Presentation on theme: "Integrated Management of Childhood Illness (IMCI)"— Presentation transcript:
1 Integrated Management of Childhood Illness (IMCI) Cristina Marie Manzano RN,RM,MAN
2 General ObjectiveTo 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 STRATEGYManagement of common childhood illness is done in an integrated mannerIncludes preventive interventionsAdjusts 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 Objectives of IMCIReduce deaths and the frequency and severity of illness and disabilityContribute to improved growth and development
5 Why IMCI? Overlap of conditions Diagnostic tools are minimal or non-existentDrugs and equipment are scarceHealth workers have few opportunities to practice complicated clinical proceduresRelies on history & signs & symptomsA global strategy with 1 purpose of improving the health of children up to age 5 and decrease their chances of death
6 Improving case management skills of health workers Components of the IMCIImproving case management skills of health workersImproving the health system to deliver IMCIImproving family and community health practicesProviding guidelines for managing child health problemsImrpoving the health system to deliver IMCIImproving family & community health practices. To improve nutrition and child development thru breastfeeding support groups or child feeding centers. Promote or improve the existing health system.
7 Target age for the IMCI strategy Young infants - 1 week up to 2 monthsOlder children – 2 months to five years old
8 Diseases covered in the IMCI PneumoniaDiarrheaDengue hemorrhagic feverMalariaMeaslesMalnutrition
9 METHODS IN MANAGING CHILDHOOD ILLNESSES Color PresentationClassification of DiseasesLevel of ManagementGreenMildHome careYellowModerateManage at the RHUPinkSevereUrgent referral in HospitalTo effectively manage childhood illnesses a color- coded system has been utilized:
11 A. Danger Signs I. Focused Assessment Vomits everything Seizure/ convulsions 38.5C & abovesleepinessSucking/ drinking inability
12 Check for General Danger Signs Ask:- is the child not able to breastfeedor drink?- does the child vomit everything?- has the child had convulsions?Look:- see if the child is abnormally sleepyor difficult to awaken?If YES…
13 Cough or DOBDiarrheaFeverEar ProblemB. Main Symptoms
18 Diarrhea How Long? <14 days >14 days. No change NO dehydration ThirstyIrritableRestlessEye sunkenSkin pinch back slowlySunken eyeballsSkin pinch backvery slowlyAbnormally SleepyDoesn’t DrinkNO dehydrationSome DehydrationSevere DehydrationHome Mg’tSpecific txREFERTx Plan AGive extra fluid2. cont. feeding3. Ff up. In 5 daysTx Plan Bw/ ORS (good for 24 hrs)in 4 hours wt(kg)x75mlfrequent sips from cupchild vomits wait 10min., cont. slowlyStop ORS child haspuffy eyelidsafter 4 hours re-assess& classify select tx planTx Plan CIVF along w/ ORSIVFLR(100ml/kg)
19 Severe Persistent diarrhea How Long?>14 daysPersistent diarrheaPersistent diarrhea+ dehydrationPersistent diarrhea+ NO dehydrationSevere Persistent diarrheaREFERSpecific TxTxTreat dehydrationfirstGive vit. ARefer to hospitalTxAdvise regardingfeedingGive vit. AFF. up in 5 days
20 With blood (dysentery) NO blood( cholera) DiarrheaStoolWith bloodNo BloodTxOral antibioticsfollow up in 2 daysWith blood (dysentery)NO blood( cholera)Tx1st linecotrimoxazole2nd linenalidixic acidTx1st line tetracycline2nd line cotrimoxazole
23 Malaria unlikely fever Malaria Risk AreaNon-Malaria Risk Area(+) malaria risk(-) blood smearno runny nose/measles(+) Malaria risk(+) blood smearno runny nose(+) Malaria riskany danger signstiff neckMalaria unlikely feverMalariaMalariaHome Mg’tSpecific txREFERTxParacetamol fever >38CFf. up in 2daysfever > 7 daysREFERTxantimalariala. 1st line chlorquine,primaquineb. 2nd line sulfadoxin,pyrimethamineParacetamol- >38.5Cfever >7 days REFERTxquinine under medicalSupervision,if a hosp.is not accessible1st dose antipyreticURGENT referral
24 Very Severe Febrile Dse. MALARIANon-Malaria Risk AreaAny danger signstiff neckNO signs of very severefebrile diseaseNO MalariaNO MalariaVery Severe Febrile Dse.Fever (NO malaria)Tx1st dose antibioticsparacetamol >38.5CREFERRAL.Txparacetamol >38.5Cfollow up in 2 days if fever persistsfever is > 7 days present REFER to hosp.
26 MEASLES now or w/in last 3 mos pus draining from eyemouth ulcersClouding of Cornea orDeep mouth ulcer oral thrush, Koplik spotsHome Mg’tSpecific txREFERTxVit. A admin.child100,000 IUadult200,000 IUPregnant10,000 IUTxVit. A 100,000 IUtetracycline ointment pus from the eye3.half strengthgentian violet mouth ulcer or oral thrush3. follow up in 2 daysTx1st dose of antibioticsVit. ATetracycline ointmentURGENT referral
28 If There is Dengue Riskbleeding gumsblack vomitus or stoolpersistent abdominal painpersistent vomitingskin petechiaeslow capillary refillif no sign tourniquet test if fever is present > 3 days
29 dengue hemorrhagic fever + Danger risk Any Danger Signs or No sign of severedengue hemorrhagic fever+ Danger riskAny Danger Signs or+ tourniquet testDHF UNLIKELYSEVERE DHFHome Mg’tREFERTxTx the causefever > 7 days REFERif NO apparent cause offever return daily toH. center until thereis no feverGive more fluidsDo not Give AspirinTxPlan C if with othersigns of bleedingDo NOT give AspirinREFERRAL
34 Visible severe wasting (<13cm upper arm circ.)edema on both feet orsevere palmar pallorSome palmar pallor orvery low weight for ageSEVERE MALNUTRITION/SEVERE ANEMIAAnemia orVery low weight for ageREFERSpecific TxVitamin AToday, tomorrow &2 weeks after tomorrowWait for 30 min.before lifting the childVitamin AAssess for feeding problem& counsel motherPallor ironAlbendazole(> 12 mos. Orno doze in previous 6 mos.)Very low weight vitamin A & ff. up after
36 THEN CHECK THE CHILD’S IMMUNIZATION STATUS IMMUNIZATION SCHEDULEAGE VACCINEBirth BCG Hep B-16 weeks DPT-1 OPV-1 Hep B-210 weeks DPT-2 OPV-214 weeks DPT-3 OPV-3 Hep B-39 months MeaslesTHEN CHECK THE VITAMIN A STATUSVITAMIN 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 SCHEDULEAGE VACCINEBirth BCG Hep B-16 weeks DPT-1 OPV-1 Hep B-210 weeks DPT-2 OPV-214 weeks DPT-3 OPV-3 Hep B-39 months MeaslesTHEN CHECK THE VITAMIN A STATUSVITAMIN A SUPPLEMENTATION SCHEDULE:The first dose at 6 months or above.Subsequent doses every 6 months.