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IMCI Guideline: Childhood Illness Management (2-5 Years)
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INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI) Nursing Responsibility: ACT (Assess, Classify, Treat) CHILD – 2 MOS. UP TO 5 YEARS OF AGE I. ASSESS GENERAL DANGER SIGNS Inability to drink or breastfeed Vomiting all intake Convulsion Abnormally sleepy; difficult to arouse TAKE NOTE: Make sure the child with any general danger sign is referred after first dose of an appropriate antibiotics & other urgent treatments Exception: Rehydration of the child according to Plan C may resolve the danger signs so that referral is no longer needed. MAIN SYMPTOMS COUGH OR DIFFICULT BREATHING Ask for how long? Count the breaths in one minute check for fast breathing 2mos to 1yo: 50bpm 1yo to 5yo: 40bpm Look for chest indrawing Look & listen for stridor Look & listen for wheezes If with wheezing & either fast breathing or chest indrawing: Give a trial of rapid-acting inhaled bronchodilator for up to three times 15-20 minutes apart. Count the breaths & look for chest indrawing again, & then classify. DIARRHEA Ask for how long? Look at the child’s general condition Abnormally sleepy or difficult to awaken? Restless or irritable? Sunken eyes? Offer child fluid (not able to drink or drinking poorly? or eagerly or thirstily) Pinch the skin of the abdomen (color goes back very slowly – longer than 2 seconds; or slowly? Is there blood in the stool? FEVER (temperature of 37.5°C or more) CBQ Malaria/Measles ASK Does the child live in a malaria area? Has the child visited/traveled or stayed overnight in a malaria area in the past 4 weeks? (If yes to either, obtain a blood smear) THEN ASK For how long has the child had fever? If more than 7 days, has fever been present every day? Has the child had measles within the last 3 months? LOOK & FEEL Stiff neck, runny nose Signs of measles: Generalized rash One of these: cough, runny nose, or red eyes If the child has measles now or within the last three months: LOOK FOR: Mouth ulcers; are they deep & extensive? Pus draining from the eye Clouding of the cornea Dengue ASK: Has the child had any bleeding from the nose or gums or in the vomitus or stools? Has the child had black vomitus? Has the child had black stools? Has the child had abdominal pain? Has the child been vomiting? LOOK & FEEL Look for bleeding from nose or gums Look for skin petechiae Feel for cold & clammy extremities Check for slow capillary refill If none of the above ASK or LOOK & FEEL signs are present & the child is 6 months or older & fever is present for more than three days: Perform the tourniquet test Ear Problem (CBQ) ASK Is there ear pain? Is there ear discharge? If yes, for how long? LOOK & FEEL Look for pus draining from the ear Feel for tender swelling behind the ear CHECK FOR MALNUTRITION: LOOK & FEEL For all children: Determine weight for age Look for edema of both feet Look for visible severe wasting For children aged 6 months or more; determine if MUAC (mid-upper arm circumference) is less than 110mm; (if tapes are not available, look for visible severe wasting CHECK FOR ANEMIA LOOK & FEEL Look for palmar pallor (Is it severe or some palmar pallor?) CHECK CHILD’S IMMUNIZATION STATUS Birth – BCG, HEPA B (1st dose) 6wks – DPT, OPV, HEPA B (2nd dose) 10wks - DPT, OPV (2nd dose) 14wks - DPT, OPV, HEPA B (3rd dose) 9mos – Measles CHECK VITAMIN A STATUS First Dose at 6 months or above Subsequent doses every 6 months CHECK DEWORMING STATUS: Give every child Mebendazole every 6 months from the age 1. Record the case on the child’s card. ASSESS OTHER PROBLEMS II. CLASSIFY & TREAT: Cough & Difficult Breathing CLASSIFICATION SEVERE PNEUMONIA OR VERY SEVERE DISEASE SIGNS Any of the ff: *any danger sign *chest indrawing *stridor in calm child PNEUMONIA Fast Breathing (if with wheezing, go directly to treat wheezing) NO PNEUMONIA; COUGH OR COLD No signs of pneumonia or very severe disease (if wheezing go directly to treat wheezing) TREATMENT *Give 1st dose of appropriate antibiotic *Give Vit.A regardless of last dose *If with chest indrawing & wheezes, go to treat wheezing *Treat child to prevent ↓ bld sugar *Refer urgently to hospital *Give appropriate antibiotic for 3 days * If wheezing (even if it disappeared after rapid-acting bronchodilator for five days) *Soothe the throat & relieve cough w/ a safe remedy * If coughing for more than 3 weeks or if having recurrent wheezing, refer for assessment for TB & asthma *Advise mother when to return ASAP *Follow up in 2 days * If wheezing (even if it disappeared after rapid-acting bronchodilator) for five days * If coughing is more than 30days, refer for assessment *Soothe the throat to relieve cough w/ safe remedy *Advise mother when to return ASAP *Follow up in 5 days if not improving Diarrhea CLASSIFICATION SEVERE DEHYDRATION SIGNS 2 of the ff signs: *Abnormally sleepy or difficult to arouse *Sunken eyes *Not able to drink or drinking poorly *Skin pinch goes back very slowly SOME DEHYDRATION 2 of the ff signs: *Restless, irritable *Sunken eyes *Drinks eagerly, thirstily *Skin pinch goes back slowly NO DEHYDRATION Not enough signs to classify as some or severe dehydration TREATMENT *If child has no other severe classification – give fluid for severe dehydration (PLAN C) OR *If child also has another severe classification – refer urgently to hospital with mother giving frequent sips of ORS on the way; advise mother to continue breastfeeding *If child is 2yo or older & there is cholera in your area, give antibiotic for cholera *Give fluid & food for some dehydration (PLAN B) *If child also has a severe classification – refer urgently to hospital with mother giving frequent sips of ORS on the way; advise mother to continue breastfeeding *Advise mother when to return immediately *Follow up in 5 days if not improving *Give ORS, zinc supplements & food to treat diarrhea at home (PLAN A) *Advise mother when to return SEVERE PERSISTENT DIARRHEA Diarrhea is 14 days or more Dehydration is present PERSISTENT DIARRHEA Diarrhea is 14 days or more No dehydration DYSENTERY Blood in the stool immediately *Follow up in 5 days if not improving *Treat dehydration before referral unless child has another severe classification *Give Vit.A *Refer to hospital *Advise the mother on feeding a child who has persistent diarrhea *Give multivitamins & minerals (including zinc) for 14 days *Follow up in 5 days *Advise when to return immediately *Give Ciprofloxacin for 3 days *Follow up in 2 days *Advise when to return immediately Fever Malaria Risk CLASSIFY VERY SEVERE FEBRILE DISEASE/ MALARIA SIGNS Any general danger sign or Stiff neck MALARIA Blood smear (+) If blood smear not done: NO runny nose & NO measles & NO other cause of fever FEVER; MALARIA UNLIKELY Blood smear (-) or Runny nose or Measles or Other causes of fever TREATMENT *Give 1st dose of quinine (under medical supervision or if a hospital is not accessible within 4 hours) *Give first dose of an appropriate antibiotic *Treat the child to prevent low blood sugar *Give one dose of paracetamol in health center for high fever (38.5°C or above) *Send blood smear with the patient *Refer urgently to the hospital *Treat the child with an oral antimalarial *Give one dose of paracetamol in health center for high fever (38.5°C or above) *Advise mother when to return immediately *Follow up in 2 days if fever persists *If fever is present every day for more than 7 days, refer for assessment *Give one dose of paracetamol in health center for high fever (38.5°C of above) *Advise mother when to return immediately *Follow up in 2 days if fever persists *If fever is present every day for more than 7 days, refer for assessment *Treat other causes of fever No Malaria Risk CLASSIFY VERY SEVERE FEBRILE DISEASE SIGNS Any general danger signs or Stiff neck FEVER; NO No signs of very severe febrile TREATMENT *Give one dose of an appropriate antibiotic *Treat the child to prevent low blood sugar *Give one dose of paracetamol in health center for high fever (38.5°C of above) *Refer urgently to hospital * Give one dose of paracetamol MALARIA disease in health center for high fever (38.5°C of above) *Advise mother when to return immediately *Follow up in 2 days if fever persists * If fever is present every day for more than 7 days, refer for assessment If measles now or within last 3 months CLASSIFY SEVERE COMPLICATED MEASLES SIGNS Any danger sign Clouding of cornea or Deep or extensive mouth ulcers MEASLES WITH EYE OR MOUTH COMPLICATIONS Pus draining from eye or Mouth ulcers MEASLES Measles now or within the last 3 months CLASSIFY SEVERE DENGUE HEMORRHAGIC FEVER SIGNS Bleeding from nose or gums or Bleeding in stools or vomitus or Black stools or vomitus or Skin petechiae or Cold & clammy extremities or Capillary refill >3sec or Persistent abdominal pain or Persistent vomiting or Tourniquet test (+) FEVER: DENGUE HEMORRHAGIC FEVER UNLIKELY No signs of severe dengue hemorrhagic fever TREATMENT *Give Vit.A *Give 1st dose of an appropriate antibiotic *If clouding of the cornea or pus draining from the eye, apply tetracycline eye ointment *Refer urgently to the hospital. *Give Vit.A *If pus draining from the eye, apply tetracycline eye ointment *If with mouth ulcers, teach the mother to treat with gentian violet *Follow up in 2 days *Advise mother when to return immediately *Give Vit.A *Advise mother when to return immediately Dengue Risk TREATMENT *If persistent vomiting or persistent abdominal pain or skin petechiae or (+) tourniquet test are the only positive signs; give ORS as in Plan B *If any other signs are positive, give fluids rapidly as in Plan C *Treat the child to prevent low blood sugar *Refer urgently to hospital *Do not give ASPIRIN *Advise mother when to return immediately *Follow up in 2 days if fever persists or child shows signs of bleeding *Do not give aspirin Ear Problem CLASSIFICATION MASTOIDITIS SIGNS Tender swelling behind the ear ACUTE EAR INFECTION Pus is seen draining from the ear & discharge is reported for less than 14 days or Ear pain CHRONIC EAR INFECTION Pus is seen draining from the ear & discharge is reported for 14 days or more NO EAR INFECTION No ear pain & no pus seen TREATMENT *Give 1st dose of an appropriate antibiotic *Give 1st dose of paracetamol for pain *Refer urgently to hospital *Give antibiotic for 5 days *Give paracetamol for pain *Dry the ear by wicking *Follow up in 5 days *Give advise when to report immediately *Dry the ear by wicking *Instill otic drops for 2 weeks *Follow up in 14 days *Advise when to return immediately *No additional treatment draining from the ear *Advise mother when to report immediately TREATMENT *Treat the child to prevent low sugar *Refer urgently to hospital VERY LOW WEIGHT SIGNS *If age up to 6mos - & visible severe wasting or - edema of both feet *If age 6mos & above & -MUAC less than 110mm or edema of both feet or visible severe wasting Very low weight for age NOT VERY LOW WEIGHT Not very low weight for age & no other signs of malnutrition Malnutrition CLASSIFICATION SEVERE MALNUTRITION *Assess the child’s feeding & counsel the mother on feeding according to the feeding recommendations *Advise mother when to return immediately *Follow up in 30 days *If the child is less than 2yo, assess the child’s feeding & counsel the mother on feeding according to the feeding recommendations - If feeding is a problem, follow up in 5 days *Advise mother when to return immediately Anemia SEVERE ANEMIA ANEMIA *Severe palmar pallor *Some palmar pallor NO ANEMIA *No palmar pallor *Refer urgently to a hospital *Give iron *Give oral antimalarial if malaria risk *Give mebendazole if child is 1yo or older & has not had a dose in the previous six months *Advise mother when to return immediately *Follow up in 14 days *If child is less than 2yo, assess the child’s feeding & counsel the mother on feeding according to the feeding recommendations -If with feeding problem, follow up in 5days TREAT THE CHILD Carry out the Treatment Steps Identified in the Classification Chart TEACH THE MOTHER TO GIVE ORAL DRUGS AT HOME Determine the appropriate drugs & dosage for the child’s age or weight Tell the mother the reason for giving the drug to the child Demonstrate how to measure a dose Watch the mother practice measuring a dose by herself Ask the mother to give the first dose to her child Explain carefully how to give the drug, then label & package the drug If more than one drug will be given, collect, count & package each drug separately Explain that all the oral drug tablets or syrups must be used to finish the course of treatment, even if the child gets better Check the mother’s understanding before she leaves the health center GIVE AN APPROPRIATE ORAL ANTIBIOTIC VAMP For Pneumonia, Acute Ear Infection or Very Severe Disease, Mastoiditis 1st Line Antibiotic: AMOXICILLIN nd 2 Line Antibiotic: COTRIMOXAZOLE AMOXICILLIN Pneumonia: Give 2x daily for 3days Acute Ear Infection: Give 3x daily for 5days COTRIMOXAZOLE Pneumonia: Give 2x daily for 3days Acute Ear Infection: Give 3x a day for 5 days AGE or WEIGHT Adult Tablet (250mg) Syrup (125mg/5ml) Tablet: 80mg trimethoprim + 400mg sulfamethoxazole Syrup: 40mg trimethoprim + 200mg sulfame thoxazole 2mos – 6 mos (3-5kg) 6mos – 12 mos (6-9kg) 12mos – 3years (10kg-14kg) 3yrs – 5yrs (15-19kg) ½ 5.0ml ½ 5ml 1 10ml ½ 5ml 1½ 15ml 1 10ml 1 10ml 2 For Dysentery Give antibiotic recommended for Shigella in the area for 3 days 1st Line Antibiotic: CIPROFLOXACIN (Give 2x for 3days) AGE or WEIGHT 2mos – 6mos (3-5kg) 6mos – 12 mos (6-9kg) 12 mos – 3yo (10-14kg) 12mos – 5yo (10-19kg) 100mg TABLET (dose/tab) ½ tablet 1 tablet 1 ½ tablet 2 tablets 250mg TABLET (dose/tab) ¼ tablet ½ tablet ½ tablet 1 tablet For Cholera 1st Line Antibiotic: Tetracycline 2nd Line Antibiotic: Erythromycin AGE or WEIGHT 2yo – 5yo (10-19kg) TETRACYCLINE Give 4x daily for 3 days Tablet 250mg 1 ERYTHROMYCIN Give 4x daily for 3days Tablet 250mg 1 GIVE AN ORAL ANTIMALARIAL 1ST LINE ANTIMALARIAL: ARTEMETER - LUMEFANTRINE 2nd Line – CHLOROQUINE & PRIMAQUINE; SULFADOXINE & PYRIMETHAMINE If Chloroquine/Primaquine Explain to the mother that she should watch her child carefully for 30minutes after giving a dose of Chloroquine; if the child vomits within 30minutes, she should repeat the dose & return to the health center for additional tablets Explain that itching is a possible side effect of the drug but it is not dangerous If Sulfadoxine/Pyrimethamine: Give single dose in health center 2 hours before intake of Chloroquine If Primaquine: Give single dose on day 4 for P. Falciparum If Artemether-Lumenfantrine combination: Give for 3 days DOSE OF ARTEMETER-LUMEFANTRINE (20 & 120mg respectively) 5-<15kg 15-< 25kg 25-<35kg (6mos. to 3yo) 1 tab 1 tab 1 tab BID 1 tab BID Give primaquine only to >1yo ½ tablet Single dose Day 0 8 hrs after Day 1 Day 2 Day 3 (4 to 8yo) 2 tabs 2 tabs 2 tabs BID 2 tabs BID Primaquine ½ to ¾ tab single dose (9 to 13 yo) 3 tabs 3 tabs 3 tabs BID 3 tabs BID Primaquine 1 tablet single dose Preferably taken with high fat diet Not recommended during pregnancy, lactation & in infant < 1yo & in severe malaria See other table for Primaquine dosage TREATMENT SCHEDULE FOR PROBABLE MALARIA & CONFIRMED P. FALCIPARUM Age (years) 0-4mos 5-11mos 1-3yo 4-6yo 7-11yo 12-15yo 16yo & > Number of Chloroquine tablet (150mg base/tablet) Day 1- 10mg base/kbw Day 2- 10mg base/kbw Day 3- 10mg base/kbw Day 1 Day 2 Day 3 ½ ½ ½ ½ ½ ½ 1 1 ½ 1½ 1½ 1 2 2 1 3 3 1½ 4 4 2 Sulfadoxine/Pyrimethamine (500mg/25mg/tablet) Primaquine (15mg/tablet) No. of tablet Single dose only Single dose only Day 1 ¼ ½ 1 1 1½ 2 3 Day 4 Not included Not included ½ 1 2 3 3 Treatment should be given after meals First day of treatment should be under the supervision of the health worker SP are generally well tolerated when used at the recommended doses for malaria & serious events are associated with hypersensitivity to sulfa component involving the skin & mucous membranes including StevenJohnson syndrome & normally occurring after repeated administration TREATMENT SCHEDULE FOR CONFIRMED P. VIVAX CASES Age (years) No. of Chloroquine tablet (150mg base/tablet) Dosage same as in P. falciparum Day 1 Day 2 Day 3 ½ ½ ½ ½ ½ ½ 1 1 ½ 1½ 1½ 1 2 2 1 3 3 1½ 4 4 2 0-4mos. 5-11mos. 1-3yo 4-6yo 7-11yo 12-15yo 15yo & > Primaquine (15mg/tablet) 1-14 days treatment Day 4 not included not included ½ daily 1 daily ¾ daily 1 daily 1 daily TREATMENT SCHEDULE FOR MIXED P. FALCIPARUM & P. VIVAX INFECTION Age (years) 0-4mos. 5-11mos. 1-3yo 4-6yo 7-11yo 12-15yo 16yo & > No. of Chloroquine tablet (150mg base/tablet) Day 1 ½ ½ 1 1½ 2 3 4 Day2 ½ ½ 1 1½ 2 3 4 Day 3 ½ ½ ½ 1 1 1½ 2 Sulfadoxine/Pyrimethamine (500mg/25mg/tablet) No. of Tablet Single dose only Day 1 ¼ ½ 1 1 1½ 2 3 Treatment should be given after meals Primaquine (15mg/tablet) No. of tablets For 14 days not included not included ½ daily ½ ¾ 1 1 First day of treatment should be under the supervision of the health worker GIVE VITAMIN A Treatment: Give one dose in the health center Supplementation: Give one dose in health center if Child is six months of age or older & Child has not received a dose of Vit.A in the past nine months AGE VITAMIN A CAPSULE 100,000 IU 1 6 mos up to 12 mos. 12 mos up to 5yo 200,000 IU ½ capsule 1 capsule GIVE PARACETAMOL FOR HIGH FEVER (38.5°C OR MORE) & EAR PAIN Give paracetamol every 6hours until high fever or ear pain is gone AGE or WEIGHT 2mos – 3yo (4-<14kg) 3yo – 5yo (14-19kg) TABLET (500mg) ¼ ½ SYRUP (120mg/5ml) 5ml (1tsp) 10ml (2tsps) GIVE IRON Give one dose daily for 14 days AGE or WEIGHT 3mos up to 4 mos. (4-<6kg) 4mos up to 12 mos. (6-<10kg) 12 mos up to 3yo (10-<14kg) 3yo up to 5yo (14-<10kg) IRON/FOLATE TABLET Ferrous SO4 200mg + 250mcg Folate (60mg elemental iron) IRON SYRUP Ferrous SO4 150mg per 5ml (6mg elemental iron per ml) IRON DROPS Ferrous SO4 25mg (25mg elemental iron per ml) 2.5ml (1/2 tsp) 0.6ml 4ml (3/4 tsp) 1.0ml ½ tablet 5ml (1tsp) 1.5ml 1 tablet 10ml (1 ½ tsp) 2.0ml GIVE MEBENDAZOLE/ALBENDAZOLE Give 500mg Mebendazole/400mg Albendazole as a single dose in health center if: The child is 12 mos up to 59 mos. The child has not had a dose in the previous 6 months AGE OR WEIGHT 12 mos up to 23 mos. 24 mos up to 59 mos. ALBENDAZOLE 400mg 1/2 1 MEBENDAZOLE 500mg 1 1 GIVE MULTIVITAMINS & MINERALS FOR PERSISTENT DIARRHEA All children with persistent diarrhea should receive supplementary multivitamins & minerals each day for two weeks. Locally available preparations are often suitable; these should provide a broad range of vitamins & minerals as possible including at least two Recommended Energy & Nutrient Intake (RENI) of folate, vitamin A, zinc, magnesium & copper. TEACH THE MOTHER TO TREAT LOCAL INFECTIONS AT HOME Explain to the mother what the treatment is & why it should be given Describe the treatment steps Watch the mother as she does the first treatment in the health center (except remedy for cough or sore throat) Tell her how often to do the treatment at home If needed for treatment at home; give mother the tube of tetracycline ointment or a small bottle of gentian violet Check the mother’s understanding before she leaves the health center TREAT EYE INFECTION WITH TETRACYCLINE OINTMENT Clean both eyes 4 times daily Wash hands Ask child to close eyes Use clean cloth & water to gently wipe away pus Then apply tetracycline eye ointment in both eyes 4 times daily Ask the child to look up Squirt a small amount of ointment on the inside of the lower lid Wash hands again Treat until there is no pus discharge Do not put anything else in the eye DRY THE EAR BY WICKING & INSTILL QUINOLONE EARDROPS Dry the ear at least 3 times daily Roll clean absorbent cloth or soft, strong tissue paper into a wick Place the wick in the child’s ear Remove the wick when wet Replace the wick with a clean one & repeat these steps until the ear is dry Instill quinolone eardrops after dry wicking three times daily for two weeks TREAT MOUTH ULCERS WITH GENTIAN VIOLET Treat the mouth ulcers twice daily Wash hands Wash the child’s mouth with clean soft cloth wrapped around the finger & wet with salt water Paint the mouth with half-strength gentian violet (0.25% dilution) Wash hands again Continue using GV for 48 hours after the ulcers have been cured Give paracetamol for pain relief SOOTHE THE THROAT, RELIEVE COUGH WITH A SAFE REMEDY Safe remedies to recommend: Breastmilk for exclusively breastfed infant Tamarind, Calamansi & Ginger decoction Harmful remedies to discourage: Codeine Cough Syrup Other Cough Syrups Oral & Nasal Decongestants GIVE THESE TREATMENTS IN HEALTH CENTER ONLY Explain to the mother why the drug is given Determine the dose appropriate for the child’s weight (or age) Use a sterile needle & sterile syringe Measure the dose accurately Give the drug as an IM injection If the child cannot be referred, follow the instructions provided GIVE AN INTRAMUSCULAR ANTIBIOTIC Give to children being referred urgently Give Gentamicin (7.5mg/kg) & Benzyl Penicillin (50,000 units per kg) AGE OR WEIGHT GENTAMICIN Dose: 7.5mg/kg 80mg vial (40mg/ml) undiluted 3-<6kg 6-<10kg 10-<15kg 0.5ml – 0.9ml 1.1ml – 1.7ml 1.9ml – 2.6ml BENZYL PENICILLIN Dose: 50,000 units per kg To a vial of 600mg (1,000,000 units) add 1.6ml sterile water to give 500,000 units/1ml 0.4ml 0.75ml 1.2ml 15-<20kg 2.8ml – 3.5ml 1.7ml NOTE: Calculate exact dose of Gentamicin base on body weight. GIVE QUININE FOR SEVERE MALARIA For children being referred with very severe febrile disease: Check which quinine formulation is available in your clinic Give first dose of intramuscular quinine & refer urgently to hospital If referral is not possible: Give first dose of IM Quinine (4-8-12 hours) The child should remain lying down for one hour (1) Repeat the Quinine injection at 4 & 8 hours later, & then every 12 hours until the child is able to take an oral antimalarial; do not continue Quinine injection for more than 1 week If no malaria risk, do not give Quinine to a child less than 4 mos of age AGE OR WEIGHT 2mos up to 4mos (4-<6kg) 4mos up to 12 mos (6-<10kg) 12mos up to 2y0 (10-<12kg) 2yo up to 3yo (12-<14kg) 3yo up to 5yo (14-10kg) INTRAMUSCULAR QUININE 150mg/ml * (in 2ml) 300mg/ml* (in 2ml) 0.4ml 0.2ml 0.6ml 0.3ml 0.8ml 0.4ml 1.0ml 0.5ml 1.2ml 0.6ml * Quinine Salt GIVE INHALED SALBUTAMOL FOR WHEEZING Use of a Spacer* A spacer is a way of delivering the bronchodilator drugs effectively into the lungs. No child under 5 years should be given an inhaler without a spacer. A spacer works as well as a nebulizer if correctly used From salbutamol metered dose inhaler (100ug/puff) give 2 puffs Repeat up to 3 times every 15 minutes before classifying pneumonia Spacers are made on the ff way: Use a 500ml drink bottle or similar Cut a hole in the bottle base in the same shape as the mouthpiece of the inhaler. This can be done using a sharp knife. Cut the bottle between the upper quarter & the lower ¾ & discard the upper quarter of the bottle Cut a small V border of the large open part of the bottle to fit the child’s nose & be used as a mask. To use an inhaler with a spacer: Remove the inhaler cap. Shake the inhaler well. Insert the mouthpiece of the inhaler through the hole in the bottle or plastic cup. The child should put the opening of the bottle into his mouth & breathe in & out through the mouth. A carer then presses down the inhaler & spray into the bottle while the child continues to breathe normally. Wait for three to four breaths & repeat for total of five sprays For younger children, place the cup over the child’s mouth & use as a spacer in the same way. *If a spacer is being used for the first time, it should be primed by 4-5 extra puffs from the inhaler. TREAT THE CHILD TO PREVENT LOW BLOOD SUGAR If the child is able to breastfeed Ask the mother to breastfeed the child If the child is not able to breastfeed but is able to swallow Give expressed breastmilk or a breastmilk substitute If neither of these is available, give sugar water Give 30-50ml of milk or sugar water before departure To make sugar water: Dissolve 4 level tsps of sugar (20grams) in a 200ml cup of clean water 4 tsp sugar :200 ml water If the child is not able to swallow Give 50ml of milk or sugar water by nasogastric tube GIVE EXTRA FLUID FOR DIARRHEA & CONTINUE FEEDING PLAN A: TREAT DIARRHEA AT HOME Counsel the mother on the 4 Rules on Home Treatment: Give extra fluid Give zinc supplements (age 2mos up to 5yo) Continue feeding When to return Give extra fluid (as much as the child will take) Tell the mother - Breastfeed frequently & for longer at each feed - If the child is exclusively breastfed, give ORS or clean water in addition to breastmilk - If the child is not exclusively breastfed, give one or more of the ff foodbased fluid (such as soup, rice water, or yogurt drinks) or ORS - It is especially important to give ORS at home when: * The child has been treated with Plan B or Plan C during this visit * The child cannot return to a health center if the diarrhea gets worst Teach the mother how to mix & give ORS; give the mother 2 packets of ORS to usual fluid intake Composition of Oresol - Potassium : 1.5 g. ; Sodium Bicarbonate 2.5g; Sodium Chloride 3.5g; Glucose 20 g (“Pa – BCG”) Homemade ORS: 1 glass of water, 1 pinch of salt and 2 tsp of sugar 1:1:2 1 liter of water, 2 tsp of salt; 8 tsp sugar 1:2:8 Show the mother how much fluid to give in addition to the usual fluid intake: - Up to 2yo: 50-100ml after each loose stool - 2yo or more: 100-200ml after each loose stool - Tell the mother to: * Give frequent small sips from a cup * If the child vomits, wait 10minutes, then continue but more slowly * Continue to give extra fluid until the diarrhea stops Give Zinc supplements (age 2mos up to 5yo) Tell the mother how much zinc to give (20mg tab): - 2 to 6 mos: ½ tab daily for 14 days - 6 mos or more: 1 tablet daily for 14 days Show the mother how to give zinc supplements: - Infants: dissolve tablet in a small amount of expressed breast milk, ORS or clean water in a cup - Older children: tablets can be chewed or dissolved in a small amount of clean water in a cup Continue feeding (exclusive breastfeeding if age is less than 6mos.) When to return PLAN B: TREAT SOME DEHYDRATION WITH ORS In the clinic, give recommended amount of reformulated ORS over a 4-hour period AGE WEIGHT In ml Up to 4mos <6kg 200-450 4-12mos 6-<10kg 450-800 1-2yo 10-<12kg 800-960 Determine amount of ORS to give during first 4 hours 2-5yo 12-<20kg 960-1600 *Use the child’s age only when you do not know the weight; this approximate amount of ORS required (in ml) can also be calculated by multiplying the child weight (in kg) x 75 *If the child wants more ORS than shown, give more *For infants under 6mos who are not breastfed, also give 100-200ml clean water during this period Show the mother how to give ORS solution Give frequent small sips from a cup If the child vomits, wait 10minutes; then continue, but more slowly Continue breastfeeding whenever the child wants After 4 hours: Reassess the child & classify the child for dehydration Select the appropriate plan to continue treatment Begin feeding the child in health center If the mother must leave before completing treatment: Show her how to prepare ORS solution at home Show her how much ORS to give to finish 4hour treatment at home Give her instructions how to prepare salt & sugar solution for use at home Explain 4 Rules of Home Treatment PLAN C: TREAT SEVERE DEHYDRATION QUICKLY Ask the following questions: Can you give IV fluid immediately? IF YES - Start IV fluid immediately - If the child can drink, give ORS by mouth while the drip is set up - Give 100 ml/kg Ringer’s Lactate Solution (or if not available, normal saline) divided as follows: AGE FIRST GIVE 30ML/KG IN: THEN GIVE 70ML/KG IN: Infants (under 12mos) 1 hour* 5 hours 1-5yo 30 minutes* 2 ½ hours *Repeat once if radial pulse is still very weak or not detectable - Reassess the child every 1-2hours; if hydration status is not improving, give the IV drip more rapidly - Also give ORS (about 5ml/kg/hour) as soon as the child can drink; usually after 3-4hours (infants) or 1-2hours (children) - Reassess an infant after 6 hours & a child after 3 hours; classify dehydration then choose the appropriate plan (A,B,C) to continue the treatment IF NO, ASK THE NEXT QUESTION Is IV treatment available nearby (within 30 minutes)? IF YES - Refer urgently to hospital for IV treatment - If the child can drink, provide the mother with ORS solution & show her how to give frequent sips during the trip IF NO, ASK THE NEXT QUESTION Are you trained to use a nasogastric (NG) tube for rehydration? IF YES - Start rehydration by tube with ORS solution: give 20ml/kg/hour for 6 hours (total of 120ml/kg) - Reassess the child every 1-2 hours: * If there is repeated vomiting or increasing abdominal distention, give the fluid more slowly * If hydration status is not improving after 3 hours, send the child for IV therapy - After 6 hours, reassess the child; classify dehydration then choose the appropriate plan (A,B,C) to continue treatment IF NO, ASK THE NEXT QUESTION Can the child drink? IF YES - Start rehydration by mouth with ORS solution: give 20ml/kg/hour for 6 hours (total of 120ml/kg) - Reassess the child every 1-2 hours: * If there is repeated vomiting or increasing abdominal distention, give the fluid more slowly * If hydration status is not improving after 3 hours, send the child for IV therapy - After 6 hours, reassess the child; classify dehydration then choose the appropriate plan (A,B,C) to continue treatment IF NO - Refer urgently to the hospital for IV or NG tube treatment NOTE: If the child is not referred to hospital, observe the child at least 6 hours after rehydration to be sure the mother can maintain hydration giving the child ORS solution by mouth. GIVE FOLLOW-UP CARE Care for the child who returns for follow-up PNEUMONIA After 2 days: Check the child for general danger signs Assess the child for cough or difficult breathing Ask: Is the child breathing slower? Is there less fever? Is the child eating better? Treatment: If with chest indrawing or a general danger sign: give a dose of second-line antibiotic or IM Benzyl Penicillin & Gentamicin; then refer urgently to the hospital If breathing rate, fever & eating are the same: change to the second-line antibiotic & advise mother to return in 2 days or refer if the child had measles within the last 3 mos If breathing is slower, fever is less & eating is better: complete the 3 days of antibiotic PERSISTENT DIARRHEA After 5 days: Ask: Has the diarrhea stopped? How many loose stools is the child having per day? Treatment: If the diarrhea has not stopped (child is still having 3 or more loose stools per day): do a full reassessment of the child; give any treatment needed; then refer to hospital If the diarrhea has stopped (child is having less than 3 loose stools per day): tell the mother to follow the usual feeding recommendation for the child’s age DYSENTERY After 2 days: Assess the child for diarrhea Ask: Are there fewer stools? Is there less blood in the stool? Is there less fever? Is there less abdominal pain? Is the child eating better? Treatment: If the child is dehydrated, treat dehydration If number of stools, amount of blood in stools, fever, abdominal pain or eating is the same or worse: Change to second-line oral antibiotic recommended for dysentery in the area; give it for 5 days; advise mother to return in 2 days. If you do not have the second line antibiotic, refer to the hospital. Exceptions if the child: - Is less than 12 months old, or - Was dehydrated on the first visit, or - Had measles within the last 3 months * Refer to hospital If fewer stools, less blood in the stools, less fever, less abdominal pain & eating better: continue giving the same antibiotic until finished Ensure that the mother understands the oral rehydration method fully & that she also understands the need for an extra meal each day for a week. MALARIA If fever persists after 2 days, or returns within 14 days: Do a full assessment of the child Assess for other causes of fever Treatment: If the child has any general danger signs or stiff neck, treat as VERY SEVERE FEBRILE DISEASE/MALARIA (artemeter po, ) If the child has any cause of fever other than malaria, provide treatment If malaria is the only apparent cause of fever: Take a blood smear. (+) Give second-line oral antimalarial without waiting for result of blood smear Advise mother to return if fever persists If fever persists after 2 days treatment with second-line oral antimalarial, refer with blood smear for reassessment If fever has been present for 7 days, refer for assessment FEVER-MALARIA UNLIKELY If fever persists after 2 days: Do a full reassessment of the child Assess for other causes of fever Treatment: If the child has any general danger sign or stiff neck, treat as VERY SEVERE FEBRILE DISEASE/MALARIA If the child has any cause of fever other than malaria, provide treatment If malaria is the only apparent cause of fever: Take a blood smear Treat with first-line oral antimalarial Advise mother to return again in 2 days if fever persists If fever has been present for 7 days, refer for assessment FEVER (NO MALARIA) If fever persists after 2 days: Do a full reassessment of the child Make sure that there has been no travel to malarious area If there has been travel, take blood smear if possible Treatment: If there has been travel to a malarious area & the blood smear is positive or there is no blood smear – classify according to fever with malaria risk & treat accordingly If there has been no travel to malarious area or blood smear is negative: If child has any general danger signs or stiff neck: treat as VERY SEVERE FEBRILE DISEASE/MALARIA If the child has any apparent cause of fever: provide treatment If there is no apparent cause of fever: advise mother to return again in 2 days if fever persists If fever has been present for 7 days, refer for assessment MEASLES WITH EYE OR MOUTH COMPLICATIONS After 2 days: Look for red eyes & pus draining from the eyes Look at mouth ulcers Smell the mouth Treatment for Eye Infection: If pus is draining from the eye Ask the mother to describe how she has treated the eye infection If treatment has been correct, refer to the hospital If treatment has not been correct, teach the mother the correct treatment If the pus is gone & redness remains, continue the treatment If pus & redness is gone, stop the treatment Treatment for Mouth Ulcers: If mouth ulcers are worse, or there is a very foul smell of the mouth, refer to the hospital If mouth ulcers are the same or better, continue using half-strength gentian violet for a total of 5 days FEVER: DENGUE HEMORRHAGIC FEVER UNLIKELY If fever persists after 2 days: Do a full reassessment of the child Do a tourniquet test Assess for other causes of fever Treatment: If the child has any signs of bleeding, including skin petechiae or a positive tourniquet test, or signs of shock or persistent abdominal pain or persistent vomiting: treat as SEVERE DENGUE HEMORRHAGIC FEVER If the child has any other apparent cause of fever, provide treatment If fever has been present for 7 days, refer for assessment If there is no apparent cause of fever, advise the mother to return daily until child has had no fever for at least 48 hours Advise mother to make sure child is given more fluids & is eating EAR INFECTION After 5 days: Reassess for ear problem Obtain child’s temperature Treatment: If there is tender swelling behind the ear or high fever (38.5˚C or above), refer urgently to hospital. Acute ear infection: if ear pain or discharge persists, treat with 5 more days of the same antibiotic; continue wicking to dry the ear; follow up in 5 days Chronic ear infection: check that the mother is wicking the ear correctly; & instilling the quinolone drops. Encourage her to continue. See the child again in 5 days. If no ear pain or discharge: praise the mother for her careful treatment; if she has not yet finished the 5-day antibiotics, tell her to use all of it before stopping FEEDING PROBLEM After 5 days: Reassess feeding Ask about any feeding problems on the initial visit Counsel the mother about any new or continuing feeding problems. If you counsel the mother to make significant changes in feeding, ask her to bring the child back again If the child is very low weigh for age, ask the mother to return in 30 days after the initial visit to measure the child’s weight gain ANEMIA After 14 days: Give iron; advise mother to return in 14 days for more iron Continue giving iron every day for 2 months with follow up every 14 days If the child has any palmar pallor after 2 months, refer for reassessment VERY LOW WEIGHT After 30 days: Weigh the child & determine if the child is still very low weight for age Reassess feeding Treatment: If the child is no longer very low weight for age, praise the mother & encourage her to continue If the child is still very low weight for age, counsel the mother about any feeding problems found; continue to see the child monthly until the child is feeding well & gaining weight regularly or is no longer very low weight for age Exception: if you do not think that feeding will improve or if the child has lost weight, refer the child COUNSEL THE MOTHER FOOD ASSESS THE CHILD’S FEEDING Ask questions about the child’s usual feeding & feeding during this illness Compare the mother’s answers to the “Feeding Recommendations” for the child’s age Ask: Do you breastfeed your child? How many times during the day? Do you also breastfeed during the night? Does the child take any other food? What food or fluids? How many times per day? What do you use to feed the child? If very low weight for age: How large are the servings? Does the child receive his own serving? Who feeds the child & how? During this illness, has the child’s feeding changed? If yes, how? ASSESS THE CHILD’S CARE FOR DEVELOPMENT Observe & ask questions about how mother cares for her child Compare the mother’s answers to the Recommendations for Care & Development Observe: How the mother plays & communicates with the child. As: How do you play with your child? How do you communicate with your child? SAMPLE FEEDING PROBLEMS Difficulty in breastfeeding Child less than 4mos. taking other milk/food Use of breastmilk substitute/cow’s milk/evaporated milk Use of feeding bottles Lack of active feeding Not feeding well during illness Complementary food not enough in quantity/quality/variety Child 6mos. above not yet given complementary foods Infants not exclusively breastfed Improper handling & use of breastmilk substitute RECOMMENDATION FOR FEEDING & CARE FOR DEVELOPMENT Up to 4 months of age Play: provide ways for your child to see, hear, feel & move Communicate: Look into your child’s eyes & smile at him or her When you are breastfeeding, it is a good time to talk to your child & get a conversation going with sounds & gestures. Breastfeed as often as the child wants, day & night, at least 8x in 24 hours Do not give other foods or fluids 4 to 6 months Play: Have large colorful things for your child to reach for & new things to see Communicate: Talk to your child & get a conversation going with sounds & gestures. Breastfeed as often as the child wants, day or night, at least 8x in 24 hours Do not give other foods & fluids. 6 to 12 months Play: Give your child clean, safe household things to handle, bang & drop Communicate: Respond to your child’s sounds & interest. Tell your child the names of things & people. Breastfeed as often as the child wants Add any of the ff: Lugaw with added oil, mashed vegetables or beans, steamed tokwa, flaked fish, pulverized roasted dilis, finely-ground meat, eggyolk, bite-sized fruits Give these foods 3x per day if breastfed & 5x per day if not breastfed 1 to 2 yo Play: Give your child things to stack up & to put into container & take out. Communicate: Ask your child simple questions. Respond to your child’s attempts to talk. Play games like “byebye.” Breastfeed as often as the child wants Give adequate amount of family foods or give rice, camote, potato, fish, chicken, meat, mongo, steamed tokwa, pulverized roasted dilis, milk & eggs, dark green leafy & yellow vegetables (malunggay, squash); fruits (papaya & banana); add oil & margarine Give these foods 5x per day Feed the baby nutritious snacks like fruits 2yo & older Play: Help your child count, name & compare things. Make simple toys for your child. Communicate: Encourage your child to talk & answer your child’s questions. Teach your child stories, songs & games. Give adequate amount of family foods at 3 meals each day Twice daily, give nutritious foods between meals such as boiled yellow camote, boiled yellow corn, peanuts, boiled saba banana, taho, fruits, fruit juices FEEDING RECOMMENDATIONS FOR A CHILD WITH PERSISTENT DIARRHEA If still breastfeeding, give more frequent, longer breastfeeds, day & night If taking other milk such as milk supplements: Replace with increased breastfeeding Replace half the milk with nutrient-rich semi-solid food Do not use condensed or evaporated milk For other foods, follow feeding recommendation for the child’s age COUNSEL THE MOTHER ABOUT FEEDING PROBLEMS (If the child is not being fed as described in the above recommendations, counsel the mother accordingly, in addition:) If the mother reports difficulty with breastfeeding, assess breastfeeding; as needed, show the mother correct positioning & attachment for breastfeeding If the child is less than 6mos old & is taking other milk or foods: Build mother’s confidence that she can produce all the breastmilk that the child needs Suggest giving more frequent, longer breastfeeds, day & night & gradually reducing other milk or foods If other milk needs are to be continued, counsel the mother to: Breastfeed as much as possible, including at night Make sure that other milk is a locally appropriate breastmilk substitute, give only when necessary Make sure that other milk is correctly & hygienically prepared & given in adequate amounts Prepare only an amount of milk which the child can consume within an hour; if there is some left-over milk, discard If the mother is using a bottle to feed the child: Recommend substituting the bottle for a cup Show the mother how to feed the child with a cup If the child is not being fed actively, counsel the mother to: Sit with the child & encourage eating Give the child an adequate serving in a separate plate or bowl Observe what the child likes & consider these in the preparation of his/her food If the child is not feeding well during illness, counsel the mother to: Breastfeed more frequently & for longer periods if possible Use soft, varied, appetizing, favorite foods to encourage the child to eat as much as possible & offer frequent small feedings Clear a blocked nose if it interferes with feeding Expect that appetite will improve as child gets better Follow up any feeding problems in 5 days FLUID FOR ANY SICK CHILD: Breastfeed more frequently & for longer periods at each feeding Increase fluids (ex: give soup, rice water, buko juice, clean water) FOR CHILD WITH DIARRHEA: Giving extra fluid can be life-saving; give fluid according to Plan A or B WHEN TO RETURN FOLLOW UP VISITS If the child has Pneumonia Dysentery Malaria, if fever persists Fever-Malaria Unlikely, if fever persists Fever-No Malaria, if fever persists Measles with Eye or Mouth Complications Dengue Hemorrhagic Fever Unlikely, if fever persists Persistent Diarrhea Acute Ear Infection Chronic Ear Infection Feeding Problem Any other illness, if not improving Anemia Very Low Weight for Age Return for follow up in: 2 days 5 days 14 days 30 days RETURN IMMEDIATELY Any sick child If child has NO PNEUMONIA, COUGH, OR COLD, also return if: If child has DIARRHEA, also return if: If child has FEVER, DENGUE HEMORRHAGIC FEVER UNLIKELY, also return if: *Not being able to drink or breastfeed *Becomes sicker *Develops a fever *Fast breathing *Difficult breathing *Blood in the stool *Drinking poorly *Any sign of bleeding *Abdominal pain *Vomiting ABOUT OWN HEALTH If the mother is sick, provide care for her or refer her for help If she has a breast problem (such as engorgement, sore nipples, breast infection) provide care for her or refer her for help Advise her to eat well to keep up her own strength & health Check the mother’s immunization status & give her Tetanus Toxoid if needed Make sure she has access to family planning & counseling on STD & AIDS prevention INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI) - program based service given by the barangay health services which means it follows a protocol Nursing Responsibility: ACT (Assess, Classify, Treat) CHILD – 2 MOS. UP TO 5 YEARS OF AGE I. ASSESS General Danger Signs Convulsion Unable to drink or breastfeed Vomiting all intake Abnormally sleepy; difficult to arouse Main Symptoms Cough or Difficult Breathing Ask for how long? Count the breaths in one minute check for fast breathing 2mos to 1yo: 50bpm 1yo to 5yo: 40bpm Look for chest indrawing Look & listen for stridor and wheezes (musical sounds) Check RR if there is fast breathing or chest indrawing Diarrhea Ask for how long? Look at the child’s general condition Abnormally sleepy or difficult to awaken? Restless or irritable? Sunken eyes? Offer child fluid (not able to drink or drinking poorly? or eagerly or thirstily) Pinch the skin of the abdomen (color goes back very slowly – longer than 2 seconds; or slowly? Is there blood in the stool? Fever (temperature of 37.5°C or more) CBQ Malaria/Measles ASK Does the child live in a malaria area? Has the child visited a malaria area in the past 4 weeks? (If yes to either, obtain a blood smear) THEN ASK For how long has the child had fever? If more than 7 days, has fever been present every day? Has the child had measles within the last 3 months? LOOK & FEEL Stiff neck, runny nose Signs of measles: Generalized rash One of these: cough, runny nose, or red eyes If the child has measles now or within the last three months: LOOK FOR: Mouth ulcers; are they deep & extensive? Pus draining from the eye Clouding of the cornea Dengue ASK: Has the child had any bleeding from the nose or gums or in the vomitus or stools? Has the child had black vomitus? Has the child had black stools? Has the child had abdominal pain? Has the child been vomiting? LOOK & FEEL Look for bleeding from nose or gums Look for skin petechiae Feel for cold & clammy extremities Check for slow capillary refill If none of the above ASK or LOOK & FEEL signs are present & the child is 6 months or older & fever is present for more than three days: Perform the tourniquet test Ear Problem (CBQ) ASK Is there ear pain? Is there ear discharge? If yes, for how long? LOOK & FEEL Look for pus draining from the ear Feel for tender swelling behind the ear Check Nutritional Status LOOK & FEEL Look for visible severe wasting Look for edema of both feet Look for palmar pallor (severe or some palmar pallor?) Determine weight for age Check Child’s Immunization Status Birth – BCG 6wks – DPT, OPV, HEPA B (1st dose) 10wks - DPT, OPV, HEPA B (2nd dose) 14wks - DPT, OPV, HEPA B (3rd dose) 9mos – Measles Check Vitamin A Status First Dose at 6 months or above Subsequent doses every 6 months II. CLASSIFY & TREAT: General Danger Signs A child with any general signs needs URGENT attention; complete assessment and any pre-referral treatment is given immediately so referral is not delayed Referral is made after first dose of an appropriate antibiotic or other urgent treatment Exception: Rehydration of the child according to Plan C may resolve danger signs so that referral is no longer needed Cough & Difficult Breathing CLASSIFICATION SEVERE PNEUMONIA OR VERY SEVERE DISEASE PNEUMONIA SIGNS Any of the ff: *any danger sign *chest indrawing *stridor in calm child Fast Breathing NO PNEUMONIA; COUGH OR COLD No signs of pneumonia or severe pneumonia TREATMENT *Give 1st dose of appropriate antibiotic *Give Vit.A regardless of last dose *Treat child to prevent ↓ bld sugar *Refer urgently to hospital *Give appropriate antibiotic for 5days *Soothe the throat & relieve cough w/ a safe remedy *Advise mother when to return ASAP *Follow up in 2 days *If coughing is more than 30days, refer for assessment *Soothe the throat to relieve cough w/ safe remedy *Advise mother when to return ASAP *Follow up in 5 days if not improving Diarrhea CLASSIFICATION SEVERE DEHYDRATION SIGNS 2 of the ff signs: *Abnormally sleepy or difficult to arouse *Sunken eyes *Not able to drink or drinking poorly *Skin pinch goes back very slowly SOME DEHYDRATION 2 of the ff signs: *Restless, irritable *Sunken eyes *Drinks eagerly, thirstily *Skin pinch goes back slowly NO DEHYDRATION Not enough signs to classify as some or severe dehydration SEVERE PERSISTENT DIARRHEA Diarrhea is 14 days or more Dehydration is present PERSISTENT DIARRHEA Diarrhea is 14 days or more No dehydration DYSENTERY Blood in the stool TREATMENT *If child has no other severe classification – give fluid for severe dehydration (PLAN C) *If child also has another severe classification – refer urgently to hospital with mother giving frequent sips of ORS on the way; advise mother to continue breastfeeding *If child is 2yo or older & there is cholera in your area, give antibiotic for cholera *Give fluid & food for some dehydration (PLAN B) *If child also has a severe classification – refer urgently to hospital with mother giving frequent sips of ORS on the way; advise mother to continue breastfeeding *Advise mother when to return immediately *Follow up in 5 days if not improving *Give fluid & food to treat diarrhea at home (PLAN A) *Advise mother when to return immediately *Follow up in 5 days if not improving *Treat dehydration before referral unless child has another severe classification *Give Vit.A if not given in the last 30days *Refer to hospital *Advise the mother on feeding a child who has persistent diarrhea *Give Vit.A if not given in the last 30days *Follow up in 5 days *Advise when to return immediately *Treat for 5 days with an oral antibiotic for Shigella in your area *Follow up in 2 days *Advise when to return immediately Fever Malaria Risk CLASSIFY VERY SEVERE FEBRILE DISEASE/ MALARIA SIGNS Any general danger sign or Stiff neck MALARIA Blood smear (+) If blood smear is not done: NO runny nose & NO measles & NO other cause of fever -pt has fever but no signs of runny nose, no measles, or any other cause of fever FEVER; MALARIA UNLIKELY Blood smear (-) or Runny nose or Measles or Other causes of fever TREATMENT *Give 1st dose of quinine (under medical supervision or if a hospital is not accessible within 4 hours) *Give first dose of an appropriate antibiotic *Treat the child to prevent low blood sugar *Give one dose of paracetamol in health center for high fever (38.5°C or above) *Send blood smear with the patient *Refer urgently to the hospital *Treat the child with an oral antimalarial *Give one dose of paracetamol in health center for high fever (38.5°C or above) *Advise mother when to return immediately *Follow up in 2 days if fever persists *If fever is present every day for more than 7 days, refer for assessment *Give one dose of paracetamol in health center for high fever (38.5°C of above) *Advise mother when to return immediately *Follow up in 2 days if fever persists *If fever is present every day for more than 7 days, refer for assessment *Treat other causes of fever No Malaria Risk CLASSIFY VERY SEVERE FEBRILE DISEASE SIGNS Any general danger signs or Stiff neck FEVER; NO MALARIA No signs of very severe febrile disease TREATMENT *Give first dose of an appropriate antibiotic *Treat the child to prevent low blood sugar *Give one dose of paracetamol in health center for high fever (38.5°C of above) *Refer urgently to hospital * Give one dose of paracetamol in health center for high fever (38.5°C of above) *Advise mother when to return immediately *Follow up in 2 days if fever persists * If fever is present every day for more than 7 days, refer for assessment If measles now or within last 3 months CLASSIFY SEVERE COMPLICATED MEASLES SIGNS Clouding of cornea or Deep or extensive mouth ulcers w/ danger signs measles in the past 3 months MEASLES WITH EYE OR MOUTH COMPLICATIONS Pus draining from eye or Mouth ulcers MEASLES Measles now or within the last 3 months -just rashes TREATMENT *Give Vit.A regardless of the previous dose *Give 1st dose of an appropriate antibiotic *If clouding of the cornea or pus draining from the eye, apply tetracycline eye ointment *If fever is present every day for more than 7 days, refer for assessment *Give Vit.A regardless of the previous dose *If pus draining from the eye, apply tetracycline eye ointment *If with mouth ulcers, teach the mother to treat with gentian violet *Follow up in 2 days *Advise mother when to return immediately *Give Vit.A regardless of the previous dose *Advise mother when to return immediately Dengue Risk CLASSIFY SEVERE DENGUE HEMORRHAGIC FEVER SIGNS Bleeding from nose or gums or Bleeding in stools or vomitus or Black stools or vomitus or Skin petechiae or Cold & clammy extremities or Capillary refill >3sec or Abdominal pain or Vomiting or Tourniquet test (+) FEVER: DENGUE HEMORRHAGIC FEVER UNLIKELY No signs of severe dengue hemorrhagic fever TREATMENT *If vomiting or abdominal pain or skin petechiae or (+) tourniquet test are the only positive signs; give ORS as in Plan B *If any other signs are positive, give fluids rapidly as in Plan C *Treat the child to prevent low blood sugar *Refer urgently to hospital *Do not give ASPIRIN *Advise mother when to return immediately *Follow up in 2 days if fever persists or child shows signs of bleeding *Do not give aspirin Ear Problem CLASSIFICATION MASTOIDITIS SIGNS Tender swelling behind the ear ACUTE EAR INFECTION Pus is seen draining from the ear & discharge is reported for less than 14 days or Ear pain CHRONIC EAR INFECTION Pus is seen draining from the ear & discharge is reported for 14 days or more NO EAR INFECTION No ear pain & no pus seen draining from the ear TREATMENT *Give 1st dose of an appropriate antibiotic *Give 1st dose of paracetamol for pain *Refer urgently to hospital *Give antibiotic for 5 days *Give paracetamol for pain *Dry the ear by wicking *Follow up in 5 days; advise when to report immediately *Dry the ear by wicking *Follow up in 5 days *Advise when to return immediately *No additional treatment *Advise mother when to report immediately Malnutrition & Anemia MUAC = mid arms, upper arms, circumference[less than 110] CLASSIFICATION SEVERE MALNUTRITION OR SEVERE ANEMIA ANEMIA OR VERY LOW WEIGHT SIGNS Visible severe wasting or Edema of both feet or Severe palmar pallor Some palmar pallor or Very low weight for age NO ANEMIA & NOT VERY LOW WEIGHT Not very low weight for age & no other signs of malnutrition TREATMENT *Give Vit.A if not given in the last 30 days *Refer urgently to hospital *Assess the child’s feeding & counsel the mother on feeding according to the FOOD box on the COUNSEL THE MOTHER chart -If feeding is a problem, follow up in 5 days *If some pallor: - Give iron - Give mebendazole if child is 2 years or older & has not had a dose in the previous 6 mos. -Follow up in 14 days *If very low weight for age: - Give Vit.A if not given in the last 30 days - Follow up in 30 days - Advise mother when to return immediately *If the child is less than 2yo, assess the child’s feeding & counsel the mother on feeding according to the FOOD box on the COUNSEL THE MOTHER chart - If feeding is a problem, follow up in 5 days *Advise mother when to return immediately TREAT THE CHILD Carry out the Treatment Steps in the Classification Chart TEACH THE MOTHER TO GIVE ORAL DRUGS AT HOME Determine the appropriate drugs & dosage for the child’s age or weight Tell the mother the reason for giving the drug to the child Demonstrate how to measure a dose Watch the mother practice measuring a dose by herself Ask the mother to give the first dose to her child Explain carefully how to give the drug, then label & package the drug If more than one drug will be given, collect, count & package each drug separately Explain that all the oral drug tablets or syrups must be used to finish the course of treatment, even if the child gets better Check the mother’s understanding before she leaves the health center GIVE AN APPROPRIATE ORAL ANTIBIOTIC For (1) Very Severe Disease, (2)Acute Ear Infection, (3) Mastoiditis (4) Pneumonia 1st Line Antibiotic: AMOXYCILLIN 2nd Line Antibiotic: COTRIMOXAZOLE AGE or WEIGHT 2mos – 12 mos (4 - <10kg) 12 mos – 5yo (10-19kg) COTRIMOXAZOLE (Trimethroprim+sulphamethoxazone) Give 2x daily for 5days Adult Tablet - 80mg Trimethroprim - 400mg Sulphamethoxazone Syrup - 40mg Trimethroprim - 200mg Sulphamethoxazone /5ml Adult Tablet: ½ Syrup: 5ml Adult Tablet: 1 Syrup: 10ml AMOXYCILLIN Give 3x daily for 5days Tablet 250mg Syrup 125mg per 5ml Tablet: ½ Syrup: 5ml Tablet: 1 Syrup: 10ml For Dysentery Give antibiotic recommended for Shigella in the area for 5 days 1st Line Antibiotic: CIPROFLOXACIN Ciprofloxacin Give 2x daily for 3 days AGE or WEIGHT 2-4mos (4 -<6kg) 4-12mos (6 -<10kg) 12mos – 5yo (10-19kg) See doses above “ “ “ “ “ “ For Cholera Give antibiotic recommended for Cholera in the area for 3 days 1st Line Antibiotic: Tetracycline 2nd Line Antibiotic: Erythromycin AGE or WEIGHT 2-4mos (4 -<6kg) 4-12mos (6 -<10kg) 12mos – 5yo (10-19kg) TETRACYCLINE Give 4x daily for 3days Capsule 250mg Not recommended ¼ ½ “ “ “ GIVE AN ORAL ANTIMALARIAL 1st Line Antimalarial: Artemeter –Lumefantrine high fat diet 2nd Line – CHLOROQUINE & PRIMAQUINE, SULFADOXINE & PYRIMETHAMINE (single dose at health center 2 hours give chloroquine) If Chloroquine/Primaquine Explain to the mother that she should watch her child carefully for 30minutes after giving a dose of Chloroquine; if the child vomits within 30minutes, she should repeat the dose & return to the health center for additional tablets Explain that itching is a possible side effect of the drug but it is not dangerous. If Sulfadoxine/Pyrimethamine – give single dose in health center; well tolerared w/in recommended dose; AGE CHLOROQUINE Give for 3days (DAY 1, 2, 3) Tablet 150mg base 2-5mos 5-12mos 1-3yo ½ tab per day ½ tab per day 1tab (day 1&2); ½ tab (day 3) ½ tab (day 1&2); 1tab (day 3) 3-5yo PRIMAQUINE Give single dose in health center of P. Falciparum Tablet 15mg base DAY 4 PRIMAQUINE Give daily for 14 days for P. Vivax Tablet 15mg base DAY 4 ½ ¼ SULFADOXINE+ PYRIMETHAMINE DAY 1 Give single dose in health center Tablet Sulfadoxine 500mg Pyrimethamine 25mg ¼ ½ ¾ ¾ ½ 1 Chloroquine for pregnant women with malaria. Sulfadoxine GIVE VITAMIN A Treatment: Give one dose in the health center Supplementation: Give one dose As supplementation, give one dose in health center if: Child is six months of age or older & Child has not received a dose of Vit.A in the past nine months AGE VITAMIN A CAPSULE 200,000 IU ½ capsule 1 capsule 6mos up to 12 mos 12 months up to 5yo GIVE PARACETAMOL FOR HIGH FEVER (38.5°C OR MORE) & EAR PAIN Give paracetamol every 6hours until high fever or ear pain is gone AGE or WEIGHT 2mos – 3yo (4-<14kg) 3yo – 5yo (14-19kg) TABLET (500mg) ¼ ½ SYRUP (120mg/5ml) 5ml (1tsp) 10ml (2tsps) GIVE IRON Give one dose daily for 14 days AGE or WEIGHT 2-4mos (4-<6kg) 4-12mos (6-<10kg) 1-3yo (10-<14kg) 3-5yo (14-19kg) IRON/FOLATE TABLET Ferrous SO4 200mg + 250mcg Folate (60mg elemental iron) ½ 1 tablet IRON SYRUP Ferrous SO4 150mg per 5ml (6mg elemental iron per ml) 2.5ml (1/2 tsp) 4ml (3/4 tsp) 5ml (1 tsp) 7.5ml (1½ tsp) GIVE MEBENDAZOLE/ALBENDAZOLE Give 500mg Mebendazole as a single dose in health center if: Hookworm/whipworm are a problem in children in the area & The child is 2yo or older & The child has not had a dose in the previous 6 months TEACH THE MOTHER TO TREAT LOCAL INFECTIONS AT HOME Explain to the mother what the treatment is & why it should be given Describe the treatment steps Watch the mother as she does the first treatment in the health center (except remedy for cough or sore throat) Tell her how often to do the treatment at home If needed for treatment at home; give mother the tube of tetracycline ointment or a small bottle of gentian violet Check the mother’s understanding before she leaves the health center TREAT EYE INFECTION WITH TETRACYCLINE OINTMENT Clean both eyes 3 times daily Wash hands Ask child to close eyes Use clean cloth & water to gently wipe away pus Then apply tetracycline eye ointment in both eyes 3 times daily Ask the child to look up Squirt a small amount of ointment on the inside of the lower lid Wash hands again Treat until redness is gone Do not use other eye ointments or drops or put anything else in the eye DRY THE EAR BY WICKING Dry the ear at least 3 times daily Roll clean absorbent cloth or soft, strong tissue paper into a wick Place the wick in the child’s ear Remove the wick when wet Replace the wick with a clean one & repeat these steps until the ear is dry TREAT MOUTH ULCERS WITH GENTIAN VIOLET Treat the mouth ulcers twice daily Wash hands Wash the child’s mouth with clean soft cloth wrapped around the finger & wet with salt water Paint the mouth with half-strength gentian violet Wash hands again SOOTHE THE THROAT, RELIEVE COUGH WITH A SAFE REMEDY Safe remedies to recommend: Breastmilk for exclusively breastfed infant Tamarind, Calamansi & Ginger Harmful remedies to discourage: Codeine Cough Syrup Other Cough Syrups Oral & Nasal Decongestants GIVE THESE TREATMENTS IN HEALTH CENTER ONLY Explain to the mother why the drug is given Determine the dose appropriate for the child’s weight (or age) Use a sterile needle & sterile syringe; measure the dose accurately Give the drug as an IM injection If the child cannot be referred, follow the instructions provided GIVE AN INTRAMUSCULAR ANTIBIOTIC For children being referred urgently who cannot take an oral antibiotic, give first dose of the IM Chloramphenicol & refer child urgently to hospital If referral is not possible: Repeat the Chloramphenicol injection every 12 hours for 5days Then change to an appropriate oral antibiotic to complete 10 days of treatment AGE OR WEIGHT CHLORAMPHENICOL Dose: 40mg per kg Add 5.0ml sterile water to vial containing 2-4mos (4-<6kg) 4-9mos (6-<8kg) 9-12mos (8-<10kg) 1-3yo (10-<14kg) 3-5yo (10-19kg) 1000mg = 5.6ml at 180mg/ml 1.0ml = 180mg 1.5ml = 270mg 2ml = 360mg 2.5ml =450mg 3.5ml = 630mg GIVE QUINIE FOR SEVERE MALARIA For children being referred with very severe febrile disease/malaria, give first does of IM Quinine & refer child urgently to hospital If referral is not possible: Give first dose of IM Quinine The child should remain lying down for one hour Repeat the Quinine injection at 4 & 8 hours later, & then every 12 hours until the child is able to take an oral antimalarial; do not continue Quinine injection for more than 1 week Do not give Quinine to a child less than 4 mos of age AGE OR WEIGHT 4-12mos (6-<10kg) 1-2yo (10-<12kg) 2-3yo (12-<14kg) 3-5yo (14-19kg) INTRAMUSCULAR QUININE 300mg/ml (in 2ml ampule) 0.3ml 0.4ml 0.5ml 0.6ml TREAT THE CHILD TO PREVENT LOW BLOOD SUGAR If the child is able to breastfeed Ask the mother to breastfeed the child If the child is not able to breastfeed but is able to swallow Give expressed breastmilk or a breastmilk substitute If neither of these is available, give sugar water To make sugar water: Dissolve 4 level tsps of sugar (20grams) in a 200ml cup of clean water If the child is not able to swallow Give 50ml of milk or sugar water by nasogastric tube GIVE EXTRA FLUID FOR DIARRHEA & CONTINUE FEEDING PLAN A: TREAT DIARRHEA AT HOME Counsel the mother on the 4 Rules on Home Treatment: Give extra fluid (as much as the child will take) Tell the mother - Breastfeed frequently & for longer at each feed - If the child is exclusively breastfed, give ORS or clean water in addition to breastmilk - If the child is not exclusively breastfed, give one or more of the ORS solution, food-based fluid (such as soup, rice water, or “buko juice”) or clean water - It is especially important to give ORS at home when: * The child has been treated with Plan B or Plan C during this visit * The child cannot return to a health center if the diarrhea gets worst Teach the mother how to mix & give ORS; give the mother 2 packets of ORS to usual fluid intake Potassium : 1.5 g. ; Sodium Bicarbonate 2.5g ; Sodium Chloride 3.5g; Glucose 20 g Homemade ORS: 1 glass of water, 1 pinch of salt and 2 tsp of sugar 1 liter of water, 2 tsp of salt; 8 tsp sugar Show the mother how much fluid to give in addition to the usual fluid intake: - Up to 2yo: 50-100ml after each loose stool - 2yo or more: 100-200ml after each loose stool - Tell the mother to: * Give frequent small sips from a cup * If the child vomits, wait 10minutes, then continue but more slowly * Continue to give extra fluid until the diarrhea stops Continue feeding (see Counsel for the Mother) When to return ( -same ) PLAN B: TREAT SOME DEHYDRATION WITH ORS Give in health center recommended amount of ORS over a 4-hour period Determine amount of ORS to give during first 4 hours AGE WEIGHT In ml Up to 4mos <6kg 200-400 4-12mos 6-<10kg 400-700 1-2yo 10-<12kg 700-900 2-5yo 12-19kg 900-1400 *Use the child’s age only when you do not know the weight; this approximate amount of ORS required (in ml) can also be calculated by multiplying the child weight (in kg) x 75 *If the child wants more ORS than shown, give more *For infants under 6mos who are not breastfed, also give 100-200ml clean water during this period Show the mother how to give ORS solution Give frequent small sips from a cup If the child vomits, wait 10minutes; then continue, but more slowly Continue breastfeeding whenever the child wants After 4 hours: Reassess the child & classify the child for dehydration Select the appropriate plan to continue treatment Begin feeding the child in health center If the mother must leave before completing treatment: Show her how to prepare ORS solution at home Show her how much ORS to give to finish 4hour treatment at home Give her enough ORS packets to complete rehydration; also give 2 packets as recommended in Plan A Explain 4 Rules of Home Treatment Continue with Plan A treatment plan PLAN C: TREAT SEVERE DEHYDRATION QUICKLY Ask the following questions: Can you give IV fluid immediately? IF YES - Start IV fluid immediately - If the child can drink, give ORS by mouth while the drip is set up - Give 100 ml/kg Ringer’s Lactate Solution (or if not available, normal saline) divided as follows: AGE FIRST GIVE 30ML/KG IN: THEN GIVE 70ML/KG IN: Infants (under 12mos) 1 hour* 5 hours 1-5yo 30 minutes* 2 ½ hours *Repeat once if radial pulse is still very weak or not detectable - Reassess the child every 1-2hours; if hydration status is not improving, give the IV drip more rapidly - Also give ORS (about 5ml/kg/hour) as soon as the child can drink; usually after 3-4hours (infants) or 1-2hours (children) - Reassess an infant after 6 hours & a child after 3 hours; classify dehydration then choose the appropriate plan (A,B,C) to continue the treatment IF NO, ASK THE NEXT QUESTION Is IV treatment available nearby (within 30 minutes)? IF YES - Refer urgently to hospital for IV treatment - If the child can drink, provide the mother with ORS solution & show her how to give frequent sips during the trip IF NO, ASK THE NEXT QUESTION Are you trained to use a nasogastric (NG) tube for rehydration? IF YES - Start rehydration by tube with ORS solution: give 20ml/kg/hour for 6 hours (total of 120ml/kg) - Reassess the child every 1-2 hours: * If there is repeated vomiting or increasing abdominal distention, give the fluid more slowly * If hydration status is not improving after 3 hours, send the child for IV therapy - After 6 hours, reassess the child; classify dehydration then choose the appropriate plan (A,B,C) to continue treatment IF NO, ASK THE NEXT QUESTION Can the child drink? IF YES - Start rehydration by mouth with ORS solution: give 20ml/kg/hour for 6 hours (total of 120ml/kg) - Reassess the child every 1-2 hours: * If there is repeated vomiting or increasing abdominal distention, give the fluid more slowly * If hydration status is not improving after 3 hours, send the child for IV therapy - After 6 hours, reassess the child; classify dehydration then choose the appropriate plan (A,B,C) to continue treatment IF NO - Refer urgently to the hospital for IV or NG tube treatment NOTE: If possible, observe the child at least 6 hours after rehydration to be sure the mother can maintain hydration giving the child ORS solution by mouth GIVE FOLLOW-UP CARE Care for the child who returns for follow-up PNEUMONIA After 2 days: Check the child for general danger signs Assess the child for cough or difficult breathing Ask: Is the child breathing slower? Is there less fever? Is the child eating better? Treatment: If with chest indrawing or a general danger sign: give a dose of second-line antibiotic or IM Chloramphenicol; then refer urgently to the hospital If breathing rate, fever & eating are the same: change to the second-line antibiotic & advise mother to return in 2 days or refer if the child had measles within the last 3 mos If breathing is slower, fever is less & eating is better: complete the 5 days of antibiotic PERSISTENT DIARRHEA After 5 days: Ask: Has the diarrhea stopped? How many loose stools is the child having per day? Treatment: If the diarrhea has not stopped (child is still having 3 or more loose stools per day): do a full reassessment of the child; give any treatment needed; then refer to hospital If the diarrhea has stopped (child is having less than 3 loose stools per day): tell the mother to follow the usual feeding recommendation for the child’s age DYSENTERY After 2 days: Assess the child for diarrhea Ask: Are there fewer stools? Is there less blood in the stool? Is there less fever? Is there less abdominal pain? Is the child eating better? Treatment: If the child is dehydrated, treat dehydration If number of stools, amount of blood in stools, fever, abdominal pain or eating is the same or worse: Change to second-line oral antibiotic recommended for Shigella in the area; give it for 5 days; advise mother to return in 2 days Exceptions if the child: - Is less than 12 months old, or - Was dehydrated on the first visit, or - Had measles within the last 3 months * Refer to hospital If fewer stools, less blood in the stools, less fever, less abdominal pain & eating better: continue giving the same antibiotic until finished MALARIA If fever persists after 2 days, or returns within 14 days: Do a full assessment of the child Assess for other causes of fever Treatment: If the child has any general danger signs or stiff neck, treat as VERY SEVERE FEBRILE DISEASE/MALARIA If the child has any cause of fever other than malaria, provide treatment If malaria is the only apparent cause of fever: Take a blood smear Give second-line oral antimalarial without waiting for result of blood smear Advise mother to return in 2 days if fever persists If fever persists after 2 days treatment with second-line oral antimalarial, refer with blood smear for reassessment If fever has been present for 7 days, refer for assessment FEVER-MALARIA UNLIKELY If fever persists after 2 days: Do a full reassessment of the child Assess for other causes of fever Treatment: If the child has any general danger sign or stiff neck, treat as VERY SEVERE FEBRILE DISEASE/MALARIA If the child has any cause of fever other than malaria, provide treatment If malaria is the only apparent cause of fever: Take a blood smear Treat with first-line oral antimalarial Advise mother to return again in 2 days if fever persists If fever has been present for 7 days, refer for assessment FEVER (NO MALARIA) If fever persists after 2 days: Do a full reassessment of the child Make sure that there has been no travel to malarious area If there has been travel, take blood smear if possible Treatment: If there has been travel to a malarious area & the blood smear is positive or there is no blood smear – classify according to fever with malaria risk & treat accordingly If there has been no travel to malarious area or blood smear is negative: If child has any general danger signs or stiff neck: treat as VERY SEVERE FEBRILE DISEASE/MALARIA If the child has any apparent cause of fever: provide treatment If there is no apparent cause of fever: advise mother to return again in 2 days if fever persists If fever has been present for 7 days, refer for assessment MEASLES WITH EYE OR MOUTH COMPLICATIONS After 2 days: Look for red eyes & pus draining from the eyes Look at mouth ulcers Smell the mouth Treatment for Eye Infection: If pus is draining from the eye Ask the mother to describe how she has treated the eye infection If treatment has been correct, refer to the hospital If treatment has not been correct, teach the mother the correct treatment If the pus is gone & redness remains, continue the treatment If pus & redness is gone, stop the treatment Treatment for Mouth Ulcers: If mouth ulcers are worse, or there is a very foul smell of the mouth, refer to the hospital If mouth ulcers are the same or better, continue using half-strength gentian violet for a total of 5 days FEVER: DENGUE HEMORRHAGIC FEVER UNLIKELY If fever persists after 2 days: Do a full reassessment of the child Assess for other causes of fever Treatment: If the child has any signs of bleeding, including petechiae or a positive tourniquet test, or signs of shock or abdominal pain or vomiting: treat as SEVERE DENGUE HEMORRHAGIC FEVER If the child has any other apparent cause of fever, provide treatment If fever has been present for 7 days, refer for assessment If there is no apparent cause of fever, advise the mother to return daily until child has had no fever for at least 48 hours Advise mother to make sure child is given more fluids & is eating EAR INFECTION After 5 days: Reassess for ear problem Obtain child’s temperature Treatment: If there is tender swelling behind the ear or high fever, treat as Mastoiditis Acute ear infection: if ear pain or discharge persists, treat with 5 more days of the same antibiotic; continue wicking to dry the ear; follow up in 5 days Chronic ear infection: check that the mother is wicking the ear correctly; encourage her to continue If no ear pain or discharge: praise the mother for her careful treatment; if she has not yet finished the 5-day antibiotics, tell her to use all of it before stopping FEEDING PROBLEM After 5 days: Reassess feeding Ask about any feeding problems on the initial visit Counsel the mother about any new or continuing feeding problems. If you counsel the mother to make significant changes in feeding, ask her to bring the child back again If the child is very low weigh for age, ask the mother to return in 30 days after the initial visit to measure the child’s weight gain ANEMIA After 14 days: Give iron; advise mother to return in 14 days for more iron Continue giving iron every day for 2 months with follow up every 14 days If the child has any palmar pallor after 2 months, refer for reassessment VERY LOW WEIGHT After 30 days: Weigh the child & determine if the child is still very low weight for age Reassess feeding Treatment: If the child is no longer very low weight for age, praise the mother & encourage her to continue If the child is still very low weight for age, counsel the mother about any feeding problems found; continue to see the child monthly until the child is feeding well & gaining weight regularly or is no longer very low weight for age Exception: if you do not think that feeding will improve or if the child has lost weight, refer the child COUNSEL THE MOTHER FOOD ASSESS THE CHILD’S FEEDING Ask questions about the child’s usual feeding & feeding during this illness Compare the mother’s answers to the “Feeding Recommendations” for the child’s age Ask: Do you breastfeed your child? How many times during the day? Do you also breastfeed during the night? Does the child take any other food? What food or fluids? How many times per day? What do you use to feed the child? If very low weight for age: How large are the servings? Does the child receive his own serving? Who feeds the child & how? During this illness, has the child’s feeding changed? If yes, how? FEEDING RECOMMENDATIONS DURING SICKNESS & HEALTH Up to 4 months of age Breastfeed as often as the child wants, day & night, at least 8x in 24 hours Do not give other foods or fluids 4 to 6 months Breastfeed as often as the child wants, day or night, at least 8x in 24 hours If the child shows interest in semisolid foods or appears hungry after breastfeeding or is not gaining weight adequately: Give small amount of lugaw with added oil, mashed vegetables or beans, steamed tokwa, flaked fish, pulverized roasted dilis, finely-ground meat, eggyolk, mashed ripe fruit like banana, mango, avocado Give these foods 1 or 2 times per day after breastfeeding 6 to 12 months Breastfeed as often as the child wants Give adequate amount of lugaw with added oil, mashed vegetables or beans, steamed tokwa, flaked fish, pulverized roasted dilis, finely-ground meat, eggyolk, bite-sized fruits Give these foods 3x per day if breastfed & 5x per day if not breastfed Feed the baby nutritious snacks like taho & fruits 1 to 2 yo Breastfeed as often as the child wants Give adequate amount of family foods or give rice, camote, potato, fish, chicken, meat, mongo, steamed tokwa, pulverized roasted dilis, milk & eggs, dark green leafy & yellow vegetables (malunggay, squash); add oil & margarine Give these foods 5x per day Feed the baby nutritious snacks like fruits 2yo & older Give adequate amount of family foods at 3 meals each day Twice daily, give nutritious foods between meals such as boiled yellow camote, boiled yellow corn, peanuts, boiled saba banana, taho, fruits, fruit juices Feeding Recommendations for a Child with Persistent Diarrhea If still breastfeeding, give more frequent, longer breastfeeds, day & night If taking other milk such as milk supplements: Replace with increased breastfeeding or Replace half the milk with nutrient-rich semi-solid food Do not use condensed or evaporated milk For other foods, follow feeding recommendation for the child’s age FEEDING PROBLEMS If the mother reports difficulty with breastfeeding, assess breastfeeding; as needed, show the mother correct positioning & attachment for breastfeeding If the child is less than 4mos old & is taking other milk or foods: Build mother’s confidence that she can produce all the breastmilk that the child needs Suggest giving more frequent, longer breastfeeds, day & night & gradually reducing other milk or foods If other milk needs are to be continued, counsel the mother to: Breastfeed as much as possible, including at night Make sure that other milk is a locally appropriate breastmilk substitute, give only when necessary Make sure that other milk is correctly & hygienically prepared & given in adequate amounts Prepare only an amount of milk which the child can consume within an hour; if there is some left-over milk, discard If the mother is using a bottle to feed the child: Recommend substituting the bottle for a cup Show the mother how to feed the child with a cup If the child is not being fed actively, counsel the mother to: Sit with the child & encourage eating Give the child an adequate serving in a separate plate or bowl Observe what the child likes & consider these in the preparation of his/her food If the child is not feeding well during illness, counsel the mother to: Breastfeed more frequently & for longer periods if possible Use soft, varied, appetizing, favorite foods to encourage the child to eat as much as possible & offer frequent small feedings Clear a blocked nose if it interferes with feeding Expect that appetite will improve as child gets better Follow up any feeding problems in 5 days FLUID FOR ANY SICK CHILD: Breastfeed more frequently & for longer periods at each feeding Increase fluids (ex: give soup, rice water, buko juice, clean water) FOR CHILD WITH DIARRHEA: Giving extra fluid can be life-saving; give fluid according to Plan A or B WHEN TO RETURN FOLLOW UP VISITS If the child has Pneumonia Dysentery Malaria, if fever persists Fever-Malaria Unlikely, if fever persists Fever-No Malaria, if fever persists Measles with Eye or Mouth Complications Dengue Hemorrhagic Fever Unlikely, if fever persists Persistent Diarrhea Acute Ear Infection Chronic Ear Infection Feeding Problem Any other illness, if not improving Anemia Very Low Weight for Age Return for follow up in: 2 days 5 days 14 days 30 days RETURN IMMEDIATELY Any sick child If child has NO PNEUMONIA, COUGH, OR COLD, also return if: If child has DIARRHEA, also return if: If child has FEVER, DENGUE HEMORRHAGIC FEVER UNLIKELY, also return if: ABOUT OWN HEALTH *Not being able to drink or breastfeed *Becomes sicker *Develops a fever *Fast breathing *Difficult breathing *Blood in the stool *Drinking poorly *Any sign of bleeding *Abdominal pain *Vomiting If the mother is sick, provide care for her or refer her for help If she has a breast problem (such as engorgement, sore nipples, breast infection) provide care for her or refer her for help Advise her to eat well to keep up her own strength & health Check the mother’s immunization status & give her Tetanus Toxoid if needed Make sure she has access to family planning & counseling on STD & AIDS prevention INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI) Part II) SICK YOUNG INFANT (AGE 1WEEK UP TO 2 MONTHS) ASSESS CHECK FOR VERY SEVERE DISEASE & LOCAL INFECTION • Ask: ♦ Is the infant having difficulty in feeding? ♦ Has the infant had convulsions (fits)? • Look, Feel & Listen: Count the breaths in one minute; repeat count if 60 or more breaths per minute Look for severe chest indrawing (Note: For the first two, young infant must be calm) Measure axillary temperature Look at the umbilicus; is it red or draining pus? Look for skin pustules Look at the young infant’s movements. If infant is sleeping, ask the mother to wake him/her. Does the infant move on his/her own? If the infant is not moving, gently stimulate him/her. - Does the infant move only when stimulated but then stop? - Does the infant not move at all? CHECK FOR JAUNDICE • Look for jaundice (yellow eyes or skin) • Look at the young infant’s palms & soles. Are they yellow? THEN ASK: DOES THE YOUNG INFANT HAVE DIARRHEA? • If yes,: For how long? Is there blood in the stool? • Look & Feel: Look at the young infant’s general condition; is the child abnormally sleepy or difficult to awaken?; restless & irritable? Look for sunken eyes Pinch the skin of the abdomen; does it go back very slowly (longer than 2 seconds) or slowly? NOTE: What is diarrhea in a young infant? A young infant has diarrhea if the stools have changed from usual pattern & are watery (more watery than fecal matter) The normally frequent or semi-solid stools of a breastfed baby are not diarrhea. THEN CHECK FOR FEEDING PROBLEM OR LOW WEIGHT FOR AGE IN BREASTFED INFANTS If an infant has no indications to refer urgently to hospital: • Ask: Is the infant breastfed? If yes, how many times in 24 hours? Does the infant usually receive any other foods or drinks? If yes, how often? What do you use to feed the infant? • Look: ♦ Determine weight for age ♦ Look for ulcers or white patches in the mouth (thrush) • Assess breastfeeding: Ask: Has the infant breastfed in the previous hour? If the infant has not fed in the previous hour, ask the mother to put her infant to the breast Observe the breastfeeding for 4 minutes If the infant was fed during the last hour, ask the mother if she can wait & tell you when the infant is willing to feed again LOOK, FEEL, LISTEN: ♥ Is the infant able to attach? (could be no attachment at all, not well attached or good attachment) To check attachment, look for: Chin touching breast Mouth wide open Lower lip turn outward More areola visible above than below the mouth (All of these signs should be present if the attachment is good) ♥ Is the infant sucking effectively that is slow, deep sucks, sometimes pausing? (could be not suckling at all, not suckling effectively or suckling effectively) ♥ Clear a blocked nose if it interferes with breastfeeding CHECK YOUNG INFANT’S IMMUNIZATION STATUS & VITAMIN A STATUS • Birth: BCG, HEPA-B1 • 6 weeks: DPT1, OPV1, HEPA-B2 • 10 weeks: DPT2, OPV2 • Vitamin A 200,000 to the mother within four weeks of delivery • Give all missed doses on this visit • Include sick infants unless being referred • Advise the caretaker when to return for the next dose CLASSIFY & TREAT VERY SEVERE DISEASE & LOCAL INFECTION: CLASSIFICATION VERY SEVERE DISEASE LOCAL BACTERIAL INFECTION SEVERE DISEASE OR LOCAL INFECTION UNLIKELY SIGNS Any one of the ff signs: Not feeding well Convulsions Fast breathing (60 bpm or more) Severe chest indrawing Fever (37.5°C or above)+ Low body temperature (less than 35.5°C)+ Movement only when stimulated or no movement at all Umbilicus red or draining pus or Skin pustules None of the signs of very severe disease or local bacterial infection TREATMENT *Give 1st dose of IM antibiotics *Treat to prevent ↓ blood sugar *Refer urgently to the hospital++ *Advise mother how to keep the infant warm on the way to the hospital *Give an appropriate oral antibiotic *Teach the mother to treat local infections at home *Advise mother to give home care for the young infant *Follow up in 2 days *Advise mother to give home care for the young infant + These thresholds are based on axillary temperature. The thresholds for rectal temperature readings are approximately 0.5°C higher. ++ If referral is not possible, see Integrated Management of Childhood Illness Management of the sick young infant module Annex 2 “Where referral is not possible.” JAUNDICE CLASSIFICATION SEVERE JAUNDICE SIGNS Any jaundice if age less than 24 hours or Yellow palms & soles at any age JAUNDICE Jaundice appearing after 24 hours of age & Palms & soles not yellow NO JAUNDICE No jaundice TREATMENT *Treat to prevent low blood sugar *Refer urgently to hospital * Advise mother how to keep the infant warm on the way to the hospital *Advise the mother to give home care for the young *Advise mother to return immediately if palms & soles appear yellow. *If the young infant is older than 14 days, refer to a hospital for assessment. *Follow up in 1 day *Advise the mother to give home care for the young infant. DIARRHEA: CLASSIFICATION SEVERE DEHYDRATION SIGNS Two of the ff signs: Abnormally sleepy or difficult to awaken Sunken eyes Skin pinch goes back very slowly SOME DEHYDRATION Two of the ff signs: Restless, irritable Sunken eyes Skin pinch goes back slowly NO DEHYDRATION Not enough signs to classify as some or severe dehydration Diarrhea lasting 14 days or more SEVERE PERSISTENT DIARRHEA DYSENTERY Blood in the stool TREATMENT *If infant does not have possible serious bacterial infection nor dysentery – give fluid for severe dehydration (Plan C) *If infant also has possible serious bacterial infection or dysentery – refer urgently to hospital with mother giving frequent sips of ORS on the way; advise mother to continue breastfeeding; advise mother to how to keep the baby warm on the way to the hospital. *Give fluid & food for some dehydration (Plan B) *If infant also has possible serious bacterial infection or dysentery – refer urgently to hospital with mother giving frequent sips of ORS on the way; advise mother to continue breastfeeding *Give fluid & food to treat diarrhea at home (Plan A) *If young infant is dehydrated, treat dehydration before referral unless the infant has also possible serious bacterial infection *Refer to hospital *Refer urgently to hospital with mother giving frequent sips of ORS on the way; advise mother to continue breastfeeding FEEDING PROBLEM OR LOW WEIGHT FOR AGE IN BREASTFED INFANTS CLASSIFICATION FEEDING PROBLEM OR LOW WEIGHT FOR AGE SIGNS Not well attached to breast or Not sucking effectively TREATMENT If not well attached or not sucking effectively, teach correct positioning & attachment If not able to attach well immediately, teach the mother to express breast milk & feed NO FEEDING PROBLEM Not low weigh for age & no other signs of inadequate feeding by a cup. If breastfeeding less than 8x a day, advise to ↑ frequency of feeding. Advise mother to breastfeed as often & for as long as the infant wants, day & night. If receiving other foods or drinks, counsel mother about breastfeeding more & reducing other foods or drinks using a cup. If not breastfeeding at all, refer for breastfeeding counseling & possible relactation; advise about correctly preparing breastmilk substitutes & using a cup Advise the mother how to feed & keep low weight infant warm at home. If with thrush, teach the mother to treat thrush at home. Advise mother to give home care for the young infant Follow up any feeding problem or thrush in 2 days Follow up low weight for age in 14 days *Advise mother to give home care for the young infant *Praise the mother for feeding the infant well TREAT THE YOUNG INFANT & COUNSEL THE MOTHER TEACH THE MOTHER HOW TO KEEP THE YOUNG INFANT WARM ON THE WAY TO THE HOSPITAL: • Provide skin to skin contact; OR • Keep the young infant clothed or covered as much as possible all the time. Dress the young infant with extra clothing including hat, gloves, socks & wrap the infant in a dry cloth & cover with blanket. GIVE AN APPROPRIATE ORAL ANTIBIOTIC FOR LOCAL INFECTION • For local bacterial infection • 1st line Antibiotic: AMOXYCILLIN • 2nd line Antibiotic: COTRIMOXAZOLE AMOXYCILLIN Give 3x daily for 5 days AGE OR WEIGHT Tablet 250mg Syrup 125mg/5ml Birth – 1mo (4kg) 1-2mos (4-<6kg) ¼ ½ 2.5ml 5ml COTRIMOXAZOLE (trimethroprim + sulphamethoxazole) Give 2x daily for 5 days Adult Tablet Pediatric Tablet Syrup Single Strength 20mg trimethoprim (40mg trime. + (80mg trime. + +100mg sulpha. 200mg sulfa) 400 mg sulfa.) ½* 1.25ml* ¼ 1 2.5ml * Avoid Cotrimoxazole in infants less than 1 month of age who are premature or jaundiced. GIVE FIRST DOSE OF INTRAMUSCULAR ANTIBIOTICS • Give first dose of both Benzylpenicillin & Gentamicin IM • Referral is the best option for a young infant classified with VERY SEVERE DISEASE; if referral is not possible, continue to give ampicillin & gentamicin for at least 5 days. Give ampicillin two times daily to infants less than one week of age & 3 times daily to infants one week or older. Give gentamicin once daily. WEIGHT 1-<1.5kg 1.5-<2kg 2-<2.5kg 2.5-<3kg 3-<3.5kg 3.5-<4kg 4-<4.5kg AMPICILLIN Dose: 50mg per kg To a vial of 250mg Add 1.3 ml sterile water = 250mg/1.5ml Undiluted 2ml vial containing 20mg=2ml at 10mg/ml 0.4ml 0.5ml 0.7ml 0.8ml 1.0ml 1.1ml 1.3ml AGE < 7days Dose: 5mg per kg 0.6ml 0.9ml 1.1ml 1.4ml 1.6ml 1.9ml 2.1ml GENTAMICIN OR Add 6 ml sterile water to 2ml vial containing 80 mg = 8ml at 10mg/ml AGE >7days Dose: 7.5mg per kg 0.9ml 1.3ml 1.7ml 2.0ml 2.4ml 2.8ml 3.2ml TREAT THE YOUNG INFANT & COUNSEL THE MOTHER To treat Diarrhea, see TREAT THE CHILD chart Immunize every sick young infant as neede TEACH MOTHER TO TREAT LOCAL INFECTIONS AT HOME • Explain how the treatment is given • Watch her as she does the first treatment in the health center • Tell her to do the treatment twice daily; she should return to the health center if the infection worsens TO TREAT SKIN PUSTULES Wash hands Gently wash off pus & crusts with soap & water Dry the area Paint with gentian violet Wash hands TO TREAT UMBILICAL INFECTION Wash hands Clean with 70% ethyl alcohol Paint with gentian violet Wash hands TO TREAT THRUSH Wash hands Wash mouth with clean soft cloth wrapped around the finger & wet with salt water Paint the mouth with half-strength gentian violet Wash hands TEACH CORRECT POSITIONING & ATTACHMENT FOR BREASTFEEDING Show the mother how to hold her infant With the infant’s head & body straight Facing her breast with infant’s nose opposite her nipples With infant’s body close to her body Supporting infant’s whole body not just the neck & shoulders Show her how to help the infant to attach She should touch her infant’s lips with her nipple She should wait until her infant’s mouth is opening wide She should move her infant quickly onto her breast, aiming the infant’s lower lip well below the nipple Look for signs of good attachment & effective sucking; if the attachment or sucking is not good, try again ADVISE MOTHER TO GIVE HOME CARE FOR THE YOUNG INFANT Food & Fluid: Breastfeed frequently, as often & for as long as the infant wants, day or night, during sickness or health Make sure the young infant stays warm at all times; in cool weather, cover the infant’s head & feet & dress the infant with extra clothing Follow-Up Visit IF THE INFANT HAS: Local Bacterial Infection Any Feeding Problem Thrush Low Weight for Age RETURN FOR FOLLOW-UP IN 2 days 14 days When to Return Immediately Breastfeeding or drinking poorly Becomes sicker Develops a fever Fast breathing Difficult breathing Blood in stool Palms & sole appear yellow Teach the Mother How to Feed by a Cup Put a cloth on the infant’s front to protect his clothes as some milk can spill Hold the infant semi-upright on the lap Put a measured amount of milk in the cup Hold the cup so that it rests lightly on the infant’s lower lip Tip the cup so that the milk just reaches the infant’s lips Allow the infant to take milk himself. DO NOT pour the milk into the infant’s mouth. Teach the Mother How to Keep the Low Weight Infant Warm at Home Keep the young infant in the same bed with the mother Avoid bathing the low weight infant. When washing or bathing, do it in a very warm room with warm water, dry immediately & thoroughly after bathing & clothe the young infant immediately. Change clothes (eg. Diapers) whenever they are wet Provide skin to skin contact as much as possible, day & night. For skin to skin contact: • Dress the infant in a warm shirt open at the front, a nappy, hat & socks • Place the infant in skin to skin contact on the mother’s chest between the mother’s breasts. Keep the infant’s head turned to one side • Cover the infant with mother’s clothes (& an additional warm blanket in cold weather) When not in skin to skin contact, keep the young infant clothed or covered as much as possible at all times. Dress the young infant with extra clothing including hat & socks, loosely wrap the young infant in a soft dry cloth & cover with a blanket. Check frequently if the hands & feet are warm; if cold, re-warm the baby using skin to skin contact Breastfeed (or express breast milk by cup) the infant frequently Treat the Young Infant to Prevent Low Blood Sugar If the young infant is able to breastfeed: Ask the mother to breastfeed the young infant If the young infant is not able to breastfeed but is able to swallow: Give 2025ml (10ml/kg) expressed breastmilk before departure. If not possible to give expressed breastmilk, give 20-50ml (10ml/kg) sugar water. (To make sugar water: dissolve 4 level teaspoons of sugar (20grams) in a 200ml cup of clean water). If the young infant is not able to swallow: Give 20-25ml (10ml/kg) of expressed breastmilk or sugar water by nasogastric tube. GIVE FOLLOW-UP CARE FOR THE SICK YOUNG INFANT ASSESS EVERY YOUNG INFANT FOR “VERY SEVERE DISEASE” DURING FOLLOW-UP VISIT LOCAL BACTERIAL INFECTION After 2 days: Look at the umbilicus – Is it red or draining pus? Look at the skin pustules – Are then many or severe pustules? Treatment: If the pus or redness remains or is worse, refer to the hospital If pus & redness improve, tell the mother to continue giving the 5 days of antibiotic & continue treating the local infection at home If skin pustules are same or worse, refer to hospital. If improved, tell the mother to continue giving the 5 days of antibiotic & continue treating the local infection at home. JAUNDICE After 1 day: Look for jaundice. Are palms & soles yellow? If palms & soles are yellow, refer to the hospital If palms & soles are not yellow, but jaundice has not decreased, advise the mother home care & ask her to return for follow up in 1 day If jaundice has started decreasing, reassure the mother & ask her to continue home care. Ask her to return for follow up at 2 weeks of age. If jaundice continues beyond two weeks of age, refer the young infant to a hospital for further assessment. DIARRHEA After 2 days: Ask: Has the diarrhea stopped? Treatment: • If the diarrhea has not stopped, assess & treat the young infant for diarrhea. See “Does the young infant have diarrhea?” • If diarrhea has stopped, tell the mother to continue exclusive breastfeeding FEEDING PROBLEM After 2 days: Reassess feeding – > See “Then check for feeding problem or low weight” Ask about any feeding problems found on the initial visit Counsel the mother about any new or continuing feeding problems. If you counsel the mother to make significant changes in feeding, ask her to bring the young infant back again If the young is low weight for age, ask the mother to return after 14 days after the initial visit to measure the young infant’s weight gain Exception: If you do not think that feeding will improve, or the young infant has lost weight, refer the child LOW WEIGHT After 14 days: Weigh the young infant & determine if the infant is still low weight for age Reassess feeding – > See “Then check for feeding problems or low weight” If the infant is no longer low weight for age, praise the mother & encourage her to continue If the infant is still low weight for age but is feeding, praise the mother; ask her to come again within a month or when she returns for immunization If the infant is still low weight for age & still has a feeding problem, counsel the mother about the feeding problem. Ask the mother to return again in 14 days (or when she returns for immunization, if this is within 2 weeks). Continue to see the young infant every few weeks until the infant is feeding well & gaining weight regularly or is no longer low weight for age Exception: If you do not think that feeding will improve, or the young infant has lost weight, refer to hospital ORAL THRUSH After 2 days: Look for ulcers or white patches in the mouth Reassess feeding > See “Then check for feeding problem or low weight” If thrush is worse or if the infant has problem with attachment or sucking, refer to the hospital If thrush is the same or better & if the infant is feeding well, continue the treatment of half-strength gentian violet for a total of 5 days IMCI COLOR-CODED SYSTEM COLOR PRESENTATION Green Yellow Pink CLASSIFICATION OF DISEASES Mild Moderate Severe LEVEL OF MANAGEMENT Home Care Manage at the RHU Urgent Referral to Hospital INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI) Part II) SICK YOUNG INFANT (AGE 1WEEK UP TO 2 MONTHS) ASSESS CHECK FOR VERY SEVERE DISEASE & LOCAL INFECTION • Ask: ♦ Is the infant having difficulty in feeding? ♦ Has the infant had convulsions (fits)? • Look, Feel & Listen: Count the breaths in one minute; repeat count if 60 or more breaths per minute Look for severe chest indrawing (Note: For the first two, young infant must be calm) Measure axillary temperature Look at the umbilicus; is it red or draining pus? Look for skin pustules Look at the young infant’s movements. If infant is sleeping, ask the mother to wake him/her. Does the infant move on his/her own? If the infant is not moving, gently stimulate him/her. - Does the infant move only when stimulated but then stop? - Does the infant not move at all? CHECK FOR JAUNDICE • Look for jaundice (yellow eyes or skin) • Look at the young infant’s palms & soles. Are they yellow? THEN ASK: DOES THE YOUNG INFANT HAVE DIARRHEA? • If yes,: For how long? Is there blood in the stool? • Look & Feel: Look at the young infant’s general condition; is the child abnormally sleepy or difficult to awaken?; restless & irritable? Look for sunken eyes Pinch the skin of the abdomen; does it go back very slowly (longer than 2 seconds) or slowly? NOTE: What is diarrhea in a young infant? A young infant has diarrhea if the stools have changed from usual pattern & are watery (more watery than fecal matter) The normally frequent or semi-solid stools of a breastfed baby are not diarrhea. THEN CHECK FOR FEEDING PROBLEM OR LOW WEIGHT FOR AGE IN BREASTFED INFANTS If an infant has no indications to refer urgently to hospital: • Ask: Is the infant breastfed? If yes, how many times in 24 hours? Does the infant usually receive any other foods or drinks? If yes, how often? What do you use to feed the infant? • Look: ♦ Determine weight for age ♦ Look for ulcers or white patches in the mouth (thrush) • Assess breastfeeding: Ask: Has the infant breastfed in the previous hour? If the infant has not fed in the previous hour, ask the mother to put her infant to the breast Observe the breastfeeding for 4 minutes If the infant was fed during the last hour, ask the mother if she can wait & tell you when the infant is willing to feed again LOOK, FEEL, LISTEN: ♥ Is the infant able to attach? (could be no attachment at all, not well attached or good attachment) To check attachment, look for: Chin touching breast Mouth wide open Lower lip turn outward More areola visible above than below the mouth (All of these signs should be present if the attachment is good) ♥ Is the infant sucking effectively that is slow, deep sucks, sometimes pausing? (could be not suckling at all, not suckling effectively or suckling effectively) ♥ Clear a blocked nose if it interferes with breastfeeding CHECK YOUNG INFANT’S IMMUNIZATION STATUS & VITAMIN A STATUS • Birth: BCG, HEPA-B1 • 6 weeks: DPT1, OPV1, HEPA-B2 • 10 weeks: DPT2, OPV2 • Vitamin A 200,000 to the mother within four weeks of delivery • Give all missed doses on this visit • Include sick infants unless being referred • Advise the caretaker when to return for the next dose CLASSIFY & TREAT VERY SEVERE DISEASE & LOCAL INFECTION: CLASSIFICATION VERY SEVERE DISEASE LOCAL BACTERIAL INFECTION SEVERE DISEASE OR LOCAL INFECTION UNLIKELY SIGNS Any one of the ff signs: Not feeding well Convulsions Fast breathing (60 bpm or more) Severe chest indrawing Fever (37.5°C or above)+ Low body temperature (less than 35.5°C)+ Movement only when stimulated or no movement at all Umbilicus red or draining pus or Skin pustules None of the signs of very severe disease or local bacterial infection TREATMENT *Give 1st dose of IM antibiotics *Treat to prevent ↓ blood sugar *Refer urgently to the hospital++ *Advise mother how to keep the infant warm on the way to the hospital *Give an appropriate oral antibiotic *Teach the mother to treat local infections at home *Advise mother to give home care for the young infant *Follow up in 2 days *Advise mother to give home care for the young infant + These thresholds are based on axillary temperature. The thresholds for rectal temperature readings are approximately 0.5°C higher. ++ If referral is not possible, see Integrated Management of Childhood Illness Management of the sick young infant module Annex 2 “Where referral is not possible.” JAUNDICE CLASSIFICATION SEVERE JAUNDICE SIGNS Any jaundice if age less than 24 hours or Yellow palms & soles at any age JAUNDICE Jaundice appearing after 24 hours of age & Palms & soles not yellow NO JAUNDICE No jaundice TREATMENT *Treat to prevent low blood sugar *Refer urgently to hospital * Advise mother how to keep the infant warm on the way to the hospital *Advise the mother to give home care for the young *Advise mother to return immediately if palms & soles appear yellow. *If the young infant is older than 14 days, refer to a hospital for assessment. *Follow up in 1 day *Advise the mother to give home care for the young infant. DIARRHEA: CLASSIFICATION SEVERE DEHYDRATION SIGNS Two of the ff signs: Abnormally sleepy or difficult to awaken Sunken eyes Skin pinch goes back very slowly SOME DEHYDRATION Two of the ff signs: Restless, irritable Sunken eyes Skin pinch goes back slowly NO DEHYDRATION Not enough signs to classify as some or severe dehydration Diarrhea lasting 14 days or more SEVERE PERSISTENT DIARRHEA DYSENTERY Blood in the stool TREATMENT *If infant does not have possible serious bacterial infection nor dysentery – give fluid for severe dehydration (Plan C) *If infant also has possible serious bacterial infection or dysentery – refer urgently to hospital with mother giving frequent sips of ORS on the way; advise mother to continue breastfeeding; advise mother to how to keep the baby warm on the way to the hospital. *Give fluid & food for some dehydration (Plan B) *If infant also has possible serious bacterial infection or dysentery – refer urgently to hospital with mother giving frequent sips of ORS on the way; advise mother to continue breastfeeding *Give fluid & food to treat diarrhea at home (Plan A) *If young infant is dehydrated, treat dehydration before referral unless the infant has also possible serious bacterial infection *Refer to hospital *Refer urgently to hospital with mother giving frequent sips of ORS on the way; advise mother to continue breastfeeding FEEDING PROBLEM OR LOW WEIGHT FOR AGE IN BREASTFED INFANTS CLASSIFICATION FEEDING PROBLEM OR LOW WEIGHT FOR AGE SIGNS Not well attached to breast or Not sucking effectively TREATMENT If not well attached or not sucking effectively, teach correct positioning & attachment If not able to attach well immediately, teach the mother to express breast milk & feed NO FEEDING PROBLEM Not low weigh for age & no other signs of inadequate feeding by a cup. If breastfeeding less than 8x a day, advise to ↑ frequency of feeding. Advise mother to breastfeed as often & for as long as the infant wants, day & night. If receiving other foods or drinks, counsel mother about breastfeeding more & reducing other foods or drinks using a cup. If not breastfeeding at all, refer for breastfeeding counseling & possible relactation; advise about correctly preparing breastmilk substitutes & using a cup Advise the mother how to feed & keep low weight infant warm at home. If with thrush, teach the mother to treat thrush at home. Advise mother to give home care for the young infant Follow up any feeding problem or thrush in 2 days Follow up low weight for age in 14 days *Advise mother to give home care for the young infant *Praise the mother for feeding the infant well TREAT THE YOUNG INFANT & COUNSEL THE MOTHER TEACH THE MOTHER HOW TO KEEP THE YOUNG INFANT WARM ON THE WAY TO THE HOSPITAL: • Provide skin to skin contact; OR • Keep the young infant clothed or covered as much as possible all the time. Dress the young infant with extra clothing including hat, gloves, socks & wrap the infant in a dry cloth & cover with blanket. GIVE AN APPROPRIATE ORAL ANTIBIOTIC FOR LOCAL INFECTION • For local bacterial infection • 1st line Antibiotic: AMOXYCILLIN • 2nd line Antibiotic: COTRIMOXAZOLE AMOXYCILLIN Give 2x daily for 5 days AGE OR WEIGHT Tablet 250mg Syrup 125mg/5ml Birth – 1mo (4kg) 1-2mos (4-<6kg) ¼ ½ 2.5ml 5ml COTRIMOXAZOLE (trimethroprim + sulphamethoxazole) Give 2x daily for 5 days Adult Tablet Pediatric Tablet Syrup Single Strength 20mg trimethoprim (40mg trime. + (80mg trime. + +100mg sulpha. 200mg sulfa) 400 mg sulfa.) ½* 1.25ml* ¼ 1 2.5ml * Avoid Cotrimoxazole in infants less than 1 month of age who are premature or jaundiced. GIVE FIRST DOSE OF INTRAMUSCULAR ANTIBIOTICS • Give first dose of both Benzylpenicillin & Gentamicin IM • Referral is the best option for a young infant classified with VERY SEVERE DISEASE; if referral is not possible, continue to give ampicillin & gentamicin for at least 5 days. Give ampicillin two times daily to infants less than one week of age & 3 times daily to infants one week or older. Give gentamicin once daily. WEIGHT 1-<1.5kg 1.5-<2kg 2-<2.5kg 2.5-<3kg 3-<3.5kg 3.5-<4kg 4-<4.5kg AMPICILLIN Dose: 50mg per kg To a vial of 250mg Add 1.3 ml sterile water = 250mg/1.5ml Undiluted 2ml vial containing 20mg=2ml at 10mg/ml 0.4ml 0.5ml 0.7ml 0.8ml 1.0ml 1.1ml 1.3ml AGE < 7days Dose: 5mg per kg 0.6ml 0.9ml 1.1ml 1.4ml 1.6ml 1.9ml 2.1ml GENTAMICIN OR Add 6 ml sterile water to 2ml vial containing 80 mg = 8ml at 10mg/ml AGE >7days Dose: 7.5mg per kg 0.9ml 1.3ml 1.7ml 2.0ml 2.4ml 2.8ml 3.2ml TREAT THE YOUNG INFANT & COUNSEL THE MOTHER To treat Diarrhea, see TREAT THE CHILD chart Immunize every sick young infant as neede TEACH MOTHER TO TREAT LOCAL INFECTIONS AT HOME • Explain how the treatment is given • Watch her as she does the first treatment in the health center • Tell her to do the treatment twice daily; she should return to the health center if the infection worsens TO TREAT SKIN PUSTULES Wash hands Gently wash off pus & crusts with soap & water Dry the area Paint with gentian violet Wash hands TO TREAT UMBILICAL INFECTION Wash hands Clean with 70% ethyl alcohol Paint with gentian violet Wash hands TO TREAT THRUSH Wash hands Wash mouth with clean soft cloth wrapped around the finger & wet with salt water Paint the mouth with half-strength gentian violet Wash hands TEACH CORRECT POSITIONING & ATTACHMENT FOR BREASTFEEDING Show the mother how to hold her infant With the infant’s head & body straight Facing her breast with infant’s nose opposite her nipples With infant’s body close to her body Supporting infant’s whole body not just the neck & shoulders Show her how to help the infant to attach She should touch her infant’s lips with her nipple She should wait until her infant’s mouth is opening wide She should move her infant quickly onto her breast, aiming the infant’s lower lip well below the nipple Look for signs of good attachment & effective sucking; if the attachment or sucking is not good, try again ADVISE MOTHER TO GIVE HOME CARE FOR THE YOUNG INFANT Food & Fluid: Breastfeed frequently, as often & for as long as the infant wants, day or night, during sickness or health Make sure the young infant stays warm at all times; in cool weather, cover the infant’s head & feet & dress the infant with extra clothing Follow-Up Visit IF THE INFANT HAS: Local Bacterial Infection Any Feeding Problem Thrush Low Weight for Age RETURN FOR FOLLOW-UP IN 2 days 14 days When to Return Immediately Breastfeeding or drinking poorly Becomes sicker Develops a fever Fast breathing Difficult breathing Blood in stool Palms & sole appear yellow Teach the Mother How to Feed by a Cup Put a cloth on the infant’s front to protect his clothes as some milk can spill Hold the infant semi-upright on the lap Put a measured amount of milk in the cup Hold the cup so that it rests lightly on the infant’s lower lip Tip the cup so that the milk just reaches the infant’s lips Allow the infant to take milk himself. DO NOT pour the milk into the infant’s mouth. Teach the Mother How to Keep the Low Weight Infant Warm at Home Keep the young infant in the same bed with the mother Avoid bathing the low weight infant. When washing or bathing, do it in a very warm room with warm water, dry immediately & thoroughly after bathing & clothe the young infant immediately. Change clothes (eg. Diapers) whenever they are wet Provide skin to skin contact as much as possible, day & night. For skin to skin contact: • Dress the infant in a warm shirt open at the front, a nappy, hat & socks • Place the infant in skin to skin contact on the mother’s chest between the mother’s breasts. Keep the infant’s head turned to one side • Cover the infant with mother’s clothes (& an additional warm blanket in cold weather) When not in skin to skin contact, keep the young infant clothed or covered as much as possible at all times. Dress the young infant with extra clothing including hat & socks, loosely wrap the young infant in a soft dry cloth & cover with a blanket. Check frequently if the hands & feet are warm; if cold, re-warm the baby using skin to skin contact Breastfeed (or express breast milk by cup) the infant frequently Treat the Young Infant to Prevent Low Blood Sugar If the young infant is able to breastfeed: Ask the mother to breastfeed the young infant If the young infant is not able to breastfeed but is able to swallow: Give 2025ml (10ml/kg) expressed breastmilk before departure. If not possible to give expressed breastmilk, give 20-50ml (10ml/kg) sugar water. (To make sugar water: dissolve 4 level teaspoons of sugar (20grams) in a 200ml cup of clean water). If the young infant is not able to swallow: Give 20-25ml (10ml/kg) of expressed breastmilk or sugar water by nasogastric tube. GIVE FOLLOW-UP CARE FOR THE SICK YOUNG INFANT ASSESS EVERY YOUNG INFANT FOR “VERY SEVERE DISEASE” DURING FOLLOW-UP VISIT LOCAL BACTERIAL INFECTION After 2 days: Look at the umbilicus – Is it red or draining pus? Look at the skin pustules – Are then many or severe pustules? Treatment: If the pus or redness remains or is worse, refer to the hospital If pus & redness improve, tell the mother to continue giving the 5 days of antibiotic & continue treating the local infection at home If skin pustules are same or worse, refer to hospital. If improved, tell the mother to continue giving the 5 days of antibiotic & continue treating the local infection at home. JAUNDICE After 1 day: Look for jaundice. Are palms & soles yellow? If palms & soles are yellow, refer to the hospital If palms & soles are not yellow, but jaundice has not decreased, advise the mother home care & ask her to return for follow up in 1 day If jaundice has started decreasing, reassure the mother & ask her to continue home care. Ask her to return for follow up at 2 weeks of age. If jaundice continues beyond two weeks of age, refer the young infant to a hospital for further assessment. DIARRHEA After 2 days: Ask: Has the diarrhea stopped? Treatment: • If the diarrhea has not stopped, assess & treat the young infant for diarrhea. See “Does the young infant have diarrhea?” • If diarrhea has stopped, tell the mother to continue exclusive breastfeeding FEEDING PROBLEM After 2 days: Reassess feeding – > See “Then check for feeding problem or low weight” Ask about any feeding problems found on the initial visit Counsel the mother about any new or continuing feeding problems. If you counsel the mother to make significant changes in feeding, ask her to bring the young infant back again If the young is low weight for age, ask the mother to return after 14 days after the initial visit to measure the young infant’s weight gain Exception: If you do not think that feeding will improve, or the young infant has lost weight, refer the child LOW WEIGHT After 14 days: Weigh the young infant & determine if the infant is still low weight for age Reassess feeding – > See “Then check for feeding problems or low weight” If the infant is no longer low weight for age, praise the mother & encourage her to continue If the infant is still low weight for age but is feeding, praise the mother; ask her to come again within a month or when she returns for immunization If the infant is still low weight for age & still has a feeding problem, counsel the mother about the feeding problem. Ask the mother to return again in 14 days (or when she returns for immunization, if this is within 2 weeks). Continue to see the young infant every few weeks until the infant is feeding well & gaining weight regularly or is no longer low weight for age Exception: If you do not think that feeding will improve, or the young infant has lost weight, refer to hospital ORAL THRUSH After 2 days: Look for ulcers or white patches in the mouth Reassess feeding > See “Then check for feeding problem or low weight” If thrush is worse or if the infant has problem with attachment or sucking, refer to the hospital If thrush is the same or better & if the infant is feeding well, continue the treatment of half-strength gentian violet for a total of 5 days IMCI COLOR-CODED SYSTEM COLOR PRESENTATION Green Yellow Pink CLASSIFICATION OF DISEASES Mild Moderate Severe LEVEL OF MANAGEMENT Home Care Manage at the RHU Urgent Referral to Hospital lOMoARcPSD|36490978 IMCI Practice Exam ( Answer KEY) Entrepreneurship (Centro Escolar University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Gio Torres (giotorres01@proton.me) lOMoARcPSD|36490978 MATERNAL AND NURSING II SKILLS LABORATORY IMCI Practice Exam D. 125 to 150 ml after each loose stool 1. IMCI is an integrated approach to child health that focuses on the well-being of the SITUATION: Jojo has had diarrhea for five days. whole child. The following are steps He has no blood in the stool. He is irritable. The included in the IMCI strategy except: health worker offers some Jojo some water, and the A. Classify the illness. child drinks poorly. His eyes are not sunken. No B. Assessing children 5 years old above general danger signs. Skin pinch goes back for major symptoms. immediately. C. Treating the child. D. Counseling and follow-up care. 11. Jojo is classified under what category? 2. When a sick infant or child is brought to the A. NO DEHYDRATION health center for consultation, the initial B. SOME DEHYDRATION action of the nurse is to assess for danger C. SEVERE DEHYDRATION signs which include checking the following D. VERY SEVERE DEHYDRATION except: 12. Jojo is under what color code? A. Is the child able to drink or breastfeed? A. Pink B. Has the child had convulsions? B. Red C. Does the child vomit everything? C. Yellow D. Is the child passing watery stool D. Green frequently? 13. Which of the following foods for dehydration 3. The major symptoms being assessed in is least likely be offered to Jojo? IMCI includes all of the following except: A. Rice water A. Cough B. Buko juice B. Fever C. Orange juice C. Diarrhea D. Soups D. Anemia 14. While giving the ORS, Jojo vomits. The 4. When assessing for the elasticity of the mother should be taught to: skin, Nurse Mona should perform this in the A. Immediately give another ORS, but abdomen with the fold of the skin: more slowly. A. Horizontal to the child’ s body B. Call the health center and ask for B. Diagonal to the child’ s body another way of giving ORS. C. Vertical to the child’ s body C. Mix 2 tbsp of sugar to the ORS. D. In different directions with the child’s D. Wait for 10 mins. Then continue, but body more slowly. 5. Generally speaking, a child is considered 15. If a child is classified under SEVERE seriously ill if he/she possesses: DEHYDRATION, the health worker should A. All of the four general danger signs first: (GDS) A. Refer the child immediately. B. All of the four main symptoms B. Give fluids using NGT. C. One or more GDS C. Proceed with Plan A D. Weight problem D. Advise the mother to return after 5 days. 6. Signs of good attachment include: (1) Child’ s chin touching breast, (2) Child’ s mouth SITUATION: Boboy is 6 months old. He weighs 5.5 wide open, (3) Child’ s tongue protrudes inkg. His temperature is 38 deg C. His mother said between sucking, (4) Child’ s lower lip he has had cough for 2 days. Boboy is able to turned outward, (5) Child sucks with breastfeed. He has no general danger signs. His characteristic sound, (6) More areola is respiration is 58 breaths per minute. There is no visible above than below the mouth. chest indrawing, and no stridor. A. 1, 3, 5, 6 B. 1, 2, 4, 6 16. Boboy is classified under: C. 1, 2, 3, 4 A. SEVERE PNEUMONIA or VERY D. All of the above SEVERE DISEASE B. PNEUMONIA SITUATION: Aina is 10 months old. She weighs 8 C. NO PNEUMONIA: COUGH or COLD D. VERY SEVERE PNEUMONIA kg. Her temperature is 38.5 deg C. She is here 17. The first- line of antibiotic to be administered today because she has had diarrhea for 3 days. as part of the pre- referral treatment to Aina does not have any general danger signs. She Boboy is: A. Amoxicillin does not have cough or difficult breathing. The child B. Tetracycline drank normally when offered some water and does C. Cotrimoxazole not seem thirsty. She does not have sunken eyes. D. Nalidixic Acid 18. Which of the following findings should be Skin pinch goes back immediately. present to classify a patient to SEVERE PNEUMONIA? 7. Aina is classified under: A. Dyspnea A. NO DEHYDRATION B. Wheezing B. SOME DEHYDRATION C. Fast breathing C. SEVERE DEHYDRATION D. Chest indrawing D. VERY SEVERE DEHYDRATION 19. If a child is classified under SEVERE 8. She is classified under what color? PNEUMONIA, the management should be A. Red to: B. Pink. A. Soothe the throat. C. Yellow B. Instruct the mother to increase fluid D. Green intake. 9. Treatment would include all of the following C. Refer him urgently to the hospital. except: D. Instruct the mother to continue A. Give extra fluid. breastfeeding. B. Breastfeed frequently. C. Follow up in 7 days if not improving. SITUATION: Andoy is a 3-week-old infant. His D. Give Zinc supplement 1 tablet 20 mg for weight is 3.6 kg. His axillary temperature is 36.5 14 days deg C. He is brought to the health center because 10. For every loose stool, Aina should be given he is having difficulty breathing. His mother says how much extra fluid? that Andoy has not had any convulsions. The health A. 25 ml to 50 ml after each loose stool worker counts 74 breaths per minute. He repeats B. 100 ml to 125 ml after each loose stool the count. The second count is 70 breaths per C. 50 ml to 100 ml after each loose stool 1 Downloaded by Gio Torres (giotorres01@proton.me) lOMoARcPSD|36490978 MATERNAL AND NURSING II SKILLS LABORATORY IMCI Practice Exam B. Quinine minute. He finds mild chest indrawing and nasal C. Cotrimoxazole flaring. He has no grunting. The fontanel does not D. Tetracycline bulge. There is no pus in his ears, the umbilicus is normal, there are no skin pustules. Andoy is calm SITUATION: Budoy, a 5-year-old child, has and awake, and his movements are normal. He diarrhea for 2 days with a frequency of 6- 7 times does not have diarrhea. per day. Assessment revealed that he has sunken 20. Andoy is classified under: eyes, vomits everything he ate, difficult to feed and A. VERY SEVERE DISEASE considered as lethargic. B. SEVERE DISEASE OR LOCAL 29. Based on the assessment, Budoy is INFECTION UNLIKELY classified under: C. LOCAL BACTERIAL INFECTION A. NO DEHYDRATION D. SEVERE PNEUMONIA B. SOME DEHYDRATION 21. Treatment plan for Andoy would include: C. SEVERE DEHYDRATION A. Give the first dose of intramuscular D. VERY SEVERE DEHYDRATION antibiotic. 30. A 3-year-old child is complaining of tender B. Treat to prevent low blood sugar. swelling behind his right ear. The health C. Refer urgently to the hospital. worker should: D. All of the above A. Advise the mother to go to the 22. Upon history taking and assessment you nearest hospital. found out that Moja has pus draining from B. Advise the mother for follow up in 3 his ears and is complaining of ear pain for days. the past 10 days. What color in the IMCI C. Dry the ear by wicking. row would you classify his condition? D. Give the child chloramphenicol. A. Pink B. Yellow SITUATION: A 3-week-old infant is rushed to the C. Green health center. The infant has red umbilicus. No D. Red convulsions, no chest indrawing, the temperature is 23. Under IMCI, an ear discharge that has been 37 degrees Celsius. Not abnormally sleepy or present for less than 14 days can be difficult to awaken. classified as: A. Complicated ear infection 31. The infant is classified under: B. Acute ear infection A. Pink row C. Chronic ear infection B. Green row D. Mastoiditis C. Yellow row 24. Nurse Ana is teaching a mother on how to D. Red row wick her child’ s ear. Nurse Ana determines 32. Appropriate treatment for this infant would that the mother understood her instructions include: if she retells the correct sequence of the A. Refer to the hospital. procedure: (1) Remove the wick when wet, B. Give oral antibiotic for 5 days. (2) Replace the wick with a clean one and C. Follow up in 2 days. repeat this procedure, (3) Roll clean D. Both B and C absorbent cloth or soft, strong tissue paper into a wick, (4) Place the wick in the child’s SITUATION: A health worker is assessing a 3ear. week-old infant, who is breastfeeding, for feeding A. 3, 4, 2, 1 problem. While breastfeeding, the health worker B. 3, 4, 1, 2 sits quietly and watches the infant breastfeed. The C. 4, 3, 2, 1 infant’ s chin is not touching the breast, there is D. 4, 3, 1, 2 more areola visible below the infant’ s mouth than 25. Assessment of a 2- year old child revealed above it. The mother reports less than 8 “baggy pants” . Using the IMCI guidelines, breastfeeds in 24 hours. how will you manage this child? A. Refer the child urgently to a hospital 33. The young infant is classified under: for confinement. A. NOT ABLE TO FEED- POSSIBLE B. Coordinate with the social worker to SERIOUS BACTERAIL INFECTION enroll the child in a feeding program. B. NO FEEDING PROBLEM C. Make a teaching plan for the mother, C. FEEDING PROBLEM OR LOW focusing on menu planning for her child. WEIGHT D. Assess and treat the child for health D. VERY SERIOUS FEEDING PROBLEM problems like infections and intestinal 34. Appropriate management would include: parasitism. A. Advise the mother to increase 26. During the physical examination of a young frequency of breastfeeding. child, what is the earliest sign of B. Refer urgently to the hospital. xerophthalmia that you may observe? C. Treat to prevent low blood sugar. A. Keratomalacia D. Give ORS B. Corneal opacity 35. The nurse assesses for chest indrawing and C. Night blindness knows which of the following is true about D. Bitot’s spot chest indrawing? A. It must be clearly visible and present SITUATION: 3-year-old Baby Benjamin was only during crying and feeding. brought in for a check-up. He had a high-grade B. It is more accurate if assessed as the fever of (39 C) for 3 days. He had no cough and child is in upright position. colds. He is lethargic and has stiff neck. He lives in C. It is when the intercostals area goes a place with known Malaria cases. OUT as the child breaths IN. D. It involves only the lower and upper 27. Baby Benjamin will fall in what category? chest wall (subcostal). A. MALARIA UNLIKELY 36. Dwyane has had diarrhea for a week and he B. FEVER is very irritable with sunken eyeballs, but no C. VERY SEVERE FEBRILE blood in the stool. When the nurse pinches DISEASE/MALARIA the skin on the child’ s abdomen, it goes D. NO MALARIA back slowly. His parents tell the nurse that 28. Baby Benjamin would be given a first dose he is eager to drink whenever they offer of this second- line of drug under medical fluids. These signs are classified on to what supervision or if a hospital is not accessible type of dehydration? within 4 hours: A. SEVERE DEHYDRATION A. Chloramphenicol 2 Downloaded by Gio Torres (giotorres01@proton.me) lOMoARcPSD|36490978 MATERNAL AND NURSING II SKILLS LABORATORY IMCI Practice Exam breaths out. B. VERY SEVERE DEHYDRATION C. Lower chest wall goes out when the C. SOME DEHYDRATION child breaths out. D. NO DEHYDRATION D. Lower chest wall goes out when the 37. After administration of additional fluids, the child breaths in. child vomits, the mother correctly 46. A child with fever has an axillary understood the nurse instruction if she did temperature of at LEAST? which of the following? A. 37.5 degrees Celsius A. Stop the feeding and bring the child to B. 37.6 degrees Celsius the health center. C. 37.7 degrees Celsius B. Let the child lie down on his side. D. 37.8 degrees Celsius C. Pause for 10 minutes and resume 47. Under IMCI, children with severe disease more slowly. are referred to the hospital especially if the D. Discontinue the feeding until Miguelito child manifests which of the following? ask for water. A. Wheezing 38. In assessing severe palmar pallor, the nurse B. Stopped feeding well. would be right if she is looking for a palm C. Difficult to awaken. that is: D. Fast breathing A. Paper white 48. Under IMCI, a child with ear problem should B. Paper white with a tinge of pink be assessed for the following except: C. Acrocyanotic A. Ear pain D. None of the above B. Is there any fever? C. Ear discharge SITUATION: The World Health Organization D. If discharge is present for how long? (WHO), hand in hand with UNICEF and other 49. Under IMCI, if the child does not have ear agencies, developed a strategy known as the problem, using IMCI, what should you as Integrated Management of Childhood Illness the nurse do? (IMCI). The strategies used in IMCI are not only A. Check for tender swellings, behind the focused on the needs of curative care but it also ear. answers aspects of nutrition, immunization, and B. Check for ear discharge. other important elements of disease prevention and C. Go the next question, check for health promotion. The following questions are malnutrition. about IMCI. D. Check for ear pain. 39. Most classification tables have three rows. 50. Under IMCI, an ear discharge that has been The colored rows signify the severity of the present for less than 14 days can be illness. If a child is to be treated with home classified as: treatment this is classified under what A. Complicated ear infection color? B. Acute ear infection A. Pink C. Chronic ear infection B. Yellow D. Mastoiditis C. Blue 51. Under IMCI, a child who no dehydration D. Green needs home treatment. Which of the 40. The following assessments are to be done following is not included in instructions for prior to checking of general danger signs, home treatment/home treatment care? except: A. Know when to return to the health A. Determine the age of the child. center. B. Assess if the child has cough or B. Give oresol every 4 hours. difficulty of breathing. C. Give the child extra fluids. C. Ask the mother what the problems is/are D. Continue feeding the child. of the child. 52. Under IMCI, a child who has had diarrhea D. Determine if it is an initial or follow – up for 14 days but has no signs of dehydration visit. is classified as: 41. Use the steps on the ASSESS AND A. Severe dysentery CLASSIFY THE SICK CHILD chart for ages: B. Severe persistent diarrhea A. 1 week to 2 months old C. Dysentery B. 1 week to 5 years old D. Persistent diarrhea C. 2 months to 5 years old 53. Muymuy has had diarrhea for 5 days. There D. anyone under 5 years old is no blood in the stool, he is irritable. His 42. Which of the following findings indicate fast eyes are sunken. The nurse offers fluid to breathing? the child and he drinks eagerly. When the A. Respiratory rate of 50 or more breaths nurse pinched the abdomen, it goes back for a 15-month-old child. slowly. Considering the classifications under B. Respiratory rate of 40 or more breaths IMCI, how will you classify Muymuy’ s for a 2-month-old child. illness? C. Respiratory rate of 50 or more breaths A. No dehydration for a 2-week-old infant. B. Moderate dehydration D. Respiratory rate of 60 or more C. Severe dehydration breaths for a 6-week-old infant. D. Some dehydration 43. The first- line antibiotic administered as part 54. Under IMCI, which of the following of the pre-referral treatment to a child with classifications requires a follow up visit in 14 SEVERE PNEUMONIA OR VERY SEVERE days? DISEASE is: A. ANEMIA A. Amoxycillin B. VERY LOW WEIGHT FOR AGE B. Tetracycline C. CHRONIC EAR INFECTION C. Cotrimoxazole D. FEVER: MALARIA UNLIKELY, if fever D. Nalidixic Acid persists 44. A child with SEVERE PNEUMONIA will 55. In breastfeeding, the following are principles manifest which of the following? for good attachment, except: A. Dyspnea A. Mouth wide open B. Wheezing B. More areola visible below than above C. Fast breathing the mouth D. Chest indrawing C. Chin touching the breast. 45. Chest indrawing is defined as: D. Lower lip turned outward. A. Lower chest wall goes in when the 56. In dehydration using PLAN B, how much of child breaths in. the ORS will you give to a child who weighs B. Lower chest wall goes in when the child 10 kg in the first 4 hours? 3 Downloaded by Gio Torres (giotorres01@proton.me) lOMoARcPSD|36490978 MATERNAL AND NURSING II SKILLS LABORATORY IMCI Practice Exam A. 450 ml B. 550 ml C. 650 ml D. 750 ml 57. The correct sequence in performing the case management process is: (1) Give follow- up care, (2) Classify the illness, (3) Identify the treatment, (4) Assess the child/young infant, (5) Counsel the mother, (6) Treat the child/refer. A. 4, 2, 3, 6, 5, 1 B. 4, 2, 3, 3, 1, 5 C. 4, 2, 3, 1, 5, 6 D. 4, 2, 3, 1, 5, 6 58. A nurse is a community health nurse. Her approach in dealing with childhood illnesses is guided by the principles stated in her IMCI manual. Which is not included? A. All sick children must be routinely assessed for major symptoms. B. A combination of individual signs leads to a child’s diagnosis. C. The IMCI guidelines address most, but not all, of the major reasons a sick child is brought to a clinic. D. The guidelines under IMCI do not describe the management of trauma or other acute emergencies due to accidents or injuries. 59. A classification in IMCI table that means the child does not need specific medical treatment. And the health worker teaches the mother how to care for her child at home: A. Pink B. Yellow C. Red D. Green 60. Which of the following findings indicate fast breathing? A. An 18-month-old child with a respiratory rate of 35 B. A 2-month-old infant with a respiratory rate of 55 C. A 2-month-old child with a respiratory rate of 45 D. A 6-week-old infant with a respiratory rate of 50 61. A mother or any significant others usually brings the child to the health center because the child is sick. When you see the mother with her sick child you should first: A. Greet the mother appropriately. B. Ask the child’s age. C. Ask what the child’s problem. D. Determine if this is an initial or follow- up visit for this problem. SITUATION: A three-year-old child has had diarrhea for three days. There is no blood in the stool. The child is drinking poorly. He is not abnormally sleepy. And skin pinch goes back slowly. 65. The child is classified under: A. VERY SEVERE DEHYDRATION B. SEVERE DEHYDRATION C. SOME DEHYDRATION D. NO DEHYDRATION 66. Treatment for the child would include: A. Plan A B. Plan B C. Plan C D. Plan D 67. For every loose stool the mother should give how many extra fluids to the child? A. 25 ml B. 25 to 50 ml C. 50 to 100 ml D. 100 to 200 ml SITUATION: Minion is 3 years old. She has had diarrhea for 15 days. Minion has no general danger signs. She does not difficulty breathing. There is no blood in the stool. She is restless and skin pinch goes back very slowly. 68. Minion is classified as having: A. VERY SEVERE PERSISTENT DIARRHEA B. PERSISTENT DIARRHEA C. SEVERE PERSISTENT DIARRHEA D. DYSENTERY 69. If Minion has blood in the stool, he is classified under: A. VERY SEVER PERSISTENT DIARRHEA B. PERSISTENT DIARRHEA C. SEVERE PERSISTENT DIARRHEA D. DYSENTERY SITUATION: Mitsui, 2-year-old, is brought to the health center because he has felt hot for 2 days. There is malaria risk. He does not have general danger signs. He does not have a cough, difficulty breathing or diarrhea. He has a runny nose, and the blood smear was negative. 70. This child is classified as having: A. VERY SEVERE FEBRILE DISEASE/MALARIA B. FEVER: MALARIA UNLIKELY C. MALARIA D. COUGH OR COLD 71. The first line antimalarial drug is: A. Artemether-Lumefantrine B. Chloroquine C. Primaquine D. Sulfadoxine SITUATION: Baby Gee is 10 months old. She is coughing for 3 days. She is not vomiting. There is no convulsion, and she is not abnormally sleepy. Her RR is 45 breaths per minute. 62. Nurse Hannah asks the mother if this is the child’ s first visit. The mother replies, “Opo, unang bisita namin dito sa health center.” Based on the mother’s statement, the health worker documents this as: A. An initial visit B. Follow-up visit C. Chief complaint D. Follow through visit. 63. Based on the assessment, the appropriate treatment for this child is: A. Plan A B. Plan B C. Plan C D. Refer to the hospital. 64. Baby Gee is classified under: A. Pink row B. Yellow row C. Green row D. Red row SITUATION: Shibang is 3 years old. She weighs 14.5 kg. Her temperature is 37-degree C. Her mother came to the health center today because Shibang has been sick for the last two days. She was crying last night and complained that her ear was hurting. She has no GDS. Shibang does not have cough or difficulty breathing. She does not have diarrhea and fever. The health worker does not see any pus draining for the child’s ear. There is a tender swelling behind the child’ s left ear. 4 Downloaded by Gio Torres (giotorres01@proton.me) lOMoARcPSD|36490978 MATERNAL AND NURSING II SKILLS LABORATORY IMCI Practice Exam 56 cycle/minute. Based on this finding, the 72. The health worker record Shibang’ s sign of following statements are true and ear problem and classify them as: applicable: (A) The child has pneumonia, A. Acute ear infection (B) The child must be referred to the B. Chronic ear infection hospital immediately, (C) Soothe the throat C. Mastoiditis and relieve cough with a safe remedy, (D) D. No ear infection The child can be treated at home. 73. If Shibang has pus draining in her ear for 15 A. A, B, C days and no ear pain instead of having B. A, C, D tenderness behind the left ear, she is C. B, C classified under: D. C, D A. Acute ear infection 82. A child who was found to have pneumonia B. Chronic ear infection was being treated appropriately in the rural C. Mastoiditis health center. After parental counseling D. No ear infection about the disease the child was discharged. 74. Under CHRONIC EAR INFECTION The mother is instructed to return to the classification, appropriate management health center after: would include: A. One day A. Oral antibiotic for 5 days B. Two days B. Urgent referral to hospital C. 30 days C. Dry the ear by wicking. D. 14 days D. No treatment necessary 83. To effectively and accurately assess for 75. As you wick the child’ s ear, you should tell chest indrawing the nurse should be aware the mother to: of the principle of respiratory assessment. A. Use a piece of bond paper for making a Which is not true is assessing chest wick. indrawing? B. Carefully rotate the wick to completely A. It is when the intercostals areas goes IN remove the pus. when the child breaths IN. C. Use a cotton- tipped applicator for B. It is more accurate if assessed as the wicking. child is lying flat. D. Place the wick in the child’ s ear until C. It must be clearly visible and present all the wick is wet. the time and not only during crying and 76. The mother asks the health worker, “ feeding. Pagkatapos maubos ng luga, ano pa ang D. It involves only the lower chest wall ilalagay ko sa tainga nya?” The health (subcostal) and not all the areas in worker accurately responds by saying: between the ribs. A. “Lagyan nyo po ng baby oil ang tainga 84. The mother and her 12- month- old infant nya pagkatapos nitong matuyo” return to the clinic after 3 days because the B. “Lagyan nyo po ng bulak ang tainga nya symptoms are not relieved. The infant pagkatapos matanggal ang luga” developed stridor and was not able to C. “Wala na pong ilalagay sa tainga ng breast feed. Part of the management in this anak niyo pagkatapos matuyo ito” situation is giving Vitamin A supplements. D. “Buhusan nyo po ng maligamgam na Based on the child’ s age the dose of the tubig para malinis ng mabuti ang tainga Vitamin A to be given is: nya” A. 10, 000 IU 77. A child who is 10 months old and B. 100, 000 IU breastfeeding should be given with what C. 200, 000 IU complementary foods? D. 1 capsule A. Flaked fish, malunggay, peanuts 85. Johnny, a 3- year- old, was brought to the B. Steamed tokwa, mashed vegetables, RHU by her mother because of diarrhea. On egg yolk assessment, the child is playful and alert. C. Pulverized roasted dilis, squash, banana Which of the following will you not advise D. Monggo, camote, boiled yellow corn the boy’s mother? 78. The following except one are A. Boil water for formula for 15-30 minutes. recommendations for a child who is not B. Tell the mother she can give the child a feeding well during illness: banana to eat. A. Breastfeed the child more frequently, C. Stop giving milk as it worsens and for a longer time at each feed. diarrhea. B. Give the child soft, varied and D. Instruct the mother to return the child to appetizing foods, as well as the child’ s the RHU after 3 days. favorite foods. 86. As Johnny or a child comes to the clinic C. Clear the child’ s blocked nostrils if they complaining of diarrhea the nurse should: interfere with feedings. A. Classify for dehydration. D. Follow-up any feeding problem in 10 B. Child is restless and irritable. days. C. Ask how long the diarrhea has been 79. What is the sign that the infant is sucking present. effectively during breastfeeding? D. All of the above. A. The infant suckles with slow deep 87. Based on Johnny’ s presented condition, he sucks and sometimes pauses. was classified in the green row. He was sent B. There is cheek indrawing. home after the nurse counseled his mother C. The infant is taking a rapid, shallow with regards to the 4 rules of home suck. treatment. Which of the following is not D. Silent sucking included? 80. In Integrated Management of Childhood A. Give extra fluid. Illness (IMCI), severe conditions generally B. Give Vitamin A supplement. require urgent referral to a hospital. Which C. Continue feeding. of the following severe conditions DOES D. When to return. NOT always require urgent referral to a 88. To check for the skin turgor of a child having hospital? diarrhea, the nurse will: A. Mastoiditis A. Pinch the child’s abdomen. B. Severe dehydration B. Pinch the child’s outer upper arm. C. Severe pneumonia C. Apply pressure on the skin at the foot D. Severe febrile disease area. 81. Dolor brought her 2- year- old daughter to D. Look for sunken eyes. the health center because of 2 days cough 89. Part of the discharge counseling done to and 3 days colds. On assessment, the Johnny’ s mother, the nurse would conclude nurse counted the child’ s respiration to be 5 Downloaded by Gio Torres (giotorres01@proton.me) lOMoARcPSD|36490978 MATERNAL AND NURSING II SKILLS LABORATORY IMCI Practice Exam an 8- year- old with obvious edema of the that she understands the teaching with feet and weighing 20% less than his ideal regards to the child’ s need for additional weight for age was spotted by the team. fluid intake when she states that she needs According to the IMCI manual, they will to give additional fluids to his child classify Totoy in what color- code category? amounting of: A. Pink A. 50 to 100 ml after each loose stool B. Yellow B. 150 to 200 ml after each loose stool C. Green C. 100 to 200 ml after each loose stool D. Red D. 50 to 200 ml after each loose stool 99. Measles is one of the common childhood 90. If Johnny vomits after administration of diseases nowadays because of increased additional fluids, the mother is instructed to: temperature. If a child comes to the clinic A. Pause for 10 minutes and resume complaining of pus draining from his eyes, more slowly. you will place the child in what color B. Let the baby lie down on his side. classification? C. Stop feeding and bring the baby to the A. Pink health center. B. Yellow D. Discontinue feeding. C. Green 91. If Johnny has diarrhea for 8 days but he has D. Red no signs and symptoms of dehydration, the 100. In the IMCI treatment plan, what is following are true except: used to clean the mouth if a child has A. He is drinking normally. measles with mouth complication? B. His skin pinch went back immediately. A. Diluted hydrogen peroxide C. He has severe persistent diarrhea. B. Sterile water only D. He is classified in the green row. C. Diluted betadine 92. Syd, a 5- year- old child, is brought to the D. Diluted gentian violet clinic by her mother because of ear problem. Under IMCI, a child with ear problem should be assessed for the following except: A. Ear pain B. Is there any fever? C. Ear discharge D. If discharge is present for how long? 93. Upon history taking and assessment you found out that Syd is having pus draining from his ears and is complaining of ear pain for the past 10 days. What color in the IMCI row would you classify his condition? A. Pink B. Yellow C. Green D. Red 94. Under IMCI, an ear discharge that has been present for less than 14 days can be classified as: A. Complicated ear infection B. Acute ear infection C. Chronic ear infection D. Mastoiditis 95. You advise and instruct Syd’ s mother to wick his ears to remove the discharges. As a nurse, you determine that the mother understands your instruction after she retells the correct sequence of the procedure: (1) Remove the wick when wet, (2) Replace the wick with a clean one and repeat this procedure, (3) Roll clean absorbent cloth or soft, strong tissue paper into a wick, (4) Place the wick in the child’ s ear. A. 3, 4, 2, 1 B. 3, 4, 1, 2 C. 4, 3, 2, 1 D. 4, 3, 1, 2 96. After classifying Syd’ s condition, you will advise his mother to return to the clinic for a follow up check- up after how many days? A. 2 days B. 5 days C. 14 days D. 30 days 97. Under IMCI, if the child does not have ear problem, what should you do as his nurse do? A. Check for tender swellings, behind the ear. B. Check for ear discharge. C. Go to the next question, check for malnutrition. D. Check for ear pain. 98. Part of the curriculum of student nurses is the community involvement in the nearest barangay. Leah together with her team members suggest conducting Operation Timbang of children 10 years- old and below in Barangay Maybunga. Totoy Bato, 6 Downloaded by Gio Torres (giotorres01@proton.me) IMCI Quiz 1 1. IMCI integrated approach to child health that focuses on the A. well-being of the whole child B. 0-2months only C. 2months- 5years old only D. Maternal and child care 2. Components of IMCI include all of the following, except; A. Improving case management skills of health workers B. Improving over-all health systems to deliver IMCI C. Improving family and community health practices D. Contribute to healthy growth and development of Children 3. Principles of IMCI to all sick young infants birth up to 2 months are examined for A. Very severe disease and local bacterial infection B. General danger signs C. Anemia and malnutrition D. Persistent diarrhea and dysentery 4. Principles of IMCI to all sick children aged 2 months up to 5 years are examined for A. Very severe disease and local bacterial infection B. General danger signs C. Anemia and malnutrition D. Persistent diarrhea and dysentery 5. One of the benefits of IMCI strategy was to promote and prevent as well as cure among children because A. It emphasizes important preventive interventions such as immunization and breastfeeding B. It improves case management skills of health workers C. It improves over-all health systems to deliver IMCI D. It improves family and community health practices 6. The child's illness is classified based on a color-coded triage system wherein yellow color indicates A. Urgent hospital referral or admission B. Initiation of specific outpatient treatment C. Supportive home care D. Contribute to healthy growth 7. The basis for classifying the child's illness on a color-coded triage system wherein pink color indicates; A. Initiation of specific outpatient treatment B. Supportive home care C. Urgent hospital referral or admission D. Management skills of health workers 8. Element of case management process includes classifying the illness which means; A. Making decisions as regards the severity of the illness B. Determine whether this is an initial or a follow-up visit C. Checking for general danger signs D. Assessing the main symptoms and other processes indicated in the chart 9. One of the responsibilities of the nurse during green code case management process is giving an advice on home management that emphasizes as to A. Teach the mother or other caregiver how to give oral drugs and treat local infections at home. B. Give essential treatment before the patient is transferred C. Counsel the mother includes assessing how the child is to be fed D. Treat the local infection 10. The case management process for sick children aged 2 months to 5 months is presented in three charts which is entitled as; except: A. Assess and classify the sick child B. Follow-up C. Treat the child D. Counsel the mother 2nd Year This study source was downloaded by 100000859341955 from CourseHero.com on 03-12-2024 20:17:03 GMT -05:00 https://www.coursehero.com/file/207215426/IMCI-QUIZ-1-AND-2docx/ 1 11. Where can the IMCI case management guidelines be used? A. In the inpatient ward of a hospital B. In a neonatal ward C. At first-level health facilities D. At the house hold level 12. The IMCI clinical guidelines are designed for use with certain age groups. One group is 2 months up to 5 years. What is the other age group? A. Birth up to 5 years B. Birth up to 2 months C. 2 months up to 1 year D. 2 months up to 9 years 13. To be classified as having JAUNDICE a young infant must have the following signs: yellow palms and soles if age is more than 24 hours) if age is more than 24 hours A. Only yellow eyes and skin B. B Any jaundice if age less than 24 hours C. Pus draining from the eyes D. No signs suggesting jaundice 14. What is the cut-off rate for fast breathing in a child who is 11 months old? A. 60 breaths per minute or more B. 50 breaths per minute or more C. 40 breaths per minute or more D. 30 breaths per minute or more 15. At the general condition of the child (does the infant move when stimulated or does not move even when stimulated, restless and irritable). To classify the dehydration status of young infant with diarrhea you will look, except A. For sunken eyes a B. For edema of both feet C. If the young infant is drinking eagerly or poorly 16. What is the minimum axillary temperature (in degree Celsius ) for fever in sick young infants? A. 38.5 B. 37.5 C. 38 D. 37 17. In a sick young infant, which respiratory rate is considered as "fast breathing?" A. 40 or more breaths per minute B. 50 or more breaths per minute C. 60 or more breaths per minute D. 70 or more breaths per minute 18. The young infant who has diarrhea has two or more of the following signs: abnormally sleepy or difficult to awaken, sunken eyes, pinched skin goes back to its original state very slowly (longer than 2 seconds). How will you classify the diarrhea for dehydration? A. No dehydration B. Severe dehydration C. Some dehydration D. Severe, persistent diarrhea 19. A young infant can become sick and die very quickly from serious bacterial infections such A. Pneumonia sepsis, and meningitis. B. Diarrhea, dengue fever and malnutrition C. Fever, jaundice and infected umbilicus D. Skin rashes, skin lesions and measles 20. When the nurse is looking for signs of very severe disease, she is observing for a A. Serious infection. B. Diarrhea C. Malnutrition D. Dengue fever 21. Nurse Myra is about to assess an infant when signs should Myra will do? A. Infected umbilicus and skin rashes B. Count breathing look for severe lower chest in drawing C. Nausea and vomiting D. Persistent diarrhea and dysentery 22. Which of the following statement that reflects the most common significant cause of birth asphyxia among premature newborn? 2nd Year This study source was downloaded by 100000859341955 from CourseHero.com on 03-12-2024 20:17:03 GMT -05:00 https://www.coursehero.com/file/207215426/IMCI-QUIZ-1-AND-2docx/ 2 A. An infant who has been breastfeed since birth B. An infant who has been exposed to bacterial infection C. An infant who did not receive a Vitamin K injection D. An infant who has not been able to feed since birth 23. During assessment, the student nurse observes that the young infant's arms and legs are looked blue and breathing was stopped. What indication are these signs for? A. Convulsion B. Pneumonia C. Jaundice D. Diarrhea 24. During Convulsion, when a young infant has rhythmic movements of a part of the body, such like rhythmic twitching of the mouth and/or blinking of eyes. These may be a sign of A. Loss of consciousness B. Respiratory distress C. Pneumonia D. Bacterial infection 25. Mild chest in drawing is normal in a young infant because the; A. Weak respiratory muscle B. Chest wall is soft C. Medulla oblongata is impaired D. Insufficient oxygen supply into the infant's lung 26. Fever is uncommon in the first two months of life. Nurse Maricar is assessing the body temperature of a two-week young infant. She noted a body temperature of 38.2 C, this indicates a; A. Very severe disease B. Bacterial infection C. Viral infection D. Pneumonia 27. A full term infant may have a mild jaundice on the third or fourth day of life and disappears before the age of 2 weeks because A. The infant's weight is less than 2.5 kg at birth B. The infant has poor sucking reflex C. The infant's GI tract is not fully mature to eliminate stool. D. The infant's liver is not fully mature to eliminate the bilirubin formed in the body 28. It is a serious condition resulting from the presence of harmful microorganisms in the blood or other tissues and the body's response to their presence, potentially leading to malfunction of various organs, shock, and death. This refers to: A. Fever B. Sepsis C. Dehydration D. Coughing 29. The sick young infant is said to have low body temperature. The public health nurse knows that the axillary temperature of the infant would be less than: A. 36.5 °C B. 36 °C C. 35.5 °C D. 35 °C 30. If assessment of a sick young infant reveals convulsions, or fast breathing, or severe chest in drawing, or nasal flaring, or grunting, or bulging fontanelle, which treatment would be considered inappropriate? A. Treat the infant to prevent the lowering of his or her blood sugar level. B. Give the infant the first dose of intramuscular antibiotics. C. Treat the local infection in the health center, and teach the mother to treat local infection at home. D. Advise the mother regarding how to keep the infant warm on the way to the hospital 2nd Year This study source was downloaded by 100000859341955 from CourseHero.com on 03-12-2024 20:17:03 GMT -05:00 https://www.coursehero.com/file/207215426/IMCI-QUIZ-1-AND-2docx/ 3 IMCI Quiz 2 1. A young infant who is less than 7 days olid and weighs less than 2 kg is considered A. Very low weight B. Low birth weight C. Low weight D. Gain weight well after birth. 2. The student nurse is assessing the infant for breastfeeding. She observes that the child's attachment is not good when, A. More areola seen below infant's bottom lip than above top lip B. More areola seen above infant stop in that below bottom lip C. Mouth wide open and lower lip turned outwards D. Chin touching breast 3. Poor attachment during breastfeeding indicates that breastmilk may not remove effectively A. Engorgement B. Mastitis C. Sore nipples D. Fever 4. Which of the following that the infant shows suckling effectively A. In drawing of the cheeks B. Taking only rapid, shallow sucks. C. Continue to breastfeed for a long time D. Suckles with slow deep sucks and sometimes pauses 5. The nurse observes that the infant is not attaching well and suckling poorly. What is the best nursing action should the nurse will do? A. Helpful to have common bottles or cups B. Let mother demonstrate or explain how a feed is prepared C. Help the mother to improve positioning and attachment D. Let the mother to describe what foods or fluids she is giving to the young infant. 6. Infants older than 7 days weighing less than 2 kg are classified as A. Low weight B. Weight for age C. Very low weight D. Low weight for age 7. Young infants, who are HIV positive or of unknown HIV status with symptoms consistent with HIV should not be given: A. Vit. K B. Hep B C. BCG D. DPT 8. When the young infant's weight for age is not below the line for-2 Z score, this indicates; A. Not low weight for age B. Very low weight for age C. Low weight for age D. All of these 9. The student nurse identifies the infant has low weight. What is the most appropriate instruction to be given to the mother of the young infant? A. Advise the mother how to give home care for the young infant B. Advice the mother to check breastfeeding of the young infant is improving. C. Advise the mother how to feed and keep the low weight Infant warm at home. D. Advise the mother to give an exclusive and frequent breastfeeding to her young infant 10. For the young infant who have a feeding problem or low weight for age. The student nurse should advice the following, except; A. Teach each mother about any specific help her infant needs, such as better positioning and attachment for breastfeeding. B. Advise the mother of any young infant to breastfeed as often and for as long as the infant wants, day and night. C. If the infant is still not able to attach well, teach the mother 2nd Year This study source was downloaded by 100000859341955 from CourseHero.com on 03-12-2024 20:17:03 GMT -05:00 https://www.coursehero.com/file/207215426/IMCI-QUIZ-1-AND-2docx/ 4 how to express breastmilk and feed by a cup. D. Let her describe what foods or fluids she is giving to the young infant. 11. If assessment of a sick young infant reveals convulsions, or fast breathing, or severe chest in drawing, or nasal flaring, or grunting, or bulging fontanelle, which treatment would be considered inappropriate? A. Treat the local infection in the health center, and teach the mother to treat local infections at home. B. Advise the mother regarding how to keep the infant warm on the way to the hospital C. Treat the infant to prevent the lowering of his or her blood sugar level. D. Give the infant the first dose of intramuscular antibiotics. 12. If the infant with Severe Dehydration also has Possible Serious Bacterial Infection or Dysentery, which of the following treatment would be considered inappropriate? A. Give the infant fluid for severe dehydration (Plan C: Treat Severe Dehydration Quickly) B. Refer the infant urgently to a hospital, with the mother giving frequent sips of ORS on the way. C. Advise the mother how to keep the infant warm on the way to the hospital D. Advise the mother to continue breastfeeding the infant 13. If the infant who has diarrhea, has two of the following signs; restless, irritable; sunken eyes; pinched skin goes back to its original state very slowly. What will be the appropriate treatment to give? A. Refer the infant to a hospital. B. Give the infant fluid to treat the diarrhea at home (Plan A). C. Give the infant fluid and food for some dehydration (Plan B). D. Refer the infant urgently to a hospital, with the mother giving the infant frequent sips of ORS on the way 14. Which type of plan would the nurse instruct a child who was classified with severe dehydration? A. Plan A B. Plan B C. Plan C D. Plan D 15. Maisie 3weeks old young infant with 4kg body weight and classified as possible serious bacterial infection or very severe disease. To treat Maisie's condition, ampicillin injection will be given intramuscular to Maisie. Stock Ampicillin 250mg/vial to be diluted in 1.3ml of distilled H20 to make strength as to 250mg/1.5ml. How many ml of ampicillin will be injected to Maisie? A. A 1.2ml B. 1.1ml C. 0.8ml D. 2ml 16. In giving ampicillin intramuscular injection to a young infant, the nurse should consider what formula? A. 50 mg/kg body weight B. 7.5mg/kg body weight C. 100mg/kg body weight D. 25mg/kg body weight 17. To prevent hypoglycemia to a young infant, the mother is instructed to expressed her breastmilk and give to infant by using a paladai. To compute the amount in volume of the breastmilk, the nurse should consider this formula as; A. 10 mL/kg body weight B. 15ml/kg body weight C. 5ml/kg body weight D. 20ml/kg body weight 18. To keep the young infant warm on the way to the hospital. What instructions should the nurse advise to the mother; A. Keep the young infant clothed or covered as much as possible all the time, especially in cold weather. 2nd Year This study source was downloaded by 100000859341955 from CourseHero.com on 03-12-2024 20:17:03 GMT -05:00 https://www.coursehero.com/file/207215426/IMCI-QUIZ-1-AND-2docx/ 5 B. Wrap the infant in a soft, dry cloth, and cover with a blanket. C. Add extra clothing, including a hat, gloves and socks. D. Hold the infant in skin-to-skin contact. E. All of these 19. If the young infant t is not able to breastfeed but is able to swallow. Sugar water is advisable to prevent hypoglycemia. To make a sugar water, the nurse will; A. Dissolve 5 level teaspoons of sugar in a 200ml cup of clean water B. Dissolve 4 level teaspoons of sugar in a 200-mL cup of clean water C. Dissolve 4 table spoon of sugar in 300ml of clean water D. Dissolve 3 tablespoon of sugar in 250ml of clean water 20. To treat oral thrush, the mother should give the treatment 4 times daily for 7 days: Which procedure is advisable in applying gentian violet? A. Paint the mouth with halfstrength gentian violet using a clean soft cloth wrapped around the finger. B. Paint the mouth with full strength gentian violet using a cotton tip applicator C. Paint the skin with full-strength gentian violet using a cotton swab D. Spray the young infant skin with half strength gentian violet 21. To treat a young infant with diarrhea at home by using the Plan A, the nurse should instruct the mother with the following, except; A. Give extra fluids. B. Continue exclusive breastfeeding. C. Know when to return to hospital. D. Give ORS by mouth while the drip is being set up. 22. To treat severe dehydration quickly to a young infant less than 12months of age, the nurse chose Plan C and start intravenous fluid immediately over 1hour. A. The nurse should give; B. A.30 ml/kg body weight C. 70 ml/kg body weight D. 50ml/kg body weight E. 100ml/kg body weight 23. In preparing the approximate amount of oral rehydration solution required in ml, the nurse will use which formula? A. Calculate by multiplying the young infant's weight in kg by 75. B. Calculate by multiplying the young infant's weight in kg by 50. C. Calculate by multiplying the young infant's weight in kg by 100. D. Calculate by multiplying the young infant's weight in kg by 25. 24. In teaching the mother about correct positioning and attachment for breastfeeding. Which of the following the mother is showing on how to hold her infant? Except; A. The infant's head and body in line, B. The infant held close to the mother's body, C. The infant's lips touch the mother's breast D. The infant approaching the breast with the nose opposite the nipple 25. In teaching the mother about correct positioning and attachment for breastfeeding. The following show how the mother helps her infant attach to the nipple, except; A. Touch her infant's lips with her nipple, B. Wait until her infant's mouth is open wide C. The infant approaching the breast with the nose opposite the nipple D. Move her infant quickly onto her breast, aiming the infant's lower lip well below the nipple. 2nd Year This study source was downloaded by 100000859341955 from CourseHero.com on 03-12-2024 20:17:03 GMT -05:00 https://www.coursehero.com/file/207215426/IMCI-QUIZ-1-AND-2docx/ 6 26. In teaching the mother how to express breastmilk. The nurse should ask the mother to: A. Place her thumb on top of the breast and the first finger on the underside of the breast so they are opposite each other at least 4 cm from the tip of the nipple. B. If the milk does not appear, she should re-position her thumb and finger closer to the Nipple and compress and release the breast as before. C. Compress and release all the way round the breast, keeping her fingers the same distance from the nipple. D. Compress and release the breast tissue between her finger and thumb a few times. E. All of these 27. In teaching the mother on how to keep the low-weight infant warm at home. The following will be advised to the mother; A. Provide skin-to-skin contact as much as possible, day and night. B. Keep the young infant in the same bed as the mother. C. Change clothes whenever they are wet. D. Avoid bathing the low-weight infant. E. All of these 28. In keeping the low-weight infant warm at home. When washing or bathing the infant, the following should be considered, except; A. Clothe the young infant immediately B. Re-warm the infant using a heating device C. Do it in a very warm room with warm water D. Dry Immediately and thoroughly after bathing 29. For critical illness, give gentamicin at 5-7.5 mg/kg body weight per day once daily and ampicillin 50 mg/kg body weight twice daily until referral is possible or for 7 days. A. True B. False 30. For clinical severe infection, give gentamicin at 5-7.5 mg/kg body weight per day once daily for 7 days. A. True B. B False 2nd Year This study source was downloaded by 100000859341955 from CourseHero.com on 03-12-2024 20:17:03 GMT -05:00 https://www.coursehero.com/file/207215426/IMCI-QUIZ-1-AND-2docx/ Powered by TCPDF (www.tcpdf.org) 7
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