Nursing Care for Malaria Patients

Education and Nursing Intervention

• Educate patients on the use of mosquito nets and insecticides to prevent diseases.
• Vital signs should be monitored hourly, noting for signs of deterioration, such as narrowing pulse pressure, sudden drop in temperature, decreased blood pressure and pulse rate.
• Strict monitoring of fluid intake and output is necessary.
• Immediate referral is required for any change in the client's status, and proper documentation of procedures is necessary.

Expanded Program on Immunization (EPI)

• Established in 1976 through PD 996, EPI aims to ensure infants, children, and mothers have access to routinely recommended infant/childhood vaccines.
• In 2002, the WHO estimated that 1.4 million deaths among children under 5 years are due to diseases that could have been prevented by routine vaccination, representing 14% of global total mortality in children under 5 years of age.
• Immunization currently prevents 2-3 million deaths every year.
• An estimated 19.7 million children under the age of one year did not receive basic vaccines.
• More than 1 billion children were vaccinated over the last decade.

Six Preventable Diseases

• Tuberculosis
• Poliomyelitis
• Diphtheria
• Tetanus
• Pertussis
• Measles

Interventions/Strategies

• Overall goal: To reduce morbidity and mortality among children against the most common vaccine-preventable diseases.
• Specific goals:
  • Immunize all infants/children against the most common vaccine-preventable diseases.
  • Sustain the polio-free status of the Philippines.
  • Eliminate measles infection.
  • Eliminate maternal and neonatal tetanus.
  • Control diphtheria, pertussis, hepatitis B, and German measles.
  • Prevent extra pulmonary tuberculosis among children.

Treatment of Preventable Diseases

• Symptomatic and supportive treatment includes antipyretics, analgesics, and anti-inflammatory drugs.
• Possible blood transfusion for transient aplastic anemia.
• Complications include:
  • Self-limited arthritis and arthralgia (arthritis may become chronic).
  • Serious complications (anemia, hydrops) or fetal death if mother infected during pregnancy (primarily second trimester).
  • Aplastic crisis in children with hemolytic disease or immunodeficiency.
  • Myocarditis (rare).

Diphtheria

• Agent: Corynebacterium diphtheriae.
• Source: Discharges from mucous membranes of nose and nasopharynx, skin, and other lesions of infected person.
• Transmission: Direct contact with infected person, a carrier, or contaminated articles.
• Incubation period: Usually 2-5 days, possibly longer.
• Period of communicability: Variable, until virulent bacilli are no longer present (identified by three negative cultures); usually 2 weeks but as long as 4 weeks.

Clinical Manifestations of Diphtheria

• Vary according to anatomic location of pseudomembrane.
• Nasal: Resembles common cold, serosanguineous mucopurulent nasal discharge without constitutional symptoms; may have frank epistaxis.
• Tonsillar-pharyngeal: Malaise, anorexia, sore throat, low-grade fever, pulse increased above expected for temperature within 24 hours, smooth, adherent, white or gray membrane, lymphadenitis possibly pronounced (“bull’s neck”); in severe cases, toxemia, septic shock, and death within 6-10 days.
• Laryngeal: Fever, hoarseness, cough, with or without previous signs listed; potential airway obstruction; apprehensive; dyspneic retractions; cyanosis.

Treatment of Diphtheria

• Equine antitoxin (usually intravenously); preceded by skin or conjunctival test to rule out sensitivity to horse serum.
• Antibiotics (penicillin G procaine or erythromycin) in addition to equine antitoxin.
• Complete bed rest (prevention of myocarditis).
• Tracheostomy for airway obstruction.
• Treatment of infected contacts and carriers.
• Complications: Toxic cardiomyopathy, toxic neuropathy.

Nursing Intervention for Diphtheria

• Follow Standard and Droplet Precautions until two cultures are negative for C. diphtheriae; use Contact Precautions with cutaneous manifestations.
• Administer antibiotics in a timely manner.
• Participate in sensitivity testing; have epinephrine available.
• Administer complete care to maintain bed rest.
• Use suctioning as needed.
• Observe respiration for signs of obstruction.