Malaria

Name: Merissa Peterson

School: Georgetown School of Nursing
Class: Batch 129 A’

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 Content Page
Acknowledgement …………………………….………………………………………………… 3
Introduction ……………………………………………………………………………………… 4
Definition of term ……………………………………………………………………………….. 5
Risk Factors of Malaria ………………………………………………………………………….. 6
Causes of Malaria ……………………………………………………………………………….. 7
Clinical Manifestation …………………………………………………………………………… 8
Pathophysiology of Malaria ………………………………………………………………...…… 9
Diagnostic Evaluation ………………………………………………………………..………… 10
Medical Management …………………………………………………………………..…....11-13
Nursing Management …………………………………………………………………………... 14
Nursing Care plan for Malaria ………………………………………………………...……….. 15
Conclusion ……………………………………………………………………………………... 16
Reference ………………………………………………………………………………………. 17

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 Acknowledgement
I would first like to thank God for giving me health and strength and finish this assignment
within the speculated time.
I would also like to take this opportunity to express gratitude to everyone who has directly or
indirectly helped me to complete this assignment.

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 Introduction
Malaria is caused by the parasitic protozoan Plasmodium. It is a vector-borne disease which is
transmitted from person to person via bites from infected mosquitoes. Throughout this
assignment we will discuss the important of malaria, its definition, signs and symptom and
possible risk factors and major causes.

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 Definition
According to the Oxford Dictionary, Malaria is an intermittent and remittent fever caused by a
protozoan parasite which invades the red blood cells and is transmitted by mosquitoes in many
tropical and subtropical regions.

According to MedicineNet, An infectious disease caused by protozoan parasites from the

Plasmodium family that can be transmitted by the bite of the Anopheles mosquito or by a
contaminated needle or transfusion. Falciparum malaria is the most deadly type.

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 Risk Factors
 Immune System Deficiency - You can become infected with malaria even if you have a
normal immune system, but people who have immune system deficiencies, including
HIV, are more likely to experience severe effects of the infection.
 Pregnancy - Women who are pregnant are at increased risk of malaria infection. There
are several proposed reasons for this, including a lowered immune system which can
reactivate previous infection—or a lowered immune system which makes it more likely
for pregnant women who become bit to develop the illness.
 Newborn Babies (Transmission From Their Mother) - Some babies may be born with
malaria infection, acquiring the parasite from the mother, and not from a mosquito vector.
 Blood Transfusion - There have been reports of malaria infection that have spread from
one person to another through blood transfusions. In these instances, a blood donor who
has acquired an infection, usually from a mosquito vector, typically has not yet developed
symptoms of the illness.The transfer of blood cells, which are infected with the parasitic
organism, can then allow the parasite to thrive inside the body of the recipient of the
blood transfusion.
 Visiting a Region With a High Rate of Malaria - Travelers who visit regions with a high
rate of malaria may become infected, particularly because travelers who have not been
exposed to the infection before have not developed immunity to the condition.
 Environmental Factors - Some factors increase exposure to malaria, including a lack of
protective clothing, exposed sleeping accommodations, lack of insect repellant, and lack
of immunization. Especially when traveling, do your best to take proper precautions.

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 Causes of Malaria
Malaria is caused by the Plasmodium parasite. The parasite can be spread to humans through the
bites of infected mosquitoes. There are many different types of plasmodium parasite, but only 5
types cause malaria in humans. These are:
 Plasmodium falciparum – mainly found in Africa, it's the most common type of malaria
parasite and is responsible for most malaria deaths worldwide
 Plasmodium vivax – mainly found in Asia and South America, this parasite causes milder
symptoms than Plasmodium falciparum, but it can stay in the liver for up to 3 years,
which can result in relapses
 Plasmodium ovale – fairly uncommon and usually found in West Africa, it can remain in
your liver for several years without producing symptoms
 Plasmodium malariae – this is quite rare and usually only found in Africa
 Plasmodium knowlesi – this is very rare and found in parts of southeast Asia

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 Clinical Manifestation
Symptoms of malaria can develop as quickly as 7 days after you're bitten by an infected
mosquito. Typically, the time between being infected and when symptoms start (incubation
period) is 7 to 18 days, depending on the specific parasite you're infected with. However, in
some cases it can take up to a year for symptoms to develop.
The initial symptoms of malaria are flu-like and include:
 a high temperature of 38C or above
 feeling hot and shivery
 headaches
 vomiting
 muscle pains
 diarrhea
 generally feeling unwell
These symptoms are often mild and can sometimes be difficult to identify as malaria.
With some types of malaria, the symptoms occur in 48-hour cycles. During these cycles, you feel
cold at first with shivering. You then develop a high temperature, accompanied by severe
sweating and fatigue. These symptoms usually last between 6 and 12 hours.
The most serious type of malaria is caused by the Plasmodium falciparum parasite. Without
prompt treatment, this type could lead to you quickly developing severe and life-threatening
complications, such as breathing problems and organ failure.

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 Pathophysiology
Malaria infection involves two distinct phases, the exoerythrocytic phase, which occurs in the
liver, and the erythrocytic phase, which involves red blood cells (RBC’s). The primary portal of
infection is through the bite of a mosquito which serves as a reservoir for sporozoites which are
present in an infected mosquito’s saliva. When an infected mosquito pierces the skin of a human,
these sporozoites are released into the bloodstream where they migrate to the liver and infect
hepatocytes and multiply asexually. Infected patients will remain asymptomatic during this time,
lasting between a week and one month. Although the liver is a key host for the parasite, liver
dysfunction is not common and usually occurs in patients with additional liver conditions, such
as viral hepatitis.
As 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.
The malaria parasite classically results in paroxysm, a two-day cycle of sudden coldness,
followed by shivering, and then profuse sweating in actively infected patients (tertian fever). In
P. vivax and P. ovale infections, this cycle occurs over three days.
Malaria parasites can cause acute respiratory distress in up to 25% of adult patients, and 40% of
children thought to be caused by respiratory compensation of metabolic acidosis, noncardiogenic
pulmonary oedema, pneumonia and severe anaemia.

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 Diagnostic Evaluation
 Thick and thin blood smears. These are the most common and accurate malaria tests. A
lab technician, doctor, or nurse will take some of your blood and send it to a lab to be
stained to make any parasites show clearly. The technician spreads it on a glass slide and
looks at it with a microscope. A thin blood smear, also called a blood film, is one drop of
blood spread across most of the slide. A thick smear drops the blood on a small area. A
normal test does two of each.The number of malaria parasites in your blood can change
each day. So your test might say you don’t have malaria even if you do. For that reason,
you may need your blood drawn several times over 2-3 days for the best results.

 Rapid diagnostic test. Also called RDT or antigen testing, this is a quick option when
blood draws and smears aren't available. Blood taken from a prick on your finger is put
on a test strip that changes color to show whether you have malaria or not.This test
usually can't tell which species of malaria parasites caused your infection. Nor can it tell
whether the infection is minor or major. Your doctor should follow up all results with
blood smears.

 Molecular test. Also known as polymerase chain reaction test, it can identify the type of
parasite, which helps your doctor decide which drugs to prescribe. This test is a good
choice if your blood has low number of parasites or if the results of your blood smear are
vague.

 Antibody test. Doctors use this to find out if you've had malaria in the past. It looks for
antibodies that show up in the blood after an infection.

 Drug resistance test. Some malaria parasites are resistant to drugs. But doctors can test
your blood to see if certain drugs will work.

 Blood test. In addition to other tests, you may also have your blood drawn for a blood
count and chemistry panel. This can tell your doctor how serious your infection is and if
it's causing other problems, like anemia or kidney failure.

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 Medical Management
How to treat a patient with malaria depends on:
1. The type (species) of the infecting parasite
2. The area where the infection was acquired and its drug-resistance status
3. The clinical status of the patient
4. Any accompanying illness or condition
5. Pregnancy
6. Drug allergies, or other medications taken by the patient

Malaria is treated with antimalarial drugs and measures to control symptoms, including
medications to control fever, antiseizure medications when needed, fluids and electrolytes. The
type of medications that are used to treat malaria depends on the severity of the disease and the
likelihood of chloroquine resistance. The drugs available to treat malaria include:

 Atovaquone and Proguanil hydrochloride - Brand names: Malarone, Malanil and others.
It is a combination of two antimalarial medication atovaquone and proguanil. It is used to
treat and prevent malaria, including chloroquine-resistant malaria. It is not recommended
for severe or complicated malaria. It is taken by mouth.
o Available form: tablets
o Dosage: adults: take 1 tablet daily (atovaquone 250mg + proguanil 100mg) with
food. Children: 62.5mg atovaquone + 25mg proguanil once daily with food. For
both adult and children start treatment 1 or 2 days before entering an endemic area
and continue treatment during visit an also 7 days after leaving the endemic area.
o Adverse reaction: dizziness, headaches, insomnia.
o Nursing consideration:
1. store tablets at controlled room temperature of 15° to 30° C .
2. Atovaquone absorption maybe decreased by persistent diarrhea or vomiting.
patient with these conditions may need different anti-malaria.

 Chloroquine - (Aralen phosphate, Chloroquin) Chloroquine is an anti-malaria medicine

that works by interfering with the growth of parasites in the red blood cells of the human
body.

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 o Available form: Tablets
o Dosage: Adult: 600mg base PO; then 300mg base at 6, 24, 48 hours. Children:
10mg/kg base PO; then 5mg/kg base at 6, 24, 40 hours.
o Adverse reaction: mild to transient headaches, seizures, dizziness, vomiting etc.
o Nursing Consideration :
1. Drug dosage maybe discussed in “mg” or “mg base”; be aware of the
difference.
2. Monitor CBC and liver function studies periodically during long term
therapy.

 Mefloquine - Mefloquine, sold under the brand names Lariam among others, is a
medication used to prevent or treat malaria. When used for prevention it is typically
started before potential exposure and continued for several weeks after potential
exposure.
o Available form: Tablets
o Dosage TREAT: adults: 1,250mg (5 tablets) PO as a single dose with food and
atleast 8 ounces of water. Children: 20-25mg/kg PO as a single dose with food
and atleast 8 ounces of water. PREVENT adults and children weighing more than
45kg; 250 mg PO once weekly. This should start atleast one weel before entering
affected area.
o Adverse reaction: dizziness, headches, chest pain, vomiting etc.
o Nursing Consideration:
1. Monitor liver function test results periodically.

 Clindamycin (Cleocin) - Given with chloroquine or quinine, clindamycin is effective and

well tolerated in treating Plasmodium falciparum malaria.
o Available form: Tablets, Injectable Infusion, Oral Solution

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 o Dosage: adults: 150 to 450mg PO q 6hours or 300 to 600mg IM/IV q 6, 8, or 12
hours. Children: older than age 1 month: 8 to 20mg/kg PO daily, in divided
dosage q 6 to 8 hours or 15 to 40mg/kg IM/IV daily in divided dosage.
o Adverse reaction: nausea, vomiting, abdominal pain, diarrhea.
o Nursing consideration:
1. Obtain specimen for culture and sensitivity test before giving first dose.
Therapy may begin pending results.

 Doxycyclinehyclate– brand name Doryx, is a antibiotic used to prevent malaria and in

combination with quinine, to treat malaria.
o Available form: capsules, injection, tablets.
o Dosage: adults: 100mg PO daily beginning 1 to 2 days before travelling to
endemic area and continue for 4 weeks after travel. Children: older than age 8: 2
mg/kg PO once daily beginning 1 to 2 days before travelling to endemic area and
continue for 4 weeks.
o Adverse reaction: dysphagia, nausea, vomiting, diarrhea.
o Nursing Consideration:
1. Obtain specimen for culture and sensitivity test before giving first dose.
Therapy may begin pending results.

For pregnant women, chloroquine is the preferred treatment for malaria. Quinine, proguanil and
clindamycin typically are used for pregnant people with malaria that is resistant to chloroquine

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 Nursing Management
Physiological needs
 Turn the patient every 2h. Do not allow the patient to lie in a wet bed. Pay particular
attention to pressure points. By doing this it reduces the risk of pressure ulcers. Also by
having clean linens, it will help aid in the patient feeling more comfortable and more
confident in a clean environment.
 Ensure patient eats a well-balanced diet.
 Ensure patient is well hydrated.

Safety and security needs

 Pay careful attention to the patient’s fluid balance in severe malaria in order to avoid
over- or underhydration.
 Monitor the temperature, pulse, respiration, blood pressure and level of consciousness.
These observations should be made at least every 4 hours until the patient is out of
danger.
 If the rectal temperature rises above 39 ºC, remove the patient’s clothes and start tepid
sponging and fanning
 Instruct patient to avoid excess sun exposure to prevent worsening of drug induced
dermatoses.

Love and belonging Needs

 Establish a nurse to client relationship through therapeutic skills. This will allow your
patient to gain trust in you and feel a since of belonging and comfort.
 Acknowledge fears and concerns about the current situation.
 Provide emotional support and reassurance.

Esteem Needs
 Encourage the patient to take part in self-care activities to boost self-confidence.
 Educate patient about his/her condition along with family members.
 Explain the procedure and treatment to the patient and his/her family.

Self-actualization Needs
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  Suggest that other members of the family get tested for malaria too.

Nursing Care Plan

Assessment Nursing Goals and Nursing Rational Evaluation
Diagnosis Expected Interventions
Outcomes
Subjective Fatigue Goal: To Provide the Oxygen saturation Patient had no
Data: related to reduce the client with should be kept at 90% complaints of fatigue
difficulty insomnia as level of supplemental or greater, which will after the duration of
sleeping, evidence fatigue the oxygen therapy. allow the body tissues 8 hours.
irritated, by dark patient is to utilize the oxygen
restlessness, circles going Encourage that is being inhaled. Client was able to
difficulty under eyes. through client to get carry out some
breathing. within an 8 adequate Getting enough sleep activities to increase
hour period. amounts of will increase blood their self- esteem and
Objective sleep during the circulation. increase health
Data: Expected day. promotion.
patient is Outcome: Administration of
pale, sunken Reduction of Administer prescribed medication
eyes, fatigue. prescribed promotes the health of
irritated, medication. the client.
bags under
eyes,
Shortness of
breath.

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 Conclusion
To conclude this assignment, it clearly shows that Malaria continues to be a major worldwide
disease. However, with early diagnosis, treatment and taking into consideration the risk facotrs
we can minimize the spread of disease.

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 Reference Page
 Burke, D. (2019, March 8). Malaria: Causes, Symptoms, and Diagnosis. Retrieved from
https://www.healthline.com/health/malaria

 Fact sheet about Malaria. (n.d.). Retrieved from https://www.who.int/news-room/fact-

sheets/detail/malaria

 CDC - Malaria - About Malaria - Disease. (n.d.). Retrieved from

https://www.cdc.gov/malaria/about/disease.html

 Malaria. (2018, December 13). Retrieved from https://www.mayoclinic.org/diseases-

conditions/malaria/symptoms-causes/syc-20351184

 Bowden, V. R., & Greenberg, C. S. (2012). Pediatric nursing procedures. Philadelphia:

Wolters Kluwer Health/Lippincott Williams & Wilkins.

 Lippincott Williams & Wilkins. (2006). Nursing 2006 drug handbook. Philadelphia,
Penn.

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