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NANDA Nursing

NANDA Nursing
Minggu, 20 Februari 2011
Nursing Care Plan for Malaria
NCP for Malaria


Malaria is an infectious disease caused by a parasite, Plasmodium, which infects red

blood cells. Malaria is characterized by cycles of chills, fever, pain, and sweating.
Historical records suggest malaria has infected humans since the beginning of
mankind. The name "mal aria" (meaning "bad air" in Italian) was first used in English in
1740 by H. Walpole when describing the disease. The term was shortened to "malaria"
in the 20th century. C. Laveran in 1880 was the first to identify the parasites in
human blood. In 1889, R. Ross discovered that mosquitoes transmitted malaria. Of the
four common species that cause malaria, the most serious type is Plasmodium
falciparum malaria. It can be life-threatening. However, another relatively new
species, Plasmodium knowlesi, is also a dangerous species that is typically found only
in long-tailed and pigtail macaque monkeys. Like P. falciparum, P. knowlesi may be
deadly to anyone infected. The other three common species of malaria (P. vivax, P.
malariae, and P. ovale) are generally less serious and are usually not life-threatening.
It is possible to be infected with more than one species of Plasmodium at the same

Symptoms and Signs

The symptoms characteristic of malaria include flulike illness with fever, chills,
muscle aches, and headache. Some patients develop nausea, vomiting, cough, and
diarrhea. Cycles of chills, fever, and sweating that repeat every one, two, or three
days are typical. There can sometimes be vomiting, diarrhea, coughing, and yellowing
(jaundice) of the skin and whites of the eyes due to destruction of red blood cells and
liver cells.

People with severe P. falciparum malaria can develop bleeding problems, shock, liver
or kidney failure, central nervous system problems, coma, and can die from the
infection or its complications. Cerebral malaria (coma, or altered mental status or
seizures) can occur with severe P. falciparum infection. It is lethal if not treated
quickly; even with treatment, about 15%-20% die.
Nursing Care Plan for Malaria

Nursing Assessment for Malaria

1. Activity / rest
Symptoms: Fatigue, weakness, general malaise
Signs: Tachycardia, muscle weakness and decreased strength.
2. Circulation
Signs: Blood pressure normal or slightly decreased. Peripheral pulse strong and
rapid (phase of fever) warm skin, diuresis (diaphoresis) due to vasodilation.
Pale and moist (vasoconstriction), hypovolemia, decreased blood flow.
3. Elimination
Symptoms: Diarrhea or constipation, decreased urine output
Signs: abdominal distension
4. Food and fluid
Symptoms: Anorexia, nausea and vomiting
Signs: Weight loss, reduced subcutaneous fat, and decrease in muscle mass.
Decrease in urine output, urine concentration.
5. Neuro Sensory
Symptoms: Headache, dizziness and fainting.
Signs: Nervousness, fear, mental chaos, disorientas delirium or coma.
Breathing Signs: Tackipnea with a reduced depth of breathing. Symptoms: short
breath at rest and activity
6. Counseling / learning
Symptoms: chronic health problems, such as liver, kidney, alcohol poisoning,
history of splenectomy, had just had surgery / invasive procedures, traumatic

Nursing Diagnosis for Malaria

Nursing diagnosis in patients with malaria on the basis of signs and symptoms that
arise can be described as below (Doengoes, Moorhouse and Geissler, 1999) :
1. Changes in nutrition less than body requirements related to inadequate
food intake, anorexia, nausea / vomiting
2. High risk of infection related to decreased immune system; invasive
3. Hyperthermia related to increased metabolism, dehydration, direct
effects on the hypothalamic circulation of germs.
4. Changes in tissue perfusion related to decreased cellular components in
the need for delivery of oxygen and nutrients in the body.
5. Lack of knowledge, about illness, prognosis and treatment needs related
to lack of exposure, the interpretation of information ,cognitive limitations.
Nursing Diagnosis and Nursing Interventions for Malaria

Nursing Diagnosis and Nursing Interventions for Malaria

Nursing Diagnosis and Nursing Interventions for Malaria
1. Changes in nutrition less than body requirements related to inadequate food
intake, anorexia, nausea / vomiting

Nursing Intervention :
o Assess history of nutrition, including foods that are preferred. Observation and
record the client's food input.
Rational: watching caloric intake or lack of quality of food consumption.
o Give extra food to eat little and small.
Rational: gastric dilatation may occur when feeding too fast after a period of anorexia.
o Maintain a schedule of regular body weight.
Rational: Monitors the effectiveness of weight loss or nutrition intervention.
o Discuss the preferred client and input in a pure diet.
Rational: It can increase input, increase the sense of participation / control.
o Observation and record the events of nausea / vomiting, and other related
Rational: to show the effect of GI symptoms of anemia (hypoxia) on organ.
o Collaboration with a dietitian.
Rational: Need help in planning a diet that meets nutritional needs.
2. High risk of infection related to a decrease in body systems (main defense is
inadequate), invasive procedures.

Nursing Intervention:
o Monitor body temperature increases.
Rational: Fever caused by the effects of endotoxin on the hypothalamus and
hypothermia are important signs that reflect the development status of shock /
decrease in tissue perfusion.
o Observe the chills and diaforosis.
Rational: Shivering often precedes the height of the temperature on a common
o Monitor the sign deviation condition / failure to improve during therapy.
Rational: It can show Inaccurate antibiotic therapy or growth of organisms.
o Provide anti-infective medication as directed.
Rational: It can kill / give temporary immunity to common infections.
o Get spisemen blood.
Rational: The identification of the causes of malaria infections.

3. Hyperthermia is related to increased metabolism of circulating germ dehydration

direct effect on the hypothalamus.

Nursing Intervention:
o Monitor patient's temperature (degree and pattern), note the chills.
Rational: Hipertermi showed an acute infectious disease process. The pattern of fever
indicates a diagnosis.
o Monitor the temperature of the environment.
Rational: The temperature of the room / the number of sheets should be changed to
maintain the temperature close to normal.
o Give a warm compress bath, avoid using alcohol.
Rational: It can help reduce a fever, use of ice / alcohol may cause cold. In addition,
alcohol can dry the skin.
o Give antipyretics.
Rational: Used to reduce fever with its central action on the hypothalamus.
o Give a cooling blanket.
Rational: Used to reduce fever with hyperthermia.