Malaria is a relatively common condition caused by parasitic infection by the Plasmodium protozoans, generally acquired from the bite of a mosquito. The disease is widespread throughout the tropical and subtropical regions, including much of Latin America and Asia, however, the vast majority of reported cases – approximately 90% – occur in Sub-Saharan Africa. Show
The disease remains very prevalent in these regions with 216 million cases of malaria reported globally in 20161, resulting in an estimated 731,000 deaths2. The Malaria parasites belong to the Plasmodium (phylum Apicomplexa) genus. Infection in humans is generally caused by infection by P. malariae, P. ovale, P. knowles, P. vivax and P. falciparum34. The vast majority of infections are reported to be caused by P. falciparum, accounting for approximately 75% of cases5. Signs and SymptomsOnset of symptoms varies greatly, some patients may remain asymptomatic for up to 25 days after infection, while others may manifest in as little as 1 week6. Some cases have been reported to remain asymptomatic for a period of years, however, these cases remain very sparse. Initial manifestations of Malaria are similar to flu-like symptoms and include fever, headache, shivering, joint pain, vomiting, convulsions and haemolytic anaemia. Severe cases may present with acute respiratory distress. Progression of the disease can lead to liver and renal failure7. Additional symptoms include severe headache, low blood sugar, haemoglobin in the urine, spontaneous bleeding, coagulopathy and shock8. Patients with cerebral Malaria can exhibit neurological symptoms including abnormal posturing, nystagmus, conjugate gaze palsy, opisthotonus, seizures, decorticate and decerebrate posturing and coma7. TransmissionTransmission of the Malaria disease is dependant on the female Anopheles mosquito, which acts as a definitive host and transmits the parasite in the form of a motile sporozoite into a vertebrate host (such as a human) where the parasite can travel through the blood to multiply and complete its life cycle9. There have been reported cases of transmitted malaria infections from blood transfusions10, although these remain rare. Transmission through exposure to other body fluids is considered unlikely. PathophysiologyAs the parasite matures in the red blood cell, it will cause the cell to
swell and eventually lyse, releasing the newly multiplied parasites into the bloodstream where they can infect additional red blood cells. Immune ResponseThe parasite is relatively invisible to the body’s immune system and able to evade detection as it resides within the cells of the liver and red-blood cells. The parasite actively prevents host red-blood cells from destruction in the spleen by displaying adhesion proteins to stick to the blood vessel walls. Genetic ResistanceThe prevalence of the disease in low socio-economic combined with high levels of mortality and morbidity has resulted in genetic pressure on the human genome favouring those with genetic factors such as sickle cell traits, a glucose-6-phosphate dehydrogenase deficiency and the absence of Duffy antigens on red blood cells.
The WHO recommends a combination of quinine and clindamycin in early pregnancies (first trimester) and regular ACT
therapy for later stage pregnancies (second an third trimester). Physical AssessmentAssess the patient’s level of consciousness and monitor vital signs and urine output. Assess for evidence of shock and evidence of an enlarged spleen or liver, as well as anaemia, which could indicate active or previous malaria infection. Look for signs of bleeding and prepare for blood transfusion if patient shows excessive bleeding. Monitor blood glucose and evaluate the patients nervous system for level of consciousness hourly. Nursing Diagnosis & Care PlanImpaired Circulation related to AnemiaNursing Assessments Nursoing Interventions Hyperthermia related to increased metabolism, dehydration.Nursing Assessments Nursing Interventions Fluid volume deficitNursing Assessments Nursing Interventions Nutrition/Metabolic DeficitNursing Assessments Nursing interventions Patient/Carer Knowledge DeficitNursing Assessments Nursing Interventions 1. WHO . World Malaria Report 2017. WHO; 2017. 2. GBD 2015. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1459-1544. [PubMed] 3. Collins W. Plasmodium knowlesi: a malaria parasite of monkeys and humans. Annu Rev Entomol. 2012;57:107-121. [PubMed] 4. Mueller I, Zimmerman P, Reeder J. Plasmodium malariae and Plasmodium ovale–the “bashful” malaria parasites. Trends Parasitol. 2007;23(6):278-283. [PubMed] 5. Nadjm B, Behrens R. Malaria: an update for physicians. Infect Dis Clin North Am. 2012;26(2):243-259. [PubMed] 6. Bledsoe G. Malaria primer for clinicians in the United States. South Med J. 2005;98(12):1197-204; quiz 1205, 1230. [PubMed] 7. Bartoloni A, Zammarchi L. Clinical aspects of uncomplicated and severe malaria. Mediterr J Hematol Infect Dis. 2012;4(1):e2012026. [PubMed] 8. Rijken M, McGready R, Boel M, et al. Malaria in pregnancy in the Asia-Pacific region. Lancet Infect Dis. 2012;12(1):75-88. [PubMed] 9. Schlagenhauf-Lawlor P. Travelers’ Malaria. PMPH-USA; 2008. 10. Owusu-Ofori A, Parry C, Bates I. Transfusion-transmitted malaria in countries where malaria is endemic: a review of the literature from sub-Saharan Africa. Clin Infect Dis. 2010;51(10):1192-1198. [PubMed] 11. Bhalla A, Suri V, Singh V. Malarial hepatopathy. J Postgrad Med. 2006;52(4):315-320. [PubMed] 12. Ferri F. Protozoal infections. In: Ferri’s Color Atlas and Text of Clinical Medicine. Elsevier Health Sciences; 2009:1159. 13. Korenromp E, Williams B, de V, et al. Malaria attributable to the HIV-1 epidemic, sub-Saharan Africa. Emerg Infect Dis. 2005;11(9):1410-1419. [PubMed] 14. Waters N, Edstein M. 8-Aminoquinolines: Primaquine and Tafenoquine. In: Treatment and Prevention of Malaria: Antimalarial Drug Chemistry, Action and Use. Springer; 2012:69-93. 15. Kokwaro G. Ongoing challenges in the management of malaria. Malar J. 2009;8 Suppl 1:S2. [PubMed] How do you write a nursing patient care plan?To create a plan of care, nurses should follow the nursing process: Assessment. Diagnosis. Outcomes/Planning.. Assess the patient. ... . Identify and list nursing diagnoses. ... . Set goals for (and ideally with) the patient. ... . Implement nursing interventions. ... . Evaluate progress and change the care plan as needed.. What should a nursing care plan include?There are five main components to a nursing care plan including; assessment, diagnosis, expected outcomes, interventions, and rationale/evaluation.
What are the nursing management of malaria in pregnancy?Prompt management of maternal infection is key, using parenteral artemisinins for severe malaria, and artemisinin combination treatments (ACTs) in the second and third trimesters of pregnancy. ACTs may soon also be recommended as an alternative to quinine as a treatment in the first trimester of pregnancy.
How do you take care of a malaria patient?The diet for malaria patients should include the following:. Eat Nutritious Foods. When the patient has a malarial fever, the body's calorie and nutritional requirement increases. ... . Increase Fluid Intake. ... . Increase Protein Intake. ... . Eat Fat in Moderation. ... . Foods to avoid.. |