University of Perpetual Help System DALTA

Alabang Zapote Rd. Pamplona, Las Pinas City

COLLEGE OF NURSING
BSN IV- H Batch 2011 - 2012

A Case Study on Malaria


Submitted By:
Ma. Mercedita P. Padua
BSN IV - H Group I

Submitted To:
Mrs. Lucia Felix RN MAN USRN
22011

DEFINITION:
alaria is an acute and chronic parasitic disease transmitted by the bite oI inIected mosquitoes
and it is conIined mainly to tropical and subtropical areas. (Navales, 2006)
The primary vector oI malaria is the Iemale Anopheles mosquito which has the Iollowing
characteristics: (Navales, 2006)
a. t breeds in clear, Ilowing and shaded streams usually in the mountains.
b. t is bigger in size than the ordinary mosquito
c. t is brown in color
d. t is a night biting mosquito
e. t usually does not bite a person in motion
I. t assumes a 36 degrees position when it alights on walls, curtains, trees and the like.
alaria continues to be a major health problem in the country having an annual parasite
incidence oI 5.1/1000 population. n 1994, it was aimed that there be a 20 reduction in
morbidity annually. The nature oI malaria is a public problem requires sustained and systemic
eIIorts toward two major strategies, namely prevention oI transmission through vector control
and the detection and early treatment oI cases to reduce morbidity and prevent mortality.
(Cuevas et al, 2007)
alaria is produced by intraethrocytic parasites oI the genus Plasmodium. Four plasmodia
produce malaria in humans: Plasmodium Ialciparum, P. vivax, P. ovale and P. malariae. The
severity and charactieristic maniIestation oI the disease are governed by the inIecting species, the
magnitude oI the parasitemia, the metabolic eIIects oI the parasite, the cytokines released as a
result oI the inIection. (Cuevas et al, 2007)

ETIOLOGIC AGENT: (Navales, 2006)
The disease is caused by Iour species oI protozoa:
1) P. Ialciparum (malignant tertian)
a. ost serious malarial inIection because oI the development oI high parasitic
densities in blood (RBC) with tendency to agglutinate and Iorm into microemboli.
b. ost common in the Philippines.
2) P. vivax (Benign tertian)
a. Non liIe threatening except Ior the very young and the old.
b. aniIested by chills q48 on the 3
rd
day onward especially iI untreated.
3) P. malariae (Quartan)
a. Less Irequently seen
b. Non liIe threatening
c. Fever and chills usually occur q72 usually on the Iourth day aIter onset.
4) P. ovale
a. Rare type oI protozoan species
b. Rarely seen in the Philippines

SYNONYMS: (Navales, 2006)
Ague

ANATOMY AND PHYSIOLOGY:
The Blood
The blood consists oI cells and cell Iragments, called Iormed elements, and water with dissolved
molecules, called blood plasma.

Eyrthrocytes
Erythrocytes, or red blood cells (RBCs), transport oxygen (O
2
) and carbon dioxide (CO
2
) in the
blood. Erythrocytes contain the protein hemoglobin to which both O
2
and CO
2
attach.
ature erythrocytes lack a nucleus and most cellular organelles, thereby maximizing the cell's
volume and thus its ability to carry hemoglobin and to transport O
2
.
Erythrocytes are shaped like Ilattened donuts with a depressed center (rather than a donut hole).
Their Ilattened shape maximizes surIace area Ior the exchange oI O
2
and CO
2
and allows
Ilexibility that permits their passage through narrow capillaries.
Hemoglobin contains both a protein portion, called globin, and nonprotein heme groups. Globin
consists oI Iour polypeptide chains, each oI which contains a heme group. The heme group is a
red pigment that contains a single iron atom surrounded by a ring oI nitrogen-containing carbon
rings. One oxygen atom attaches to the iron oI each heme group, allowing a single hemoglobin
molecule to carry Iour oxygen atoms. Each erythrocyte contains about 250 million hemoglobin
molecules.
Oxyhemoglobin (HbO
2
) Iorms in the lungs when erythrocytes are exposed to oxygen as they
pass through the lungs. Deoxyhemoglobin (Hb) Iorms when oxygen detaches Iorm the iron and
diIIuses into surrounding tissues.
Carbaminohemoglobin (HbCO
2
) Iorms when CO
2
attaches to amino acids oI the globin part oI
the hemoglobin molecule. About 25 percent oI the CO
2
transported Irom tissues to lungs is in
this Iorm.
Carbonic anhydrase, an enzyme in erythrocytes, converts CO
2
and H
2
O in the blood plasma to
H

and HCO3

About 65 oI the CO
2
collected Irom tissues travels in the blood plasma as
HCO
3
.
Because they lack cellular organelles and thus physiology to maintain themselves, erythrocytes
survive Ior only about 120 days. Degenerated erythrocytes are broken down in the spleen and
liver by macrophages (phagocytic white blood cells)

Leukocytes
Leukocytes, or white blood cells (WBCs), are cells that protect the body Irom Ioreign microbes
and toxins. Although all leukocytes can be Iound in the bloodstream, some permanently leave the
bloodstream to enter tissues where they encounter microbes or toxins, while other kinds oI
leukocytes readily move in and out oI the bloodstream. Leukocytes are classiIied into two
groups, granulocytes and agranulocytes, based upon the presence or absence oI granules in the
cytoplasm and the shape oI the nucleus.

Platelets
Platelets (thrombocytes) are Iragments oI huge cells called megakaryocytes. Platelets lack a
nucleus and consists oI cytoplasm (with Iew organelles) surrounded by a plasma membrane.
Platelets adhere to damaged blood vessel walls and release enzymes that activate hemostasis, the
stoppage oI bleeding.

Plasma
Plasma is the straw-colored, liquid portion oI the blood.
Pathophysiology:
The parasite enters the mosquito`s stomach through the inIected human blood obtained
by biting or during blood meal. The parasite undergoes sexual conjugation. AIter 10 to 14 days, a
number oI young parasites are released which work their way into the salivary gland oI the
mosquito. The organisms are carried in the saliva into the victim when the mosquito bites again.
The Iemale alone plays the role oI a vector and deIinitive host in conveying the disease Irom
man to man (sexual propagation). n humans, the organisms invade the RBC where they grow
and undergo asexual schizogony. Erythrocytic merozoites are produced leading to the rupture oI
RBC upon the release oI the tiny organisms. Young merozoites invade a new batch oI RBC, to
start another schizonic cycle.
Anopheles mosquito

Gets parasite in the blood oI inIected person

Parasites multiply in mosquito

Parasites invade the salivary gland oI mosquito

osquito bites the individual and thus, injects the parasites

The parasites invade the RBC where they grow and undergo sexual propagation

RBC ruptures or burst releasing tiny organisms (merozoites)

erozoites invade new batch oI RBC to start another schizonic cycle

ndeIinite malaise and slowly rising Iever occur Ior several days

There is shaking chills, rapidly rising temperature, and proIuse sweating


Coagulation deIect


Liver and renal Iailure


Pulmonary and cerebral
edema


Coma

Death





Anemia

shock


SIGNS AND SYMPTOMS:
1. Recurrent Chills (Pathognomonic)
2. Rapidly rising Iever with severe headache
3. ProIuse sweating
4. Orthostatic hypotension
5. yalgia, with Ieeling oI well being in between
6. Anemia
7. Paroxysms may last Ior 12 hours, then, maybe repeated daily or aIter a day or two
8. alaise
9. Hepatomegaly
10.Spleenomegaly
11.n children, Iever may be continuous, convulsions and G symptoms are prominent,
spleenomegaly
12.n cerebral malaria, changes in sensorium, severe headache, and vomiting, Jacksonian or
grand mal seizure may occur.

DIAGNOSTIC TESTS:
alarial smear
n this procedure, a Iilm oI blood is placed on a slide, stained, and examined microscopically.

Rapid Diagnostic Test (RDT)
This is a blood test Ior malaria that can be conducted outside the laboratory and in the Iield. t
gives a result within 10 to 15 minutes. This is done to detect malarial parasite antigen in the
blood.

TREATMENT:
nti malarial drugs
1. Chloroquine (all species except Ior P. alariae)
2. Quinine
3. SulIadoxine Ior the resistant P. Ialciparum
4. Primaquine Ior relapse oI P. vivax and ovale

Erythrocyte exchange transfusion
For rapid production oI high levels oI parasites in the blood

NURSING INTERVENTIONS:
1. The pt. must be closely monitored
2. /O should be closely monitored to prevent pulmonary edema
a. Daily monitoring oI pt`s serum bilirubin, BUN creatinine, and parasitic count
b. I the pt exhibits respiratory and renal symptoms, determine the ABG and plasma
electrolyte
3. During the Iebrile stage, tepid sponges, alcohol rubs, and ice cap on the head will bring
the temperature down.
4. Application oI external heat and oIIering hot drinks during chilling stage is helpIul
5. Provide comIort and psychological support
6. Encourage the pt to take plenty oI Iluids
7. As the temperature Ialls and sweating begins, warm sponge baths may be given
8. The bed and clothing should be kept dry
9. Watch Ior neurologic toxicity (Irom quinine inIusion) like muscular twitching, delirium,
conIusion, convulsion and coma.
10.Evaluate the degree oI anemia
11.WOF signs especially abnormal bleeding
12.Consider severe malaria as medical emergency that requires close monitoring oI vital
signs