Good nursing care of the patient with severe malaria is of vital importance.
• Ensure meticulous nursing care. This can be life-saving, especially for the unconscious patient. Maintain a clear airway. Nurse the patient in the lateral or semi-prone position to avoid aspiration of fluid. Insert a nasogastric tube and suck out the stomach contents to minimize the risk of aspiration pneumonia. Aspiration pneumonia is a potentially fatal complication that must be dealt with immediately (see inside back cover flap). Turn the patient every 2 hours. Do not allow the patient to lie in a wet bed. Pay particular attention to pressure points.
• Keep a careful record of fluid intake and output. If this is not possible, weigh the patient daily in order to calculate the approximate fluid balance.
• Note any appearance of black urine (haemoglobinuria).
• Check the speed of infusion of fluids frequently. Too fast or too slow an infusion can be dangerous.
• Monitor the temperature, pulse, respiration, blood pressure and level of consciousness (use the Glasgow coma scale for adults, or a paediatric scale for a child; see Annexes 2 and 3). These observations should be made at least every 4 hours until the patient is out of danger.
• Report changes in the level of consciousness, occurrence of convulsions or changes in behaviour of the patient immediately. All such changes suggest developments that require additional treatment.
• If the rectal temperature rises above 39 ºC, remove the patient’s clothes and start tepid sponging and fanning. Give paracetamol (the rectal route is usually best).