MALARIA

 

MALARIA

DEFINITION OF MALARIA:

 

1.         It is an acute tropical protozoa infection caused by an infected female anopheles mosquito bite found in hot and cold climate.

2.         This is an acute tropical protozoa infection caused by plasmodium parasite.

 

MODE OF TRANSMISSION:

• Through bite by an infected anopheles mosquito
• Through blood transfusion i.e  if the blood is contaminated by malaria parasite
• Through trans-placental – mother to child.

 

CLINICAL FEATURES:

 

1.         irritability       -           This is because the child experiences

pain all over the  body.  This comes as a result of body malaise, headache, myalgia etc.

 

2.         Vomiting:       -           This is due to irritation of the GIT by the parasites.

3.         Convulsions    -           This is a result of high temperature. 

These convulsions are more common in children less than 3 years.

 

4.         Fever               -           This happens when red blood cells burst. 

This could be accompanied by slight chills.  The fever ranges between 39⁰C to 41⁰C.

5.         Coughing        -           This comes as a result of severe vomiting

6.         Sweating         -           This comes as a result of sudden fall in temperature

as the client begins to feel better.

7.         Anorexia         -           This is due to vomiting

8.         Diarrhoea        -           Due to GIT disturbances.  It can also be due to

metabolic disturbances.

 

PATHOPHYSIOLOGY:

 

First a mosquito bite occurs and sporozoites are inoculated into the host’s blood stream.  These sporozoites migrate to liver of the host for development and multiplication.  This process is called pre-erythrocytic schizogony.

 

Tissue schizous enlarges and divides to form thousand of merozoits when merozoites are formed the liver tissue ruptures and releases the merozoites into the blood stream

 

In the blood stream, the merozoites enter the red blood cells.  In the red blood cell the merozoites develops into ring forms which grow in size, becoming trophozoites.  These multiply and divide into a number of small merozoites and form schizonts.

 

The merozoites are released by rupture of the red cell membrane and enter new young red cells.  After a period, some merozoites give rise to two sexually differentiated forms of gametocytes (male and female) ready to be sucked by a mosquito.

MANAGEMENT:

 

OBJECTIVES:

 

ü  To eradicate the causative organism

ü  To prevent complications such as anaemia

ü  To reduce the temperature to normal

ü  To treat the symptoms i.e fever, diarrhoea.

 

INVESTIGATIONS:

 

• Blood slide for MPs (to detect the malaria parasite)
• History taking
• Blood for Hb to rule out anaemia
• FBC will show raised ESR

 

TREATMENT:

 

DRUGS:

 

1.         Chloroquine                -           Injection/syrup

            Dose, child                  -           10mg/Kg body weight on the first day

and second day, then 5mg/Kg weight on the third day (for syrup).

 

                                                -           Injection – 5 mg base/Kg body weight. 

A total doses given one every 8 hours.

 

            Side effects                 -           GIT disturbances, headache, convulsions,

visual disturbances, skin reactions.

 

            Nursing Implication   -           Administer the drug according to doctor’s orders

-           Observe for side effects.

 

2.         Quinine:

            Dose:                           -           Infants up to 1 year – P.O. 250 mg daily

in divided dose for 5-7 days.

                                                            Child 1-3 years – 400 mg daily individed

doses for 5-7 days.  3-6  years 650 Mg daily in divided doses every 4-6 hours for 5-7 days.  6-12 years 1000 mg (1g) daily every 4-6 hours for 5-7 days.

Injection – 10 mg/Kg body weight in 500 ml 5% glucose over 4 hours every 8 hours.

 

            Side effects:                -           Tinnitus, headache abdominal pain,

nausea, visual disturbances, confusion, hypersensitivity reactions, hypoglycaemia, renal failure.

            Nursing Implication   -           Give the drug with glucose

-           Give with a lot of water.

 

3.         Fansidar:

            Dose:                           -           5-10KgKg       -           ½ tablet

                                                -           10-20 Kg         -           1 tablet

                                                -           20-30 Kg         -           1 ½ KG

                                                -           30-45 Kg         -           2 tablets

                                                -           >45Kg             -           3 tablets

 

            Side effects:                -           Dizziness, headache, anorexia, glossitis,

general body malaise

            Nursing Implication   -           Explain the side effects

-           Encourage the client to do oral care frequently.

           

            PARACETAMOL:

            Dose- 3 months          -           1 year 60-120 mg, 1-5 years 120-250 mg,

6-12 years, 250-500 mg.  These are given 6 hourly.

 

            Side effects:                -           Liver damage on prolonged use

            Nursing Implication:  -           Avoid use for long time.

 

            NURSING CARE:

 

            OBJECTIVES:

ü  To relieve symptoms

ü  To maintain good nutritional and physiology body status

ü  To prevent complications such as cerebral malaria

ü  To educate patient on malaria preventive measures

ü  To provide comfort for the patient.

 

RELIEF OF SYMPTOMS:

 

Admit the child in a general ward which is well ventilated for good oxygenation  The ward should be clean and have good lighting, make sure that the cot is maintained dry as a wet bed is a source of discomfort.Create a peaceful environment for rest by minimizing noise.

The child will be nursed according to stages i.e cold, hot and sweating stages.

 

During the cold stage, more bedding to prevent chilling the child.A heater will be provided if possible to reduce on rigors which cause severe muscle aching.

 

During the hot stage, the windows will be opened to keep him/her comfortable.  Extra linen will be removed to reduce on heat.  A fan may be provided if possible, but it should not be directly to the child as it causes hyperventilation to the child.

 

During the sweating stage, the child will continue on light covers.  During this stage, a child will be given a bath in order to keep him/her comfortable.  Wet linen will be removed and replaced with dry and clean linen.

 

OBSERVATION

 

Observations of vital signs will be done 2 hourly to assess the child’s condition.Temperature will be done to detect hypothermia or pyrexia.  Respiration will be checked to monitor the condition of the respiratory system.  Pulse will be checked to rule out cardiac involvement.   Blood pressure will also be checked to rule out cardiovascular disorders.

 

The child will also be observed for convulsions.If present, report and carry the orders.The weight will be monitored to assess progress and it also helps in drug administration.  Observe the feeding harbits as the child may tend not to eat due to vomiting.Observing for any stool abnormalities for colour, smell, constipation or diarrhoea.  Observe for urine output to rule out kidney failure.

 

PSYCHOLOGICAL CARE:

 

Explain the condition of the child to the mother or care taker.  Explain that the condition will change as this is to allay anxiety.Allow the caretaker to ventilate his/her views about the condition of the child.

Procedures and investigations to be carried out will be explained to gain co-orperation.  Explain every thing possible being done to improve the condition of the child.

 

NUTRITION AND FLUID:

 

Encourage the mother to continue breast feeding the child if she/he is still breast feeding.  Iv fluids may be given as ordered to replace lost fluids and electrolytes through vomiting and diarrhoea.Encourage mother/caretaker to give the child adequate glucose to prevent hypoglycaemia.Proteins and vitamins should be encouraged to provide energy and quick recovery.Avoid irritating foods.

 

HYGIENE:

 

Bathing is one of the most important procedures to be done in order to promote comfort.To prevent infections.Oral care is important to stimulate appetite.  Frequent change of linen as soon as they are wet to promote comfort.

REST AND SLEEP:

 

Provide a restful environment by minimizing noise, to promote sleep.  Feed the child and bath him/her to promote sleep and rest.

Prescribed drugs should be given to relieve pain and promote sleep and comfort. Procedures should be timed in order to allow enough time for resting.

 

ELIMINATION:

 

Monitor the voiding patterns of the child to detect kidney failure.Roughage should be given to prevent constipation.Record the finding and report to the in charge.

 

IEC;

ü  The mother or caretaker will be educated on the need to sleep under treated mosquito nets.

ü  The cause of malaria will be explained to the mother and the signs and symptoms will be explained so that she is aware of these.

ü  Teach the mother not to buy drugs from anywhere as drugs sold may loose  potency.

ü  Encourage the mother to continue giving drugs to the child if she/he is to be discharged on drugs.

ü  Encourage to report recurrencies of symptoms immediately

ü  Encourage to bring the child 4-5 days after completion of medication for blood tests.

ü  Cutting of long grass and clearing of the yard should also be encouraged.

ü  All stagnant water should be removed as this is a breeding place for mosquito.

 

COMPLICATIONS:

 

1.         Cerebral malaria

2.         Anaemia

3.         Splenomegally

4.         Jaundice

5.         Black water fever

6.         Kidney failure.