General Objectives:

At the end of our duty in San Lazaro Hospital, Level III students of MSEUF-MAIN will be able to impart acquired knowledge and effective skills towards the patients through promoting, providing and maintaining, physiologic and psychological stability, and health restoration.

The aim of this study is to provide understanding to the students as well as the readers regarding Malaria. This study will show the contributing factors, occurrence and complication of the condition which is important in the preventive, promotive and rehabilitative care of the patient. We determined the appropriate nursing care and management they should provide to those patients having this kind of illness.

Specific Objectives:

Establish a trusting relationship to client and family.Perform the assigned task efficiently and dynamicallyUnderstand precisely what MALARIA is.To be able to distinguish its clinical manifestations.To illustrate the Anatomy and Physiology of the affected organ or the part of the bodyTo discuss and outline its pathophysiology.Find out how the health status of the client had been affected by the above disorders by:

Determining its predisposing factors Determining the causative agents of the disease Conducting physical examination Analyzing the results of the laboratory examinations done to the client.

Determine the appropriate nursing care and management that should be provided to the client by:

Being familiar with the various treatment done to the client; Understanding the different drugs ordered for the client and determines its

therapeutic effects and adverse reactions. Evaluate the effectiveness of the medical treatment and the nursing care plans

rendered to the client.To apply right attitude by respect through providing privacy and maintaining client’s confidentiality.

I- INTRODUCTION

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A. Background of the study

Incidence, race, gender, age, ration and proportion

Malaria is considered as the most important parasitic disease affecting man, as it is

responsible for million deaths annually. It has been identified by the World Health Organization

as one of the three major infectious disease threats, along with HIV and tuberculosis, which

together, cause more than 5 million deaths each year. Despite such high figures in mortality, the

disease is curable if it is promptly and adequately treated.

The nature of malaria as a public health problem requires sustained and systematic efforts

toward two major strategies, namely prevention of transmission through vector control and the

detection and early treatment of cases to reduce morbidity and prevent mortality.

The group of parasites causing malaria belongs to the genus Plasmodium that is normally

transmitted by the bite of an infected female mosquito belonging to the genus Anopheles.

Majority of us do not know how does this parasitic disease affect us human through the carrier

mosquito that can cause malaria.

Rationale for choosing the case

The group chose this case because it is interesting and because of its popularity

worldwide, and the fact that it has millions of deaths each year especially in South Africa. This

was also the first time of the group to handle patient with this kind of case. Although malaria is

not common in the Philippines, it is important to know about the nature of this disease. Many

countries are seeing an increasing number of imported malaria cases due to extensive travel and

migration, and because many of our fellowmen are working in different countries worldwide.

The group would also like to know and understand what this disease was all about. The

pathology and physiology of malaria, its signs and symptoms, its treatments, prevention and its

complications if not treated immediately. Because of these reasons, this case study was made.

Significance of the Study

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The Significance of this study is to enhance and gain knowledge, as well as to develop

skills and to apply interventions for patient with Malaria. This study will serve as guidelines in

assessing and providing nursing care.

These are other significance of the study that would support the above statements:

This study will give guidance to whom that is experiencing and will experience Malaria

Understand condition of Malaria associate it with the patient through the introduction of

the case.

To know the Nursing history: the Personal data, Health History, and Physical assessment

of the patient.

Illustrate the Anatomy and Physiology and Pathophysiology of the affected organ or part

of the body.

Discuss and determine manifestation and complications.

This study will create deeper knowledge on how to handle, the preventive measures and

the interventions that could be done.

Scope of limitation of Study

This study will focus only about Malaria.

This study is focusing primarily on the client’s condition

Furthermore, this study is focused on the provision of proper nursing care and

interventions that can and will alleviate condition when one experience the disease

Conceptual and Nursing Theory

FLORENCE NIGHTINGALE: Environmental theory

The environment of the patient to assist patient in recovery, the group choose the theory

of Florence Nightingale because it suit to the case of the patient. The theory focuses on

changing and manipulating the environment in order to put the patient in the best possible

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conditions for nature to act. Nightingale identified 5 environmental factors: fresh air, pure

water, efficient drainage, cleanliness/sanitation and light/direct sunlight.

Concerns of Environmental Theory

1. Proper ventilation

2. Light has quite as real and tangible effects to the body.

3. Cleanliness and sanitation.

4. Warmth, quiet and diet environment.

5. Unnecessary noise is not healthy for recuperating patients.

6. Dietary intake.

The theory is simply explained as the nurse, patient and environment interacts with each

other. There are dangers in the environment and benefits from the good environment. The role of

environmental management to patient recovery is greatly emphasized, it manipulates

environment to prevent diseases. Nurse-patient relationship focuses on cooperation and

collaboration. Nigthingale’s theory focuses on eating pattern and food preference of the patients,

provision of comfort, and protection from emotional distress and conservation of energy.

Related Literature

Malaria is a vector-borne infectious disease caused by a eukaryotic protist of the genus

Plasmodium. It is widespread in tropical and subtropical regions, including parts of the

Americas, Asia, and Africa. Each year, there are approximately 350–500 million cases of

malaria, killing between one and three million people, the majority of whom are young children

in Sub-Saharan Africa. Ninety percent of malaria-related deaths occur in Sub-Saharan Africa.

Malaria is one of the most common infectious diseases and an enormous public health

problem. Five species of the plasmodium parasite can infect humans; the most serious forms of

the disease are caused by Plasmodium falciparum. Malaria caused by Plasmodium vivax,

Plasmodium ovale and Plasmodium malariae causes milder disease in humans that is not

generally fatal. A fifth species, Plasmodium knowlesi, causes malaria in macaques but can also

infect humans. This group of human-pathogenic Plasmodium species is usually referred to as

malaria parasites.

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Usually, people get malaria by being bitten by an infective female Anopheles mosquito.

Only Anopheles mosquitoes can transmit malaria, and they must have been infected through a

previous blood meal taken on an infected person. When a mosquito bites an infected person, a

small amount of blood is taken, which contains microscopic malaria parasites. About one week

later, when the mosquito takes its next blood meal, these parasites mix with the mosquito's saliva

and are injected into the person being bitten. The parasites multiply within red blood cells,

causing symptoms that include symptoms of anemia (light-headedness, shortness of breath,

tachycardia, etc.), as well as other general symptoms such as fever, chills, nausea, flu-like illness,

and, in severe cases, coma, and death.

Although some are under development, no vaccine is currently available for malaria that

provides a high level of protection; preventive drugs must be taken continuously to reduce the

risk of infection. These prophylactic drug treatments are often too expensive for most people

living in endemic areas. Most adults from endemic areas have a degree of long-term infection,

which tends to recur, and also possess partial immunity (resistance); the resistance reduces with

time, and such adults may become susceptible to severe malaria if they have spent a significant

amount of time in non-endemic areas. They are strongly recommended to take full precautions if

they return to an endemic area.

Symptoms

Symptoms of malaria include fever, shivering, headache, nausea, fatigue, tiredness,

vomiting, hemoglobinuria, retinal damage, and convulsions. The classic symptom of malaria is

cyclical occurrence of sudden coldness followed by rigor and then fever and sweating lasting

four to six hours. P. falciparum can have recurrent fever every 36–48 hours or a less pronounced

and almost continuous fever. For reasons that are poorly understood, but that may be related to

high intracranial pressure, children with malaria frequently exhibit abnormal posturing, a sign

indicating severe brain damage. Malaria has been found to cause cognitive impairments,

especially in children. It causes widespread anemia during a period of rapid brain development

and also direct brain damage. This neurologic damage results from cerebral malaria to which

children are more vulnerable. Cerebral malaria is associated with retinal whitening, which may

be a useful clinical sign in distinguishing it from other causes of fever.

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Severe malaria is almost exclusively caused by P. falciparum infection and usually arises

6–14 days after infection. Consequences of severe malaria include coma and death if untreated—

young children and pregnant women are especially vulnerable. Splenomegaly (enlarged spleen),

severe headache, cerebral ischemia, hepatomegaly (enlarged liver), hypoglycemia, and

hemoglobinuria with renal failure may occur. Severe malaria can progress extremely rapidly and

cause death within hours or days. In the most severe cases of the disease fatality rates can exceed

20%, even with intensive care and treatment. In endemic areas, treatment is often less

satisfactory and the overall fatality rate for all cases of malaria can be as high as one in ten. Over

the longer term, developmental impairments have been documented in children who have

suffered episodes of severe malaria.

Chronic malaria is seen in both P. vivax and P. ovale, but not in P. falciparum. Here, the

disease can relapse months or years after exposure, due to the presence of latent parasites in the

liver. Describing a case of malaria as cured by observing the disappearance of parasites from the

bloodstream can, therefore, be deceptive. The longest incubation period reported for a P. vivax

infection is 30 years. Approximately one in five of P. vivax malaria cases in temperate areas

involve overwintering by hypnozoites (i.e., relapses begin the year after the mosquito bite).

Malaria parasites

Malaria parasites are members of the genus Plasmodium (phylum Apicomplexa). In

humans malaria is caused by P. falciparum, P. malariae, P. ovale, P. vivax and P. knowlesi. P.

falciparum is the most common cause of infection and is responsible for about 80% of all

malaria cases, and is also responsible for about 90% of the deaths from malaria. Parasitic

Plasmodium species also infect birds, reptiles, monkeys, chimpanzees and rodents.

Diagnostic Examination

Microscopic examination of blood films

The most economic, preferred, and reliable diagnosis of malaria is microscopic

examination of blood films because each of the four major parasite species has distinguishing

characteristics. Two sorts of blood film are traditionally used. Thin films are similar to usual

blood films and allow species identification because the parasite's appearance is best preserved in

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this preparation. Thick films allow the microscopic to screen a larger volume of blood and are

about eleven times more sensitive than the thin film, so picking up low levels of infection is

easier on the thick film, but the appearance of the parasite is much more distorted and therefore

distinguishing between the different species can be much more difficult. With the pros and cons

of both thick and thin smears taken into consideration, it is imperative to utilize both smears

while attempting to make a definitive diagnosis.

Prevention

Malaria transmission can be reduced by preventing mosquito bites with mosquito nets

and insect repellents, or by mosquito control measures such as spraying insecticides inside

houses and draining standing water where mosquitoes lay their eggs. Work has been done on

malaria vaccines with limited success and more exotic controls, such as genetic manipulation of

mosquitoes to make them resistant to the parasite have also been considered.

Methods used to prevent the spread of disease, or to protect individuals in areas where

malaria is endemic, include prophylactic drugs, mosquito eradication, and the prevention of

mosquito bites. The continued existence of malaria in an area requires a combination of high

human population density, high mosquito population density, and high rates of transmission from

humans to mosquitoes and from mosquitoes to humans. However, unless the parasite is

eliminated from the whole world, it could become re-established if conditions revert to a

combination that favors the parasite's reproduction.

Treatment

Active malaria infection with P. falciparum is a medical emergency requiring

hospitalization. Infection with P. vivax, P. ovale or P. malariae can often be treated on an

outpatient basis. Malaria infections are treated through the use of antimalarial drugs, such as

quinine or artemisinin derivatives. Treatment of malaria involves supportive measures as well as

specific antimalarial drugs. When properly treated, someone with malaria can expect a complete

recovery. Malaria infections are treated through the use of antimalarial drugs, such as quinine or

artemisinin derivatives.

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II-CLINICAL SUMMARY

A. GENERAL DATA PROFILE

Name: Patient Facebook

Address: 1858 Oro B, Santa Ana Manila Birthday: November 16 ,1983Birth Place: ManilaNationality: Filipino

Religion: Roman Catholic

Occupations: Electrician (in Africa)

Date of admission: April 26, 2011

Admitting Diagnosis: Plasmodium Falcifarum Malaria

Admitting Physician: Dr. Roberto Ibanez, MD

B.CHIEF COMPLAINT:

April 5, 2011 positive case of malaria, treated at Manila Doctors then discharged on April

11, 2011 on Iberet 500 mg 1 tab OD for 1 month then Referred to San Lazaro Hospital for repeat

malarial smear.

C.NURSING HISTORY

HISTORY OF PRESENT ILLNESS

For the last two years, patient worked as an electrician in South Africa where in the

patient’s residence was near on the forest and river. March 23, 2011 starts the patient’s fever that

is on and off for 2 weeks and experienced also malaise. April 5, 2011 had positive with malaria,

treated at Manila Doctors Hospital then discharged on April 11, 2011 on Iberet 500 mg 1 tab OD

for 1 month referred to San Lazaro Hospital for repeat malaria smear.

a. Childhood Illness -According to patient, he had experienced chicken

8

pox at the age of 9 years old, mumps at the age of 12

years old.

b. Immunizations -According to patient, he was immunized with

BCG,DPT,OPV,Hepatitis A, Hepatitis B, and MMR but

he could not recall the exact dates the immunization

were given. Patient was immunized of Hepatitis B

vaccine before going to Africa.

c. Allergies - The patient had no allergic reactions in any

foods and drugs

d. Accidents - None

e. Hospitalization -Patient Diagnosed of Plasmodium Falcifarum at

Manila Doctor’s Hospital then this is the 2nd time to

hospitalized with the same diagnosis and was only refer

to San Lazaro Hospital for repeat malarial smear

f. Medications or currently taking - Iberet 500mg 1 tab OD for 1 moth.

g. Domestic Travels - South Africa

D.FAMILY HISTORY

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E .SOCIAL HISTORY- INCLUDE THEORIES AND DEVELOPMENT

Psychosocial Theory According To Erik Erikson

According to this theory young adulthood had intimate relationship with another person

and a commitment to work and relationship. Based on our interview with the patient, we found

out that the theory of Erikson correlates with the information that we’ve gathered to the patient.

According to the patient, he really loves his wife and their relationship. The patient worked for

two years abroad and returned once a year, with the two year gap in their relationship, trust still

remained between them and with these feelings, their relationship surmounted all doubt and

became better than it was before.

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According to Sigmund Freud

According to this theory, the genital stage correlates to the patient’s age because the

patient wanted to gain independence and decision making by working and from his age the

patient wanted to be a good husband to his wife and father to their children. When it comes with

decision making, the patient is the one who make decision for his problem as long as he knows

that he can solve it with his own. The patient is in the stage of independency.

F .ENVIRONMENT/ LIVING CONDITION

The patient works as electrician in Africa for almost two years, and the environment

where he lives and work can be found near the forest and mountains. In their place also there is

an epidemic of Malaria, so the patient’s environment is considered as a factor for having that

kind of disease.

G. PHYSICAL ASSESSMENT

Parameters Normal Findings Actual Findings

Interpretation

GeneralAppearance

Clean in appearance & well groomed

Slightly pale and weak in appearance

>Patient has a proper personal hygiene even though he had body weakness

Skin fair skin turgor Patients skin is dry

Skin color is brown and slightly yellowish

>Negative lesions noted

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Warm to touch No lesions Intact dermis

Head symmetrical head no signs of alopecia or

foreign bodies in hair

Rounded in shape and symmetrical

Smooth skull contour

Absence of masses

Symmetric facial features

Symmetric facial movement

Eyes symmetrical in shape eyes move in conjugate

fashion pupils are equally distributed

Skin intact No discharge;

no discoloration

Symmetrical eye brows

Equally distributed eye lashes

Black color of pupils; equal in size

Pupils constrict when looking at near object; dilate when looking at far object

When looking straight ahead, client can see objects in the periphery.

Both eyes coordinated

>PERRLA findings>Both eyes are functioning normally

Ears canals are clear w/o discharge

appearance of external ear is normal

both ear can hear normally

Symmetrical Color same as

facial skin Mobile firm

and not tender

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Able to hear both ear

Nose centrally located sinuses are non-tender

Symmetric and straight

No discharge Uniform color Not tender Air moves

freely as the client breathe through the nose

>There is a good airway patency

Mouth tongue is centrally located pinkish and slightly dry lips no lesion on mouth

Lips is slightly darker

No dentures Teeth color is

slightly yellowish

Slightly dark gums

Tongue moves freely

Pink and smooth tonsils

Dry mouth

>Patient can eat without discomfort>Dry mouth because the patient drink only small amount of fluids

Neck symmetric can turn from side to side

Muscle equal in size

Coordinated movements with no discomfort

Equal strength

Lungs and Thorax

respiratory rate =20breaths per minute

thorax is symmetric With equal chest expansion

when breathing

Chest symmetric

Spine vertically aligned

Absence of adventitious breath sounds

No tenderness, absence of masses

>The patient is not in respiratory distress

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Heart Blood pressure=120/80mmhg

Pulse rate = 100bpm Negative dysrhythmia

Pressure = 130/100 mmHg

Pulse Rate=126 bpm

>The patient has elevated BP and Pulse Rate

Abdominal Umbilicus centrally located

w/ soft non tender abdomen upon palpation

With slightly globular abdomen

Absence of rashes or lesions

Uniform in color

Extremities No bone depravities No tenderness or swelling

bones

Equal strength on each body side

No swelling of joints

Body weakness/malaise

>No abnormal findings aside that there is body malaise due to the disease process

H.PATTERNS OF FUNCTIONING

Functional Health Pattern

Before Hospitalizatio

n

During Hospitalizatio

n

Interpretation

Health management Pattern

Self medication

Second time to be hospitalized

Patient seeking medical attention in severe cases that needs immediate attention

Nutritional/ Metabolic

a. Number of meals per day

b. Appetite

4 times a day

w/ very good appetite

3 times a day

Slightly poor appetite

There is a little bit changes regarding to the number of meals

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c. Glass of water per day

d. Body built

e. Height and weight

8 glasses of water

w/ normal body built

5’5” and 98 kg

2-5 glasses of water

Slightly smaller than before

5’5” and 93 kg

that pt. consumed per day. As well as his appetite and water intake was decreased.

Elimination

a. Frequency of urination

b. Amount of urine per day

c. Frequency of bowel movement

d. Consistency of the feces

e. Amount defecated per day

5-6 times a day

Moderate

Once a day

Formed

Moderate

3 times a day

Scanty

None

None

None

The frequency of his urination and defecating decreased. The possible caused of this is his current condition.

Activity and Exercise

a. Exercise

b. Fatigability

c. ADL

NO EXERCISE(but active)

Not easily get tired

Independent

Isometric exercise

Not easily get tired

Slightly dependent

Even before hospitalization the patient is lack of exercise, but he has an active lifestyle.

Cognitive/Perceptual

a. Orientation Oriented to time place and person

Oriented to time place, and person appropriately to verbal and physical stimuli

The patient still oriented

Self Perception/Self concept

Have a high self worth/

Have a high self worth/

He still has a high self worth

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Coping/Stress

Values and Beliefs

importance

Patient seeks for some advice to his friends and relatives when he has problems and burdens, burdens and stresses

He has awareness that God really exist

importance

Patient is always talking with his family and friends to lessen stress

His awareness to God became stronger than before

in spite of his current disease.

He has a good coping techniques

Even he is still in the hospital he still believe in God that he will get recover and survive

COURSE IN THE WARD

Doctor’s Order

4/26/11

>admit to PAV VI

> Secure consent

>Informed ward MD of this Admission

>IVF D50.9 at 40 cc/hr

1:15 pm

> Start medication of Artemether/Lumefantrine

>IVF D50.9 cc/hr

> refer

1:45

> For repeat malarial smear today then refer once with result

.> for blood test

>Hold order of Artemether/Lumefantrine

4/27/11

>For repeat malarial smear today

4/28/11

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>For malarial smear repeat today

I-LABORATORY DIAGNOSTIC EXAM

Sample Submitted: 04/18/2011 03:00:00 pm

Result Verified: 04/19/2011 11:21:05 am

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Test request: 04/18/2o11

Hematology Result Normal ValueMalarial Smear Positive Negative

Malarial Serologic Positive Negative

Remarks: Positive for P. falciparum Ring forms: 32/IL of blood

Sample Submitted: 04/18/2011 03:00:00 pmResult Verified: 04/18/2011

03: 43:25 pmTest Request: 04/18/2011

Examination Result Normal ValueHemoglobin 109 140.00-175.00g/LHematocrit 0.33 0.42-0.50RBC Count 3.74 4.50-5.90x10^12/LWBC Count 6.27 4.00-10.50x10^9/L

Basophil 0.00-0,01Eosinophil 0.01 0.01-0.04

Stab 0.01 0.02-0.05Neutrophil 0.58 0.36-0.66

Lymphocyte 0.34 0.24-0.44Monocyte 0.06 0.02-0.12

PLATELET Count 296 150.00-450.00x10^9/LRDW 17.2 12.00-17.00%MCV 88.8 80.00-96.00flMCH 29.1 27.50-33.20pg

MCHC 32.8 33.40-35.50g/dl

Malarial Smear

Date Regulated: 4/26/2011

Date released: 4/26/2011

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Interpretation:

Malarial Smear is used to diagnose malaria, parasitic infestation of blood; evaluate febrile disease of unknown origin.

Interpretation:

Malaria is diagnosed by a blood test to check for parasites, and for the infection.

Microscopic Findings

No Malaria Parasite Seen

Malaria Smear Result Form

Date Regulated: 4/27/2011

Date Released: 4/27/2011

Microscopic Findings

Parasite: No Malaria Parasite Seen

III- CLINICAL DISCUSSION OF THE DISEASE

Anatomy and Physiology

Human liver development begins during the third week

of gestation and does not achieve mature architecture

until about 15 years of age. It reaches its largest relative

size, 10% of fetal weight, around the ninth week. It is

about 5% of body weight in the healthy neonate. The

liver is about 2% of body weight in the adult. It weighs

around 1400g in an adult female and about 1800g in the

male.

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Interpretation:

Repeat Malarial Smear is done to make sure if the

patient is still positive for malaria or the patient is

recover from the disease.

The liver is located in the right upper quadrant of the abdomen, just below the diaphragm. It is

almost completely behind the rib cage but the lower edge may be palpated along the right costal

margin during inspiration. A connective tissue layer called Glisson's capsule covers the surface

of the liver. The capsule extends to invest all but the smallest the vessels within the liver.

The falciform ligament attaches the liver to the abdominal wall and diaphragm and divides the

liver into a larger right lobe and a smaller left lobe.

In 1957, the french surgeon Claude Couinaud described 8

liver segments. Since then, radiographic studies describe

an average of twenty segments based on distribution of

blood supply. Each segment has its own independent

vascular and biliary branches. Surgeons utilize these

independent segments when performing liver resection for

tumor or transplantation. There are at least three reasons

why segmental resection is superior to simple wedge

resection. First, segmental resection minimizes blood loss

because vascular density is reduced at the borders between

segments. Second, it results in improved tumor removal for

those cancers which are disseminated via intrasegmental branches of the portal vein. Third,

segmental resection spares normal liver allowing for repeat partial hepatectomy.

Each segment of the liver is further divided into lobules.

Lobules are usually represented as discrete hexagonal

aggregations of hepatocytes. The hepatocytes assemble as

plates which radiate from a central vein. Lobules are served

by arterial, venous and biliary vessels at their periphery.

This model is useful for teaching purposes but more closely

resembles the adult pig lobule than the human. Human

lobules have little connective tissue separating one lobule

from another. The paucity of connective tissue makes it

more difficult to identify the portal triads and the

20

boundaries of individual lobules. Central veins are easier to identify due to their large lumen and

because they lack connective tissue that invests the portal triad vessels.

Lobules consist of hepatocytes and the spaces between them. Sinusoids are the spaces between

the plates of hepatocytes. Sinusoids receive blood from the portal triads. About 25% of total

cardiac output enters the sinusoids via terminal portal and arterial vessels. Seventy-five percent

of the blood flowing into the liver comes through the portal vein; the remaining 25% is

oxygenated blood that is carried by the hepatic artery. The blood mixes, passes through the

sinusoids, bathes the hepatocytes and drains into the central vein. About 1.5 liters of blood exit

the liver every minute.

The liver is central to a multitude of physiologic functions, including:

Clearance of damaged red blood cells & bacteria by phagocytosis.

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PathophysiologyBook Based

22

Pathophysiology

(Client Based)

23

24

DRUG STUDY

25

IV.NURSING PROCESS

Long term Objectives

The study aims to restore the mobilization and prevent complication of the patient

through collaborative management with physician, Medicine Technologist associate with

nutritionist.

After treatment, the patient’s condition will be better through proper compliance of the

patient in taking medications, proper participation to the medical and nursing intervention

Prioritized List Nursing Problem

Diagnosis Prioritization RationaleImbalanced Nutrition: Less than body requirements related to lack of interest in food

1 The group decided that this is the most critical diagnosis since a lack of proper nutrition is conducive to a failed body system. A nutrient-lacking body will have lowered resistance to infections or complications.

Activity Intolerance related to body weakness

2 This was decided as the second prioritized diagnosis since an intolerance in activity will contribute to a lack in performing activities of daily living, thus, providing for an unsanitary environment for the patient

Knowledge deficit related to lack of information of the disease

3 A lack of knowledge is the last prioritized yet still just as important for the reason that a lack in knowledge regarding the illness will promote to the clients’ anxiety. A lack of knowledge will also make the client unaware of possible complications for the disease.

NCP Based on the sequence of Prioritized problems

Assessment Nursing Diagnosis Planning Nursing Intervention Rationale Evaluation

Subjective: “Wala

akong

Imbalanced nutrition less than body

At the end of all nursing

Weighed daily or as indicated.

Assess adequacy of nutritional intake.

Within the shift patient

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ganang kumain” as verbalized by the patient

Objective: Fatigue Loss of

appetite Weight

loss (98kg-93kg)

requirements related to lack of interest in food.

intervention patient will regain his appetite and/or interest in food.

Ascertained patient’s dietary program and usual pattern compared with recent intake.

Provided liquids continuing nutrients and electrolytes as soon as patient can tolerate oral fluids progress to more solid foods as tolerated.

Included SO in meal planning as indicated.

Discuss eating habits, including food preferences/ intolerances.

Encourage client to choose foods or have family members bring foods that seam appealing

Promote pleasant, relaxing environment, including socialization when possible.

Prevent/ minimize unpleasant odors.

Health Teaching given such as:a. Maintained proper

hygieneb. Increase oral fluid

intake

Identifies deficit and deviations from therapeutic needs.

Oral rate is preferred when patient is alert and a bowel function is restored.

Provide use of involvement; provide information for SO to understand nutritional needs.

To appeal to client’s likes or dislikes.

To stimulate appetite.

To enhance intake.

May have a negative effect on appetite/ eating.

To promoteoptimum wellness

regain his appetite and interest in foods

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c. Exercise daily and adhere to treatment / medical regimen

d. Encourage adequate rest period

Provide therapeutic environment

To promote comfort

Assessment Diagnosis Planning Intervention Rationale Evaluation

S > “Hindi pa rin ako ganon nakakkilos at kailangan ko pa din daw magpahinga”.

O > oriented to time & place>slightly pale in appearance>Vital signs taken: BP= 130/100mmHgPR = 126 bpm

>Activity intolerance related to body weakness.

>At the end of nursing intervention the patient will be able to use identified techniques to enhance activity tolerance.

>Established rapport & therapeutic communication.

>Assess cardiopulmonary response to physical activity including vital signs before, during & after activity.

>Note client reports of weakness, fatigue, pain, difficulty accomplishing tasks and or insomnia.

>Ascertained ability to stand & move about & degree of assistance necessary.

>To build trust & good Nurse-Patient Relationship.

>To identify causative or precipitating factors.

>Symptoms may be result of/or contribute to intolerance of activity.

>To determine current status & needs associated with participation

>At the end of the nursing intervention the patient identified techniques to enhance activity intolerance.>Goal met.

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>Plan care to carefully balance rest period with activity.

>Encourage to increase exercise/activity levels gradually.

>Promote comfort measures.

>Assist client in learning & demonstrating appropriate safety measures.

in desired activities.

>To reduce fatigue.

>To conserve energy.

>To enhance ability to participate in activity.

>To prevent injuries.

Assessment Diagnosis Planning Intervention Rationale Evaluation

29

Subjective:“Hindi ko nga alam kung bakit ako ngkaron ng ganitong sakit eh” as verbalized by the patient

Knowledge deficit related to lack of information of the disease

At the end of the nursing interventions the patient will be able to verbalize understanding of the condition and treatment.

>NPI established and maintained

>Assess level of knowledge about the disease

>Provide information about the disease

>Encouraged to verbalize questions

>Health Teachings rendered such as:

a.)Proper Hand washing techniques

b.)Proper personal hygiene

c.)Encouraged to take plenty of fluids

d.)Encouraged to used protective measures

e.)Eat nutritious foods

To build trust and rapport

To evaluate the awareness about the disease

To enhance knowledge

To encourage to cooperate on the discussions

To avoid cross contamination

To avoid spreading of the disease

After all the nursing interventions the patient verbalized that patient knowledge was enhanced about the disease

SUMMARY

Patient Facebook is a 27 year old, electrician in South Africa. He works and lives there for almost two years, and he came here in the Philippines only once a year. The patient came back here in the Philippines not for vacation but because his father died. But after two weeks he experienced body malaise, sweating and high fever with a temperature of 39 C. At first patient

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Facebook was admitted at Manila Doctor’s Hospital last April 5, which was his first time hospitalization. Then after six days, April 11 Patient Facebook was discharged with a diagnosis of Plasmodium Falcifarum Malaria. Patient Facebook was recovered but after 3 days, he experienced again the symptoms of Malaria, he experienced on and off fever, body malaise and loss of appetite. So the patient’s wife decided to admit his again at Manila Doctor’s Hospital, but the hospital decided to refer the patient at San Lazaro Hospital for malarial smear. The wife of the patient agreed because they can’t afford the fee in Manila Doctors Hospital.

Upon admission to San Lazaro Hospital Pavilion six (6), last April 26, which was his 2nd

time hospitalization the result of malarial smear was positive that is why he need to be confined for more observation. The patient had an IVF D50.9 at 40 cc/hr. The patient was ordered again for malarial smear and resulted to negative that is why the Artemether/Lumefantrine which was his only drug was hold. Based on our interview with him, he was the only one in his family that has this kind of disease and he considered that he got this infection in South Africa where he works and lives. Because according to patient Facebook, the environment there is forest and shaded mountain with river. According to him also, in South Africa the malaria case is epidemic. Currently the patient is still at recovery stage, he doesn’t have fever and he only felt slight body malaise. The patient said that he is feeling better now unlike before.

During our duty with Patient Facebook, we gave health teachings to him and to his wife to promote wellness such as: (a) Encouraged to maintain proper sanitation or clean their house and surroundings, especially with those areas that mosquitoes can live;(b) Encouraged also to eat nutritious foods such as vegetables and fruits.; (c) Advised the importance of cleanliness at all times; (d)Encouraged patient to take enough rest and sleep; (e) Advised patient to have daily exercise, only those activities which he can tolerate and (f)emphasize the importance of having a proper hygiene and hand washing.

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