Malaria is the disease with the weirdest fever pattern, and exam writers love it for exactly that reason. Chills, then burning fever, then sweating, and then repeat. There are also some drug safety details that are easy to miss under pressure. Here are my notes, then a practice test.
Table of Contents
What is Malaria?
Malaria is a parasitic infection caused by Plasmodium parasites, spread by the bite of infected female Anopheles mosquitoes, which usually bite from dusk to dawn.
- Five species infect humans: P. falciparum (the most dangerous), P. vivax, P. ovale, P. malariae, and P. knowlesi.
- Found in tropical areas, including some parts of the Philippines such as Palawan.
- Rarely spread through blood transfusion, shared needles, or from mother to baby.
- Watch Out For: severe anemia, cerebral malaria, kidney failure, low blood sugar, and respiratory distress.
- Safety Precaution: Standard precautions. It doesn’t spread directly from person to person through casual contact.
Pathophysiology
Parasites enter through the bite, travel to the liver, and multiply. They then enter and destroy red blood cells, releasing more parasites. This destruction causes the periodic fever and hemolytic anemia. In P. vivax and P. ovale, some parasites stay dormant in the liver and can cause relapses months later.
Assessment and Diagnostic Findings
Clinical presentation: Repeated cycles of chills, high fever, and heavy sweating, with headache, muscle aches, nausea, and fatigue. Fever may be irregular at first.
Physical exam: Pallor, jaundice, and an enlarged spleen.
Warning signs of severe malaria: confusion, seizures, decreased urine output, severe anemia, difficulty breathing, and low blood sugar.
Laboratory findings
- Thick and thin blood smears are the gold standard to find and identify the parasite. Repeat if the first is negative and malaria is still suspected.
- Rapid diagnostic tests are also used.
- CBC shows anemia and low platelets.
NCLEX Tip: Any fever after travel to or living in a malaria area is malaria until proven otherwise.
Medical Management
- Artemisinin-based combination therapy (ACT), such as artemether–lumefantrine, is the usual treatment for uncomplicated falciparum malaria. Other drugs may be used depending on species and local resistance.
- Severe malaria: IV artesunate.
- Primaquine or tafenoquine is added for P. vivax and P. ovale to clear the dormant liver stage. Test for G6PD deficiency first, because these drugs can cause severe hemolysis.
- Supportive care: fluids, antipyretics, blood transfusion, and management of complications.
- Prevention: mosquito nets treated with insecticide, repellent, long sleeves at dusk and dawn, and preventive medication for travelers.
Nursing Management
Nursing care focuses on monitoring, fever control, safety with medications, and prevention.
- MONITOR: vital signs and temperature pattern, level of consciousness, urine output, signs of bleeding or anemia, and blood glucose.
- During chills: Provide warm blankets. During the fever: remove extra blankets, give tepid sponging and antipyretics as ordered. During sweating: change linens and clothes and offer fluids.
- Medication safety: Confirm G6PD status before primaquine or tafenoquine. Give medicines with food if nausea is a problem. Report vision changes, ringing in the ears, or irregular heartbeat.
- Safety: Seizure precautions if the client has cerebral malaria.
- Education: Sleep under an insecticide-treated net, use repellent, wear long sleeves at dusk and dawn, and take preventive medication as prescribed. Seek care right away for fever after being in a malaria area.
NCLEX High-Yield Notes
- Spread by the female Anopheles mosquito (dusk to dawn).
- Cyclic chills, fever, and sweating.
- Blood smear confirms the diagnosis.
- P. falciparum is the most severe and can cause cerebral malaria.
- Check G6PD before primaquine or tafenoquine.
- IV artesunate for severe malaria.
Mnemonic (MALARIA):
- Mosquito (female Anopheles) at night
- Anemia from red cell destruction
- Liver stage can relapse (vivax and ovale)
- Artemisinin-based drugs
- Rounds of chills, fever, sweats
- Insecticide-treated nets
- Assess G6PD before primaquine
