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close this bookManagement of Severe Malaria : A Practical Handbook - Second Edition (WHO, WHO - CDS; 2000; 78 pages)
View the documentTable 1 Antimalarial chemotherapy of severe falciparum malaria
View the documentPreface
View the documentIntroduction
open this folder and view contentsSevere falciparum malaria
close this folderGeneral management
View the documentNursing care
View the documentSpecific antimalarial chemotherapy
open this folder and view contentsClinical features and management of complications in adults
open this folder and view contentsSpecial clinical features of severe malaria and management of common complications in children
open this folder and view contentsSpecial clinical features and management of severe malaria in pregnancy
open this folder and view contentsDiagnosis of malaria
View the documentPrognostic indicators
View the documentCommon errors in diagnosis and management
View the documentSelected further reading
View the documentAnnex 1. Notes on antimalarial drugs
View the documentAnnex 2. The Glasgow coma scale
View the documentAnnex 3. A coma scale for children
View the documentAnnex 4. Cannulating the femoral vein
View the documentAnnex 5. Setting up an intra-osseous infusion in children
View the documentAnnex 6. Measurement of central venous pressure
View the documentSummary of the management of severe falciparum malaria
View the documentBack cover

Nursing care

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).

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