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Cristina Marie Manzano RN,RM,MAN Integrated Management of Childhood Illness (IMCI)

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Presentation on theme: "Cristina Marie Manzano RN,RM,MAN Integrated Management of Childhood Illness (IMCI)"— Presentation transcript:

1 Cristina Marie Manzano RN,RM,MAN Integrated Management of Childhood Illness (IMCI)

2 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

3 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

4 O BJECTIVES OF IMCI Reduce deaths and the frequency and severity of illness and disability Contribute to improved growth and development

5 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

6 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

7 T ARGET AGE FOR THE IMCI STRATEGY Young infants - 1 week up to 2 months Older children – 2 months to five years old

8 D ISEASES COVERED IN THE IMCI Pneumonia Diarrhea Dengue hemorrhagic fever Malaria Measles Malnutrition

9 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

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11 11 I. F OCUSED A SSESSMENT 1. Vomits everything 2. Seizure/ convulsions  38.5C & above 3. sleepiness 4. Sucking/ drinking inability

12 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 13 1. Cough or DOB 2. Diarrhea 3. Fever 4. Ear Problem

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15 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 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

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18 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 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 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

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23 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 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

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26 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

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28 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 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

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31 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

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33 1. N UTRITION

34 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

35 2. I MMUNIZATION 3. V ITAMIN A S UPPLEMENTATION

36 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 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.

38 THAT’S ALL FOLKS!!!

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