Malaria

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MALARIA
 Malaria is a protozoan infection caused by Plasmodium which has 5 types:  P. falciparum  P. vivax  P. ovale  P. malariae Transferred to humans through vector infection from the female Anopheles Mosquito



FACTS ON MALARIA
 In the Philippines, 12 million (13 percent of the population) are at high risk of malaria causing death.

WORLDWIDE:   Malaria cases-219 million cases of malaria are estimated to occur around the world each year. Malaria deaths-660 000 deaths occur each year, mostly in children under five years of age. (from WHO report, 2012)

WHO ARE AT RISK OF MALARIA?
  Countries in the tropics People across the life span ◦ Older people ◦ Young Children (under 5 years of age) ◦ Travelers ◦ Pregnant women (can cause fetal stillbirth, fetal anemia, spontaneous abortion and even death) ◦ HIV/AIDS patients

PATHOPHYSIOLOGY

INCUBATION PERIOD
     Malaria can develop weeks, months or years after a traveller has been bitten depending on the species of parasite causing the infection. The time lapse between being bitten by an infected mosquito and the appearance of the parasite in the blood varies from seven to 30 days with P. falciparum, but is usually around 10 days. With P. vivax, P. ovale, and P. malariae it may be longer. The incubation period from the time of being bitten to the appearance of clinical symptoms varies according to the species of mosquito: around 14 days for P. vivax and P. ovale, 12 days for P. falciparum and 30 days for P. malariae (Bell, 1999).

SIGNS AND SYMPTOMS:
     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 orseizures) can occur with severe P. falciparum infection. It is lethal if not treated quickly; even with treatment, about 15%-20% die.



DIAGNOSIS:
  Blood tests (blood culture for presence of Plasmodium) Clinical Signs and Symptoms

TREATMENT:
 Chloroquine phosphate (Aralen) is the drug of choice for all malarial parasites except for chloroquine-resistant Plasmodium strains. Although almost all strains of P. malariae are susceptible to chloroquine, P. falciparum, P. vivax, and even some P. ovale strains have been reported as resistant to chloroquine. Unfortunately, resistance is usually noted by drug-treatment failure in the individual patient. There are, however, multiple drug-treatment protocols for treatment of drugresistant Plasmodium strains (for example, quinine sulfate plus doxycycline [Vibramycin, Oracea, Adoxa, Atridox] or tetracycline[Achromycin], or clindamycin [Cleocin], or atovaquoneproguanil[Malarone]).



PREVENTION:
    Mosquitoes bite between dawn and dusk so travellers should be advised to: Wear long-sleeve clothing, long trousers or skirts and limit the amount of exposed skin; Avoid dark colours - mosquitoes are not attracted to light colours; Impregnate clothing with permethrin solution. This should be carried out using a bucket or plastic bag according to the manufacturer's instructions. Mosquito nets can also be treated in this way (Auerbach et al, 1999). This treatment works well with cotton clothing and it can be washed up to five times after being impregnated with the solution. It is recommended that the clothing is not worn in direct contact with the skin (Caumes, 2000); Use a spray containing permethrin on clothing. Clothes should be sprayed inside and out for 3060 seconds and allowed to dry for two to four hours before being worn (Caumes, 2000); Apply insect repellents regularly in cream, spray or gel form that contain diethyltoluamide (DEET);

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Sleep under a net impregnated with permethrin; Use coils and mats impregnated with insecticide in closed rooms to repel the mosquitoes. Follow the ABCD rule: Awareness of risk of malaria. Bite prevention. Chemoprophylaxis (taking antimalarial medication exactly as prescribed). Prompt Diagnosis and treatment.

NURSING MANAGEMENT:
Nursing Diagnosis 1. Hyperthermia related to the development of malaria parasites in red blood cells. Nursing Intervention: 1. · Assess any complaints or signs of increased body temperature changes. R /: Increased body temperature will exhibit a variety of symptoms such as red eyes and the body feels warm. 2. Observation of vital signs, especially body temperature as indicated. R /: To determine interventions. 3. Warm water compress on the forehead and both axilla. R /: stimulates the hypothalamus to the center of the temperature setting. 4. Collaboration of antipyretic drugs. R /: Controlling fever.

Nursing Diagnosis 2. Risk for Fluid Volume Deficit related to hyperthermia Nursing Interventions: 1. Supervise the input and output of fluids. Estimate loss of fluid through sweat. R /: Provides information about the fluid balance, are guidelines for fluid replacement. 2. Observations of decreased skin turgor. R /: Indicates excessive fluid loss / dehydration. 3. Give parenteral fluids if needed. R /: Helping peroral fluid intake.

Nursing Diagnosis 3. Imbalanced Nutrition, Less Than Body Requirements related to anorexia Nursing Interventions: 1. Encourage bed rest / or activity restrictions. R /: Maintaining sufficient energy savings. 2. Provide oral hygiene. R /: a clean mouth can enhance the flavor of food. 3. Provide food in a well ventilated, pleasant environment, the situation is not in a hurry, accompany. R /: Pleasant surroundings lower stress and more conducive to eating. 4. Collaboration of antiemetic drugs. R /: Eliminate the symptoms of nausea and vomiting.

Nursing Diagnosis 4 Knowledge Deficit: about disease Nursing Interventions: 1. Determine the patient's perception of the disease process. R /: Creating a knowledge base and provide awareness of individual learning needs. 2. Review the disease process, the cause / effect relationship factors that cause symptoms and identify ways to lose factors. Encourage questions. R /: Trigger factors / ballast individuals, so the patient needs to be aware of lifestyle factors may trigger symptoms. Accurate knowledge base gives patients the opportunity to make an informed decision / choice about the future and control of chronic diseases. Although many patients know about the disease itself, they can experience that has been left behind or wrong concept. 3. The review: medicine, destination, frequency, dosage, and possible side effects. R /: Improving understanding and to increase cooperation in the program.

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 Adolescent and Youth Health Program (AYHP) Botika Ng Barangay (BnB) Breastfeeding TSEK Blood Donation Program Child Health and Development Strategic Plan Year 2001-2004 CHD Scorecard Committee of Examiners for Undertakers and Embalmers Committee of Examiners for Massage Therapy (CEMT) Climate Change Dental Health Program Emerging and Re-emerging Infectious Disease Program Environmental Health Expanded Program on Immunization Essential Newborn Care Family Planning Food and Waterborne Diseases Prevention and Control Program Food Fortification Program

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         National Tuberculosis Control Program Natural Family Planning National Filariasis Elimination Program National Rabies Prevention and Control Program Newborn Screening National HIV/STI Prevention Program National Mental Health Program National Dengue Prevention and Control Program National Prevention of Blindness Program Occupational Health Program Persons with Disabilities Pinoy MD Program Province-wide Investment Plan for Health (PIPH) Philippine Medical Tourism Program Provision of Potable Water Program (SALINTUBIG Program - Sagana at Ligtas na Tubig Para sa Lahat)

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 Rural Health Midwives Placement Program (RHMPP) / Midwifery Scholarship Program of the Philippines (MSPP) Schistosomiasis Control Program Soil Transmitted Helminth Control Program Smoking Cessation Program

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Garantisadong Pambata

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  Human Resource for Health Network Health Development Program for Older Persons (Bureau or Office: National Center for Disease Prevention and Control ) Health Development Program for Older Persons R.A. 7876 (Senior Citizens Center Act of the Philippines) Health Development Program for Older Persons (Global Movement for Active Ageing (Global Embrace 1999)) Health Development Program for Older Persons R.A. 7432 (An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges) Health and Well-being of Older Persons Infant and Young Child Feeding (IYCF) Iligtas sa Tigdas ang Pinas Inter Local Health Zone Integrated Management of Childhood Illness (IMCI)

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  Urban Health System Development (UHSD) Program Unang Yakap (Essential Newborn Care: Protocol for New Life) Violence and Injury Prevention Program Women's Health and Safe Motherhood Project Women and Children Protection Program



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 Knock Out Tigdas 2007 Leprosy Control Program LGU Scorecard Licensure Examinations for Paraprofessionals Undertaken by the Department of Health Malaria Control Program Measles Elimination Campaign (Ligtas Tigdas)

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