TOP RANK REVIEWER SUMMARY BY RESURRECCION, CRYSTAL JADE R.N
Integrated Management of Childhood Illness
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Developed by WHO and UNICEF
Combined delivery of essential interventions at Community health systems level.
Objectives:
1. Reduced death and frequency of severity of illness
2. And disability.
3. Improved growth and development.
Components:
1. Improving case mgt skills of health workers.
2. Overall health systems.
3. Family & Community health practices.
Child covered by IMCI:
1. Birth up to 2 months (sick young infant)
2. 2 months up to 5 years old (sick young child)
Basis for classifying child’s admission
Pink - Urgent Hospital Referral/Admission.
1. Give first dose of antibiotic
Ampicillin - q6 if referral isn’t available
Gentamicin
2. Treat low blood sugar
Breastfeeding
4 teaspoons of sugar 200ml of clean water.
3. Refer
Explain the need for referral, to agree
Calm fears
Write referral note for mom to take the child in hospital
Give mother instructions/supplies needed.
Yellow - Outpatient Treatment (May go home)
1.
2.
3.
4.
Treat local Infection - Amoxicillin, Cotrimoxazole
Treat specific - Tetracycline (eye ointment) , Violet Gentian (mouth ulcers) , Quinolone (for ear drops)
Advise the mother.
Follow up care.
Green - Supportive Home Care
1. Counsel mother/Advise Mother - When to return to the health center, What food and fluids to
give on the child.
2. Follow up care - Reassess children for new problems.
TOP RANK REVIEWER SUMMARY BY RESURRECCION, CRYSTAL JADE R.N
STEPS ON IMCI CASE MANAGEMENT PROCESS
Ask the mother what the problem is (child) - 1st Step.
1. Assess/child infant - History Taking/Physical Exam, General Danger signs, Nutrition & Immunization
stats, Finish All Q’s even if step you answer that.
2. Classify the illness - Pink/Red, Yellow, Green
3. Identify specific treatments for children - Color classification
4. Treat a child.
5. Counsel mother - When to return to the health center, What food and fluids to give on the child.
6. Give follow up care - reassess the child.
General Danger Signs
1. Vomits everything - even breastmilk or little water.
2. Unable to eat/drink.
3. Lethargy/unconscious/unresponsive/abnormally sleepy
4. Convulsions - History of convulsions is not classified as severe.
Coughing or Difficult Breathing
1. Any General danger signs
2. Stridor in a calm child
1. Severe pneumonia
2. Very severe pneumonia
1. Give the first dose of antibiotic
ampicillin or gentamicin.
2. Refer Urgently to hospital
1. Chest indrawing
2. Fast Breathing
<2 mos - 60 breaths/min
2-12 mos - 50
breaths/min
12mos-5yrs - 40 breaths
min
Pneumonia
1. Give oral amoxicillin for 5
days.
2. Give inhaled bronchodilator
for 5 days if wheezing.
3. If coughing for more than 14
days recurrent wheeze, refer
for possible TB or Asthma
Assessment.
4. Follow up in 3 Days
1. No signs of pneumonia or
very severe disease.
Cough or cold
1. If wheezing (or disappeared
after rapidly acting
bronchodilator for 5 days).
2. Soothe the throat and relieve
cough with a safe remedy.
3. If coughing/recurrent
wheezing refer.
4. Follow up 5 days if not
improving.
Practice:
1. Any danger signs 2. Stridor in calm child 3. RR of child 12 mos to 5 years 4. Yellow classification 5. Green classification 6. Antibiotic for pneumonia -
TOP RANK REVIEWER SUMMARY BY RESURRECCION, CRYSTAL JADE R.N
7. Antibiotic for severe pneumonia 8. Fast breathing 9. Refer urgently to hospital Classify Diarrhea or Dehydration
Two of the following signs:
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Severe dehydration
Give fluid for severe DHN
PLAN C or
● If a child has Severe
classification.
Refer urgently to the
hospital with mother
giving frequent ors otw
Advise mother continue
BF
● If a child is 2 years old and
there’s cholera in your area,
give antibiotics for cholera.
Some dehydration
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Lethargic or unconscious
Sunken eyes
Not able to drink or drinking
poorly.
Skin pinch goes back very
slowly.
Two of the following signs:
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Restless, Irritable
Sunken eyes
Drinks Eagerly, Thirsty
Skin pinch goes back slowly.
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Not enough signs to classify
as some or severe
dehydration.
No dehydration
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Practice:
10. Some dehydration 11. No dehydration 12. Unconscious 13. Plan C 14. Drinks eagerly 15. Sunken eyes 16. Skin pinch goes back slowly 17. Skin pinch goes back very slowly 18. Plan A 19. Not enough signs 20. Pink classification 21. restless/irritable 22. Refer -
Give fluid, Zinc supplements
and food for some DHN PLAN
B
If a child also has a severe
classification
Refer and give him ORS on
the way.
Continue breastfeeding.
Follow up in 5 days if not
improving.
Give fluid, Zinc supplements
and food to treat diarrhea at
home PLAN A
Follow up in 5 days if not
improving.
TOP RANK REVIEWER SUMMARY BY RESURRECCION, CRYSTAL JADE R.N
If Diarrhea 14 days or more
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Dehydration present
Severe persistent diarrhea
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No Dehydration
Persistent Diarrhea
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Blood in the stool
Dysentry
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Treat dehydration before
referral unless the child has
another classification.
Refer to the hospital
Advise mother on feeding a
child who has persistent
diarrhea
Give multivitamins and
minerals including zinc for 14
days
Follow up in 5 days.
Give ciproflaxacin for 3 days
oral
Follow-up in 3 days
Classify Fever: High or Low Malaria Risk
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Any danger signs convulsions, vomits, lethargy
or unable to eat.
Stiff neck
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Malaria Test positive
Very severe Febrile Disease
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Malaria
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Malaria test negative
Other cause of fever present
Fever: No malaria
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Treat dehydration before
referral unless the child has
another classification.
Refer to the hospital
Advise mother on feeding a
child who has persistent
diarrhea
Give multivitamins and
minerals including zinc for 14
days
Follow up in 5 days.
Give one dose of
paracetamol
Give appropriate antibiotic
(culture)
Advise mother
Follow up in 3 days if you
have a fever.
If fever is present everyday
for 7 days, Refer.
TOP RANK REVIEWER SUMMARY BY RESURRECCION, CRYSTAL JADE R.N
If Measles now or Within last 3 months
Classify ear problem
Classify for anemia
Classify for Nutritional status
TOP RANK REVIEWER SUMMARY BY RESURRECCION, CRYSTAL JADE R.N
COMMUNICABLE DISEASE
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Caused by infectious agents whether bacteria /virus spread from person to person.
Contagious - easily transmitted can be airborne/droplet
Infectious - not easily transmitted can be blood borne, food borne, STD’s gonorrhea or chlamydia
“All contagious diseases are infectious but not all infectious are contagious”
Pathogenicity - ability of pathogen to cause a disease.
Virulence - Ability to damage a host.
TOP RANK REVIEWER SUMMARY BY RESURRECCION, CRYSTAL JADE R.N
CHAIN OF INFECTION
Mode of transmission:
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Vehicle route - Food, water, Blood or non living thing
Vector borne - infections transmitted by the bite of infected arthropod species, such as mosquitoes, ticks,
triatomine bugs, sandflies, and blackflies.
Example: Aedes mosquito - zika - chikungunya virus
Example: Anopheles mosquito- filariasis, malaria
Example: Culex mosquito - Japanese Encephalitis
Airborne - Droplet nuclei, Remain long in air heavy (small particles at 5mm)
Droplet - large and short distances (up to 6 ft/2 meters) Thru sneezing for a long period of time on the
surface.
Direct contact - tissues or fluids, physical transfer through mucous membranes (eyes and mouth) open
wounds abraded skin.
Indirect - contaminated objects (fomites), unclean hands.
TOP RANK REVIEWER SUMMARY BY RESURRECCION, CRYSTAL JADE R.N
Communicable Diseases
DIPHTHERIA
Causative agent: Corynebacterium diphtheria or Klebbs- loffler
Mode of transmission: Droplet especially secretions from mucous membranes of the nose and nasopharynx
and from skin and other lesions; Milk has served as a vehicle.
Incubation Period: 2 – 5 days
SIGNS AND SYMPTOMS:
● Respiratory Diphtheria
Ex: Sore throat, Fever
Difficulty swallowing
Bull neck appearance
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Pathognomonic sign: Pseudomembrane (A thick, gray membrane covering the throat and tonsils.)
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Laryngeal Diphtheria
Ex: Gradually increasing hoarseness, cough, stridor
Nasal Diphtheria
Ex: Clear nasal discharge but every becomes blood stained
Cutaneous Diphtheria
Skin ulcers commonly in the legs.
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Diagnostic test:
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Nose/throat swab
Moloney’s test – a test for hypersensitivity to diphtheria toxin
Schick’s test – determines susceptibility to bacteria
Interventions:
1. Isolate the child until two negative nose and throat culture are negative (24 hours apart)
2. Bed rest is necessary (except for nasal diphtheria)
3. Oral hygiene (warm mouth wash, NEVER TOOTHBRUSH)
Prevention:
● Active immunization: DPT immunization
● Passive immunization: Anti-toxin
Drug-of-Choice: Erythromycin 20,000 - 100,000 units IM once only
Complication: MYOCARDITIS, Respiratory, Airway obstruction.
TOP RANK REVIEWER SUMMARY BY RESURRECCION, CRYSTAL JADE R.N
PERTUSSIS (WHOOPING COUGH)
Three stages:
1. Catarrheal or Prodromal stage:
● 7-14 days
● Mild fever, headache, colds
● Persistent cough
2. Paroxysmal stage (Spasmodic or whooping stage)
● 14-28 days
● Paroxysmal cough (Several sharp coughs in one expiration, followed by deep inspiration, which
● may be accompanied by. Whoop)
● Cough is worse at night
● Anorexia
3. Convalescent stage:
● Lasts 21 days
● Less cough and vomiting
Diagnostic Test:
Bordet-gengou agar test - is an enriched, casein peptone medium with potato infusion and glycerol to
supply the nutrients necessary to support the growth of B. pertussis. Defibrinated sheep blood supplies
additional nutrients and enables the detection of hemolytic reactions, which aid in the identification of B.
Management:
● Drug of choice: Erythromycin or Penicillin 20,000 - 100,000units
● Isolation and complete bed rest
● For paroxysmal stage: Avoid dust pollutants, oxygenation, calm atmosphere
● Watch out for airway obstructions
Prevention:
• Active immunization: DPT immunization
• Booster: 2 years and 4-5 years
• Patient should be segregated until after 3 weeks from the appearance of paroxysmal cough
• Passive immunization: Gamma globulin IgG No toxins
TETANUS “Lockjaw”
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Etiologic agent: Clostridium tetani – anaerobic spore-forming heat- resistant and lives in soil or intestine
Neonate: umbilical cord
Children: dental caries
Adult: puncture wound; after septic abortion
Mode of transmission: Indirect contact – inanimate objects, soil, street dust, animal and human feces,
puncture wound
Incubation Period: Varies from 3 days to 1 month, falling between 7– 14 days
Signs and symptoms
● Convulsion is the first warning symptom among children
● Restlessness and irritability
TOP RANK REVIEWER SUMMARY BY RESURRECCION, CRYSTAL JADE R.N
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Muscular stiffness progresses
Trismus : Tight jaw, inability to open mouth
Stiff arm and legs, then whole body
Resus sardonicus: Facial muscle spasm
Opisthotonus: Backward arching of the back as a result of dominance of extensor muscles of the
spine, head draws back.
No specific test, only a history of puncture wound
Treatment:
● Antitoxin anti tetanus serum (ATS)
● Tetanus immunoglobulin (TIG) (if the patient has allergy, should be administered in fractional doses)
● Antibiotics (Penicillin G)
● Diazepam – for muscle spasms
Prevention:
● Active immunization: DPT immunization
● Tetanus toxoid (artificial active) immunization among pregnant women
● Passive immunization: Tetanus immuno-globulin or antitoxin
Poliomyelitis “Infantile paralysis”
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Causative agent: Poliovirus (Legio debilitans)
Man is the only reservoir
Mode of transmission: Fecal – oral
Incubation period: 5-14 days
Signs and symptoms:
Abortive Poliomyelitis
● Upper respiratory tract infection symptoms
● Fever, Headache, Vomiting
Non-Paralytic polio
● Stiffness of neck, back and limbs
● Nausea and vomiting
● Increase protein in CSF
Paralytic Polio
● Spinal: Paralysis appear within a day or two after above manifestations; Limb paralysis most
common; chest, diaphragm, bladder and bowel paralysis may also occur.
Bulbar Polio
● Life threatening; swallowing problem and regurgitation; aspiration may occur; Encephalitis
Diagnostic test: CSF analysis / lumbar tap
Management:
● Rehabilitation involves ROM exercises
● Symptomatic
Prevention:
● Active immunization: OPV, IPV vaccination (Trivalent poliovirus vaccine)
Sabin: Attenuated; Orally
Salk: Killed virus; Injection
TOP RANK REVIEWER SUMMARY BY RESURRECCION, CRYSTAL JADE R.N
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Passive immunization: Gamma Globulin
MEASLES “Morbilli Rubeola”
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Causative agent: RNA containing paramyxovirus
Period of Communicability: 4 days before the appearance of rash to 5 days after rash appearance
Mode of transmission: Airborne -droplet secretions from nose and throat
Incubation period: 10 days – fever ;14 days – rashes appear (8-13 days)
Coryza
Common colds and occur before rash appearance
Fever (Highest just before the appearance of the rash)
Barking cough
Conjunctivitis and photophobia; Enlarged posterior cervical lymph nodes
Koplik’s spots: Appear on day before rash. Whitish spots with reddish base on the
inside of the mouth
Rash: Appears on 2nd to 5th day and remain about a week
Appears first on the face, behind the ears, on the neck, forehead or cheeks then spread downwards over the
rest of the body (Trunk, arms, legs)
Itchy rash
No specific diagnostic test
Management:
• Isolation and bed rest.
• Supportive and symptomatic
• Eye care with warm saline solution
• Antipyretics for fever; Encourage fluids
• Mouth care for Koplik’s spots
Prevention:
• Active immunization: Live attenuated vaccine
• Passive immunization: Newborn through the mothers; Gamma globulin
• Disinfection of soiled articles Isolation of cased from diagnosis until about 5-7 days
after onset of rash
MUMPS
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Etiology: Paramyxovirus
Incubation Period: 14-21 days
Communicability Period: One to six days before the first symptoms appears until swelling disappears
Mode of transmission: Droplet; Direct or indirect contact
Prodromal Phase:
● Coryza
● Low grade fever
● Vomiting, headache, malaise
TOP RANK REVIEWER SUMMARY BY RESURRECCION, CRYSTAL JADE R.N
Acute Phase:
● Pain in or behind ears; Pain on swallowing or chewing
● Swelling and pain in glands (unilateral or bilateral)
● Orchitis and mastitis may occur
Complication: Sterility
Management:
● Symptomatic treatment
● Isolation and bed rest until swelling disappears
● Encourage fluids and soft foods
● Apply hot or cold compress for swelling.
● Orchitis: Support scrotum, use cold compress for 20 minutes.
Prevention:
● Active immunization: Live attenuated vaccine
● Passive immunization: Gamma-globulin
CHICKEN POX
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Etiologic agent: Varicella-zoster virus
Period of Communicability: From as early as 1 to 2 days before the rashes appear until the lesions
have crusted.
Mode of transmission: Airborne
Incubation Period: 2-3 weeks, commonly 13 to 17 days
Prodromal stage:
● Mild fever, anorexia, headache
Acute Phase:
Vesiculo-pustular rashes
● Centrifugal appearance of rashes – rashes which begin on the trunk and spread peripherally and
more abundant on covered body parts
Pruritus
No specific diagnostic exam
● Treatment is supportive.
● Drug-of-choice: Acyclovir / Zovirax ® (orally to reduce the number of lesions; topically to lessen the
pruritus)
● To relieve itching, antihistamine, or calamine lotion.
● Cool sponge bath. Mittens may be used to avoid scratching
● Keep in isolation until lesions have been crusted.
● NEVER give ASPIRIN. Aspirin when given to children with viral infection may lead to development of
REYE’S SYNDROME.
TOP RANK REVIEWER SUMMARY BY RESURRECCION, CRYSTAL JADE R.N
GERMAN MEASLES “Rubella”
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Causative agent: Rubella virus or RNA containing Togavirus (Pseudoparamyxovirus)
Teratogenic infection can cause congenital heart disease and congenital cataract.
Mode of transmission: Droplet, Direct/ Indirect contact
Incubation Period: 14-21 days
Communicable Period: During Prodromal period and 5 days after the rash.
Prodromal stage:
● Mild fever (Disappears when rash appear)
● Malaise, headache, anorexia
● Runny nose, sore throat
● Forscheimer spots – red pinpoint patches on the oral cavity
● Faint maculopapular rashes. Small pinpoint pink or pale red macules which fades on pressure.
● Enlargement of posterior cervical and postauricular lymph nodes
Diagnostic Test: Rubella Titer (Normal value is 1:10); below 1:10 indicates susceptibility to Rubella.
● Instruct the mother to avoid pregnancy for three months after receiving the MMR vaccine.
● MMR is given at 15 months of age and is given intramuscularly.
Prevention:
● MMR vaccine (live attenuated virus) - Derived from chick embryo
● Contraindication: Allergy to eggs