Nurse safety: caring for malaria patients

How Nurses Should Deal with Patients with Malaria Without Contracting the Disease

Abstract

Malaria is one of the major health issues faced on a global level and must be dealt with utmost care. Malaria can progress at a very fast rate, and patients can subsequently become too sick to even take medication by mouth. But if certain precautionary measures are taken, it is possible to stop to at least stop the direct transfer of parasites. The nursing staff is important in any medical procedure and can help in reducing any epidemic for this reason Nursing staff must take great care when dealing with a malaria case, be it giving attention to fluid equilibrium, or calculating the dosage value.

Introduction

Hook

Malaria is one of the major health problems around the world. According to statistics, the disease has had more than 40% of the population globally and more than 2,400 million people are exposed to varying degrees of risk of malaria in about 100 countries. In addition to this, with modern and fast means of travel, a large number of people from non-malarial areas are exposed to malarial infections that can seriously affect them after returning home and can be fatal. Decades ago with the advancement in medicine and technology, doctors were sure that it could be defeated, and control measures started to be very effective because the various drugs were working well. Now the picture is completely different and malaria has been rediscovered as a very serious disease.

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Background

Malaria is transmitted by a female mosquito called anopheline and it is a protozoan ailment. Malaria is caused by parasitic protozoa of the genus Plasmodium, which alternately infect humans and hosts of the insect. There are four main species of malaria that have been identified to cause human malaria which are described as:

• Plasmodium falciparum (with a mean incubation of 12 days).
• Plasmodium vivax (with a mean incubation of 13 days).
• Plasmodium ovale (with a mean incubation of 17 days).
• Plasmodium malaria (with a mean incubation of 28 days).

Malaria can prove to be a potentially fatal disease, especially for people traveling to infected areas. They should take appropriate precautions and seek help from doctors to reduce the risk of contracting it. In particular, children are more at risk because they become seriously ill in a very short time. According to a World Health Organization, 2002 report if children having malaria are left unattended, they can quickly develop serious problems like seizures, coma, and even death. Usually, the fever takes place in three stages:

• The first phase known as the cold phase is marked by shivering, cold, and chills.
• The second phase known as the hot phase follows right after. In this phase, the patient’s temperature rises rapidly up to 41°C and the person may be delirious.
• The third and final phase called the sweating phase occurs when the patient's temperature suddenly drops again. The patient’s clothes and bedding are drenched in sweat. The patient is extremely tired and weak at this point but eventually starts feeling better.

Malaria can be prevented and treated. Early diagnosis and prompt medication are two important aspects of the treatment.

Problem Statement

Malaria cases must be dealt with utmost care. So far, it’s known that some Malaria infected patients die because of the unsatisfactory work of nursing staff. Due to the negligence of nurses, a patient can suffer. Malaria can progress at very fast rate, and patients can subsequently become too sick to even take medication by mouth. Treating malaria late can result in brain damage. Other than that, pregnant women and little children cannot be dealt in the same way as other patients. A study was conducted in Tanzania, where the performance of nurses of 60 malaria patients was observed. A very small fraction of 6.7% received proper required care, the remaining 93.3 percent were not dealt in a satisfactory way. Some of the major reasons of unsatisfactory care are wrongly calculated dosage, improper use of IV Drips and other medical equipment with syringes, or not administering the syringe at the right part of the body, etc.

Research Questions

Although a great amount of work has been done on the medical treatment of Malaria, but another important question needs to be addressed, what is the proper way for nurses to deal with patients infected with Malaria? So that it won’t spread to other patients and to other medical staff. Since Malaria Parasite is present in the red blood cells of an infected person, it can spread through blood transfusion. Reuse of a needle or syringe can result in the spread of this deadly disease. It has also been found that the decreasing trend of malaria cases has stopped and in some areas, this trend is on a rise, because of this medical staff must give special attention to Malaria cases. Dealing with a malaria patient does not just involve the treatment, the follow-up after treatment is also important. A patient must know about the frequency and amount of anti-malarial drugs, and the steps of further prevention of Malaria

Hypothesis

Hospitals in most of the areas affected by a mosquito infected by malaria often properly trained nursing staff. But if certain precautionary measures are taken, it is possible to stop to at least stop the direct transfer of parasites. We do not, and may never, know the exact number of people who die because of the negligence of medical staff. But is still important to understand that special care is required when dealing with Malaria. It was found in Ahvaz, Iran, that 27% of the people affected by malaria shared needles or syringes in the previous week. And such cases can be avoided if the nursing staff disposes of syringes properly.

Thesis Statement

The nursing staff is important in any medical procedure and can help in reducing any epidemic for this reason Nursing staff must take great care when dealing with a Malaria Case, be it by giving attention to fluid equilibrium, or calculating the dosage value.

Literature Review

Malaria can prove to be fatal it’s not handled properly; more than 400,000 people die from malaria each year [1]. Good nursing is extremely important when treating a malaria patient. It is essential that a nurse must carefully not the amount of dose being given to the patient since fluid balance is important. Some patients are also unconscious, and they require special treatment. And it is also important that complications in the treatment must also be detected as early as possible [2]. For this reason, nurses must deal with malaria patients with extreme care.

But it has been found in many cases (especially in Africa), nurses do not deal with patients in a proper way. Some patients have even claimed that they were reprimanded by nurses, and were treated like little children. And at times even pregnant women were misinformed about the dosage they were given [3]. When the performance of nurses was observed in Tanzania it was found that the majority of the patients were not treated satisfactorily. Some patients were given doses at the wrong time, while others were given the wrongly calculated dose of quinine. In some cases, the dose was administered in the buttock. [4]

It is also important that a nurse must make sure that the patient is taking the medicine. In a study in North Eastern Tanzania, it was found that some nurses allowed their patients to take medicine at home. Which allowed the patient to throw their malaria medicine away instead of consuming it. The nurses must make sure that the patients are taking their medicine in the clinic. [5]

The malaria parasite is present in the red blood cell of an infected patient, and blood transfusion can be a cause of its spread. Even though it’s a rare possibility, but it was observed in Iran that it’s still a possibility [6]. A study done in Brazil showed that this was most commonly found in the users of injectable drugs [7]. Nurses and other medical staff must make sure that needles and syringes must not used again at any cost. This way disease will not spread to other patients.

The present study will discuss the proper way a nurse should deal with Malaria Patients. So, their disease can be treated in the most careful manner and it will not spread to other patients.

Method

If malaria is treated effectively and proper consultation and nursing care has been received, patients can usually expect to make a complete recovery, but severe malaria left untreated can develop extremely rapidly and can be life-threatening. To treat malaria, firstly, the steps of diagnosis are taken by the nurse.

2. Diagnosis

Proper nursing care and management can be lifesaving for the patient. Usually, malaria is hard to identify at first because of the common symptoms that are associated with malaria and also because of the fact that providing proper treatment to the patient is often delayed. Due to these reasons, malaria is not always top of a nurse's list of differential diagnoses which can ultimately prove fatal.

The diagnosis process is performed carefully by the nurse via microscopic examination of blood on thick and thin slides while making sure that no contractions occur. Ideal time to draw the blood is when the patient has a fever and it is important to realize that a single negative test is not diagnostic and that other series of tests should be performed at intervals of four to six hours. In children, Malaria is generally more difficult to diagnose because of misleading symptoms, such as gastrointestinal features, sore throat, or flu-like symptoms. Therefore, the diagnosis of malaria should always be considered in a child with a fever or very ill who has visited the endemic areas of malaria. The typical pattern of malaria symptoms is a cyclical appearance of chills, followed by rigor, high temperatures, and sweating.

Prevention

Nurses usually recommend patients several common ways to prevent mosquitoes the widespread of the disease and minimizing contraction. These mainly include the use of:

• Clothes - the more the skin is covered, the less opportunities insects will have to bite.
• Insect repellents - they must contain dietolutylamide (DEET). Up to 50% resistance can be applied to adult skin; A concentration of 10-20% is recommended for infants and children. Repellents should be applied to all exposed skin.
• Insecticides - can be used in the environment as a denaturing spray or it can be applied to clothing or to cotton and ankle bands.
• Mosquito nets - these should be treated with an insecticide such as permethrin. It is essential to sleep under a net, if not in air-conditioned accommodation.
• Vaporizers - connect these to the power supply and heat a carpet or coil soaked in permethrin that releases a pyrethroid vapor.

Treatment

For the treatment, people are advised to use medication to avoid the spreading of the disease. The appropriateness of the choice of drug depends on the type of malaria. To minimize the widespread, it is strongly recommended by nurses to take preventive medication when traveling to a region of the world that has malaria. Some of the drugs advised are as follows:

• Quinine
• Doxycycline
• Atovaquone and proguanil

A detailed note on the role of a nurse to treat and manage malaria while preventing the contraction of the disease is as follows:

Result

The results show that different drugs have been effective in different ways. Quinine has been effective in treating malaria. This includes the treatment of malaria due to Plasmodium falciparum.

Atovaquone/proguanil belongs to a class of medicines known as antimalarials and one tablet should be given daily. It is effective in preventing and treating malaria caused by mosquito bites in countries where malaria is common. Atovaquone and proguanil are highly effective against P. falciparum and appear to be well tolerated.

Doxycycline should be used to prevent malaria when traveling to endemic areas of malaria and is a good option for areas with multi-resistant chloroquine or P. falciparum. For prophylaxis, doxycycline is given once a day, starting 1 to 2 days before the trip, in the malarial areas and for 4 weeks after departure.

Discussion

Symptoms of malaria can reappear long after recovery and have no signs of malaria for long periods. This is because the malarial parasites survive in the blood if the patient has not had any treatment or has had partial treatment. These can be eradicated, but the dormant hypnozoites can hide in the liver cells, causing a recurrence and a relapse of the disease, which can occur between eight and 24 weeks, depending on the specific parasite.

Educating patients about taking and completing recommended anti-malarial courses should reduce rates of recurrence and relapse. Therefore, it is important to encourage nurses working in primary care to consider their own knowledge about malaria and to reflect on the need for accurate and rapid diagnosis; efficient management; and consistent prevention.

Limitations

Travel tips involve describing all available medicines, some of which can be eliminated depending on age or medical history and allow the user to make an informed choice. All drugs, except chloroquine and proguanil, require a prescription from a general practitioner, and the client should be buying them at a pharmacy for the retail price. Antimalarial drugs are also not cheap and can add significant costs to the travel plans of large families. In addition, some medications can cause long-term kidney problems in some people who have certain blood-related problems.

Conclusion

To prevent malaria, people need to have a good understanding of how the disease is transmitted and the methods used to prevent infection. Knowing what does not work is just as important as knowing what does works. To this end, nurses are there to guide people not only in treatment but also to prevent the spread of the disease and what measures people can take to minimize the malaria contraction of malaria.

References

1. Mendis K, Sina BJ, Marchesini P, Carter R. (2001). The neglected burden of Plasmodium vivax malaria. Am. J. Trop. Med. Hyg. 64:97–106
2. Breman JG, Alilio MS, White NJ, editors. Northbrook (IL): American Society of Tropical Medicine and Hygiene; (2007 Dec). Defining and Defeating the Intolerable Burden of Malaria III: Progress and Perspectives: Supplement to Volume 77(6) of American Journal of Tropical Medicine and Hygiene.
3. Mubyazi, G., Bloch, P., Kamugisha, M. et al. (2005). Intermittent preventive treatment of malaria during pregnancy: a qualitative study of knowledge, attitudes and practices of district health managers, antenatal care staff and pregnant women in Korogwe District, North-Eastern Tanzania. Malar J 4, 31.
4. Shogo Kanamori, Thecla W. Kohi, Tumaini Nyamhanga, Sixbert Mkude. Assessing the Performance of Nurses in the Management of Malaria Patients in Tanzania
5. Mumbai G1, Bloch P, Kamugisha M, Kitua A, Ijumba J. Intermittent preventive treatment of malaria during pregnancy: a qualitative study of knowledge, attitudes and practices of district health managers, antenatal care staff and pregnant women in Korogwe District, North-Eastern Tanzania.
6. Alavi SM1, Alavi L, Jaafari F. Outbreak investigation of needle sharing-induced malaria, Ahvaz, Iran.
7. Barata LC1, Andriguetti MT, de Matos MR. The outbreak of malaria induced among users of injectable drugs.
8. Nicholas Day and Arjen M. Dondorp. (2007). The Management of Patients with Severe Malaria.
9. Altaras, R., Nuwa, A., Agaba, B., Streat, E., Tibenderana, J. K., Martin, S., & Strachan, C. E. (2016). How Do Patients and Health Workers Interact around Malaria Rapid Diagnostic Testing, and How Are the Tests Experienced by Patients in Practice? A Qualitative Study in Western Uganda. PloS one, 11(8), e0159525. https://doi.org/10.1371/journal.pone.0159525.
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