Nursing care

The management of the patient with severe malaria is as important as chemotherapy and here the nurse has a crucial role to play.

· Meticulous nursing care should be given to unconscious patients. Maintain a clear airway. Turn the patient every two hours. Do not allow the patient to lie in a wet bed. Particular attention should be paid to pressure points and the patient should be nursed on his or her side to avoid aspiration of fluid. Aspiration pneumonia is a potentially fatal complication, and must be dealt with immediately (see inside back cover flap).

· A careful record of fluid intake and output must be kept, the appearance of black urine noted and specific gravity measured.

· The speed of infusion of fluids should be checked frequently.

· Temperature, pulse, respiration and blood pressure must be monitored regularly every 4 - 6 hours for at least the first 48 hours.

· Changes in the level of consciousness, occurrence of convulsions or changes in behaviour of the patient must be reported immediately.

· If rectal temperature rises above 39 °C, vigorous tepid sponging and fanning must be applied, and paracetamol may be given.