IMCI

IMCI

1. IMCI PRESENTED BY : DR. HAYAT AL KIYUMI

2. OBJECTIVES 1 ) NURSE ROLE IN APPROCHING CHILD AT TRIAGE . 2 ) CHILD FOR VACCINATION. 3) DOCTOR ROLE IN APPROCHING CHILDREN AGE 2 MOTHNS TO 5 YRS. 4) DOCTOR ROLE IN APPROCHING YOUNG INFANT AGE 1 WEEK UP TO 2 MONTHS.

3. INTRODUCTION IMCI : INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS . CHILDREN < 5 YRS

4. MANAGEMENT OF A CHILD AGED 2 MONTHS – 5 YRS AT TRIAGE : WEIGHT HEIGHT : ONCE/MONTH TEMPERATURE REASON FOR VISIT PULSE RATE RESPIRAOTY RATE

5. RESPIRATORY RATE ABNORMAL RR FOR DIFFRERNT AGE GROUPS RR IN NEONATE > 60 /MIN RR IN 2 – 12 MONTHS > 50/MIN RR IN 1 – 5 YRS OLD > 40/MIN CHEST IN DRAWING ( NOT DURING BREASTFEEDING)

6. DANGER SIGNS 1 – LETHARGY / UNCONSCIOUSNESS 2 – VOMITING 3 – CONVULSIONS 4 – INABILITY TO DRINK OR BREASTFEEDED ** IF ONE OR MORE OF THESE SIGNS ------ > SERIOUSLY ILL ------ > REFERRED. * IF NO ABOVE DANGER SIGNS ( & NO FEVER OR SOB) …. > THEN CHECK NUTRITIONAL STATUS.

7. NUTRITIONAL STATUS 1 ) PEM : A) CHILDREN WITH SEVERE MALNUTRITION ( INCREASE RISK FOR MORTALITY & NEED URGENT REFERRAL ) B ) IDENTIFY CHILDREN WITH SUB – OPTIMAL GROWTH

8. Chart for classification of pem Weight for age below – ve 3 rd red zone PEM SEVERE Weight for age between – ve 2 nd and – ve 3 rd orange zone PEM MODERATE Weight above – ve 2 nd green zone NO PEM

9. PEM IF CHILD HAS PEM , OR MOTHER C/O FEEDING DIFFICUTY … CHECK BREASTFEEDING. FEEDING IS NOT < 8 TIMES/DAY ASK IF THERE IS H/O UTI , FREQUENT DIARRHEA & COUGH INVESTIGATION: URINE ROUTINE HGB STOOL ROUTINE ( PARACITE)

10. pem Severe PEM …… > REFERED MODERATE PEM ----- > 1) DO IX 2) REFERRAL TO DIETITION 3) F/U AFTER 2 WKS, THEN REVIEW EVERY MONTH

11. CHART FOR CLASSIFICATION OF ANEMIA SEVERE ANEMIA HB < 7 GM/DL ANEMIA HB ( 7 – 11 ) GM/DL NO ANEMIA HB > 11 GM/DL

12. F/U ANEMIA REPEAT HGB , IF RAISE BY 0.5 TO 1 GM IN 2 WKS , CONTINUE ORAL IRON FOR 3 MONTHS THEN REVIEW.

13. CONTUNIED ASSESSMENT CHECK IMMUNIZATION STATUS PSYCHOSOCIAL ASSESSMENT TO DETECT DEVELOPMENTAL DELAY.

14. VACCINATION WHAT TO WRITE IN NOTES FOR VACCINATED CHILD : 1) DUE FOR VACCINATION ……. 2) WEIGHT IN GREEN ZONE & UPGOING 3) NO DANGER SIGNS 4) NORMAL PSYCHOSOCIAL ASSESSMENT CHECKED BY BOTH NURSE & DOCTOR.

15. VACCINATION IF NO TSH THERE ASK LAB TECHNICION TO TALK TO FOCAL POINT OF DELIVERY HOSPITAL . ON NO TEL NUMBER , TO CALL DGHS TO GIVE YOU ANY MURMUR REFER. EYE EXAMINATION: BY TORCH ABOUT 30 CM ……. > IF WHITE PUPIL ( CATARACT) IF RED PUPIL ( NORMAL ) ONLY MARKED SQUINT REFER & DO NOT WAIT.

16. VACCINATION F/U AT 9 MONTHS ….. > HGB + BLOOD GROUP NO VACCINATION AT THIS AGE. COMPLIMENTARY FOOD STARTED. AT 13 MONTHS TO BE SEEN BY DR. FOR OPV , IF CHILD HAS DIARRHEA BETTER TO GIVE HER/HIM & TO REEPAT IT AFTER ONE MONTH.

17. VACCINATIONA IF BOWING LEG REFER AT 18 MONTHS .. REPEAT IX IF NO TEETH REFER ( VITAMIN D DEFICIENCY) IF TEETH DECAY … REFER TO DENTIST. - TO F/U OBESITY

18. ASSESSMENT & CLASSIFICATION OF SICK CHILD ( 2 MONTHS – 5 YRS) HISTORY: ASK CARE GIVER 1) DOSE THE CHILD HAVE COUGH OR DIFFICULT BREATHING ? 2) ANY EAR PROBLEMS ? 3) DIARRHEA ? 4) FEVER ? 5) ANY THROAT PROBLEM ? 6) ANY OTHER PROBLEM ?

19. CHART FOR CALSSIFICATION OF COUGH OR DIFFICULT BREATHING SEVERE PNEUMONIA ANY GENERAL DAANGER SIGN OR CHEST IN –DRAWING PNEUMONIA FAST BREATHING PNEUMONIA WITH WHEEZ FAST BREATHING & AUDIBLE WHEEZ CORYZA WITH WHEEZ AUDIBLE WHEEZ CORYZA NO CHEST IN- DRAWING , FAST BREATHING OR WHEEZ

20. COUGH RX OF PENUMONIA : ORAL ANTIBIOTICS ( EX ; AMOXYCILLIN ) FOR 5 DAYS. REVIEW AFTER 2 DAYS EXTENT ANTIBIOITCS TO 7 DAYS IF NECESSARY . GIVE AUGMENTEN IF NO IMPROVEMENT. ADVICE FOR SAFE REDEMY

21. COUGH CHILD WITH PERSISTENT COUGH > 15 DAYS ….. REFER TO R/O : TB ASTHMA WHOOPING COUGH ** COUGH SYRUP WITH CODEIN ………… > CONSTIPATION.

22. EAR PROBLEM * MAIN CAUSE OF DEFENNESS ….. > LEARNING PROBLEMS 1)ASK FOR EAR PAIN ( OR RUB EAR) 2) LOOK FOR EAR DISCAHRGE OR PUS 3) LOOK FOR TENDER SWELLING BEHIND THE EAR.

23. CHART FOR CLASSIFICATION OF EAR PROBLEM MASTODITIS EAR DISCHARGE & TENDER SWELLING BEHIND THE EAR ACUTE OTITIS MEDIA IF EAR PAIN OR EAR DISCHARGE IS PUS FOR < 14 DAYS CHRONIC O. M IF EAR PAIN OR EAR DISCAHRGE > 14 DAYS OTHER PROBLEM NO SIGN OF EAR INFECTION FOUND

24. EAR PROBLEM ACUTE O. M : AMOXYCILLIN FOR 5 DAYS REVIEW AFTER 2 DAYS IN DISCHARGE NOT REDUCE , GIVE 2 ND LINE ANTIBIOTICS GIVE PARACETAMOL FOR PAIN RELIEF DRY EAR BY SOFT WICKS REVIEW AFTER 5 DAYS , IF NO IMPROVEMENT TO BE REFERRED TO ENT CHRONIC O. M … REFER TO ENT

25. THROAT PROBLEM THROAT INFECTION ( IF CAUSED BY STERPTOCOCCUS ) ---- > RHEUMATIC FEVER -------- > CARDIA PROBLEM. MORE COMMON IN > 2 – 3 YRS ALL CHILD > 2 YRS ….. EXAMIN THROAT. CHILD < 2 YRS …. EXAMIN IF ONLLY FEVER IS THERE.

26. CHART FOR CLASSIFICATION OF THROAT PROBLEM STERPTOCOCCAL SORE THROAT (TAKE THROST SWAB IF POSSIBLE , START OSPEN 10 DAYS , IF C/S –VE STOP IT) ENLARGED TENDER LN IN FRONT OF NECK . WHITE/YELLOW EXUDATE OR SEVERE CONGESTION NON- STERPTOCOAL SORE THROT CONGESTION OF THROAT WITH NO ENOUGH SIGNS TO CLASSIFY AS STERPTOCOCCAL SORE THROAT

27. DIARRHEA STOOL IN BREASTFEED CHILD …. SOFTER & MORE FREQUENT. DIARRHEA LAST < 14 DAYS ( ACUTE DIARRHEA) > 14 DAYS ( PERSISTENT DIARRHE) ---- > reduce weight --- > PEM DIARRHEA : 1) DYSENTERIC ( BLOOD IN STOOL ) … 10 % 2) NON- DYSENTERIC ASK : 1 ) FOR HOW LONG IS DIARRHEA ? 2) IS THERE BLOOD IN STOOL ?

28. CLASSIFICATION OF DEHYDRATION SEVERE DEHYDRATION TWO OF 0 SIGNS : LETHRGIC OR UNCONSCIOUS SUNKEN EYES NOT ABLE TO DRINK OR DRINKING POORLY SKIN PINCH GOES BACK VERY SLOWLY > 2 S MILD TO MODERATE DEHYDRATION 2 OF FOLLOWING SIGN RESTLESS , IRRITABLE SUNKEN EYES DRINK EAGERLY, THIRSTY SKIN PINCH GOSE BACK SLOWLY NO DEHYDRATION NOT ENOUGH SIGNS TO CLASSIFY

29. TREATMENT OF DIARRHEA IF NO DEHYDRATION : 1) EDUCATE MOTHER HOW TO PREPARE ORS 2) GIVE 100 ML OF ORS /STOOL FOR CHILD < 1 YR 3) GIVE 200 ML OF ORS /STOOL FOR CHILD > 1 YRS 4 ) GIVE OTHER FLUID IN ADDITION TO ORS 5) ADVICE MOTHER TO RETURN TO THE CLINIC , IF CHILD DEVELOPS BLOOD IN STOOL, DRINKS POORLY , BECOES SICKER , OR IS NOT BETTER IN THREE DAYS .

30. TREATMENT OF DIARRHEA IF CHILD HAS MILD TO MODERATE DEHYDRATION : - GIVE 75 ML/KG OF ORS /4 HRS - CONTINUE BREASTFEEDING IF CHILD IS BREAST- FED - REASSES & RECLASSIFY AFTER 4 HRS…. IF 1) NO DEHYDRATION… SEND HOME. 2) STILL MODERATE DEHYDRATED… REPEAT THE ABOVE RX **

31. Treatment of diarrhea 3) if severe dehydration … refer ** HOW TO TREAT PERSISTENT DIARRHEA ??? TREATMENT OF DYSENTERY DIARRHEA: A) NALIDIXIC ACID X 5 DAYS , IF G6PD +VE , USE CEPRADINE B) F/U IN 2- 3 DAYS & CHANGE TO ANOTHER ANTIBIOTIS IF NO RESPONSE C) REFER URGENTLY IF CHILD IS < 1 YR OR IF PEM +VE.

32. FEVER TEMPERATURE : > 37.5 C BY AXILLA DURATION IF > 5 DAYS ( SERIOUSE ILLNESS ) .. REFER URGENTLY

33. CHART FOR CLASSIFICATION OF FEVER VERY SEVERE FEBRILE DISEASE / MENINGITIS ANY DANGER SIGN OR STIFF NECK , BULGING FONTANEL MALARIA NO RUNNY NOSE , NO MEASLES , NO OTHER CAUSE OF FEVER & MALARIA PARASITE ON BLOOD SMEAR FEVER CAUSE KNOWN CHILDREN ALREADY CLASSIFIED AS PNEUMONIA, EAR INFECTION, OR SORE THROAT MEASLES / RUBELLA GENERALIZED RASH & COUGH , RUNNY NOSE OR RED EYES UTI CRYING WHILE PASSING URINE URINE MICROSCOPY , > 20 WBC/CMM FEVER CAUSE UNKNOWN NO OBVIOUS CAUSE OF FEVER

34. MANAGEMENT OF YOUNG INFANT AGED 1 WEEK UP TO 2 MONTHS ASSESS & CALSSIFY - CHECK FOR BACTERIAL INFECTION. - LOOK FOR JAUNDICE. - IF THERE IS DIARRHEA - FEEDING PROBLEM OR LOW WEIGHT - CHECK IMMUNIZATION STATUS - ASSESS FOR OTHER PROBLEM

35. CHART FOR CLASSIFICATION OF INFECTION IN YOUNG INFANT AGED 1 WEEK UP TO 2 MONTHS CLASSIFY AS SIGNS SEVERE BACTERIAL INFECTION / SEPSIS ANY ONE OF THE FOLLOWING : LETHARGY OR UNCONSCIOUSNESS, CONVULSIONS , NOT ABLE TO SUCK , PERSISTENT VOMITING, FAST BREATHING> 60/MIN, SEVERE CHEST INDRAWING /NASAL FLAIRE & GRUNTING, REDNESS AROUND UMBILICUS EXTENDING TO SKIN & TISSUE > 1 CM , MULTIPLE SKIN PUSTULES, PUS DISHARGING FRO EAR, SEVERE PURULENT EYE DISCHARGE, HYPOTONIA, TEMP ( 37.6 – 37.9 WITH ANY OF ABOVE SIGNS) TEMP > 37.9 OR BELOW 35 C CORYZA ( COUGH, COLD) RUNNY NOSE , TEMP ( 37.6 TO 37.9 ) BABY ACTIVE & FEEDING WELL

36. CHART FOR CLASSIFICATION OF INFECTION IN YOUNG INFANT AGED 1 WEEK UP TO 2 MONTHS CLASSIFY AS SIGNS LOCAL INFECTION OF : UMBILICUS SKIN EYES ANY ONE OF THE FOLLOWING : REDNESS & SWELLING OF SKIN EXTENDING < 1 CM BEYOND UMBILICUS. SOME SKIN PUSTULES. SOME PURULENT EYE DISCHARGE NO INFECTION NONE OF THE ABOVE

37. MANAGEMENT OF YOUNG INFANT AGED 1 WEEK UP TO 2 MONTHS - JAUNDICE IN 1 ST 24 HRS …. SERIOUSE - JAUNDICE AFTER 48 HRS EITHER : 1) SIGNIFICANT ….. JAUNDICE UP TO PALMS & SOLES 2) NOT SIGNIFICANT …… NOT EXTENDING UPTO PALMS & SOLES.

38. MANAGEMENT OF YOUNG INFANT AGED 1 WEEK UP TO 2 MONTHS ASSESS DIARRHEA REFER ALL CASES OF DYSENTRY TO HOSPITAL URGENTLY AS IT LIKELY TO CAUSE SEPTCEMIA & SHOCK. - SEVERE DEHYDRATION , ANY TWO OF : A) LETHARGIC OR UNCONSCIOUS B) SUNKEN EYES C) SKIN PINCH GOES VERY SLOWLY - SOME OF DEHYDRATION , ANY TWO OF: A) RESTLESS OR IRRITABLE B) SUNKEN EYES C) SKIN PINCH GOES SLOWLY

39. MANAGEMENT OF YOUNG INFANT AGED 1 WEEK UP TO 2 MONTHS - CHECK FOR FEEDING PROBLEMS OR LOW WEIGHT. - CHECK IMMUNIZATION STATUS - DO ROUTINE CLINICL CHECK UP **WHEN TO FOLLOW UP ?????

40. MANAGEMENT OF YOUNG INFANT AGED 1 WEEK UP TO 2 MONTHS TO RETURN IMEDIATELY IF INFANT HAS ANY OF THESE SIGNS : - NOT BREASTFEEDING OR DRINKING POORLY - BECOMES SICKER - DEVELOPS A FEVER - FAST BREATHING - DIFFICULT BREATHING BLOOD IN STOOL

41. MANAGEMENT OF YOUNG INFANT AGED 1 WEEK UP TO 2 MONTHS ADVICE FOR FOLLOW – UP VISIT. RETURN FOR FOLLOW-UP NOT LATER THAN : IF THE INFANT HAS : 2 DAYS LOCAL BACTRIAL INFECTION ANY FEEDING PROBLEM THRUSH 14 DAYS LOW WEIGHT FOR AGE

42. THANK YOU