Malaria Nursing Diagnosis and Nursing Care Plan

Malaria Nursing Care Plans Diagnosis and Interventions

Malaria Nursing Care Plans Diagnosis and Interventions

Malaria is a life-threatening disease that usually thrives in tropical countries like Africa and Philippines. Globally, there were 241 million cases of malaria recorded in 2020, about 627,000 of which were reported deaths from malaria.

This disease is transmitted through bites of female Anopheles which carries the parasite. Of the five parasite species that cause malaria in humans, Plasmodium falciparum and Plasmodium vivax are the two most dangerous.

The most common and lethal malaria parasite on the continent of Africa is P. falciparum. The most common malaria parasite outside of sub-Saharan Africa is P. vivax. In an effort to control the spread of malaria, the World Health Organization suggests a vaccine for people with a high infection rate.

Signs and Symptoms of Malaria

Malaria symptoms often appear between 10 and 15 days following the infected insect bite. High fever, chills, and sweating may be accompanied by:

  • Headache
  • Nausea
  • Diarrhea
  • Muscle and joint pain
  • Cough
  • Rapid heart rate
  • Jaundice
  • Convulsions
  • Fatigue
  • Bloody stools

Types of Malaria

Humans are infected by five species of Plasmodium parasite. Four types of it naturally infect humans: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale.

On the other hand, Plasmodium knowlesi do not directly infect humans, instead it is transmitted for macaques to humans making it a zoonotic malaria. The degree of malaria transmission will vary depending on the varieties (species) of Anopheles prevalent in a region at a certain period.

  • Plasmodium falciparum.  This species is responsible for the most severe form of malaria. P. falciparum can infect RBCs of all ages, leading to high parasitemia levels; sequestration is a characteristic of P falciparum; as the parasite develops over the course of its 48-hour life cycle, the organism exhibits adherence properties that cause the parasite to be sequestered in small postcapillary vessels.
  • Plasmodium vivax. Patients with P vivax infection experience relapses 50% of the time between a few weeks and five years after the initial illness. P. vivax only infects immature RBCs, resulting in limited parasitemia. If this type of infection is left untreated, it typically lasts for 2-3 months with diminishing frequency and intensity of paroxysms.
  • Plasmodium ovale. Similar to P. vivax infections, albeit typically less severe, P. ovale infections frequently go away on their own. Like P. vivax, P. ovale mainly infects young RBCs, and its parasitemia is typically lower than that of P falciparum.
  • Plasmodium malariae. Compared to those infected with P. vivax or P. ovale, those with P. malariae stay asymptomatic for a significantly longer period of time. P. malariae infections frequently recur.
  • Plasmodium knowlesi. It is believed that simian malaria cases also occur in Central America and South America. Patients infected with this, or other simian species, should be treated as aggressively as those infected with falciparum malaria because P knowlesi may cause fatal disease. There are reported cases of native cases in Malaysian Borneo, Thailand, Myanmar, Singapore, the Philippines, and other nearby nations.

Cause of Malaria

Malaria is caused by a plasmodium parasite which is transmitted to humans by an infected female mosquito bite. The cycle starts when an uninfected mosquito feeds on an infected human.

The mosquito acquires the parasite and acts as a vector. Once the parasite gains access to a human host, it travels to the liver where it can remain dormant for years. Upon maturity, they leave the liver and infect red blood cells.

During this period, signs and symptoms typically start to manifest. Other modes of transmission can be from mother to unborn child, blood transfusions, and needle sharing.    

Risk Factors to Malaria

The risk of being infected by malaria increases when there is low utilization of Insecticide Treated bed Nets, and Indoor Residual Spray in places with high infection rate.

Availability of mosquito breeding sites like stagnant water may also pose a threat. Lastly, specific groups of people may be at higher risks: infants and children, older adults, pregnant women and their unborn children, travelers coming from areas with no malaria cases.  

Complications of Malaria

The three main malarial consequences are nephrotic syndrome (NS), severe malarial anemia, and cerebral malaria.

  • Nephrotic syndrome. Nephrotic syndrome, which manifests similarly to membranoproliferative glomerulonephritis with proteinuria and diminished renal function and may result in renal failure, develops related to glomerular antigen-antibody complex deposition.
  • Severe malarial anemia. The suppression of bone marrow during severe infection, cell lysis, splenic evacuation, autoimmune lysis of immune-marked erythrocytes, poor iron incorporation into new heme molecules, and poor iron uptake into hemoglobin are some of the TNF-alpha-mediated mechanisms that cause severe malarial anemia.
  • Cerebral malaria. A slow onset altered mental status, violent behavior, headache, and an extremely high fever (up to 42 degrees C) are the symptoms of cerebral malaria, which accounts for 80% of fatal malaria cases and is most frequently caused by P. falciparum infection. Coma, metabolic acidosis, hypoglycemia, and possibly seizures and death follow.

Diagnosis of Malaria

Diagnosis for malaria should usually include the following:

  • Comprehensive history taking. The location of residence, recent travel, use of chemoprophylaxis, exposures (such as sick contacts, freshwater, caves, farm/wild animals, insects/arthropods), HIV status, history of a current or recent pregnancy, history of G6PD deficiency, history of sickle cell disease, history of anemia, history of blood or other cancers, and history of previous malaria infections are all crucial questions to ask when taking a patient’s history (including successful or failed treatments).
  • Complete blood count. A complete blood count in malaria patients indicates thrombocytopenia in 60–70% of cases and anemia in varied degrees in 29% of adults and 78% of children.
  • Comprehensive metabolic panel. A thorough metabolic panel may identify electrolyte abnormalities brought on by the release of intracellular contents and concurrent dehydration, hepatocellular injury secondary to parasitic invasion, indirect hyperbilirubinemia caused by hemolysis, kidney injury secondary to glomerular damage, and all of these conditions.
  • Coagulation panel. In individuals with severe thrombocytopenia or liver dysfunction, a coagulation panel may show coagulopathy that raises the risk of bleeding. Proteinuria that is suggestive of nephrotic syndrome may be seen on a urine test.
  • Microscopy.  A microscopic examination of Giemsa-stained thick and thin smears of free-flowing venipuncture blood samples is the gold standard for diagnosing malaria.

Treatment for Malaria

Treatment for malaria should usually include the following:

  • Inpatient treatment. To make sure that medications are tolerated, patients with elevated parasitemia (>5% of RBCs infected), CNS infection, or other severe symptoms, as well as those with P falciparum infection, should be thought about for inpatient treatment. Blood smears should be obtained daily to show a response to treatment.
  • Pharmacologic management. Quinoline-related substances, antifolates, artemisinin derivatives, and antimicrobials are the four main pharmacological classes now used to treat malaria; as of yet, no one medication capable of eradicating all stages of the parasite’s life cycle has been developed or identified. These substances prevent growth by collecting inside the parasite’s acid vesicles, which raises the organism’s internal pH. They also prevent hemoglobin use and parasite metabolism.

Prevention of Malaria

  • Personal protective measures. In order to prevent mosquito bites, individuals should take the following precautions to decrease the risk of contracting malaria.
    • To protect exposed skin from mosquitoes, use DEET (diethyltoluamide) insect repellent.
    • Cover mattresses with mosquito netting.
    • Install screens on the doors and windows.
    • Use the insect repellent permethrin on clothing, mosquito nets, tents, sleeping bags, and other items.
    • Put on slacks and long sleeves to protect the skin.
  • Vaccination. In a trial study, a vaccine for kids was created and tested in Ghana, Kenya, and Malawi. Children who contract Plasmodium falciparum malaria, which is a serious illness, can be protected with the RTS, S/AS01 vaccination. A malaria vaccine is being developed by other initiatives.

Nursing Diagnosis for Malaria

Nursing Care Plan for Malaria 1

Hyperthermia

Nursing Diagnosis: Hyperthermia related to increased metabolic rate secondary malaria as evidenced by body temperature above the normal range, localized redness, raised heart rate and respiratory rate, appetite loss, weakness, and seizures.

Desired Outcomes

  • The patient will keep body temperature below 102.2 °F (39 °C).
  • The patient will maintain normal ranges for BP and HR.
Nursing Intervention for MalariaRationale
Check for signs and symptoms of hyperthermia.Check for signs and symptoms of hyperthermia such as flushed face, weakness, rash, respiratory difficulty, tachycardia, malaise, headache, and irritability. Keep an eye out for complaints of perspiration, hot, dry skin, or feeling excessively heated.
Check for any indications of dehydration due to hyperthermia.  To identify dehydration, keep an eye out for symptoms including thirst, a dry tongue, chapped lips, dry oral membranes, poor skin turgor, decreased urine output, elevated urine concentration, and a weak, rapid pulse.
Keep an eye on the patient’s blood pressure and heart rate.With the onset of hyperthermia, HR and BP rise.
Every hour, as often as recommended, or whenever the client’s condition changes, take an accurate temperature reading and record it.Making correct treatment decisions and identifying temperature trends will be made easier by using a consistent temperature measurement technique, location, and tool. If necessary, use two temperature monitoring modes. All non-invasive techniques for determining body temperature have accuracy and precision variations in comparison to core temperature techniques that are unique to each type and technique. It should be noted that there is a 0.5 degree Celsius temperature discrepancy between core temperature monitoring and other non-invasive techniques.
Keep an eye on the patient’s fluid intake and urine output. To check on the patient’s fluid condition if they are unconscious, central venous pressure or pulmonary artery pressure should be taken.Fluid resuscitation may be necessary to treat dehydration. The patient is so dehydrated that they can no longer sweat, which is essential for evaporative cooling.
When necessary, give out cooling blankets or hypothermia blankets.When one needs to swiftly lower the body temperature, use cooling blankets with water circulation. To stop the client from shivering, set the temperature regulator to 1oC lower than the client’s current temperature.
Give the patient a sponge bath or a lukewarm bath.A non-pharmacological method to enable evaporative cooling is a tepid sponge bath. Alcohol should not be consumed as it can quickly chill the skin and produce shivering.

Nursing Care Plan for Malaria 2

Risk for Infection

Nursing Diagnosis: Risk for infection related to inadequate primary defenses and contact with contagious agents

Desired Outcomes: 

  • The patient will maintain normal vital signs and demonstrate the lack of any malaria-related symptoms.
  • The patient will keep up with or rebuild defenses.
Nursing Intervention for MalariaRationale
Observe and record any signs and symptoms of infection such as redness, fever, increased pain, and swelling.These are the usual signs of an infection. Often, a fever is the first indication of an infection. An infection may be indicated by a temperature of more than 37.7° (99.8° F), and septicemia may be indicated by an extremely high temperature coupled with chills and perspiration.    
Monitor and record the patient’s white blood cell (WBC) count.The body’s efforts to fight germs are indicated by a rising WBC count. The following values apply: Low: <4,500Normal: 4,500-11,000High: >11,000 A very low WBC count could be a sign of a serious infection risk. Older patients may have the infection without having a higher WBC count. WBC differential may additionally reveal an uptick or decline in certain illnesses.
Ask clients about their travel experiences.  The healthcare team can prevent outbreaks and better understand infectious symptoms by incorporating travel history into the examination.
Encourage a balanced diet and the consumption of foods high in calories and protein.A balanced diet and proper nutrition help the immune systems be more effective and improve the health of all the tissues in the body. The body can maintain and regenerate tissues, and a healthy immune system is supported by enough diet.
Encourage a balanced diet and the consumption of foods high in calories and protein.A balanced diet and proper nutrition help the immune systems be more effective and improve the health of all the tissues in the body. The body can maintain and regenerate tissues, and a healthy immune system is supported by enough diet.

Nursing Care Plan for Malaria 3

Impaired Tissue Perfusion

Nursing Diagnosis: Impaired Tissue Perfusion related to decrease in the cellular elements required for the body to receive oxygen and nutrition secondary to malaria as evidenced by chest pain, dyspnea, weak peripheral pulses, and decreased urine output.

Desired Outcomes: 

  • The patient will identify factors that enhance circulation.
  • The patient will show increasing exercise tolerance.
  • The patient will not exhibit continued impairments or greater deterioration.
  • The patient will take actions or exhibit behaviors to increase tissue perfusion.
  • The patient will demonstrate maximal tissue perfusion as evidenced by warm and dry skin, present and strong peripheral pulses, vital signs that are within the patient’s normal range, a balanced I&O, the absence of edema, normal ABGs, an alert LOC, and the absence of chest discomfort.
Nursing Intervention for MalariaRationale
Check for indications of diminished tissue perfusion.There are specific symptomatic clusters that can have a variety of causes. Evaluation of the criteria that define ineffective tissue perfusion establishes a baseline for subsequent comparison.
Verify breathing patterns and the lack of respiratory activity.    Respiratory discomfort may be brought on by ischemia pain or a malfunctioning cardiac pump. However, sudden or persistent dyspnea may be a symptom of thromboembolic pulmonary consequences.
Verify any sudden or persistent variations in mental state.    Hypoxia, systemic emboli, and electrolyte/acid-base changes all affect brain perfusion. It also has a direct impact on cardiac output.
Utilize pulse oximetry to keep an eye on pulse rate and oxygen saturation.An effective method for identifying oxygenation changes is pulse oximetry.
Note for the presence of pallor, cyanosis, mottled, cold, or clammy skin. Analyze the strength of each pulse.  Peripheral pulse absence needs to be reported or handled right away. Skin perfusion may be affected, and pulses may stop, as a result of systemic vasoconstriction brought on by decreased cardiac output. Assessment is therefore necessary for ongoing comparisons.

Nursing Care Plan for Malaria 4

Fluid Volume Deficit

Nursing Diagnosis: Fluid Volume Deficit related to dehydration and excessive sweating secondary to malaria as evidenced by changes in mental state, tachycardia, weak pulse, feelings of weakness and thirst, concentrated urine, sunken eyes and dry mucous membranes, lower skin turgor, hypotension, or orthostatic hypotension

Desired Outcome: The patient will be normovolemic as evidenced by systolic blood pressure that is greater than or equal to 90 mm Hg (or the patient’s baseline), the lack of orthostasis, a heart rate of 60 to 100 beats per minute, a urine output of more than 30 mL per hour, and normal skin turgor.

Nursing Intervention for MalariaRationale
Keep track of and record all vital indicators, especially the BP and HR.   Hypotension and tachycardia may result from a decrease in the volume of blood in circulation. A compensatory mechanism to sustain cardiac output is change in HR. If there is also an electrolyte imbalance, the pulse is typically weak and erratic. Hypovolemia is accompanied by hypotension.
Check for symptoms of dehydration in the oral mucous membranes and skin turgor.The skin might display signs of dehydration. Skin turgor should be assessed across the sternum or on the inner thighs of elderly people because their skin loses flexibility with age. Longitudinal furrows can be seen encircling the tongue.
Track BP for changes in orthostatic pressure (changes seen when changing from supine to standing position). Watch the patient’s heart rate for orthostatic changes.  Postural hypotension is an indication of fluid loss that is frequently seen. A 20 mm Hg reduction in systolic blood pressure and a 10 mm Hg drop in diastolic blood pressure are the symptoms. With age, the incidence rises.
Analyze any mental or sensory changes (confusion, agitation, slowed responses).An excessively high or low blood sugar, electrolyte imbalances, acidosis, diminished cerebral perfusion, or the onset of hypoxia can all affect mentation and the sensory system. Regardless of the cause, impaired consciousness can make a patient more likely to aspirate.
Assess the urine’s color and volume. Report two (2) hours in a row with urine output that was less than 30 ml/hr.Not less than 30ml of urine per hour is considered normal urine output. Urine concentration indicates a fluid deficiency.

Nursing Care Plan for Malaria 5

Knowledge Deficit

Nursing Diagnosis: Knowledge Deficit related to lack of knowledge about the cause, course, and prognosis of the disease secondary to malaria as evidenced by verbalization of questions or comments of misunderstanding, incorrectly following directions, information requests, and the emergence of issues that should have been avoided.

Desired Outcomes: 

  • The patient will express verbally his or her understanding of the disease’s course, prognosis, and any side effects.
  • The patient will recognize how signs and symptoms relate to the illness and link these symptoms to their underlying causes.
  • The patient will start making the essential lifestyle changes and follow the treatment plan.
Nursing Intervention for MalariaRationale
Determine the patient’s motivation and openness to learning about malaria.Learning demands effort. Patients must see a need or goal for their education. Additionally, they are free to reject receiving educational services.    
Set the learning needs’ priority within the overall care plan for malaria.Knowing what has to be discussed is important, especially if the patient is already familiar with the circumstances. It will assist in avoiding wasting vital time if one knows what to prioritize.
Take into account the patient’s preferred method of learning, particularly if they have previously learnt and retained new material.  Every person has a unique learning style, which must be taken into consideration while designing an educational program. Others might like group sessions over one-on-one education, while some may favor textual materials over visual ones. Knowledge mastering will be facilitated by matching the educational approach with the learner’s preferred learning style.  
Assess the patient’s ability to learn and use new information.    Promoting enhanced patient self-efficacy in their capacity to acquire the needed knowledge or skills may be the first step in teaching. a few lifestyle adjustments.
Include the patient in developing the lesson plan, starting with defining learning objectives and goals at the start of the session.Setting goals enables the patient to be aware of the topics and expectations for the session. Adults frequently prioritize schooling that is problem-based and present-tense.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna C. RN, BSN, PHN

Anna C. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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