A 44-year-old man is seen at a physician's office in the United States, during a

weekend, for suspected malaria.

The patient was born in Pakistan but has lived in the United States for the past 12
years. He frequently travels back to Pakistan to visit friends and relatives. His last visit
there was for two months, returning 11 months before the current episode. He did not
take malaria prophylaxis then.
 Five weeks ago, he was diagnosed with malaria and treated at a local hospital. The
blood smear at that time was reported by the hospital as positive for malaria, species
undetermined. He was then treated with two days of IV fluids (nature unknown) and
tablets (nature unknown) and recovered.
 The patient now presents with a history of low-grade fever for the past few days, with
no other symptoms. A blood smear is taken and examined at a hospital laboratory by
the technician (no pathologist is available this weekend). Through a telephone
discussion, the technician states that she sees four parasites per 1000 red blood cells,
with rings, "other forms with up to four nuclei," and that some of the infected red blood
cells are enlarged and deformed.
 
 Questions:
 1. What are the medical diagnosis of the patient and the causative agent of the
condition?
The most probable medical diagnosis for the patient's current condition would be
malaria since the reported microscopic results are compatible with the causative agent
Plasmodium vivax. This is evident in the blood smears taken wherein some infected red
cells are enlarged and deformed, and the "other forms with four nuclei" are compatible
with the presence of schizonts. Furthermore, the history suggests a relapse of P. vivax
malaria, following an earlier episode five weeks ago. The initial treatment apparently did
not include primaquine, thus allowing hypnozoites' persistence, which caused this
relapse.

 2. What are your expected additional assessment data (signs and symptoms)? 
The patient is expected to show symptoms such as moderate to severe shaking
chills  high fever headache nausea and vomiting and anemia.
 3. Based on the pathogen life cycle and pathogenesis, explain why your expected
additional assessment data appears to the patient?
The infected red blood cells stick to each other and to walls of capillaries and at the end
of that infection cycle, causing red blood cells rupture. This process lowers the number
of red blood cells and can cause anemia in a severe stage. The patient is expected to
experience fever because it is the body's innate defense mechanism in response to
infection with detected parasites. The patient experiences chills and rigors because this
is the body's way of increasing heat production and, thus, increase body temperature.
The headache and nausea result from the high proinflammatory cytokine response and
high serum cytokine levels in P. vivax malaria infections, mainly because there is a
lower pyrogenic threshold compared to P falciparum infections with similar parasitemia.
 4. Provide at least three nursing interventions ( 1-promotive , 1-curative and 1-
preventive) for the patient.

Curative:
Implement pharmacological management of malaria by administrating antimalarial
drugs such as Chloroquine per the physician’s orders.  

Preventive:
Have the client avoid mosquitoes by limiting exposure during times of typical blood
meals, wearing long-sleeved clothing, and using insect repellants to prevent infection;
avoid wearing perfumes and colognes.

Promotive:
Review the disease process and therapy, focusing on patient's concerns; discuss
importance of adhering to therapy; go over medication, purpose, frequency, dosage,
and side effects; have a family member or trusted individual listen to and understand
guideline of treatment as the patient chooses.

References:
How to Break a Fever. (n.d.). Retrieved from Healthline website:
https://www.healthline.com/health/how-to-break-a-fever
‌
Martin, P., BSN, & R.N. (2020, June 30). Drug Dosage Calculation Practice Quiz (100+
Questions). Retrieved September 29, 2020, from Nurseslabs website:
https://nurseslabs.com/drug-dosage-calculations-practice-quiz/
‌Prevention, C.-C. for D. C. and. (2019, January 28). CDC - Malaria - References and
Resources - Interactive Training - Clinical Case Study 1. Retrieved September 29,
2020, from www.cdc.gov website:
https://www.cdc.gov/malaria/references_resources/interactive_training/cc-1/index.html
‌
Plasmodium vivax - Assignment Point. (n.d.). Retrieved September 29, 2020, from
www.assignmentpoint.com website:
https://www.assignmentpoint.com/science/health/plasmodium-vivax.html