Presentation on theme: "Cristina Marie Manzano RN,RM,MAN Integrated Management of Childhood Illness (IMCI)"— Presentation transcript:
Cristina Marie Manzano RN,RM,MAN Integrated Management of Childhood Illness (IMCI)
G ENERAL O BJECTIVE To ensure that before graduation, all students undergo the enhanced curriculum for Nursing where IMCI is integrated starting at Level II up to level IV
IMCI AS A STRATEGY Management of common childhood illness is done in an integrated manner Includes preventive interventions Adjusts curative interventions to the capacity and functions of the health system (evidence based – syndromic approach) Involves the family members and the community in the health care process
O BJECTIVES OF IMCI Reduce deaths and the frequency and severity of illness and disability Contribute to improved growth and development
W HY IMCI? Overlap of conditions Diagnostic tools are minimal or non-existent Drugs and equipment are scarce Health workers have few opportunities to practice complicated clinical procedures Relies on history & signs & symptoms
C OMPONENTS OF THE IMCI 1. Improving case management skills of health workers 2. Improving the health system to deliver IMCI 3. Improving family and community health practices
T ARGET AGE FOR THE IMCI STRATEGY Young infants - 1 week up to 2 months Older children – 2 months to five years old
D ISEASES COVERED IN THE IMCI Pneumonia Diarrhea Dengue hemorrhagic fever Malaria Measles Malnutrition
METHODS IN MANAGING CHILDHOOD ILLNESSES To effectively manage childhood illnesses a color- coded system has been utilized: Color Presentation Classification of Diseases Level of Management Green MildHome care YellowModerateManage at the RHU PinkSevereUrgent referral in Hospital
11 I. F OCUSED A SSESSMENT 1. Vomits everything 2. Seizure/ convulsions 38.5C & above 3. sleepiness 4. Sucking/ drinking inability
C HECK FOR G ENERAL D ANGER S IGNS Ask : - is the child not able to breastfeed or drink? - does the child vomit everything? - has the child had convulsions? Look : - see if the child is abnormally sleepy or difficult to awaken? If YES…
13 1. Cough or DOB 2. Diarrhea 3. Fever 4. Ear Problem
15 Pneumonia Age <2 mos. No Pneumonia Home Mg’t Tx 1.Cough > 30 days Refer 2. Relieve cough w/ safe remedy 3. Advise mother on danger sign 4. Ff up in 5 days Cough/ colds (+) fast breathing >60 cpm Pneumonia Specific tx Tx 1.Antibiotics for 5 days 2.Relieve cough w/ safe remedy 3. Advise mother on danger sign 4. Ff up in 2days Danger signs Severe Pneumonia REFER Tx 1.1st dose antibiotic 2. Vitamin A 100,000 IU 3. breast feeding/ water with sugar >2 mos.
16 Pneumonia Age No Pneumonia Home Mg’t Tx 1.Cough>30days Refer 2. Relieve cough w/ safe remedy 3. Advise mother on danger sign 4. FF. up in 5 days Cough/ colds (+) fast breathing 2 – 11 mos. 50 1 – 5 y/o 40 Pneumonia Specific tx Danger signs VSP REFER Tx 1.1st dose antibiotic 2. Vitamin A 100,000 IU 3. breast feeding/ water with sugar >2 mos. (+) fast breathing chest indrawing VSD Tx 1.Antibiotics for 5 days 2.Relieve cough w/ safe remedy 3. Advise mother on danger sign 4. Ff up in 2days
18 Diarrhea How Long? <14 days NO dehydration Home Mg’t Tx Plan A 1.Give extra fluid 2. cont. feeding 3. Ff up. In 5 days No change T hirsty I rritable R estless E ye sunken S kin pinch back slowly Some Dehydration Specific tx Tx Plan B w/ ORS (good for 24 hrs) 1.in 4 hours wt(kg)x75ml 2.frequent sips from cup 3.child vomits wait 10 min., cont. slowly 4.Stop ORS child has puffy eyelids 5.after 4 hours re-assess & classify select tx plan S unken eyeballs S kin pinch back very slowly A bnormally Sleepy D oesn’t Drink Severe Dehydration REFER Tx Plan C IVF along w/ ORS IVF LR(100ml/kg) >14 days.
19 Diarrhea How Long? >14 days Persistent diarrhea REFER Tx 1.Treat dehydration first 2.Give vit. A 3.Refer to hospital Persistent diarrhea + dehydration Persistent diarrhea + NO dehydration Specific Tx Tx 1.Advise regarding feeding 2.Give vit. A 3.FF. up in 5 days Severe Persistent diarrhea
20 Diarrhea Stool With blood With blood (dysentery) Tx 1.1st line cotrimoxazole 2.2nd line nalidixic acid Tx 1.Oral antibiotics 2.follow up in 2 days NO blood( cholera) Tx 1.1st line tetracycline 2.2nd line cotrimoxazole No Blood
23 MALARIA Malaria Risk Area Malaria unlikely fever Home Mg’t Tx 1.Paracetamol fever >38C 2.Ff. up in 2 days 3.fever > 7 days REFER (+) malaria risk (-) blood smear no runny nose/measles (+) Malaria risk (+) blood smear no runny nose Malaria Specific tx Tx 1. antimalarial a. 1st line chlorquine, primaquine b. 2nd line sulfadoxin, pyrimethamine 2.Paracetamol- >38.5C 3.fever >7 days REFER (+) Malaria risk any danger sign stiff neck Malaria REFER Tx 1.quinine under medical Supervision,if a hosp. is not accessible 2.1st dose antipyretic 3.URGENT referral Non-Malaria Risk Area
24 MALARIA NO Malaria Very Severe Febrile Dse. Tx 1.1st dose antibiotics 2.paracetamol >38.5C 3.REFERRAL. Any danger sign stiff neck NO signs of very severe febrile disease NO Malaria Fever (NO malaria) Tx 1.paracetamol >38.5C 2.follow up in 2 days if fever persists 3.fever is > 7 days present REFER to hosp. Non-Malaria Risk Area
26 MEASLES now or w/in last 3 mos Home Mg’t Tx 1.Vit. A admin. child 100,000 IU adult 200,000 IU Pregnant 10,000 IU Measles 1.pus draining from eye 2.mouth ulcers Specific tx Tx 1. Vit. A 100,000 IU 2.tetracycline ointment pus from the eye 3.half strength gentian violet mouth ulcer or oral thrush 3. follow up in 2 days 1.Clouding of Cornea or 2.Deep mouth ulcer oral thrush, Koplik spots REFER Tx 1.1st dose of antibiotics 2.Vit. A 3.Tetracycline ointment 4.URGENT referral
28 If There is Dengue Risk 1. bleeding gums 2. black vomitus or stool 3. persistent abdominal pain 4. persistent vomiting 5. skin petechiae 6. slow capillary refill 7. if no sign tourniquet test if fever is present > 3 days
29 Dengue Home Mg’t Tx 1.Tx the cause 2. fever > 7 days REFER 3.if NO apparent cause of fever return daily to H. center until there is no fever 4.Give more fluids 5.Do not Give Aspirin + Danger risk No sign of severe dengue hemorrhagic fever + Danger risk Any Danger Signs or + tourniquet test REFER Tx 1.Plan C if with other signs of bleeding 2.Do NOT give Aspirin 3.REFERRAL DHF UNLIKELYSEVERE DHF
31 EAR PROBLEM NO ear pain No pus Pus draining from ear < 14 days Ear pain Pus draining from ear >14 days Ear pain Tender swelling behind the ear NO ear infection No Mg’t NO further assessment Acute Ear Infection Specific Tx Tx 1.antibiotics for 5 days 2.paracetamol for pain 3.dry ear by wicking 4.Ff up in 5 days Chronic Ear Infection Specific Tx Tx 1.dry ear by wicking 2.Ff up in 5 days Mastoiditis REFER Tx 1.1st dose of antibiotic 2.1st dose of paracetamol 3.REFER
1. N UTRITION
34 Visible severe wasting (<13cm upper arm circ.) edema on both feet or severe palmar pallor Some palmar pallor or very low weight for age SEVERE MALNUTRITION/ SEVERE ANEMIA Anemia or Very low weight for age REFERSpecific Tx Vitamin A 1.Today, tomorrow & 2 weeks after tomorrow 2.Wait for 30 min. before lifting the child Vitamin A 1.Assess for feeding problem & counsel mother 2.Pallor iron 3.Albendazole (> 12 mos. Or no doze in previous 6 mos.) 4.Very low weight vitamin A & ff. up after
2. I MMUNIZATION 3. V ITAMIN A S UPPLEMENTATION
36 THEN CHECK THE CHILD’S IMMUNIZATION STATUS IMMUNIZATION SCHEDULE AGEVACCINE BirthBCG Hep B-1 6 weeksDPT-1OPV-1Hep B-2 10 weeksDPT-2OPV-2 14 weeksDPT-3OPV-3Hep B-3 9 monthsMeasles THEN CHECK THE VITAMIN A STATUS VITAMIN A SUPPLEMENTATION SCHEDULE: The first dose at 6 months or above. Subsequent doses every 6 months.
37 THEN CHECK THE CHILD’S IMMUNIZATION STATUS IMMUNIZATION SCHEDULE AGEVACCINE BirthBCG Hep B-1 6 weeksDPT-1OPV-1Hep B-2 10 weeksDPT-2OPV-2 14 weeksDPT-3OPV-3Hep B-3 9 monthsMeasles THEN CHECK THE VITAMIN A STATUS VITAMIN A SUPPLEMENTATION SCHEDULE: The first dose at 6 months or above. Subsequent doses every 6 months.