal diet when vomiting has stopped; continue breastfeeding infants and young children.

Pharmacological Management

Antimicrobial therapy for cholera is an adjunct to fluid therapy and is not an essential therapeutic component.

• Antibiotics. Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting; although not necessarily curative, treatment with an antibiotic to which the organism is susceptible diminishes the duration and volume of the fluid loss and hastens clearance of the organism from stool.
• Vaccines. In June, 2016, the first U.S. cholera vaccine was approved by the FDA; contains live attenuated cholera bacteria that replicate in the gastrointestinal tract of the recipient to provide immunity; it is indicated for active immunization against disease caused by Vibrio cholerae serogroup O1 in adults aged 18-64 y traveling to cholera-affected areas.

Nursing Management

The nursing care of a client with cholera include the following:

Nursing Assessment

Assessment of the patient with cholera are as follows:

• Assess for dehydration. Assess the status of dehydration ( skin color, temperature, skin turgor, mucous membranes, eyes, crown, body temperature, pulse, respiration, behavior, weight loss).
• Observe for diarrhea. Observe for a sudden attack of diarrhea, fever, anorexia, vomiting, nausea, abdominal cramps, increased bowel sounds, and bowel movements more than 3 times a day, with liquid stool consistency, with or without mucus or blood.
• Assess the level of knowledge of the family. Assess for the knowledge of diarrhea at home, dietary knowledge, and knowledge about the prevention of recurrent diarrhea.

Nursing Diagnosis

Based on the assessment data, the major nursing diagnosis for cholera are:

• Deficient fluid volume related to excessive fluid loss through the stool or emesis.
• Imbalanced Nutrition: less than body requirements related to loss of fluids through diarrhea, inadequate intake.
• Risk for infection related to microorganisms that penetrate the gastrointestinal tract.
• Impaired Skin Integrity: perianal, related to irritation from diarrhea.
• Anxiety related to separation from parents, unfamiliar environment, a stressful procedure.

Nursing Care Planning and Goals

The major nursing care planning goals for cholera:

• Patient will maintain adequate hydration.
• Patient will consume adequate nutritional requirements.
• Patient will prevent onset of infection.
• Patient will maintain skin integrity.
• Patient will prevent anxiety.

Nursing Interventions

The nursing interventions on a patient diagnosed with cholera are:

• Monitor intake and output. Note number, character, and amount of stools; estimate insensible fluid losses like diaphoresis; measure urine specific gravity and observe for oliguria.
• Weigh daily. Daily weight is an indicator of overall fluid and nutritional status.
• Maintain hydration. Replace ongoing fluid losses until diarrhea stops.
• Administer medications as indicated. Give an oral antibiotic to the patient with severe dehydration as prescribed.

Evaluation

Nursing goals are met as evidenced by:

• Patient was able to maintain adequate hydration.
• Patient was able to consume adequate nutritional requirements.
• Patient was able to prevent onset of infection.
• Patient was able to maintain skin integrity.
• Patient was able to prevent anxiety.

Documentation Guidelines

Documentation in a patient with cholera include the following:

• Individual findings, including factors affecting, interactions, nature of social exchanges, specifics of individual behavior.
• Cultural and religious beliefs, and expectations.
• Plan of care.
• Teaching plan.
• Responses to interventions, teaching, and actions performed.
• Attainment or progress toward the desired outcome.

Practice Quiz: Cholera

Nursing practice questions for cholera. For more practice questions, visit our NCLEX practice questions page.

References

Sources and references for this cholera study guide:

• Black, J. M., & Hawks, J. H. (2005). Medical-surgical nursing. Elsevier Saunders,. [Link]
• Cholera – Vibrio cholerae infection | Cholera | CDC. (2020). Retrieved 1 March 2020, from https://www.cdc.gov/cholera/
• Willis, L. (2019). Professional guide to diseases. Lippincott Williams & Wilkins. [Link]

Welcome to your NCLEX reviewer for drug calculations! In this nursing test bank, practice dosage calculation problems to measure your competence in nursing math. As a nurse, you must be able to accurately and precisely calculate medication dosages to provide safe and effective nursing care. The goal of this quiz is to help students and registered nurses alike to grasp and master the concepts of medication calculation.

Drug Dosage Calculation Practice Quiz

In this section are the practice problems and questions for drug dosage calculations. This nursing test bank set includes 100+ questions broken down into four parts. Included topics are dosage calculation, metric conversions, unit conversions, parenteral medications, and fluid input and output. As you can tell, this NCLEX practice exam requires tons of calculations, so get your calculators ready!

Remember to answer these questions at your own pace and don’t forget to read the rationales! Don’t be discouraged if you have incorrect answers, you are here to learn! Make sense of the rationales and review the drug dosage calculations study guide below.

Quizzes included in this guide are:

• Part 1: NCLEX Dosage Calculation Practice Questions (15 Items)
• Part 2: Oral Medications Dosage Calculations Practice Quiz (40 Items)
• Part 3: Parenteral Medications Dosage Calculations (50 Items)
• Part 4: Fluid Intake and Output Calculations (10 Items)

Guidelines

• Read and understand each question before choosing the best answer. 
• Since this is a review, answers and rationales are shown after you click on the "Check" button. 
• There is no time limit, answer the questions at your own pace. 
• Once all questions are answered, you'll be prompted to click the "Quiz Summary" button where you'll be shown the questions you've answered or placed under "Review". Click on the "Finish Quiz" button to show your rating. 
• After the quiz, please make sure to read the questions and rationales again by click on the "View Questions" button. 
• Comment us your thoughts, scores, ratings, and questions about the quiz in the comments section below!

Part 1: NCLEX Dosage Calculation Practice Questions (15 Items)

Welcome to the first part of your drug dosage calculation practice! Included topics in this section are practice for unit conversions and medication dosage calculations. Get your calculators ready!

Part 2: Oral Medications Dosage Calculations Practice Quiz (40 Items)

All practice questions in this section are related to dosage calculations for oral medications. Don’t forget to read the rationales!

Part 3: Parenteral Medications Dosage Calculations (50 Items)

You’ve made it to the third part of the drug calculation quiz! In this section, we’ll overdose you with parenteral medication calculation practice problems – all 50 of them! Wipe your tears and get your calculators ready! (Note that, parenteral includes IV administration but we’ll separate them from this quiz).

Part 4: Fluid Intake and Output Calculations (10 Items)

Last part of the quiz! Here, we’ll test your skills on calculating fluid intake and output!

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Drug Calculations Reviewer for Nurses

This is your study guide to help you refresh or review what you know about drug dosage calculations including tips on how to answer them.

NCLEX Tips for Dosage Calculation Questions

• The fill-in-the-blank question format is usually used for medication calculation, IV flow rate calculation, or determining the intake-output of a client. In this question format, you’ll be asked to perform a calculation and type in your answer in the blank space provided. 
• Always follow the specific directions as noted on the screen. 
• The unit of measure you need for your final answer is always given. 
• There will be an on-screen calculator on the computer for you to use. 
• Do not put any words, units of measurements, commas, or spaces with your answer, type only the number. Only the number goes into the box. Rounding an answer should be done at the end of the calculation or as what the question specified, and if necessary, type in the decimal point.

Nursing Responsibilities for Medication Administration

• 10 Rights of Medication Administration. Understanding the 10 Rights of Drug Administration can help prevent many medication errors. Nurses, who are primarily involved in the administration of medications, benefit from this simplified memory aid to help guide them to administer medications safely.
  • Right Drug. The first right of drug administration is to check and verify if it’s the right name and form. Beware of look-alike and sound-alike medication names. Misreading medication names that look similar is a common mistake. These look-alike medication names may also sound alike and can lead to errors associated with verbal prescriptions. Check out The Joint Commission’s list of look-alike/sound-alike drugs.
  • Right Patient. Ask the name of the client and check his/her ID band before giving the medication. Even if you know that patient’s name, you still need to ask just to verify. 
  • Right Dose. Check the medication sheet and the doctor’s order before medicating. Be aware of the difference between an adult and a pediatric dose. 
  • Right Route. Check and verify the order (i.e., per orem, IV, SQ, IM)
  • Right Time and Frequency. Check the order for when it would be given and when was the last time it was given. 
  • Right Documentation. Make sure to write the time and any remarks on the chart correctly. 
  • Right History and Assessment. Secure a copy of the client’s history to drug interactions and allergies. 
  • Right Drug Approach and Right to Refuse. Give the client enough autonomy to refuse the medication after thoroughly explaining the effects. 
  • Right Drug-Drug Interaction and Evaluation. Review any medications previously given or the diet of the patient that can yield a bad interaction to the drug to be given. Check also the expiry date of the medication being given. 
  • Right Education and Information. Provide enough knowledge to the patient of what drug he/she would be taking and what are the expected therapeutic and side effects.

Systems of Measurement

• There are three systems of measurement used in nursing: the metric system, the apothecaries’ system, and household system. 
• Metric System
  • The most widely used international system of measurement.
  • The basic units of metric measures are the gram (weight), meter (length or distance), and liter (volume).
  • It is a decimal-based system that is logically organized into units of 10. Basic units are multiplied or divided by 10 to form secondary units. 
• Apothecaries’ System
  • The apothecaries’ system is one of the oldest systems of measurement, older than the metric system and is considered to be out of date. 
  • The basic units used in this system are the grain (gr) for weight, minim for volume, ounce, and pound. All of which are seldomly used in the clinical setting. 
  • Quantities in the apothecaries’ system are often expressed by lowercase Roman numerals when the unit of measure is abbreviated. And the unit of measure precedes the quantity. Quantities less than 1 are expressed as fractions. Examples: “gr ii”, “gr ¼ ”
  • And yes, it can be confusing therefore use the metric system instead to avoid medication errors.
• Household System
  • Household system measures may be used when more accurate systems of measure are not required. 
  • Included units are drops, teaspoons, tablespoons, cups, pint, and glasses.
• Other Systems of Measurement
  • Milliequivalent (mEq)
    • The milliequivalent is an expression of the number of grams of a medication contained in 1 milligram of a solution.
    • Examples: the measure of serum sodium, serum potassium, and sodium bicarbonate is given in milliequivalents.
  • Unit (U)
    • Unit measures a medication in terms of its action, not its physical weight. 
    • When documenting, do not write “U” for unit, rather spell it as “unit” as it is often mistaken as “0”. 
    • Examples: Insulin, penicillin, and heparin sodium are measured in units.

Converting Units of Weight and Measure

• Converting values between metric system
  • For drug dosages, the metric units used are the gram (g), milligram (mg), and microgram (mcg). For volume units milliliters (mL) and liters (L). 
  • It is simple to compute for equivalents using the metric system. It can be done by dividing or multiplying; or by moving the decimal point three places to the left or right. 
  • Do not use a “trailing zero” after the decimal point when the dosage is expressed as a whole number. For example, if the dosage is 2m mg, do not insert a decimal point or the trailing zero as this could be mistaken for “20” if the decimal point is not seen. 
  • On the other hand, do not leave a “naked” decimal point. If a number begins with a decimal, it should be written with a zero and a decimal point before it. For example, if the dosage is 2/10 of a milligram, it should be written as 0.2 mg. It could be mistaken for 2 instead of 0.2. 

• Converting Units Between Systems
  • Household and metric measures are equivalent and not equal measures.
  • Conversions to equivalent measures between systems is necessary when a medication prescription is written in one system but the medication label is stated in another.
  • Medications are not always prescribed and prepared in the same system of measurement; therefore conversion of units from one system to another is necessary.
  • Common conversions in the healthcare setting include pound to kilograms, milligrams to grains, minims to drops. 

Methods for Drug Dosage Calculations

• Standard Method
  • The commonly used formula for calculating drug dosages. 
  • Where in:
    • D = Desired dose or dose ordered by the primary care provider. 
    • H = dose on hand or dose on the label of bottle, vial, ampule.
    • V = vehicle or the form in which the drug comes (i.e., tablet or liquid). 

STANDARD FORMULA

Example:
Order: Acetaminophen 500 mg On hand: Acetaminophen 250 mg in 5 mL Desired (D) = 500 mg On hand (H) = 250 mg Vehicle (V) = 5 mL Computation: Answer: 10 mL

• Ratio and Proportion Method
  • Considered as the oldest method used for drug calcluation problems.
  • For the equation, the known quantities are on the left side, while the desired dose and the unknown amount to administer are on the right side.
  • Where in:
    • D = Desired dose or dose ordered by the primary care provider. 
    • H = dose on hand or dose on the label of bottle, vial, ampule.
    • V = vehicle or the form in which the drug comes (i.e., tablet or liquid). 
    • X = amount to administer
  • Once the equation is set up, multiply the extremes (H and x) and the means (V and D). Then solve for x.

RATIO AND PROPORTION METHOD

H : V = D : x

• Fractional Equation Method
  • A method similar to ratio and proportion but expressed as fractions.
  • Where in:
    • D = Desired dose or dose ordered by the primary care provider. 
    • H = dose on hand or dose on the label of bottle, vial, ampule.
    • V = vehicle or the form in which the drug comes (i.e., tablet or liquid). 

FRACTIONAL EQUATION METHOD

Example:
Order: Digoxin 0.25 mg On hand: Digoxin 0.125 mg tablets Desired (D) = 0.25 mg On hand (H) = 0.125 mg Vehicle (V) = 1 tablets Computation: Answer: 2 tablets

• Fluid Intake and Output Calculation
  • Intake and output (I&O) measurement and recording is usually done to monitor a client’s fluid and electrolyte balance during a 24-hour period. 
  • Intake and output is done for patients with increased risk for fluid and electrolyte imbalance (e.g., heart failure, kidney failure). 
  • Unit used in measurement of I&O is milliliter (mL). 
  • Measuring fluid intake entails recording each item of fluid consumed or administered, all of the following fluids are recorded: 
    • Oral fluids (e.g., water, juice, milk, soup, water taken with medication). 
    • Liquid foods at room temperature (e.g., ice cream, gelatin, custard). 
    • Tube feedings including the water used for flushes. 
    • Parenteral fluids
    • Blood products
    • IV medications
  • Measurement of fluid output includes: 
    • Urinary output
    • Vomitus
    • Liquid feces
    • Tube drainage
    • Wound and fistula drainage
  • Measurement of fluid input and output are totaled at the end of the shift and documented in the patient’s chart. 
  • Determine if fluid intake and fluid output are proportional. When there is a significant discrepancy between intake and output, report to the primary care provider.

Recommended Links

If you need more information or practice quizzes, please do visit the following links:

• NCLEX Questions Nursing Test Bank and Review – Your ultimate guide to the NCLEX-RN. Includes 3,500+ practice questions to help you gain knowledge and confidence during the actual exams!

This study guide will give an overview of the Zika virus, including its transmission, symptoms, diagnosis, treatment, prevention and nursing management.

Zika virus was first identified in the Zika forest of Entebbe, Uganda in 1947 when a group of scientists examined a febrile rhesus monkey for Yellow fever. This infectious disease has been linked to incidences of microcephaly (babies being born with underdeveloped brains), Guillain-Barré syndrome, myelitis, and other neurologic conditions.

What is Zika virus?

Zika virus is a mosquito-borne flavivirus that is transmitted to humans primarily through the bite of an infected Aedes species mosquito (Aedes aegypti and Aedes albopictus).

• The Zika virus (ZIKV) is a member of the Flaviviridae virus family and the Flavivirus genus.
• In most cases, Zika virus infection causes a mild, self-limited illness.
• The incubation period is likely 3-12 days.
• The spectrum of Zika virus disease overlaps with other that of arboviral infections, but rash (maculopapular and likely immune-mediated) typically predominates.
• In April 2016, a deputy director at the Centers for Disease Control and Prevention (CDC) warned that the risk of Zika virus infection in the United States may have been previously underestimated, citing the increased range of the mosquito vectors (now in 30 US states, up from 12 as previously thought) and the travel risks associated with the 2016 Olympics in Brazil.
• Nonhuman and human primates are likely the main reservoirs of the virus, and anthroponotic (human-to-vector-to-human) transmission occurs during outbreaks.

Pathophysiology

Zika virus is well-adapted to grow in various hosts, ranging from arthropods to vertebrates.

• Viral attachment to unidentified cellular receptors is mediated by the E (envelope) glycoprotein.
• This is followed by endocytic uptake and then uncoating of the nucleocapsid and release of viral RNA into the cytoplasm.
• A viral polyprotein is produced and modified by the endoplasmic reticulum.
• Immature virions collect both in the endoplasmic reticulum and in secretory vesicles before being released.

Causes

Zika virus is transmitted to people primarily through the bite of an infected Aedes species mosquito (Ae. aegypti and Ae. albopictus).

• Mosquitoes. A mosquito gets infected with a virus when it bites an infected person during the period of time when the virus can be found in the person’s blood, typically only through the first week of infection; infected mosquitoes can then spread the virus to other people through bites.
• Infected pregnant mother to child. A pregnant woman already infected with Zika virus can pass the virus to her fetus during the pregnancy or around the time of birth.
• Through sex. Zika can be passed through sex from a person who has Zika to his or her partners; Zika can be passed through sex, even if the infected person does not have symptoms at the time.
• Through blood transfusion. There have been multiple reports of possible blood transfusion transmission cases in Brazil.
• Through lab and healthcare setting exposure. There are reports of laboratory acquired Zika virus infections, although the route of transmission was not clearly established in all cases.

Statistics and Incidences

The global prevalence of Zika virus infection has not been widely reported owing to asymptomatic clinical course, clinical resemblance to other infection with other flaviviruses (dengue, chikungunya), and difficulty in confirming diagnosis.

• In 2015 and 2016, large outbreaks of Zika virus occurred in the Americas, resulting in an increase in travel-associated cases in US states, widespread transmission in Puerto Rico and the US Virgin Islands, and limited local transmission in Florida and Texas.
• Based on sporadic case reports, entomological surveys, and seroprevalence surveys, Zika virus infection had been reported in various hosts, including humans, primates, and mosquitoes, in 14 countries across Africa, Asia, and Oceania, as of 2014.
• In May 2015, Brazil reported the first outbreak of Zika virus infection in the Americas.
• he Brazil Ministry of Health estimated around 440,000-1,300,000 suspected cases of Zika virus infection in December 2015.
• In March 2016, the WHO reported that Zika virus was actively circulating in 38 countries and territories, 12 of which have reported an increase in GBS cases or laboratory evidence of Zika virus among patients with GBS.
• As of June 2016, a total of 591 laboratory-confirmed travel-associated Zika virus infections have been reported in the United States, with none acquired via local vector-borne transmission.

Clinical Manifestations

Many people infected with Zika virus won’t have symptoms or will only have mild symptoms. The most common symptoms of Zika are:

• Fever. One of the most common and early signs of Zika is fever, which may occur within the first week of illness.
• Rash. The rash in Zika virus infection is usually a fine maculopapular rash that is diffusely distributed; it can involve the face, trunk, and extremities, including palms and soles; occasionally, the rash may be pruritic.
• Headache. Retroocular headache is a symptom of zika virus.
• Joint pain. Arthralgia involving the small joints of the hands and feet is also a common symptom of Zika virus.
• Conjunctivitis (red eyes). Viral conjunctivitis in Zika is also self-limiting.
• Muscle pain. Muscle pain may last for 2 to 7 days just like the other symptoms.

Assessment and Diagnostic Findings

Diagnostic testing for Zika virus infection can be accomplished using both molecular and serologic methods.

• Nucleic acid amplification test. Nucleic acid amplification test, or NAAT, is a generic term referring to all molecular tests used to detect viral genomic material; NAAT assays are the preferred method of diagnosis because they can provide confirmed evidence of infection.
• Zika virus antibody testing. IgM levels are variable, but generally become positive starting in the first week after onset of symptoms and continuing for up to 12 weeks post symptom onset or exposure, but may persist for months to years.
• Plaque reduction neutralization tests (PRNT). Plaque reduction neutralization tests (PRNT) are quantitative assays that measure virus-specific neutralizing antibody titers. PRNTs can resolve false-positive IgM antibody results caused by non-specific reactivity and at times help identify the infecting virus.

Medical Management

There is no specific medicine or vaccine for Zika virus.

• Medical care. Supportive care with rest and adequate fluid hydration is advised; symptoms such as fever and pain can be controlled with acetaminophen.
• Consultations. Expert consultation with a maternal-fetal medicine and infectious diseases specialists is advised for management of Zika virus infection during pregnancy.
• Prevention. The best method for preventing Zika virus infection is to avoid travel to areas with active Zika virus transmission; different strategies to prevent mosquito bites include wearing full-sleeved shirts and long pants, sleeping under mosquito bed net, and treating clothing with permethrin.

Nursing Management

Nursing care in a patient with Zika virus include the following:

Nursing Assessment

Assessment of a patient with Zika virus include:

• History. The incubation period is likely 3-12 days; owing to the mild nature of the disease, more than 80% of Zika virus infection cases likely go unnoticed; the spectrum of Zika virus disease overlaps with other that of arboviral infections, but rash (maculopapular and likely immune-mediated) typically predominates.
• Physical exam. The WHO recommends that newborns born to mothers with Zika virus infection undergo head circumference measurement between 1 and 7 days after birth; ahead circumference of more than 2 standard deviations below the mean is considered microcephaly; a circumference of more than 3 standard deviations below the mean is classified as severe microcephaly, which should prompt neuroimaging.

Nursing Diagnosis

Based on the assessment data, the following are the nursing diagnosis for a patient with Zika virus:

• Acute pain related to severe retroocular headaches. and joint pain.
• Hyperthermia related to increased metabolic rate and dehydration.
• Fluid volume deficit related to excessive sweating and dehydration.
• Knowledge deficit related to lack of exposure and information about the disease process, its treatment, and prognosis.

Nursing Care Planning and Goals

The major nursing care planning goals for a patient with Zika virus include:

• Patient describes satisfactory pain control at a level less than 3 to 4 on a rating scale of 0 to 10.
• Patient maintains body temperature below 39° C (102.2° F).
• Patient explains measures that can be taken to treat or prevent fluid volume loss.
• Patient and folks explain disease state, recognizes need for medications, and understands treatments.

Nursing Interventions

Below are the nursing interventions for a patient with Zika virus:

• Relieve pain. Acknowledge reports of pain immediately; get rid of additional stressors or sources of discomfort whenever possible; provide rest periods to promote relief, sleep, and relaxation; determine the appropriate pain relief method; provide analgesics as ordered, evaluating the effectiveness and inspecting for any signs and symptoms of adverse effects.
• Decrease fever. Eliminate excess clothing and covers; give antipyretic medications as prescribed; encourage ample fluid intake by mouth; provide high caloric diet or as indicated by the physician; and educate patient and family members about the signs and symptoms of hyperthermia and help in identifying factors related to occurrence of fever; discuss importance of increased fluid intake to avoid dehydration.
• Provide adequate fluid volume. Urge the patient to drink prescribed amount of fluid; emphasize importance of oral hygiene; provide comfortable environment by covering patient with light sheets; administer parenteral fluids as prescribed; consider the need for an IV fluid challenge with immediate infusion of fluids for patients with abnormal vital signs; provide measures to prevent excessive electrolyte loss (e.g., resting the GI tract, administering antipyretics as ordered by the physician); taach family members how to monitor output in the home; instruct them to monitor both intake and output.
• Educate patient and folks. Grant a calm and peaceful environment without interruption; provide an atmosphere of respect, openness, trust, and collaboration; include the patient in creating the teaching plan, beginning with establishing objectives and goals for learning at the beginning of the session; provide clear, thorough, and understandable explanations and demonstrations; when presenting a material, start with the basics or familiar, simple, and concrete information to less familiar, complex ones; and allow repetition of the information or skill.

Evaluation

Nursing goals are met for a patient with Zika virus as evidenced by:

• Patient described satisfactory pain control at a level less than 3 to 4 on a rating scale of 0 to 10.
• Patient maintained body temperature below 39° C (102.2° F).
• Patient explained measures that can be taken to treat or prevent fluid volume loss.
• Patient and folks explained disease state, recognizes need for medications, and understands treatments.

Documentation Guidelines

Documentation in a patient with Zika virus include:

• Individual findings, including factors affecting, interactions, nature of social exchanges, specifics of individual behavior.
• Cultural and religious beliefs, and expectations.
• Plan of care.
• Teaching plan.
• Responses to interventions, teaching, and actions performed.
• Attainment or progress toward the desired outcome.

Summary

Here are some of the most important points about Zika virus:

• Zika virus was first described in a febrile rhesus monkey in the Zika forest of Entebbe, Uganda, and was reported in a human field worker shortly thereafter.
• Zika virus is transmitted to humans primarily through the bite of an infected Aedes species mosquito (Ae. aegypti and Ae. albopictus); the incubation period is likely 3-12 days.
• A pregnant woman already infected with Zika virus can pass the virus to her fetus during the pregnancy or around the time of birth.
• In 2015 and 2016, large outbreaks of Zika virus occurred in the Americas, resulting in an increase in travel-associated cases in US states, widespread transmission in Puerto Rico and the US Virgin Islands, and limited local transmission in Florida and Texas.
• The most common symptoms of Zika are fever, rash, headache, joint pain, conjunctivitis, and muscle pain.
• Diagnostic testing for Zika virus infection can be accomplished using both molecular and serologic methods.
• Supportive care with rest and adequate fluid hydration is advised; symptoms such as fever and pain can be controlled with acetaminophen.

References

Sources and references for this Zika virus study guide:

• Navalkele, BD, MD. (2018, Dec 11). Zika Virus. Retrieved from https://emedicine.medscape.com/article/2500035-overview
• Centers for Disease Control and Prevention. (2019, Nov 20). Zika Virus. Retrieved from https://www.cdc.gov/zika/index.html

Are you ready to learn? This nursing test bank includes over 3,500 nursing practice questions covering a wide range of nursing topics that are absolutely free! No registration required! Answer all of our mock exams to help you prepare and review for any nursing school exam (including NCLEX-RN and NCLEX-PN). Our goal is to provide aspiring nurses with free resources and help them become registered nurses.

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On this nursing test bank are practice questions about prioritization, delegation, and assignment. These common NCLEX questions are challenging to answer, but with enough practice using the questions below, you will ace them!

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Safety and Infection Control Nursing Test Banks

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NCLEX-PN Nursing Test Bank

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Test-Taking Strategies and Tips

Reviewing nursing concepts for your exam is just one part, you’ll need to learn how to answer correctly the questions too. Here are some test taking tips:

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