NCP for Malaria
Malaria is an infectious disease caused by a parasite, Plasmodium, which infects red blood cells. Malaria is characterized by cycles of chills, fever, pain, and sweating. Historical records suggest malaria has infected humans since the beginning of mankind. The name "mal aria" (meaning "bad air" in Italian) was first used in English in 1740 by H. Walpole when describing the disease. The term was shortened to "malaria" in the 20th century. C. Laveran in 1880 was the first to identify the parasites in human blood. In 1889, R. Ross discovered that mosquitoes transmitted malaria. Of the four common species that cause malaria, the most serious type is Plasmodium falciparum malaria. It can be life-threatening. However, another relatively new species, Plasmodium knowlesi, is also a dangerous species that is typically found only in long-tailed and pigtail macaque monkeys. Like P. falciparum, P. knowlesi may be deadly to anyone infected. The other three common species of malaria (P. vivax, P. malariae, and P. ovale) are generally less serious and are usually not life-threatening. It is possible to be infected with more than one species of Plasmodium at the same time.
Symptoms and Signs
The symptoms characteristic of malaria include flulike illness with fever, chills, muscle aches, and headache. Some patients develop nausea, vomiting, cough, and diarrhea. Cycles of chills, fever, and sweating that repeat every one, two, or three days are typical. There can sometimes be vomiting, diarrhea, coughing, and yellowing (jaundice) of the skin and whites of the eyes due to destruction of red blood cells and liver cells.
People with severe P. falciparum malaria can develop bleeding problems, shock, liver or kidney failure, central nervous system problems, coma, and can die from the infection or its complications. Cerebral malaria (coma, or altered mental status or seizures) can occur with severe P. falciparum infection. It is lethal if not treated quickly; even with treatment, about 15%-20% die.
Nursing Assessment for Malaria
- Activity / rest
Symptoms: Fatigue, weakness, general malaise
Signs: Tachycardia, muscle weakness and decreased strength.
Signs: Blood pressure normal or slightly decreased. Peripheral pulse strong and rapid (phase of fever) warm skin, diuresis (diaphoresis) due to vasodilation. Pale and moist (vasoconstriction), hypovolemia, decreased blood flow.
Symptoms: Diarrhea or constipation, decreased urine output
Signs: abdominal distension
- Food and fluid
Symptoms: Anorexia, nausea and vomiting
Signs: Weight loss, reduced subcutaneous fat, and decrease in muscle mass. Decrease in urine output, urine concentration.
- Neuro Sensory
Symptoms: Headache, dizziness and fainting.
Signs: Nervousness, fear, mental chaos, disorientas delirium or coma.
Breathing Signs: Tackipnea with a reduced depth of breathing. Symptoms: short breath at rest and activity
- Counseling / learning
Symptoms: chronic health problems, such as liver, kidney, alcohol poisoning, history of splenectomy, had just had surgery / invasive procedures, traumatic injury.
Nursing Diagnosis for Malaria
Nursing diagnosis in patients with malaria on the basis of signs and symptoms that arise can be described as below (Doengoes, Moorhouse and Geissler, 1999) :
- Changes in nutrition less than body requirements related to inadequate food intake, anorexia, nausea / vomiting
- High risk of infection related to decreased immune system; invasive procedure
- Hyperthermia related to increased metabolism, dehydration, direct effects on the hypothalamic circulation of germs.
- Changes in tissue perfusion related to decreased cellular components in the need for delivery of oxygen and nutrients in the body.
- Lack of knowledge, about illness, prognosis and treatment needs related to lack of exposure, the interpretation of information ,cognitive limitations.
Nursing Care Plan for Malaria