MALARIA

Definition: An acute, infectious blood borne disease.

Etiology
Malaria parasites hosted by female mosquito: Anopheles mosquito.

Symptomatology

fever
rigors
headaches
sweating
tiredness
myalgia (limbs and back)
abdominal pain
diarrhea
loss of appetite
orthostatic hypotension
nausea
slight jaundice
cough
enlarged liver and spleen (sometimes not palpable)
vomiting

Anatomy
Blood Components
Blood is a highly specialized tissue composed of many different kinds of
components. Four of the most important ones are red blood cells, white blood cells,
platelets amd plasma. All humans produce these blood components.

1. Red Blood Cells

Red blood cells, or erythrocytes, are relatively large microscopic cells without
nuclei. In this latter trait, they are similar to the primitive prokaryocytic cells
of bacteria. Red blood cells normally make up 40-50% of the total blood
volume. They transport oxygen from the lungs to all of the living tissues of
the body and carry away carbon dioxide. The red blood cells are produced
continuously in our bone marrow from stem cells. Hemoglobin is the gas
trabsporting protein molecule that makes up 95% of the red blood cell. Each
cell has about 270,000,000 iron-rich hemoglobin molecules. People who are

anemic generally have a deficiency in red blood cells. The red color of blood
is primarily due to oxygenated red blood cells. The red blood cells remain
viable for only about 120 days before they are removed from the blood and
their components recycled in the spleen.

2. White Blood Cells

White blood cells, or leukocytes, exist in variable numbers and types but
make up a very small part of bloods volume normally only about 1%. Most
are produced in our bone marrow from the same kind of stem cells that
produce our red blood cells. Some white blood cells (called lymphocytes) are
a major part of the immune system. Other white cells (called granulocytes
and macrophages) protect our bodies from infection by surrounding and
destroying bacteria, viruses, fungi, or other parasites. They also have the
function of getting rid of old, unneeded blood cells as well as foreign matter
such as dust and asbestos. Individual white blood cells usually only last 18-36
hours before they also are removed.

3. Platelets
Platelets, or thrombocytes, are cells that lot blood at the site of wounds. They
do this by adhering to the walls of the blood vessels, thereby plugging the
rupture in the vascular wall. They also can release coagulating chemicals
which cause clots to form in the blood that can plug up narrowed blood
vessels. There are more than a dozen types of blood clotting factors and
platelets that need to interact in the blood clotting process. Recent research
has shown that platelets help fight infections by releasing proteins that kill
invading bacteria and some other microorganisms. In addition, platelets
stimulate the immune system. Individual platelets are about 1/3 the size of
red blood cells. They have a lifespan of 9-10 days. Like the red and white
blood cells, platelets are produced in the bone marrow from stem cells.

4. Plasma

Plasma is the relatively clear liquid protein and salt solution which carries the
red blood cells, white blood cells and platelets. Normally, 55% of our bloods
volume is made up of plasma. About 95% of it consists of water. As the heart
pumps blood to cells throughout the body, plasma brings nourishment to
them and removes the waste products of metabolism. Plasma also contains
blood clotting factors, sugars, lipids, vitamins, minerlas, hormones, enzymes,
antibodies, and other proteins. It is likely that plasma contains some of every
protein produced byt the body approximately 500 have been identified in
human plasma so far.
Platelets
Platelets, or thrombocytes, are small, irregularly-shaped anuclear cell
fragments (i.e. cells that do not have a nucleus containing DNA), 2-3 m in
diameter, which are derived from fragmentation of precursor megakaryocytes. The
average lifespan of a platelet is normally just 5 to 9 days. Platelets play a
fundamental role in hemostasis and are a natural source of growth factors. They
circulate in the blood of mammals and are involved in hemostasis, leading to the
formation of blood clots. The function of platelets is the maintenance of
haemostasis. This is achieved primarily by the formation of thrombi, when damage
to the endothelium of blood vessels occurs. On the converse, thrombus formation
must be inhibited at times when there is no damage to the endothelium.
In addition to being the chief cellular effector of hemostasis, platelets are
rapidly deployed to sites of injury or infection, and potentially modulate
inflammatory

processes

by

interacting

with leukocytes and

by

secreting cytokines, chemokines, and other inflammatory mediators. Platelets also

secrete platelet-derived growth factor (PDGF).

Pathophysiology

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.

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.

Bilirubin affects the liver == nausea and vomiting and result into
dehydration.

In response to the parasites invasion, the bodys immune system releases

white blood cells (leucocytes) results 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

Diagnostic Procedure:
1.
Malarial smear In this procedure, a film of blood is placed on a slide,
stained, and examined microscopically.
2.
Rapid diagnostic test (RDT) This is a blood test for malaria that can be
conducted outside the laboratory and in the field. It gives a result within 10 to 15
minutes. This is done to detect malaria parasite antigen in the blood.
Medical Management:
Medical management includes drugs such as chloroquine, mefloquine, primaquine,
quinine, pyrimethamine-sulfadoxine (Fansidar), and doxycycline.
Nursing management
1. The patient must be closely monitored.
a. Intake and output should be closely monitored to prevent pulmonary
edema.
b. Daily monitoring of patients serum bilirubin, BUN creatinine, and
parasitic count

2. If the patient exhibits respiratory and renal symptoms, determine the arterial
blood gas and plasma electrolyte
3. During the febrile stage, tepid sponges, alcohol rubs, and ice cap on the head
will help bring the temperature down.
4. Application of external heat and offering hot drinks during chilling stage is
helpful.
5. Provide comfort and psychological support.
6. Encourage the patient to take plenty of fluids.
7. As the temperature falls and sweating begins, warm sponge bath maybe
given.
8. The bed and clothing should be kept dry.
9. Watch for neurologic toxicity (from quinine infusion) like muscular twitching,
delirium, confusion, convulsion, and coma.
10. Evaluate the degree of anemia.
11. Watch for any signs especially abnormal bleeding.
12. Consider severe malaria as medical emergency that requires close
monitoring of vital signs.
3 important nursing diagnoses & its intervention
Nursing Diagnosis:
Changes in nutrition less than body requirements related to inadequate food intake,
anorexia, nausea / vomiting

Nursing Intervention :
Assess history of nutrition, including foods that are preferred. Observation
and record the client's food input.
Rational: watching caloric intake or lack of quality of food consumption.
Give extra food to eat little and small.
Rational: gastric dilatation may occur when feeding too fast after a period of
anorexia.
Maintain a schedule of regular body weight.
Rational: Monitors the effectiveness of weight loss or nutrition intervention.

High risk of infection related to a decrease in body systems (main defense is

inadequate), invasive procedures.

Nursing Intervention:
Monitor body temperature increases.
Rational: Fever caused by the effects of endotoxin on the hypothalamus and
hypothermia are important signs that reflect the development status of shock /
decrease in tissue perfusion.

Observe the chills and diaforosis.

Rational: Shivering often precedes the height of the temperature on a common
infection.
Monitor the sign deviation condition / failure to improve during therapy.
Rational: It can show inaccurate antibiotic therapy or growth of organisms.
Hyperthermia is related to increased metabolism of circulating germ dehydration
direct effect on the hypothalamus.
Nursing Intervention:
Monitor patient's temperature (degree and pattern), note the chills.
Rational: Hipertermi showed an acute infectious disease process. The pattern
of fever indicates a diagnosis.
Monitor the temperature of the environment.
Rational: The temperature of the room / the number of sheets should be
changed to maintain the temperature close to normal.
Give a warm compress bath, avoid using alcohol.
Rational: It can help reduce a fever, use of ice / alcohol may cause cold. In
addition, alcohol can dry the skin.