Malaria: Nursing Care Plan, Nursing Diagnoses and Interventions

How does Malaria affect our body? 

        First, the parasites grow and multiply in the liver cells and then infect red blood cells. After infecting red blood cells, they grow and multiply and later destroy them. The death of the red blood cell causes the release of malaria parasites to neighboring red blood cells, perpetuating further infection. 

Clinical manifestations of Malaria: 

Early Symptoms: fever, headache, chills, GI symptoms (e.g. diarrhea and vomiting)

Severe manifestations of complicated malaria: anemia, abnormal bleeding, circulatory collapse, jaundice, hemoglobinuria, respiratory distress, pulmonary edema, altered mental status, cerebral malaria (CNS infections), renal failure (rare complication), 

Nursing Care for patients with Malaria: 

a. Physical Examination: 

   1. Assess level of consciousness using Glasgow Coma Scale during assessment and/or hourly if severely ill. 

   2. Monitor vital signs and urine output. Look for evidence of shock 

       (e.g. low BP, high RR, high HR).

   

   3. Look for enlarged spleen (Splenomegaly), which may indicate previous infection of malaria. 

   4. Assess for signs of anemia and bleeding. Be equipped to provide blood transfusion if needed. 

   5. Monitor for hypoglycemia, especially for populations at increased risk, such as pregnant women.

b. Complicated Severe Malaria Laboratory Tests: 

   - Severe anemia

   - Hypoglycemia

   - Acidosis

   - Renal impairment

   - Hyperlactatemia

Visit Nursing Care of Malaria Patients for more detailed information about nursing plan of care for patients with uncomplicated and complicated (severe) malaria during physical examination, pre-referral, transfer, and post-referral care. 

Nursing Diagnoses for Malaria:	Nursing Assessments:	Nursing Interventions:
1. Impaired Circulation related to anemia and destruction of RBC needed for delivery of oxygen and nutrients in the body.	- Assess pt’s airway, breathing,  and respiratory condition (e.g. respiratory distress, shortness of breath, shallow fast-paced breathing) - Monitor vital signs, especially body temperature. - Assess skin color, pulse, and capillary refill.	- Pt may need supplemental oxygen if condition is severe. - Maintain a well-ventilated room. - Head of the bed at 30º. - Lessen activities that require moderate to high exertion.
2. Hyperthermia related to increased metabolism, dehydration, direct effects of parasites on the hypothalamic circulation.	- Monitor vital signs and keep an eye on increase and changes in body temperature.	- Warm water compress on forehead and both axilla (not more than 15 minutes each time). - Maintain warm environment by using warm blankets, adequate clothing). Pt may sweat excessively. Make sure to avoid exposing pt to wet clothes and linens. - Administration of antipyretic drugs as ordered.
3. Fluid Volume deficit	- Monitor I&O of pt. - Assess for dehydration (e.g. skin turgor)	- Expect loss of fluid through sweat. Provide information about fluid balance and guideline for fluid replacement. - Administer parenteral fluids as ordered.
4.  Imbalanced Nutrition, less than body requirements	- Assess for GI symptoms (e.g. nausea, passing gas, abdominal distention)	- Provide food in a well ventilated, pleasant environment as tolerated. - Provide oral hygiene - Encourage bed rest/lessened activity for the time being. - Administer PRN anti-emetic medications as appropriate.
5. Risk for Knowledge Deficit about disease	- Assess what the patient knows and concerns about the disease	- Review the disease process and therapy, focusing on pt’s concerns. - Discuss importance of adhering to therapy. Go over medication, purpose, frequency, dosage, and side effects. - Have a family member or trusted individual listen to and understand guideline of treatment as the patient chooses.

NCP NANDA: Nursing Intervention of Malaria is a site that briefly goes over nursing interventions for malaria and related signs and symptoms for each diagnosis. There are 4 main diagnoses presented on the page, but is really helpful because it elaborates on important nursing diagnoses, assessments, and interventions for malaria. Most information above are directly quoted from NCP NANDA. 

Bibliography:

NCP NANDA. (n.d.). Retrieved May 13, 2015, from http://ncpnanda.blogspot.com/2013/03/nursing-      intervention-of-malaria.html

NANDA Nursing. (n.d.). Retrieved May 13, 2015, from http://nanda-nursing.blogspot.com/2011/02/

   nursing-care-plan-for-malaria.html

Retrieved May 18, 2015 from http://www.tm.mahidol.ac.th/eng/tropical-medicine-knowledge/book-pocket-guilines/i-book-nurse02-pocket-guilines-part2.pdf