MALARIA

DISEASE
 GROUP 4 MEMBERS

Elaine Manzanillo Junar Mercado Richard Navarro Angelo Parcon

Lovely Patino Ana Pondevida Lyle Ramilo Kyle Sabay

 CASE SCENARIO
Zaldy Zhornack, a 36-yo male who lives in Marinduque visits his relatives in Antipolo. He
was admitted in FUMC because of sustained fever for 12 days prior to admission. During
assessment, Zaldy presented with fever and chills, as well as malaise, severe headache,
fatigue, nausea and vomiting, abdominal discomfort, and muscle pains. When asked
about his diet, Zaldy verbalized that he had a poor oral intake for 4 days. There are no
symptoms of difficulty of breathing nor signs of respiratory distress. On admission, Zaldy’s
physical examination revealed a high-grade fever of 40OC, a blood pressure of 110/70 mmHg, a
heart rate of 80 bpm and a respiration rate of 22 breaths per minute. He looked sick and he is
sweating profusely. Breath sounds was normal upon auscultation of both lungs, but he had
mild tenderness on the upper right side of the abdomen and the epigastrium and
Zaldy had no signs of neurological deficits during the time of assessment. Zaldy’s
abdominal ultrasound reveals hepatomegaly and splenomegaly. A thick and thin malarial
smear were done and showed normochromic red blood cells with ring-form of
plasmodium falciparum in the normal-sized red cells. CBC reveals a RBC of 4.0 million/mm3,
a Hct of 57%, a WBC of 4,000/mm3, and differential count revealing an increasing monocytes
value. A splenic biopsy is also done and reveals senescent red blood cells. Zaldy was
prescribed with Artemether Lumefantrine orally and was advised to take the drug 2 times a
day with meals for 3 days. The doctor also ordered erythrocyte exchange transfusion. Because
of poor oral intake, Zaldy received a normal saline infusion for hydration for 7 days.
 TABLE OF CONTENTS

01 02 03
ABOUT THE DISEASE PATHOPHYSIOLOGY IMPORTANCE OF DIAGNOSTIC AND
LABORATORY TESTS

05 04 06
NURSING CARE PLAN DRUG STUDY REFERENCES
01 About the Disease
 INTRODUCTION
According to Burke (2019), “Malaria is a life-threatening
disease. It’s typically transmitted through the bite of an
infected Anopheles mosquito. Infected mosquitoes carry
the Plasmodium parasite. When this mosquito bites you,
the parasite is released into your bloodstream.” She added
that “Once the parasites are inside your body, they travel to
the liver, where they mature. After several days, the mature
parasites enter the bloodstream and begin to infect red
blood cells.”
02 PATHOPHYSIOLOGY
 Non-modifiable Sporozoites from the mosquito’s salivary glands is
Factors: Modifiable Factors:
Male injected into the human’s bloodstream using its Lives in Marinduque
36 years old Proboscis

Sporozoites travel to the liver

Binds to tetraspanin CD81 receptor along with

co-receptor SR-B1 of hepatocytes

Infection in the hepatocyte and hypertrophy and

hyperplasia of the Kupffer cells and are filled with Hepatomegaly
malarial pigment

Sporozoites undergo asexual reproduction

LEGEND
(Schizogony)

Contributing Factors
Replication of Sporozoites to form merozoites while
Disease Process some hepatocytes die

Manifestations PAGE 1
Merozoites enter the circulation and each one binds to
surface receptors and infects RBCs of any age

Merozoites undergo asexual reproduction inside the

RBCs (Eryhtrocytic phase)

Transformational changes where two or more ring

forms are in a single RBC (1st Stage)

Trophozoite grows (Late Trophozoite or 2nd stage)

Trophozoite grows more by digesting Hgb and

RBC of 4.0
leaving behind Hemozoin (3rd stage); Parasites are million/mm3
now called Schizont

Replicative phase where the parasites undergo

Page 4
mitosis and differentiate into merozoites

PAGE 2
 Some merozoites undergo Gametogony

Produces gametocytes and remains in RBCs and get

sucked up by another female Anopheles mosquito

Gametocytes reaches the mosquito’s gut, mature and

forms a zygote (Sporogony)

Ookinate

Oocysts

Oocysts rupture releasing sporozoites and makes

their way in mosquito’s salivary glands

The life cycle of P. Falciparum repeats

PAGE 3
 Rupture of Plasmodium-infected RBCs

Red cell membrane products, hemozoin pigment,

and other toxic factors such as
glycosylphosphatidylinositol (GPI) are released into
the blood.

Hemozoin is released and is rapidly engulfed by

phagocytes

As a result of phagocytosis, several functions of

monocytes are seriously compromised

Impaired Hz-laden monocytes do not undergo

apoptosis

Differential count
Prolonged impaired monocyte survival and maintains in revealing an increasing
the bloodstream monocytes value.

PAGE 4
 Infected RBCs goes into the spleen

Macrophages release proinflammatory cytokines

(TNF-alpha, IL-1β, IL-6, and IFN-gamma)
Malaise, severe
headache, fatigue,
Inflammatory environment is amplified by reciprocal nausea and vomiting,
muscle pains, Hct of 57%
activation loops involving monocytes, NKT cells, T cells,
and endothelial cells
Hepatosplenomegaly
Abdominal discomfort
Mild tenderness on the
Excessive inflammatory response upper right side of the
abdomen and the
epigastrium
Plasmodial DNA intracellularly react with the Toll-like
receptor-9, leading to the release of proinflammatory Sustained fever for 12
cytokines that in turn induce COX-2-upregulating days
Fever and chills
prostaglandins High-grade fever of 40°C
Sweating profusely
Induction of apoptosis in developing erythroid cells in
the bone marrow

Malaria
PAGE 5
 Importance of
03 diagnostic and
laboratory
testing
 PHYSICAL EXAMINATION
According to Dunning & Fischbach (2011),
Physical examination, these tests may confirm
or rule out a diagnosis or may provide valuable
information about a patient’s status and
response to therapy that may not be apparent
from the history and physical exam alone.

Indications:
-Check for possible diseases so they can be
treated early.
-Palpation as an important part of the physical
examination. Used to detect tenderness on the
abdomen.

Clinical Implications:
-Physical findings in malaria may include fever,
and weakness. Other findings on physical exam
are splenomegaly, and hepatomegaly.

Patient’s Case:
-Revealed a high-grade fever of 40 degrees
Celsius
-He looked sick and he is sweating profusely
-Mild tenderness on the upper right side of
the abdomen and the epigastrium
According to John Hopkins Medicine (n.d.), an
abdominal ultrasound is a noninvasive procedure
Abdominal ultrasound
used to assess the organs and structures within the
abdomen. This includes the liver, gallbladder,
pancreas, bile ducts, spleen, and abdominal aorta.
Ultrasound technology allows quick visualization of
the abdominal organs and structures from outside
the body.

Indications:
-It is used to help diagnose pain or distention NORMAL
(enlargement) and evaluate the kidneys, liver,
gallbladder, bile ducts, pancreas, spleen and
abdominal aorta.
SPLENOMEGALY
Clinical Implications:
-Hyperreactive Malarial Splenomegaly (HMS) is
defined as a massive enlargement of the spleen
resulting from abnormal immune responses after
repeated exposure to the malaria parasites. HEPATOMEGALY
-The malaria parasites enter that person's
bloodstream and travel to the liver. When the
parasites mature, they leave the liver which causes
hepatomegaly and infect red blood cells.

Patient’s Case:
-Abdominal ultrasound reveals that the patient have
splenomegaly, and hepatomegaly
 Think and Thick Malarial Smear
Doctors use thick and thin blood smears to determine whether
you have malaria. Thick and thin blood smears will let doctors
know the percentage of red blood cells that are infected
(parasite density) and what type of parasites are present.
(Healthwise staff, 2020)
Clinical Implications:
- Normochromic anemia is the type of anemia in which
the circulating RBCs are the same size (normocytic) and
have a normal red color (normochromic).
- Plasmodium falciparum, the most virulent of the human
malaria parasites, causes up to one million deaths per
year.

Patient’s Case:
The test result showed normochromic red blood cells with
ring-form of plasmodium falciparum in the normal-sized red
cells.

Normal Values:
No parasites are present in red blood cells. Your doctor will
repeat the test every 8 hours for 1 or 2 days if he or she still
suspects that you have malaria.
 COmplete blood count (CBC)
According to Stanford Health Care, (n.d) this checks
for anemia or evidence of other possible infections.
Anemia sometimes develops in people with malaria,
because the parasites damage red blood cells.

Indications:
● Assess your general state of health
● Check if you have an infection
● See how well certain organs, such as the liver
and kidneys, are working
● Screen for certain genetic conditions

Patient’s case:
CBC reveals:
● RBC of 4.0 million/mm3 (Decreased)
● Hct of 57% (Increased)
● WBC of 4,000/mm3 (Decreased)
● Differential count revealing an increasing
monocytes value.
 Splenic biopsy
According to Myhealth (2020), A needle biopsy of the spleen is
a process that involves taking a small sample of spleen tissue
(biopsy). It's also known as a fine-needle aspiration or
aspiration biopsy. A microscope will be used to examine the
tissue sample for signs of infection caused by a single-celled
parasite of the genus plasmodium

Indications
- A spleen biopsy may be done when blood tests are abnormal.
It also may be done when an ultrasound, a CT scan, or an MRI
shows a problem with the spleen.

Clinical Implications:
- Invasion by the malaria parasite, P. falciparum brings about
extensive changes in the host red cells. Which includes
senescent red blood cells or the process by which a cell ages
and permanently stops dividing but does not die.

Patient’s Case:
- Splenic Biopsy reveals senescent red blood cells
.
03 NURSING CARE
PLAN
NCP #1
PRIORITY
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Objective: Hyperthermia Short Term Plan: INDEPENDENT Short Term Plan:

After 1 ½ hours of
*fever of 40 C, Related to
After 1 ½ hours of nursing intervention the
*Chills illness Identify underlying cause such as To assess causative/ patient :
nursing intervention the
*Fatigue AEB the loss of thermoregulation, e.g. may contributing factors: * temperature returned to
patient
*Increase RR 22 patient is normal range.
occur in infections,
- temperature will return YES__NO__
breaths per having fever
*Identified underlying
minute of 40 degree to normal range. cause or contributing
Assess whether body temperature Defined as body
celsius, - Identify underlying reflects heat stroke. temperature higher than factors and importance
chills,fatigue of treatment, as well as
cause or contributing 105°F (40.5°C), which is signs/symptoms
and his RR is factors and importance associated with neurological requiring further
22 b/min. of treatment, as well as dysfunction and is potentially evaluation or
signs/symptoms intervention.
life threatening.
YES__NO__
requiring further
evaluation or Assess neurological responses, High fever accompanied by Long term Plan:
intervention. noting the level of consciousness changes in mentation (from After 8 hours of nursing
interventions the patient
Long term Plan: and orientation, reaction to stimuli, confusion to delirium) may was:
reaction of pupils, and presence of indicate septic state or *free of complications,
After 8 hours of nursing such as irreversible brain
posturing or seizures. heatstroke.
interventions the patient or neurological damage
will: and acute renal failure.
Monitor blood pressure and invasive Central YES__NO__
- Be free of hemodynamic parameters if hypertension or postural * free of seizure activity.
complications, such as available (e.g., mean arterial hypotension can occur. YES__NO__
irreversible brain or pressure [MAP], Goal was met?
neurological damage Yes__ No__
and acute renal failure. Partially Met?
Identify underlying cause such as To assess causative/
Yes__ No__
- Be free of seizure loss of thermoregulation, e.g. may contributing factors: Not met?
activity. occur in infections, YYes__ No__
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Objective: Hyperthermia Short Term Plan: INDEPENDENT Short Term Plan:

After 1 ½ hours of nursing
*fever of 40 C, Related to
After 1 ½ hours of intervention the patient :
*Chills illness Monitor and record all sources Which can potentiate fluid * temperature returned to
nursing intervention the
*Fatigue AEB having of fluid loss such as urine and electrolyte losses. normal range.
patient
*Increase RR fever of 40 YES__NO__
vomiting and diarrhea, wounds,
- temperature will return *Identified underlying cause
22 breaths per degree celsius fistulas, and insensible losses, or contributing factors and
minute. , chills,fatigue to normal range. importance of treatment, as
and his RR is - Identify underlying Promote surface cooling by Alcohol sponge baths are well as signs/symptoms
22 b/min. requiring further evaluation
cause or contributing means of undressing or cool, contraindicated because or intervention.
factors and importance tepid sponge baths. they increase peripheral YES__NO__
of treatment, as well as vascular constriction and
signs/symptoms Long term Plan:
central nervous system
After 8 hours of nursing
requiring further (CNS) depression; cold interventions the patient
evaluation or water sponges or was:
intervention. immersion can increase *free of complications, such
as irreversible brain or
Long term Plan: shivering, producing heat.
neurological damage and
acute renal failure.
After 8 hours of nursing YES__NO__
Maintain bedrest to reduce metabolic
interventions the patient * free of seizure activity.
demands and oxygen
will: YES__NO__

- Be free of Provide high-calorie diet, enteral to meet increased Goal was met?
complications, such as nutrition, or parenteral nutrition metabolic demands Yes__ No__
irreversible brain or Partially Met?
Yes__ No__
neurological damage Not met?
and acute renal failure. YYes__ No__
- Be free of seizure
activity.
 ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Objective: Hyperthermia Short Term Plan: DEPENDENT Short Term Plan:

After 1 ½ hours of
*fever of 40 C, Related to illness
After 1 ½ hours of nursing nursing intervention the
*Chills AEB having Administer antipyretics as to reduce body patient:
intervention the patient
*Fatigue fever of 40 prescribed e.g. paracetamol temperature/restore *temperature returned to
*Increase RR 22 degree celsius , - temperature will return to normal body/organ function: normal range.
normal range. YES__NO__
breaths per chills,fatigue and
*Identified underlying
minute. his RR is 22 - Identify underlying cause Administer medications, as To treat underlying cause or contributing
b/min. or contributing factors and indicated, e.g. Artemether cause, (for infection), factors and importance of
treatment, as well as
importance of treatment, as Lumefantrine. signs/symptoms requiring
well as signs/symptoms further evaluation or
requiring further evaluation intervention.
or intervention. Administer replacement fluids To support circulating volume YES__NO__
and electrolytes. and tissue perfusion.
Long term Plan: Long term Plan:
After 8 hours of nursing
After 8 hours of nursing interventions the patient
interventions the patient was:
will: *free of complications,
such as irreversible brain
- Be free of complications, or neurological damage
such as irreversible brain or and acute renal failure.
YES__NO__
neurological damage and * free of seizure activity.
acute renal failure. YES__NO__
- Be free of seizure activity. Goal was met?
Yes__ No__
Partially Met?
Yes__ No__
Not met?
YYes__ No__
 NCP
POTENTIAL
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Risk factor: Risk for Short Term Plan: INDEPENDENT Short Term Plan:
deficient fluid After 30 mins. of nursing
Insufficient After 30 mins of nursing
volume related interventions the patient :
fluid intake interventions the patient Note possible conditions or To assess
to Insufficient processes that may lead to causative/contributing factors: *Identified individual risk factors
Nausea will:
fluid intake, deficits: (1) fluid loss (e.g., fever, and appropriate interventions.

Vomiting nausea, - Identify individual risk diarrhea, vomiting, excessive YES__No__

vomiting, and factors and appropriate sweating; heat stroke. Long term Plan:
Sweating sweating interventions
Profusely After all the nursing
profusely Long term Plan: Note the client’s level of To evaluate the ability to interventions until the day of
discharge the patient::
- After all the nursing consciousness and mentation express needs.
interventions until the *Maintained fluid volume at a
functional level as evidenced by
day of discharge the Evaluate nutritional status, This can negatively affect individually adequate urinary
patient will: noting current intake and type fluid intake. output with normal specific
of diet. Note problems(e.g., gravity, stable vital signs, moist
-Maintain fluid volume at nausea, fever.) mucous membranes, and good
a functional level as skin turgor.
evidenced by YES__NO__
Review laboratory data (e.g., To evaluate fluid and
individually adequate *Demonstrated behaviors or
hemoglobin electrolyte status lifestyle changes to prevent
urinary output with
normal specific gravity, Hb]/hematocrit.[Hct],osmolalit development
stable vital signs, moist y, electrolytes [e.g., sodium of fluid volume deficit.
mucous membranes, and potassium], blood urea YES__NO__
and good skin turgor. nitrogen/creatinine [BUN/Cr]) Goal was met?
- Demonstrate Yes__ No__
Partially Met?
behaviors or lifestyle Yes__ No__
changes to prevent Not met?
development YYes__ No__

of fluid volume deficit.

ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Risk factor: Risk for Short Term Plan: INDEPENDENT Short Term Plan:
deficient fluid After 30 mins. of nursing
Insufficient After 30 mins of nursing
volume related interventions the patient :
fluid intake interventions the patient Compare current fluid intake To ensure an
to Insufficient to fluid goal. Monitor intake accurate picture *Identified individual risk factors
Nausea will:
fluid intake, and appropriate interventions.
- Identify individual risk and output (I&O) balance, if of fluid status.
Vomiting nausea, YES__No__
vomiting, and factors and appropriate indicated, being aware of
Long term Plan:
Sweating sweating interventions changes in intake or output,
Profusely After all the nursing
profusely Long term Plan: as well as insensible losses. interventions until the day of
discharge the patient::
After all the nursing
Assess skin and oral mucous For signs of dehydration, *Maintained fluid volume at a
interventions until the
membranes such as dry skin and functional level as evidenced by
day of discharge the individually adequate urinary
patient will: mucous membranes, poor output with normal specific
skin turgor, delayed capillary gravity, stable vital signs, moist
- Maintain fluid volume mucous membranes, and good
at a functional level as refill, and flat neck veins. skin turgor.
evidenced by YES__NO__
individually adequate Monitor vital signs for changes That may cause
*Demonstrated behaviors or
urinary output with (e.g., orthostatic hypotension, or be the effect lifestyle changes to prevent
normal specific gravity, tachycardia, or fever) of dehydration. development
stable vital signs, moist of fluid volume deficit.
mucous membranes, YES__NO__
Weigh the client and compare To prevent occurrence of
and good skin turgor. Goal was met?
with recent weight history. deficit:
- Demonstrate Yes__ No__
Perform serial weights to Partially Met?
behaviors or lifestyle Yes__ No__
determine trends.
changes to prevent Not met?
development
of fluid volume deficit.
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Risk factor: Risk for Short Term Plan: INDEPENDENT Short Term Plan:
deficient fluid After 30 mins. of nursing
Insufficient After 30 mins of nursing
volume related interventions the patient :
fluid intake interventions the patient Offer a variety of fluids and To increase the client’s
to Insufficient water-rich foods, and make them daily fluid intake. *Identified individual risk
Nausea will:
fluid intake, factors and appropriate
- Identify individual risk available throughout the day, if the interventions.
Vomiting nausea,
vomiting, and factors and appropriate client is able to take oral fluids. YES__No__
Sweating sweating interventions Assist/remind the client to drink, as Long term Plan:
Profusely profusely needed. Determine individual fluid
Long term Plan: After all the nursing
needs and establish replacement interventions until the day of
After all the nursing discharge the patient::
over 24 hrs.
interventions until the
*Maintained fluid volume at a
day of discharge the functional level as evidenced
patient will: •Encourage oral intake: To prevent occurrence of by individually adequate
•Provide water and other fluid needs deficit: urinary output with normal
- Maintain fluid volume specific gravity, stable vital
at a functional level as to a minimum amount daily (up to signs, moist mucous
evidenced by 2.5 L/day or amount determined by membranes, and good skin
healthcare provider for client’s age, turgor.
individually adequate
weight, and condition). YES__NO__
urinary output with
normal specific gravity, •Offer fluids between meals and *Demonstrated behaviors or
lifestyle changes to prevent
stable vital signs, moist regularly throughout the day. development
mucous membranes, •Provide fluids in a manageable cup, of fluid volume deficit.
and good skin turgor. bottle, or with drinking straw. YES__NO__
- Demonstrate •Allow for adequate time for eating
Goal was met?
behaviors or lifestyle and drinking at meals. Yes__ No__
changes to prevent •Ensure that immobile or restrained Partially Met?
development Yes__ No__
client is assisted. Not met?
of fluid volume deficit.
ASSESSMENT DIAGNOSIS PLANNING IMPLEMENTATION RATIONALE EVALUATION

Risk factor: Risk for Short Term Plan: DEPENDENT Short Term Plan:
deficient fluid After 30 mins. of nursing
Insufficient After 30 mins of nursing
volume related interventions the patient :
fluid intake interventions the patient Provide supplemental IV To prevent occurrence of
to Insufficient fluids as indicated. deficit: *Identified individual risk factors
Nausea will:
fluid intake. and appropriate interventions.

Vomiting - Identify individual risk (normal saline) YES__No__

factors and appropriate
Long term Plan:
Sweating interventions Encourage the To determine replacement
Profusely After all the nursing
Long term Plan: patient/caregiver to maintain needs. interventions until the day of
a diary of fluid intake, number discharge the patient::
After all the nursing
interventions until the and amount of voidings, and *Maintained fluid volume at a
functional level as evidenced by
day of discharge the estimate of other fluid losses individually adequate urinary
patient will: (e.g., wounds ) output with normal specific
gravity, stable vital signs, moist
- Maintain fluid volume mucous membranes, and good
at a functional level as skin turgor.
evidenced by YES__NO__
individually adequate *Demonstrated behaviors or
urinary output with lifestyle changes to prevent
normal specific gravity, development
stable vital signs, moist of fluid volume deficit.
mucous membranes, YES__NO__
and good skin turgor. Goal was met?
- Demonstrate Yes__ No__
Partially Met?
behaviors or lifestyle Yes__ No__
changes to prevent Not met?
development
of fluid volume deficit.
05 Drug study
 DRUG MECHANISM OF ACTION INDICATIONS AND POSSIBLE POSSIBLE NURSING CONSIDERATION
RATIONALE CONTRAINDICATION COMMON
SIDE EFFECTS

Generic Name: Lumefantrine binds to Coartem Tablets are Patients with known •headache, BASELINE ASSESSMENT
Artemether hemin produced during indicated for hypersensitivity to •dizziness, •Check family history of QT
Lumefantrine hemoglobin breakdown, treatment of acute, artemether, •fever, prolongation or
Brand Name: preventing detoxification to uncomplicated lumefantrine, or to •cough, proarrhythmic conditions
Coartem crystalline malaria pigment malaria infections due any of the excipients •feeling weak such as hypokalemia,
Classification: (hemozoin). During the to Plasmodium should not receive or tired, bradycardia, or recent
Antimalarials. same process, the perOXide falciparum Coartem Tablets •muscle pain, myocardial ischemia
Dosage: group in artemether binds •tenderness, INTERVENTION/EVALUATI
N/A to heme and releases toxic •weakness, ON
Frequency: free-radicals. •joint pain, •Administer with food
2 times a day for Artemether is a prodrug •vomiting, •Follow with food or drink
3 days that is rapidly converted to and loss of (milk, formula, pudding,
Route: diydroartemisinin (DHA), appetite broth, porridge) if possible
Oral itsactive metabolite. Both • Lack of adequate food
components inhibit nucleic increases risk for malaria
acid and protein synthesis. relapse.
 DRUG MECHANISM OF INDICATIONS POSSIBLE POSSIBLE NURSING CONSIDERATION
ACTION AND CONTRAINDI COMMON SIDE
RATIONALE CATION EFFECTS

Generic Name: PATIENT/FAMILY TEACHING

Artemether •Instruct patients to take Coartem Tablets
Lumefantrine with food. Patients who do not have an
Brand Name: adequate intake of food are at risk for
Coartem recrudescence of malaria
Classification: •notify their physicians if they have any
Antimalarials. symptoms of prolongation of the QT
Dosage: interval, including prolonged heart
N/A palpitations or a loss of consciousness
Frequency: •Instruct patient to notify health care
2 times a day for professional immediately if signs of
3 days hypersensitivity (skin rash, hives, other
Route: skin reactions, rapid heartbeat, difficulty
Oral breathing or swallowing, swelling of the
lips, tongue, face, tightness or throat,
hoarseness) occur.
 DRUG MECHANISM INDICATIONS POSSIBLE POSSIBLE NURSING CONSIDERATION
OF ACTION AND CONTRAINDICATI COMMON SIDE
RATIONALE ON EFFECTS

GENERIC NAME: -Sodium is a -Prescription -Hypersensitivity Frequent: BASELINE ASSESSMENT

Sodium chloride major cation medicine used to sodium chloride -Facial flushing. -Obtain baseline serum electrolyte
injection of for fluid and -Fluid retention studies.
BRAND NAME: extracellular electrolyte -Hypernatremia Occasional: Assess fluid balance (I&O, daily weight,
Normal Saline fluid replenishment -Fever; irritation, lung sounds, edema)
for intravenous phlebitis, INTERVENTION/EVALUATION
CLASSIFICATION: -Controls administration extravasation at -Monitor fluid balance (I&O, daily weight,
Electrolyte water injection site. lung sounds, edema), IV site for
extravasation.
supplement distribution, -Normal Saline
-Monitor serum electrolytes, acid-base
fluid and may be used
balance, B/P
DOSAGE: electrolyte alone or with
-IV site should be free from pain,
Not indicated balance other
tenderness, redness, or swelling.
medications.
-Check for fluid leaking, redness, pain,
FREQUENCY: -Indicated as a tenderness, and swelling
Not indicated source of water PATIENT/FAMILY TEACHING
and -Ensure patient is informed to alert the
ROUTE: electrolytes. health care provider if they experience
IV pain or notice swelling or redness at the
IV site.
 REFERENCES
● Burke ,D. Malaria, March 2019,https://www.healthline.com/health/malaria
● Doengers, M., Moorehouse, M., Murr, A. (2019) Nurses Pocket Guide, Diagnoses, Prioritized Interventions, and
Rationales, 15th edition.
● RxList. (2020). Coartem (Artemether Lumefantrine tablets): Uses, dosage, side effects, interactions, warning. RxList
https://www.rxlist.com/coartem-drug.htm#medguide.
● Doyle, G. R., & McCutcheon, J. A. (n.d.). 8.3 IV Fluids, IV Tubing, And Assessment Of an IV System – Clinical Procedures
for Safer Patient Care. 8.3 IV Fluids, IV Tubing, and Assessment of an IV System – Clinical Procedures for Safer Patient
Care. https://opentextbc.ca/clinicalskills/chapter/8-2-types-of-iv-therapy/.
● John Hopkins Medicine (n.d). Abdominal Ultrasound.
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/abdominal-ultrasound
● Dunning & Fischbach (2011). Nurse’s quick reference to common laboratory & diagnostic test, 5th Ed.
● Myhealth.Aberta.ca (2020. Needle Biopsy of the Spleen.
https://myhealth.alberta.ca/Health/aftercareinformation/pages/condition.aspx
● Stanford health care. (n.d.). Malaria Diagnosis. https://stanfordhealthcare.org