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Malaria

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. Malaria Cont. Maria Risk areas – Namibia High Risk areas: North East: Kavango- &

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Malaria

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  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.

  2. 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

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

  4. 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 invadered 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.

  6. 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.

  7. Malaria pathophysiology (cont) • In response to the parasites invasion, the body’s 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

  8. 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..

  9. 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.

  10. Malaria RX Continued Medications: Uncomplicated malaria: • 1st Line:Adults:Artemether/Lumefantrine. BD for 3 days. Exemption: Pregnancy & > 5kg • Children 2-6 months and > 5kg Sulphadoxine/Pyrimethadine • 2nd Line: Quinine (Quinine also for complicated malaria, IVI and p/o. • (See National Malaria Policy on Malaria)

  11. Malaria: Nursing Management • According to thenursing 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)

  12. 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. Nursing care Plan for Malaria

  13. 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 Nursing care Plan for Malaria

  14. 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. Nursing care Plan for Malaria

  15. Nursing Diagnosis: Potential oliguria, signifying renal failure due to bilirubin Nursing Intervention Urine output to watch oliguria. (Normal=30ml/hour Urine dipstic for proteinuria & hematuria Nursing care Plan for Malaria

  16. 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 Nursing care Plan for Malaria

  17. 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 Nursing care Plan for Malaria

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