Malaria Nursing Diagnosis

I am glad for the journey we have had together as we studied about malaria for the last three months. It has been an enlightening moment for me and i believe it was the same for you the reader. Today's blog will be the last one in which i plan to discuss more about the nursing diagnosis that are most prioritized when attending to a sick patient with malaria.

To start off the main focus for our patient like we stated when i wrote about the symptoms is that they lack appetite and may end up becoming anorexic. This mainly is due to nausea and vomiting which is evident because they often throw up. This led me to prioritize my first nursing diagnosis as follows:

1. Imbalanced Nutrition Less Than Body Requirements related to inadequate food intake; anorexia; nausea / vomiting. 
2. Risk for infection related to decreased immune system; invasive procedure.
3. Hyperthermia related to increased metabolism, dehydration, a direct effect on the hypothalamic circulation of germs.
4. Impaired tissue perfusion related to a decrease in the cellular components needed for the delivery of oxygen and nutrients in the body.
5. Knowledge deficient: the disease, prognosis and treatment needs related to lack of exposure / recall error interpretation of information, cognitive limitations.

Imbalanced Nutrition Less Than Body Requirements related to inadequate food intake; anorexia; nausea / vomiting

Related to	Plan and outcome	Nursing intervention
Inability to ingest foods Inability to digest foods Inability to absorb or metabolize foods Inability to procure adequate amounts of food Knowledge deficit Unwillingness to eat Increased metabolic needs caused by disease process or therapy	Patient or caregiver verbalizes and demonstrates selection of foods or meals that will achieve a cessation of weight loss. Patient weighs within 10% of ideal body weight.	Consult dietitian for further assessment and recommendations regarding food preferences and nutritional support. Suggest ways to assist patient with meals as needed: ensure a pleasant environment, facilitate proper position, and provide good oral hygiene and dentition. Provide companionship during mealtime. For patients with changes in sense of taste, encourage use of seasoning. For hospitalized patients, encourage family to bring food from home as appropriate. Suggest liquid drinks for supplemental nutrition. Encourage exercise.

References

EHS: Nursing Diagnosis Care Plans, 4/e - Nutrition, Altered: Less than Body Requirements - Starvation; Weight Loss; Anorexia. (n.d.). Retrieved May 31, 2015, from http://www1.us.elsevierhealth.com/MERLIN/Gulanick/archive/Constructor/gulanick36.html

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Nursing care for indivuduals with Malaria

To continue from where we stopped last week on malaria treatment, a patient needs more care considering the types of symptoms one experiences. This week's blog will focus on patient management which is also a critical part in ensuring they get better. Malaria wears one down to a point that there is no strength left to do a thing. Appetite is usually gone and one is forced to eat and drink water to stay hydrated. The following are some of the nursing cares that often help in the patient's recovery.

1. Changes in nutrition less than body requirements related to inadequate food intake, anorexia, nausea / vomiting. This is the hardest part because usually a sick person does not have the appetite. In my case I hated any fried foods and would throw up wherever I would smell it. The fact is patients with malaria should continue intake and activity as tolerated because it ensures they get enough nutrients which helps them recover faster. Fluid intake can be in form of IV route and for the patients who are at home it is better to continue assisting them to drink plenty of water. If a patient does not take plenty of water it may lead to dehydration which is usually caused by the sweating, vomiting and/or diarrhea. Rehydration needs to be carried out in a very careful way to prevent pulmonary edema so input and output for each patient should be recorded to keep track of the level of hydration (British Medical Bulletin 2015)
2. High risk of infection related to a decrease in body systems - For the patients who are admitted in the hospital 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.  It is always advised to report changes in the level of consciousness, occurrence of convulsions or changes in behavior of the patient which may be signs of serious complications. All such changes suggest developments that require additional treatment. If the rectal temperature rises above 39 ^o C, remove the patient's clothes and start tepid sponging and fanning. (Nursing crib 2015). Patients with non– P falciparum malaria who are well can usually be treated on an outpatient basis. Obtaining blood smears every day helps demonstrate response to treatment. If the lab results show that (>5% of RBCs infected), CNS infection, or otherwise severe symptoms the patient is considered for inpatient treatment to ensure that medicines are tolerated. IV preparations of anti malarial are available for the treatment of severe complicated malaria (Medscape 2015)

Once a patient starts treatment therapy, they are advised to stay in bed and avoid any activities for the first few days because of the side effects which may include dizziness and fatigue.

REFERENCES

Malaria Treatment & Management. (n.d.). Retrieved May 21, 2015, from http://emedicine.medscape.com/article/221134-treatment#aw2aab6b6b1aa

British Medical Bulletin. (n.d.). Retrieved May 22, 2015, from http://bmb.oxfordjournals.org/content/75-76/1/29.full

Malaria | Nursing Crib. (n.d.). Retrieved May 22, 2015, from http://nursingcrib.com/communicable-diseases/malaria/

Treatment of Malaria

When i had malaria attack back in Africa, the biggest problem was to access a health center which was usually a very far away. Just as i stated in last week's blog, I that had to walk for almost 5 miles to the nearest dispensary to be tested for the symptoms i had like chills, fever, myalgia, athralgia etc.  Mostly the doctor would tell that it was malaria even before the lab at the clinic got the test results back. One question they would ask was "have you been using mosquito net at night ?" and if the answer was no then that was the best indicator that one had been infected. Well today my focus is not how we were diagnosed back in Africa but this blog is to explain the types of treatments a patient gets once diagnosed with malaria. Usually the secret is to be tested earlier than later because the treatment for malaria depends on the type of bacteria that has infected you and the amount of time it has been in the body.  Malaria can be a deadly disease mostly if caused by plasmodium falciparum and if treatment is not initiated immediately then there is a higher risk that the patient may die (cdc 2012).

According to the WHO (2015), the primary goal of the treatment is to make sure that the bacterium is eliminated from the body. To do this a patient has to take medications which are dependent on the type of the malaria bacterium that has infected you.  The following are some of the regimens used to treat different malaria bacteria.

·         Coartem is a combination of the two medicines artemether and lumefantrine. It is used to treat malaria caused by P. falciparum. It is usually given as a total of 6 doses over a period of 3 days. Some of the side effects experienced by taking coartem includes: Mild weakness or dizziness, mild headache; joint or muscle pain; or cough(Drugs.com 2015)

·         Chloroquine is the most effective medicine for treating a malaria infection caused by P. ovale or P. malariae parasites. This medication is mostly taken by mouth, usually with food to prevent stomach upset. Daily or weekly dosing, dosage amount, and length of treatment are based on the medical condition. To prevent relapses of infections caused by these two parasites, a patient is advised to continue taking chloroquine after you leave the area where these parasites are present. Chloroquine is also used to treat P. falciparum and P. vivax infections in areas where resistance to chloroquine has not been confirmed.(WHO 2015).

Some of the side effects of taking chloroquine are but not limited to: Blurred vision, nausea, vomiting, abdominal cramps, headache, and diarrhea(Webmd 2015)

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REFERENCES

Malaria Treatment (United States). (n.d.). Retrieved May 21, 2015, from http://www.cdc.gov/malaria/diagnosis_treatment/treatment.html

Overview of malaria treatment. (n.d.). Retrieved May 21, 2015, from http://www.who.int/malaria/areas/treatment/overview/en/

Coartem (artemether/lumefantrine) Uses, Dosage, Side Effects - Drugs.com. (n.d.). Retrieved May 21, 2015, from http://www.drugs.com/coartem.html

Chloroquine oral : Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD. (n.d.). Retrieved May 21, 2015, from http://www.webmd.com/drugs/2/drug-8633/chloroquine-oral/details#side-effects

Signs and symptoms of Malaria

So far i have managed to define what malaria is, the major cause, epidemiology and how the disease is diagnosed. In today's blog, my main focus will be on the signs and symptoms of the disease and which one makes one go out looking for health care. Just like i explained earlier, the experience is not worth looking forward to. When i had the disease it was the worst experience to go through and considering i was in a third world country where going to the hospital was by means of walking it was my worst experience. That's the story for another day but let me start off by explaining the very first sign when the bacterium starts affecting the body.

Chills

 The first sign of malaria that shows is shaking and a feeling of cold that makes one shiver. According to the CDC (2010), this is normally called the cold stage which indicates that the incubation is over and the bacterium is attacking the body system.

Fever and headache

After the cold episode the body reacts by having a high fever which comes and goes every other day or few days. How often a fever returns varies with each species of malaria. Many infections do not show this classic pattern of returning fevers at all. The fever is usually caused by the rupture of erythrocytic-stage schizonts (NCBID 1996)  The fever and headache may also lead to nausea and vomiting. of all the symptoms that a person experiences, fever is the number one cause that makes one go to the hospital.

Sweating and weakness

 This is when the body's temperature returns to normal and causes the sweating. The patient may also feel weak; tired with some muscle and joint aches which usually is the reason that makes many people feel they are sick. For the places where there are no many mosquitoes these signs may be confused with influenza.  
The picture below shows the classical signs and symptoms in a summarized way:

http://image.slidesharecdn.com/clinicalfeature-140516075814-phpapp02/95/malaria-clinical-features-2-638.jpg?cb=1400227243

REFERENCES:

Malaria disease. (n.d.). Retrieved May 21, 2015, from http://www.cdc.gov/malaria/about/disease.html

Crutcher, J. (n.d.). Retrieved May 21, 2015, from http://www.ncbi.nlm.nih.gov/books/NBK8584/

Diagnosis of malaria

This week's blog will focus mostly on malaria disease progression and the methods used to diagnose  if one has malaria. Some of the risks that expose one to contract malaria are:

·         A person resides in an area where several cases of malaria have been reported in the past few days.

·         A person is exposed to mosquitoes.

In the earlier blogs I wrote how the malaria bacteria gets into human body when a mosquito infected with malaria bacteria bites a human. According to the (CDC 2015) the signs and symptoms of malaria do not show up immediately because there is always an incubation period which can be from 7- 30 days.

When the signs and symptoms starts showing which is the initial stage most people experience flu-like symptoms such as fever, chills, headache, nausea, sweat, malaise (weakness and discomfort), muscle aches and vomiting. If you are not well and have any of these symptoms, get tested for malaria without delay. If you experience flu-like symptoms that have not subsided in 2-3 days it is always suggested visiting a doctor as you could be at risk of suffering from malaria.

How to Diagnose:

http://www.zipheal.com/wp-content/uploads/2013/03/diagnosis_of_malaria.jpg

The most common and the cheapest way to diagnose for malaria is by blood smear; the parasite is readily detected by blood smears and antigen tests. The test is done when a thick and thin smear is made from a drop of blood. The smear is stained and observed under a microscope for malaria parasite.

The presence of Plasmodium in blood confirms the diagnosis of malaria and also differentiates between the four common types of parasite – Plasmodium vivax, Plasmodium falciparum, Plasmodium ovale and Plasmodium malariae. It is important to distinguish between these types since the treatment for each could vary. The test should be done when the patient is experiencing chills and fever and the reports of this test can be available on the same day of testing(Health site 2015)

The video below shows laboratory work during the testing of blood for malaria.

                                                https://www.youtube.com/watch?v=VgDeKRC_1qk

CITATIONS:
Diagnosis of malaria -- everything you should know. (n.d.). Retrieved May 8, 2015, from http://www.thehealthsite.com/diseases-conditions/diagnosis-of-malaria-everything-you-should-know/

Disease. (n.d.). Retrieved May 8, 2015, from http://www.cdc.gov/malaria/about/disease.html