c c c c

c


c


c
Ãc 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.

Ãc 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.

{
 c


c
c
c Establish a trusting relationship to client and family.
c Perform the assigned task efficiently and dynamically
c Understand precisely what 
 is.
c To be able to distinguish its clinical manifestations.
c To illustrate the Anatomy and Physiology of the affected organ or the part of the body
c To discuss and outline its pathophysiology.
c Find out how the health status of the client had been affected by the above disorders by:
dc £etermining its predisposing factors
dc £etermining the causative agents of the disease
dc ºonducting physical examination
dc Analyzing the results of the laboratory examinations done to the client.
c £etermine the appropriate nursing care and management that should be provided to the
client by:
dc eing familiar with the various treatment done to the client;
dc Understanding the different drugs ordered for the client and determines its
therapeutic effects and adverse reactions.
dc Evaluate the effectiveness of the medical treatment and the nursing care plans
rendered to the client.
c To apply right attitude by respect through providing privacy and maintaining client¶s
confidentiality.

1
c c c c

cc
Ú c

  


c  

c
c

c
c

cc  
c
c
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. £espite 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 ^
that is normally
transmitted by the bite of an infected female mosquito belonging to the genus
 
Majority of us do not know how does this parasitic disease affect us human through the carrier
mosquito that can cause malaria.

c 

cc  c

c 
c

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. ecause of these reasons, this case study was made.


c c c c

c { 
cc

c{
c
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.c

0  
  



  
  
 
 


Ãc This study will give guidance to whom that is experiencing and will experience Malaria
Ãc Understand condition of Malaria associate it with the patient through the introduction of
the case.
Ãc To know the Nursing history: the Personal data, Health History, and Physical assessment
of the patient.
Ãc Illustrate the Anatomy and Physiology and Pathophysiology of the affected organ or part
of the body.
Ãc £iscuss and determine manifestation and complications.
Ãc This study will create deeper knowledge on how to handle, the preventive measures and
the interventions that could be done.

c { 
cc

cc{
c

Ãc This study will focus only about Malaria.

Ãc This study is focusing primarily on the client¶s condition
Ãc 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

c 

cc c
c
c

c 
c

c

c
Ãc 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

Õ
c c c c

conditions for nature to act. Nightingale identified 5 environmental factors: fresh air, pure
water, efficient drainage, cleanliness/sanitation and light/direct sunlight.
ºoncerns of Environmental Theory
1. Proper ventilation
. Light has quite as real and tangible effects to the body.
Õ. ºleanliness and sanitation.
Ú. Warmth, quiet and diet environment.
5. Unnecessary noise is not healthy for recuperating patients.
6. £ietary 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.

c 


c






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

^
. It is widespread in tropical and subtropical regions, including parts of the
Americas, Asia, and Africa. Each year, there are approximately Õ50±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 ^
 

. Malaria caused by ^
 
,
^
 
and ^
 


causes milder disease in humans that is not
generally fatal. A fifth species, ^

 , causes malaria in macaques but can also
infect humans. This group of human-pathogenic ^
 species is usually referred to as





 .

Ú
c c c c

Usually, people get malaria by being bitten by an infective female

  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.

{
 c
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. ^

 can have recurrent fever every Õ6±Ú 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. ºerebral malaria is associated with retinal whitening, which may
be a useful clinical sign in distinguishing it from other causes of fever.

5
c c c c

Severe malaria is almost exclusively caused by ^

 infection and usually arises
6±1Ú days after infection. ºonsequences of severe malaria include coma and death if untreated²
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
0%, 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.

ºhronic malaria is seen in both ^
 and ^
, but not in ^

. Here, the
disease can relapse months or years after exposure, due to the presence of latent parasites in the
liver. £escribing 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 ^

infection is Õ0 years. Approximately one in five of ^ 
 malaria cases in temperate areas
involve overwintering by hypnozoites (i.e., relapses begin the year after the mosquito bite).

c  

c

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

humans malaria is caused by ^

, ^


, ^
, ^
 and ^
 . ^


 is the most common cause of infection and is responsible for about 0% of all
malaria cases, and is also responsible for about 90% of the deaths from malaria. Parasitic
^
 species also infect birds, reptiles, monkeys, chimpanzees and rodents.


 c


     

 

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

6
c c c c

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.

^


c
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.






Active malaria infection with ^ 

 is a medical emergency requiring

hospitalization. Infection with ^ 
, ^ 
or ^ 


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.

Î
c c c c



c{  c
c
c 
c  c^
c


c c c c ^


c
c
c

c c c  cc!c{
c ccc
!
c c c 

c"c#$c
!
c^
c c c c


c c c  c
c

c c c c
 c
c
  
 c c c 

 c%c  &c
c


cc c c'"c'(c
c


c  c ^ c cc

c


c^  c 
c

c
)ccc
c
c
c
!
c^
c
c
April 5, 011 positive case of malaria, treated at Manila £octors then discharged on April
11, 011 on Iberet 500 mg 1 tab O£ for 1 month then Referred to San Lazaro Hospital for repeat
malarial smear.

c

{ c{ c
c
c { cc^{c

{{c
c
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 Õ, 011 starts the patient¶s fever that
is on and off for  weeks and experienced also malaise. April 5, 011 had positive with malaria,
treated at Manila £octors Hospital then discharged on April 11, 011 on Iberet 500 mg 1 tab O£
for 1 month referred to San Lazaro Hospital for repeat malaria smear.
 c c c c


c c
c -According to patient, he had experienced chicken
pox at the age of 9 years old, mumps at the age of 1
years old.

c )
 c -According to patient, he was immunized with
º
,£PT,OPV,Hepatitis A, Hepatitis , and MMR but
he could not recall the exact dates the immunization
were given. Patient was immunized of Hepatitis 
vaccine before going to Africa.

c 

c xc The patient had no allergic reactions in any
foods and drugs

c 

c xc None

c  
)
c -Patient £iagnosed of Plasmodium Falcifarum at
Manila £octor¶s Hospital then this is the nd time to
hospitalized with the same diagnosis and was only refer
to San Lazaro Hospital for repeat malarial smear

c 
 
 cc 

c
c xc Iberet 500mg 1 tab O£ for 1 moth.


c 

 c
 c xc South Africa

c
c

9
c c c c


 
c{ c

c
c
c
c
c Patient Facebook is the only one who has
c
c malaria, there was no family history of the
c disease in the patient¶s family. Patient only
c
c considered the environment in Africa as a
c factor on his present illness.
c

10
c c c c

c
{
c{ c
c{c c
^cc

 Ú
   
c

According to this theory young adulthood had intimate relationship with another person
and a commitment to work and relationship. ased 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.c
c
c
c
c
c
c
c

11
c c c c

ccccccccccccccccccccccccccccccccccccccccÚ
  



c

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.
c
c
c
 cc
c
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.
c

c^ {
c {{{{c
c
^


 c c c
c 

 


c
 c

eneralc dc ºlean in appearance & well dc Slightly pale >Patient has a
Appearancec groomed and weak in proper personal
appearance hygiene even
though he had
body weakness
{c dc fair skin turgor dc Patients skin is >Negative
dry lesions noted
dc Skin color is
brown and
slightly
yellowish

1
c c c c

dc Warm to touch
dc No lesions
dc Intact dermis


c dc symmetrical head dc Rounded in

dc no signs of alopecia or shape and
foreign bodies in hair symmetrical
c dc Smooth skull
contour
dc Absence of
masses
dc Symmetric
facial features
dc Symmetric
facial
movement

c dc symmetrical in shape dc Skin intact >PERRLA
dc eyes move in conjugate dc No discharge; findings
fashion no >oth eyes are
dc pupils are equally distributed discoloration functioning
dc Symmetrical normally
eye brows
dc Equally
distributed eye
lashes
dc lack color of
pupils; equal
in size
dc Pupils
constrict when
looking at near
object; dilate
when looking
at far object
dc When looking
straight ahead,
client can see
objects in the
periphery.
dc oth eyes
coordinated

1Õ
c c c c

 c dc canals are clear w/o dc Symmetrical

discharge dc ºolor same as
dc appearance of external ear is facial skin
normal dc Mobile firm
dc both ear can hear normally and not tender
dc Able to hear
c both ear
Nosec dc centrally located dc Symmetric >There is a good
dc sinuses are non-tender and straight airway patency
c dc No discharge
dc Uniform color
dc Not tender
dc Air moves
freely as the
client breathe
through the
nose
Mouthc dc tongue is centrally located dc Lips is slightly >Patient can eat
dc pinkish and slightly dry lips darker without
dc no lesion on mouth dc No dentures discomfort
c dc Teeth color is >£ry mouth
slightly because the
yellowish patient drink only
dc Slightly dark small amount of
gums fluids
dc Tongue moves
freely
dc Pink and
smooth tonsils
dc £ry mouth
c
Neckc dc symmetric dc Muscle equal
c dc can turn from side to side in size
dc ºoordinated
c movements
with no
discomfort
dc Equal strength
c
Lungs and dc respiratory rate =0 dc ºhest >The patient is
Thoraxc breaths per minute symmetric not in respiratory
c dc thorax is symmetric dc Spine distress
dc With equal chest expansion vertically
when breathing aligned
dc Absence of

1Ú
c c c c

c adventitious
breath sounds
dc No tenderness,
absence of
masses
c
Heartc dc lood dc Pressure = >The patient has
c pressure=10/ 0mmhg 1Õ0/100 elevated P and
dc Pulse rate = 100bpm mmHg Pulse Rate
dc Negative dysrhythmia dc Pulse
Rate=16 bpm
c

Abdominalc dc Umbilicus centrally dc Absence of

c located rashes or
c dc w/ soft non tender lesions
abdomen upon palpation dc Uniform in
dc With slightly globular color
abdomen c

c
Extremitiesc dc No bone depravities c dc Equal strength >No abnormal
c dc No tenderness or swelling on each body findings aside
bonesc side that there is body
malaise due to
dc No swelling of the disease
joints process
dc ody
weakness/
malaise
c
c

^ {cc c
c

c

c^

c !

c c 

 


c
 
)
c  
)
c
dc À    Self Second time to Patient seeking
   medication be hospitalizedc medical attention
in severe cases
that needs
immediate
attention

15
c c c c

dc       c c c
 c c c

c 
cc
 c
c Ú times a day Õ times a day There is a little
c bit changes

c



c w/ very good Slightly poor regarding to the
c appetite appetite number of meals
c that pt. consumed
c per day. As well

c  cc*

c
cc glasses of water -5 glasses of as his appetite
c water and water intake
c was decreased.c

c !c
c w/ normal body Slightly smaller
c built than before
c


c 

cc*

c 5¶5´ and 9 kg 5¶5´ and 9Õ kg
dc      c c c
 c c c

c 
+
 cc
c 5-6 times a day Õ times a day The frequency of
c his urination and

c 
cc
c
c Moderate Scanty defecating
c decreased. The
c possible caused

c 
+
 cc*
c Once a day None of this is his



c current condition.
c

c  

 cc

c

c Formed None
c


c 
c



c
c Moderate None
c
dc Ú

  c c c
 c

c 
 
c NO EXERºISE Isometric exercise Even before
c (but active) hospitalization
c the patient is lack

c 

c Not easily get Not easily get of exercise, but
c tired tired he has an active
c lifestyle.

c 
c Independent Slightly dependent
c
c
c
dc º
 


c


c Oriented to time Oriented to time The patient still
place and person place, and person oriented

16
c c c c

appropriately to
verbal and
physical stimuli
dc    Have a high self Have a high self He still has a
   worth/ importance worth/ importance high self worth in
 spite of his
 current disease.

dc º  c Patient seeks for Patient is always He has a good
 some advice to his talking with his coping
 friends and family and friends techniques
 relatives when he to lessen stress
 has problems and
 burdens, burdens
 and stresses

dc ë

  He has awareness His awareness to Even he is still in
that
od really
od became the hospital he
exist stronger than still believe in
before
od that he will
get recover and
survive
c

c {ccc, c


- c
c
cc.'"c
>admit to PAV VI
> Secure consent
>Informed ward M£ of this Admission
>IVF £50.9 at Ú0 cc/hr
 c 
> Start medication of Artemether/Lumefantrine
>IVF £50.9 cc/hr
> refer
.
> For repeat malarial smear today then refer once with result
.> for blood test
>Hold order of Artemether/Lumefantrine

1Î
c c c c

.'/c
>For repeat malarial smear today
.'c
>For malarial smear repeat today


!  c {c c

{ 
c{

cccc(.'(c
c c cccccccccccc($((((c c


c

ccccccccc(.#'(c
c c ccccccccccc'( cc


c
+

c(.'c



c 

c c
c
Malarial Smear Positive Negative
Malarial Serologic Positive Negative

Remarks: Positive for P. falciparum

Ring forms: Õ/IL of blood Interpretation:
c

{ 
c{

c(.'(c Malarial Smear is used to diagnose

cccccccccccccccccccccccccccccccccc($((((c c malaria, parasitic infestation of blood;


c

cccccc(.'(c evaluate febrile disease of unknown
c c ccccccccc($c.$' c c c origin.


c
+

ccccccccc(.'(c
c
c

c 

c c
c
Hemoglobin 109 1Ú0.00-1Î5.00g/L
Hematocrit 0.ÕÕ 0.Ú-0.50
Rº ºount Õ.ÎÚ Ú.50-5.90x10^1/L
Wº ºount 6.Î Ú.00-10.50x10^9/L
asophil 0.00-0,01
Eosinophil 0.01 0.01-0.0Ú
Stab 0.01 0.0-0.05
Neutrophil 0.5 0.Õ6-0.66
Lymphocyte 0.ÕÚ 0.Ú-0.ÚÚ
Monocyte 0.06 0.0-0.1
PLATELET ºount 96 150.00-Ú50.00x10^9/L
R£W 1Î. 1.00-1Î.00%
MºV . 0.00-96.00fl

1
c c c c

MºH 9.1 Î.50-ÕÕ.0pg

MºHº Õ. ÕÕ.Ú0-Õ5.50g/dl

c
c 

 


c
c
c Malaria is diagnosed by a 


to check for
c parasites, and for the infection.
c
c
c
c
c{
c
c


c


cc .'"'(c


c


cc .'"'(c
c
    c c
cc^ 

c{

c
c
c{
c

cc
c


c


cc .'/'(c


c


cc .'/'(c
    c c
c
^ 

ccc^ 

c{

c
c
c


 


c
c
c
Repeat Malarial Smear is done to make sure if the
c
patient is still positive for malaria or the patient is
c
c recover from the disease.
c

19
c c c c

c

c{{{ccc{ {c

c 
cc^ c

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 % of body weight in the adult. It weighs
around 1Ú00g in an adult female and about 1 00g in the
male.

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
lisson'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 195Î, the french surgeon ºlaude ºouinaud described
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

0
c c c c

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 boundaries of individual
lobules. ºentral 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
5% 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 5% 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:
ºlearance of damaged red blood cells & bacteria by phagocytosis.

1
c c c c

c^
  c
üc!c!
c


c c c c

üc P
  c
%

c!
&c

Õ
c c c c

c c{ c
c

Ú
c c c c


{ c^{{c
c
c
c

c


c
c
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

c ^
)
c

c c^
c
c
  c ^
)
c 

c

c

c c The group decided that this


c
cc is the most critical diagnosis

+


c


c
c since a lack of proper
 cc



ccc nutrition is conducive to a
failed body system. A
nutrient-lacking body will
have lowered resistance to
infections or complications.


c


c 'c This was decided as the



c
cc*

c 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
0*

c
 
c


c $c A lack of knowledge is the

c cc

cc last prioritized yet still just


c

c 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.
c

5
 c c c c

c
c ^c!
cc

c
+

cc^
)
c 
 c
c

Assessment Nursing Planning Nursing Intervention Rationale Evaluation

£iagnosis
Subjective: c Imbalanced c At the end c Weighed daily or as c Assess c Within
c 'Wala nutrition less of all indicated. adequacy the shift
akong than body nursing of patient
ganang requirements interventi nutritional regain
kumain´ related to on patient intake. his
as lack of will regain appetite
verbalized interest in his c Ascertained patient¶s c Identifies and
by the food. appetite dietary program and deficit and interest
patient and/or usual pattern deviations in foods
Objective: interest in compared with recent from
c Fatigue food. intake. therapeutic
c Loss of needs.
appetite
c Weight c Provided liquids c Oral rate is
loss continuing nutrients preferred
(9 kg- and electrolytes as when
9Õkg) soon as patient can patient is
tolerate oral fluids alert and a
progress to more solid bowel
foods as tolerated. function is
restored.

c Included SO in meal c Provide use

planning as indicated. of
involvemen
t; provide
information
for SO to
understand
nutritional
needs.

c £iscuss eating habits, c To appeal

including food to client¶s
preferences/ likes or
intolerances. dislikes.

c Encourage client to c To
choose foods or have stimulate
family members bring appetite.

6
c c c c

foods that seam

appealing

c Promote pleasant, c To enhance

relaxing environment, intake.
including
socialization when
possible.

c Prevent/ minimize c May have a

unpleasant odors. negative
effect on
appetite/
eating.

c Health Teaching c To promote

given such as: optimum
a.c Maintained proper wellness
hygiene
b.c Increase oral fluid
intake
c.c Exercise daily and
adhere to
treatment /
medical regimen
d.c Encourage
adequate rest
period

c Provide c To promote
therapeutic comfort
environment

Î
 c c c c



c   c ^c 



c 

c 
c
S > 'Hindi pa rin >Activity >At the end of >Established rapport & >To build trust & >At the end of
ako ganon intolerance nursing therapeutic good Nurse- the nursing
nakakkilos at related to body intervention the communication. Patient intervention
kailangan ko pa din weakness. patient will be Relationship. the patient
daw magpahinga´. able to use
identified
identified >Assess >To identify
O > oriented to time techniques to cardiopulmonary causative or
techniques to
& place enhance activity response to physical precipitating enhance
>slightly pale in tolerance. activity including vital factors. activity
appearance signs before, during & intolerance.
>Vital signs taken: after activity. >
oal met.
P= 1Õ0/100mmHg
PR = 16 bpm >Note client reports of >Symptoms may
weakness, fatigue, be result of/or
pain, difficulty contribute to
accomplishing tasks intolerance of
and or insomnia. activity.

>Ascertained ability to >To determine

stand & move about & current status &
degree of assistance needs associated
necessary. with participation
in desired
activities.

>Plan care to carefully >To reduce

balance rest period fatigue.
with activity.

>Encourage to increase >To conserve

exercise/activity levels energy.
gradually.

>Promote comfort >To enhance

measures. ability to
participate in
activity.

>Assist client in >To prevent

learning & injuries.
demonstrating
appropriate safety
measures.


 c c c c



c   c ^c 



c 

c 
c
Subjective: Knowledge At the end of >NPI established and To build trust After all the
'Hindi ko nga deficit related the nursing maintained and rapport nursing
alam kung bakit to lack of interventions interventions
ako ngkaron ng information the patient will >Assess level of To evaluate the the patient
ganitong sakit eh´ of the disease be able to knowledge about the awareness verbalized that
as verbalized by verbalize disease about the patient
the patient understanding disease knowledge was
of the >Provide information enhanced
condition and about the disease To enhance about the
treatment. knowledge disease
>Encouraged to
verbalize questions To encourage to
cooperate on the
>Health Teachings discussions
rendered such as:

a.)Proper Hand
washing techniques To avoid cross
contamination
b.)Proper personal
hygiene

c.)Encouraged to
take plenty of fluids

d.)Encouraged to
used protective To avoid
measures spreading of the
disease
e.)Eat nutritious
foods

c {  c

9
c c c c

c
c
Patient Facebook is a Î 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. ut
after two weeks he experienced body malaise, sweating and high fever with a temperature
of Õ9 º. At first patient Facebook was admitted at Manila £octor¶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 Õ 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 £octor¶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 £octors Hospital.

Upon admission to San Lazaro Hospital Pavilion six (6), last April 6, which was
nd
his  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 £50.9 at Ú0 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. ased 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. ecause 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. ºurrently 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.

£uring 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 orc
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.1c % &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.

c
c
c
c

Õ0