Malaria
Malaria
Malaria
COMPILED
DEFINITION OF MALARIA:
Plasmodium falciparum
Plasmodium vivax
Plasmodium ovale
Plasmodium malariae
Anophelus fenestus
Anophelus gambiae
Erabiensis
MODE OF TRANSMISSION:
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LIFE CYCLE OF MALARIA
The malaria parasite life cycle involves two hosts (mosquito and human being). The
sexual reproductive phase takes place in the mosquito while the asexual reproductive
phase occurs in the human half.
STAGE ONE: A female mosquito that has already fed on a blood meal from an
infected person bites another person and injects sporozoites which are found in its
saliva.
STAGE TWO: This is also known as the liver stage. The sporozoites rapidly enter the
liver cells and transform into tissue schizonts that reproduce asexually to generate
large numbers of merozoites. Note that in plasmodium vivax and plasmodium ovale a
dormant stage(hypnozoite) can persist in the liver and cause relapses by invading the
blood stream weeks or even years later.
STAGE THREE: After 5-20 days the merozoites rapture the liver cells and begin the
erythrocytic cycle (RBC cycle). During the cycle the merozoites invade the RBCs in the
peripheral blood system, where they feed and multiply further resulting into a large
increase of parasite population in the human host. The release of merozoites
produces the characteristic fever in the patient.
STAGE FOUR AND FIVE: After the asexual cycle, some merozoites develop into
gametocytes the sexual form which are ingested by the mosquito sucking blood.
STAGE SIX: In the mosquito gut, male and female gametes merge from the
gametocytes and fuse into zygote which migrate into the gut wall where they
produce the oocysts. Each oocyst generates approximately 1000 sporozoites. After 2
weeks the sporozoites migrate into the mosquitos salivary gland becoming highly
infective after 9 days and the cycle resumes.
CLINICAL FEATURE
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These convulsions are more common in children less
than 3 years.
metabolic disturbances.
PATHOPHYSIOLOGY:
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.
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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:
INVESTIGATIONS:
2. Quinine:
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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.
3. Fansidar:
Dose: - 5-10KgKg -
tablet
- 10-20 Kg - 1
tablet
- 20-30 Kg - 1
KG
- 30-45 Kg - 2
tablets
- >45Kg - 3
tablets
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PARACETAMOL:
NURSING CARE:
OBJECTIVES:
To relieve symptoms
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 be
provided if possible to reduce on rigors which cause severe muscle aching.
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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
The child will also be observed for convulsion. 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.
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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:
Prescribe 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.
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IEC;
1. 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.
2. Teach the mother not to buy drugs from anywhere as drugs sold may
loose its potency.
COMPLICATIONS:
1. Cerebral malaria
2. Anaemia
3. Splenomegally
4. Jaundice
6. Kidney failure.
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MARKING KEY
MALARIA:
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3. Fever accompanied by rigors and sweating when malaria parasite are
released from red blood cells into the blood stream after incubation period.
Fever is usually characterised by the cold, hot and sweating stages.
2% 2%
To be sucked.
2%
2% Pre-
erythrocyte sporozoites and
2%
2% Sporozoites go
to the hosts liver
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Cells where development and multiplication
Takes place.
2%
Of merozoites.
2%
Stream
The liver tissue ruptures to release the merozoites into the blood stream.
In the blood stream the merozoites enter the Red Blood cells.
In the Red cell the merozoites develop into ringforms which grow in size,
becoming trophozoites.
These multiply and divide into a number of small merozoites and form mature
schizonts.
The merozoites are released by rupture of the red cell membrane and enter new
young red cells.
After a period some meroites give rise to two sexually differentiated forms of
gametocytes (male an female), ready to be sucked by a mosquito.
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(c) Describe management.
Intravenously 1200 mg in1000 mls of 10% dextrose to run in 4 hours stat, then
600 mg in 500 Ml 10% dextrose. 8 hourly to run in 4 hours by three (03) to six
(06) doses or 30 Mg/Kg body Weight followed by 10 Mg/Kg body weight quinine.
2. Headache
3. Confusion
4. Ataxia
5. Hypotension
6. Tachycardia
7. Tinnitus
8. Hypoglycaemia
9. Temporary deafness
Nursing Implications:
1. Check apical pulse rate and blood pressure before commencing treatment
2. Fansidar: (Antimetabolite)
Side Effects:
1. Atrophic glossitis
2. Agranulocytosis
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3. Aplastic anaemia
4. Leukopenia
5. Thrombocytopaeni
6. Headache
Nursing Implications:
Pregnant women
Side Effects:
1 Abdominal pains
1. Diarrhoea
3. Ventricular dysarrythimias
Nursing Implications
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2. Advise a fat containing diet for fast absorption
5. Paracetamol Tablets:
6. Ferrous Sulphate
Side Effects:
Liver damage after prolonged use. Kidney damage after prolonged use.
Nursing Implication:
Total: = 15%.
Objectives: 2%
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Environment: (2%)
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- Patient continues on light bed covers
Observations (12%)
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- If established, give a lot of fluid especially
intravenously. Give 12% for 12 points.
- This will cool down the body but will also provide
nutrition and hydration.
Elimination:
Hygiene: 2%
Sweating stage
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- Linen be changed if wet with sweat for comfort
Psychological care: 1%
Health Education 3%
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3. Renal failure may occurs in falciparum malaria usually caused by
extrarenal factors.
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