Malaria

1
Malaria

• A major public health problem-Namibia.
• Seasonal (Rainy season)
• Mean incidence 255/1000 population.
• Mortality 61 96/100,000 population.
• About 26.4 OPD 21.6 of all
• admissions.

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Malaria Cont

• Maria Risk areas Namibia
• High Risk areas North East Kavango-
• Caprivi region
• North the 4 O- regions
• North West region (Opuwo, Khorixas)
• Low Risk Area Erongo-, Otjozondjupa-, Khomas-
  Omaheke region
• No-Risk Area Hardap- Karas region

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Malaria

• Definition An acute, infectious blood borne
  disease.
• Cause Malaria parasites hosted by female
  mosquito Anopheles mosquito.

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Malaria (Continued)

• Mode of transmission Bite by female anopheles
  mosquito.
• Types of mosquitoes that transmit malaria
• - Plasmodium Falcifarum in Namibia
• Plasmodium Malaria
• -Plasmodium Vivae
• Target for the parasites Red blood cells and
  platelets

5
Path physiology/ Disease process of Malaria

• The female anopheles mosquito carries the malaria
  parasites in its saliva
• Bite by the female anopheles mosquito
• Injection of malaria parasites in the blood
• Malaria parasites invade red blood cells
  platelets
• Malaria parasites feeds on the hemoglobin of red
  blood cells ? Hemolysis of red blood cells and
  platelets ? results into Anemia and bleeding
  tendency.

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Path physiology/ Disease process of Malaria

• Hemolysis of RBC and Platelets produces the
  bilirubin--- creates jaundice (yellow
  discoloration of skin and mucus).
• Bilirubin may obstruct the tubules of the
  glomeruro apparatus of the kidneys resulting
  into renal failure.
• Malaria pathophysiology (cont)
• Bilirubin affects the liver nausea and
  vomiting and result into dehydration.

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Malaria pathophysiology (cont)

• In response to the parasites invasion, the bodys
  immune system releases white blood cells
  (leucocytes) result into (leucocytosis) to fight
  infection, heat production pyrexia.
• Malaria parasites can affect the brain, causing
  cerebral malaria
• edema of the brain cells
• suppression of vital centers in the brain
  (cardiac- respiratory, vomiting center).
• Resultant unconsciousness and death

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Potential complications of malaria

• Acute complications dehydration from vomiting,
  anemia from hemolysis of red blood cells, and
  cerebral malaria and death
• Chronic complications anemia,
• renal failure due to damage of glomerulo
  apparatus by the bilirubin..

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Management of Malaria

• Medical Management
• Investigations and potential findings
• history of malaria e.g. epidemic area season
  and clinical manifestations
• a positive blood smear for malaria.

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Malaria RX Continued

• Medications Uncomplicated malaria
• 1st Line AdultsArtemether/Lumefantrine. BD
  for 3 days. Exemption Pregnancy gt 5kg
• Children 2-6 months and gt 5kg Sulphadoxine/Pyrimet
  hadine
• 2nd Line Quinine (Quinine also for complicated
  malaria, IVI and p/o.
• (See National Malaria Policy on Malaria)

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Malaria Nursing Management

• According to the nursing process
• Assessment ( actual, and potential nursing
  diagnosis)
• (based on S S and pathophysiology)
• Planning of nursing interventions and expected
  outcome.
• Implementation of nursing interventions
• Evaluation of outcome.
• (brainstorm on the black board)

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Nursing care Plan for Malaria

• Nursing Diagnosis
• High body metabolism due to immune response
  (interaction of antigen wbc) as evidenced by
  Pyrexia shivering

• Nursing Intervention
• Tepid spongy
• Ventilation
• Temp monitoring
• Anti-Malaria Rx to reverse the pathophysiology of
  the disease.

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Nursing care Plan for Malaria

• Nursing Diagnosis
• Nausea, vomiting due to cerebral malaria, effect
  of
• ? bilirubin on the liver

• Nursing Intervention
• Anti emetic per prescription
• Measure volume of vomitus as output record

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Nursing care Plan for Malaria

• Nursing Diagnosis
• Potential dehydration due to vomiting fever

• Nursing Intervention
• Adjust fluid intake to output.
• More fluid orally, if no vomiting
• Urine output to watch oliguria.

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Nursing care Plan for Malaria

• Nursing Diagnosis
• Potential oliguria, signifying renal failure due
  to bilirubin

• Nursing Intervention
• Urine output to watch oliguria.
• (Normal30ml/hour
• Urine dipstic for proteinuria hematuria

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Nursing care Plan for Malaria

• Nursing DX
• Potential anemia due to hemolysis of RBC
  Platelets, as evidenced by heamturia

• Nurse Interventions
• Hb monitoring
• Iron preparates e.g. Pregamol
• HP diet, Vitamines Minerals
• Avoid injuries

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Nursing care Plan for Malaria

• Nursing DX
• Potential cerebral Malaria (swelling of brain
  cells, suppression of vital centres e.g.
  cardiac-, respiratory centres as evidenced by
  headache, confusion

• Nurse Interventions
• Monitoring of consciousness level
• Quite environment
• Vital signs monitoring if not ?
• Observe consciousness level.
• Safety measures