Malaria,causes,signs and symptoms,complications,predisposing factors,investigation ,treatment,nursing care,nursing diagnosis

   

image showing patient with simple malaria and comlicated malaria

Malaria

Malaria is a condition caused by plasmodium and characterised by high fever, joint pain and general body weakness.

Causes

The commonest cause of malaria is plasmodium falciparum, which is caried by infected female anopheles mosquitos. The other plasmodium that can causes malaria are;

·       Plasmodium ovale

·       Plasmodium vivax

·       Plasmodium knowlesi

·       Plasmodium malariae

Predisposing factors

Not sleeping under treated mosquitos net

Bushes around home

Stagnant water collected in a broken bottle, broken pot, pit hole

Stay out late at night outside the house

failure to immunised against malaria

Life cycle of malaria

In mosquitos

When the uninfected female anopheles mosquitos bite a person having malaria.it feed on the person’s blood during the process of feeding the mosquitos ingest the malarial parasites. when they reach in the stomach the microgamete will then generate  after penetrating the stomach this become ookinetes invading the mosquitos gut and later develop in to oocytes. Oocytes continues to grow becoming sporozoite then rupture releasing it, it is the one that goes to the saliver and pass on the person when mosquitos bite during feeding.

In man

When an infected mosquitos with malarial parasite bite uninfected person, the sporozoite  enter the blood stream through saliver.the sporozoites then travel to the liver through the blood flow. they attack the liver cell and mature in to schizonts. they then multiply in the liver cells causing it to rapture releasing the merozoite in to the bloods stream, this form attack the red blood cells. they destroy the red blood cells ,some of them begin to asexually multiply. The process continue.

When the parasites become many in the circulation the patient will start to show sign ans symptoms of malaria

 

 

Signs and symptoms

Simple malaria

This is malaria without complication

Fever

Headache

chill

Joint pain

General body weakness

Nausea and vomiting

Lack of appetite

Dry cough

Complicated malaria

This is malaria with complication, it has the other signs and symptoms for simple malaria and complication,

The following there the things that complicated malaria

Hypoglycaemia

Convulsion

Hepatomegaly (enlargement of the liver)

Splenomegaly (enlargement of the spleen)

anaemia

jaundice

urinating blood

oliguria

investigations

history taking.

Ask how the patient is feeling, the main complains, the medical history and if the patient has taken any medication

 physical examination

do physical examination from head to toe looking for the following

anaemia and jaundice from the eye and any eye infection like discharge, redness

feel for liver and spleen if they are enlarged.

Assess the Glasgow coma scale

Laboratory test

there are series of investigation done to rule out malaria from other infections, this test are

·       malarial rapid diagnostic test (MRDT)

·       blood slid for malarial parasite (BS)

other test include

·       complete blood count

·       urinalysis

·       random blood sugar

·       ultrasound scan

·       MRI in case of convulsion

Treatment

Malaria is treated with antimalarial medications according to the guideline from the ministry of heath

Example of antimalarial drug/medication available

·       Artemether  + lumefantrine (coatem)

·       Quinine

·       Artemether

·       Pialaxin

·       Artesunate

·       Fansida for prophylaxis

Prevention of malaria

sleeping under treated mosquito’s net

clearing Bushes around compound and around home

destroying Stagnant water collected in a broken bottle, broken pot, pit hole

entering early inside at night  in the house

closing all the widows and door early in the evening

immunised against malaria

taking malarial prophylaxis especially pregnant mother

using mosquitos repellent

complication of malaria

Hypoglycaemia

Convulsion

 Brain damage

acidosis

Anaemia

Liver failure

Renal failure

Cerebral malaria

Circulatory collapse

Pulmonary oedema

Threatened abortion

Shock

Spontaneous bleeding

Specific Nursing management for malaria

Create rapport to allay the patient/relative anxiety and aide cooperation

Take vital signs and monitor that is temperature ,pulse rate, respiration

Do tepid sponging and administer antipyretic

Monitor for complications like acute kidney injuries,  anaemia, convulsion, hypoglycaemia for early detection and treatment

Monitor input and out put through fluid balanced chart

Administer medication as prescribe by the doctor eg artesunate, paracetamol

Monitor for side effects of the medication especially the one with deadly side effect like quinine

Educate the patient on malaria ie the medications, the possible side effect ,the possible complication

For psychological care Counsell the patient /attendant about the situation

Provide well balanced diet to provide energy and nutrient need by the body

Encourage exercise for prevent of muscle stiffness

Regular changing of the position to prevent pressure sore

Encourage good hygiene like changing of bed sheet, bed birth, oral care to provide comfort and prevent patient from getting other infection

Advise on discharge example follow up, adherent to mediations

Document all the activities for continuous care

Nursing diagnosis for malaria

Actual nursing diagnosis

Hyperthermia related to infection by malarial parasite(plasmodium)as evidenced by patient hot on touch, thermometer reading of 38.9 degree Celsius, patient severing, sweeting, rapid heart rate, convulsing.

Unstable glucose level related to luck of appetite, inability to eat, unconsciousness as evidenced by glucometer reading of 1.9mm/dl.

Acute pain related to body inflammatory response to malarial parasites, response to infection as evidenced by patient complaining of headache, join pain.

Impaired tissue perfusion related to destruction of red blood cell by malarial parasite, anaemia as evidenced by difficult in breathing, pale mucus membranes

Fatigue related to hyper parasitemia as evidenced by patient complain of general body weakness ,tiredness

Activity intolerance related to anaemia as evidenced by patient not able to do activity of daily living.

Impaired urine out put related to destruction of kidney cells by malarial parasite as evidenced by patient urinating blood, oliguria.

Knowledge deficits related to lack of knowledge about malaria as evidenced by patient asking a lot of questions

 Risky nursing diagnosis

Risk for unstable glucose level related to lost of appetite

Risk for infection related to splenomegaly

Risk for fluid vallum deficit related to vomiting

Risk for renal failure related to urinating blood

Risk for injury related to convulsion

Risk for nutrition less than body requirement related to increased body demand

Risk for impaired tissue perfusion related to anaemia

Nursing care plan for malaria

assessment	Nursing diagnosis	implementation	rational	Expected outcome	evaluation
Subjective data   Patient complains of heache,fever,join pain,no medication taken Objective data Temperature 40.0 degree centigrade,pules 30 b/m,rbs 1.9mm/dl	Hyperthermia related to infection malarial parasite(plasmodium) as evidenced by thermometer reading of 40.0 degree celius	Tepid sponge   Open adjusten window   Exposed the patient       Administer antipyretics sg paracetamol, NSAID   Administer antimalarial	To allow heat lost   To allow free air circulation   To allow heat lost by evaporation and a void over heating the patient   To work on the heat regulatory centre     To combat malarial parasite	To reduced temperature by 3 degree celisus within 4 hours	Temperature was reduced to 37 within 4 hours
	Unstable glucose level related to luck of appetite, inability to eat, unconsciousness as evidenced by glucometer reading of 1.9mm/dl	Administer dextrose     Pass NG Tube   Feed the patient       Monitor glucose level every 3o minutes	To introduced glucose in to circulation   For feeding   To provide energy and glucose to the patient   To detect any abnormalities	To improve glucose level to normal within 2minute	Glucose was restore to normal within 2minute
	Acute pain related to body response to malarial parasite As evidenced by patient complain of headche	Cold compress     Administer pain killer as prescribe by doctor eg diclofenact,paracetamol   Encourage rest	To reduced inflammatory response To relief from pain           To relax the body	To relief pain within 2 hours	Pain was relief within three hour
	Impaired tissue perfusion related to destruction of red blood cell reducing oxygen carying capacity as evidenced pale mucus membrane	Administer oxygen       Transfuse with packed cell     Monitor for signs and symptoms of shock	To introduced oxygen into the blood stream   To replace the destroyed red blood cells   To detect early and early intervention	To improve tissue perfusion within 30 minutes	Tissue perfusion was improved within 3o minutes
	Fatigue related to hyper parasitemia as evidenced by patient complain of general body weakness ,tiredness     Activity intolerance related to anaemia as evidenced by patient not able to do activity of daily living	Encourage adequate rest	To enable body recover
	Risk for fluid vallum deficit related to vomiting	Encourage enough fluid intake eg water ,juice
	Risk for unstable glucose level related to lost of appetite	Encourage well balanced diet

 

 

Summery on malaria

Definition

Malaria is a condition caused by plasmodium and characterized by high fever, joint pain, and general body weakness.

---

Causes

The commonest cause is Plasmodium falciparum, carried by infected female anopheles mosquitoes.
Other plasmodia that cause malaria include:

• Plasmodium ovale
• Plasmodium vivax
• Plasmodium knowlesi
• Plasmodium malaria

---

Predisposing Factors

• Not sleeping under treated mosquito net
• Bushes around home
• Stagnant water in broken bottles, pots, pit holes
• Staying out late at night
• Failure to be immunised against malaria

---

Life Cycle of Malaria

In Mosquito

When an uninfected female anopheles mosquito bites a person with malaria, it ingests parasites. In the stomach, microgametes generate and become ookinetes, which invade the mosquito gut and develop into oocytes. Oocytes grow into sporozoites, rupture, and move to the salivary glands. These are passed to a person during feeding.

In Man

When an infected mosquito bites an uninfected person, sporozoites enter through saliva and travel to the liver. They mature into schizonts, multiply, and rupture liver cells releasing merozoites into the bloodstream. These attack and destroy red blood cells. As parasites increase, the patient shows signs and symptoms of malaria.

---

Signs and Symptoms

Simple Malaria (Uncomplicated)

• Fever
• Headache
• Chills
• Joint pain
• General body weakness
• Nausea and vomiting
• Lack of appetite
• Dry cough

Complicated Malaria

Includes symptoms of simple malaria plus:

• Hypoglycaemia
• Convulsion
• Hepatomegaly
• Splenomegaly
• Anaemia
• Jaundice
• Urinating blood
• Oliguria

---

Investigations

History Taking

Ask how patient is feeling, main complaints, medical history, and any medication taken.

Physical Examination

Check from head to toe for:

• Anaemia and jaundice from eyes
• Eye infection (discharge, redness)
• Enlarged liver and spleen
• Glasgow coma scale

Laboratory Tests

• Malarial rapid diagnostic test (MRDT)
• Blood slide for malarial parasite (BS)

Other tests include:

• Complete blood count
• Urinalysis
• Random blood sugar
• Ultrasound scan
• MRI in case of convulsion

---

Treatment

Malaria is treated with antimalarial medications according to Ministry of Health guidelines.

Examples:

• Artemether + lumefantrine (Coartem)
• Quinine
• Artemether
• Pialaxin
• Artesunate
• Fansida for prophylaxis

---

Prevention of Malaria

• Sleeping under treated mosquito net
• Clearing bushes around home
• Destroying stagnant water
• Entering early indoors at night
• Closing windows and doors early
• Immunisation against malaria
• Malarial prophylaxis (especially in pregnancy)
• Using mosquito repellent

---

Complications of Malaria

• Hypoglycaemia
• Convulsion
• Brain damage
• Acidosis
• Anaemia
• Liver failure
• Renal failure
• Cerebral malaria
• Circulatory collapse
• Pulmonary oedema
• Threatened abortion
• Shock
• Spontaneous bleeding

---

Specific Nursing Management for Malaria

• Create rapport to allay anxiety
• Take and monitor vital signs
• Tepid sponging and give antipyretic
• Monitor for complications (AKI, anaemia, convulsion, hypoglycaemia)
• Monitor input and output
• Administer medications as prescribed
• Monitor for side effects, especially quinine
• Educate patient about malaria, side effects, and complications
• Provide counselling
• Provide well-balanced diet
• Encourage exercise to prevent muscle stiffness
• Regular position change to prevent pressure sores
• Encourage good hygiene (bed sheets, bed bath, oral care)
• Give discharge advice (follow up, adherence)
• Document all activities

---

Nursing Diagnoses

Actual Diagnoses

• Hyperthermia related to malarial infection
• Unstable glucose level related to lack of appetite/inability to eat
• Acute pain related to inflammatory response
• Impaired tissue perfusion related to destruction of RBCs
• Fatigue related to hyperparasitemia
• Activity intolerance related to anaemia
• Impaired urine output related to kidney cell destruction
• Knowledge deficit related to lack of knowledge

Risk Diagnoses

• Risk for unstable glucose level
• Risk for infection
• Risk for fluid volume deficit
• Risk for renal failure
• Risk for injury
• Risk for nutrition less than body requirement
• Risk for impaired tissue perfusion

---

Nursing Care Plan (Summary)

• Hyperthermia: tepid sponge, open windows, expose patient, antipyretics, antimalarials
• Unstable glucose: administer dextrose, NG tube, feed patient, monitor glucose
• Acute pain: cold compress, analgesics, encourage rest
• Impaired tissue perfusion: give oxygen, transfuse packed cells, monitor for shock
• Fatigue/activity intolerance: encourage adequate rest
• Risk for fluid deficit: encourage enough fluid
• Risk for unstable glucose: encourage balanced diet

comonly ask quetions

Explain the life cycle of malaria in mosquitoes?

• An uninfected female anopheles mosquito bites a person with malaria.

• The mosquito feeds on the person’s blood.

• During feeding, malaria parasites are ingested.

• In the mosquito stomach, microgametes develop.

• The parasites penetrate the stomach wall.

• They become ookinetes and invade the mosquito gut.

• Ookinetes develop into oocytes.

• Oocytes grow and form sporozoites.

• The oocytes rupture and release sporozoites.

• Sporozoites move to the mosquito salivary glands.

• They are passed to humans during mosquito feeding.

Describe the life cycle of malaria in man?

Answer:

• An infected mosquito bites an uninfected person.

• Sporozoites enter the bloodstream through saliva.

• Sporozoites travel to the liver via blood flow.

• They invade liver cells.

• They mature into schizonts.

• Schizonts multiply inside liver cells.

• Liver cells rupture and release merozoites.

• Merozoites enter the bloodstream.

• They attack and destroy red blood cells.

• Some parasites multiply asexually.

• When parasites increase, signs and symptoms of malaria appear.

Frequently ask question(FAQ)

What is malaria?

condition caused by plasmodium and characterised by high fever, joint pain and general body weakness.

How is malaria transmitted?

From infected  person  to uninfected by a bite of infected female anopheles mosquitos(from persion to persion)

How do we call the parasite that cause malaria?

the parasite that cause malaria malaria is called plasmodium.

What are the four main example of plasmodium?

Here are the list of plasmodium;

Plasmodium falciparum, Plasmodium ovule, Plasmodium vivax, Plasmodium knwylesi, Plasmodium malaria

What are the commonest signs and symptoms of malaria?

Fever, Headache, chill, join pain, General body weakness, Nausea and vomiting,Lack of appetite.

What are the complication of malaria?

This are the complication of malaria; Hypoglycaemia, Convulsion, hepatomegaly (enlargement of the liver), Splenomegaly (enlargement of the spleen), anaemia, jaundice, urinating blood, oliguria, liver failure, kidneys failure, pulmonary oedema, acidosis, shock.