003 assesment for diarrhea plan a and b

7/27/2019 003 Assesment for Diarrhea Plan a and B

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ASSESSMENT AND MANAGEMENT

OF CHILDREN WITH DIARRHOEA

DR MOHD DAUD BIN CHE YUSOF

PAKAR PERUBATAN KELUARGA,

KLINIK KESIHATAN BANDAR KUANTAN


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4.0 ASSESS AND CLASSIFY

DIARRHOEA


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Diarrhoea

Also called loose or watery stools.

Frequent passing of normal stools is not diarrhoea. The number of stools normally passed in a day varies with

the diet and age of the child.

In many regions diarrhoea is defined as three or moreloose or watery stools in a 24-hour period.

Babies who are exclusively breastfed often have stoolsthat are soft; this is not diarrhoea.


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What are the Types of Diarrhoea?

If an episode of diarrhoea lasts less than 14 days,it is acute diarrhoea.

If the diarrhoea lasts 14 days or more, it ispersistent diarrhoea

Diarrhoea with blood in the stool, with orwithout mucus, is called dysentery


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4.1 ASSESS DIARRHOEA

A child with diarrhoea is assessed for:

how long the child has had diarrhoea

blood in the stool to determine if the child hasdysentery, and for

signs of dehydration.


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Look at the following steps for assessing a child with diarrhoea:

Does the child have diarrhoea?

IF YES, ASK :

For how long?

Is there blood in

the stool?

LOOK AND FEEL:

Look at the childs general conditionIs the child:

Drowsy or unconscious?

Restless or irritable?

Look for sunken eyes

Offer the child fluid. Is the child:Not able to drink or drinking poorly?Drinking eagerly, thirsty?

Pinch the skin of the abdomenDoes it go back:

Very slowly (longer than 2 seconds)?Slowly?


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Pinch the skin


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Two or more of the following

signs:

Drowsy or unconscious

Sunken eyes

Not able to drink or

drinking poorly

Skin pinch goes back very

slowly

SEVERE

DEHYDRATION

Refer URGENTLY to hospitalIf child has no other severe classification:

- Give fluid for severe dehydration (Plan C)

OR

If child also has anoth er severe classif ication:

- Give frequent sips of ORS on the w ay

-Advise the mother to cont inue breastfeeding

If chi ld is 2 years or older and there ischolera in your area, give ant ibiot ic for

cholera after taking rectal swab


signs:

Restless, irritable

Sunken eyes

Drinks eagerly, thirsty

Skin pinch goes backslowly

SOME

DEHYDRATION

Give fluid, zinc supplements and food for somedehydration (Plan B)

If child also has a severe classif ication:

- Refer URGENTLY to hospital with m other

giving frequent sips of ORS on the way

-Advise the mother to cont inue

breastfeeding

Advise mother when to return immediately

Follow-up in 5 days if not improving

Not enough signs to classify

as some or severe

dehydration

NO

DEHYDRATION

Give fluid, zinc supplements and food to treat

diarrhoea at home (Plan A)



CLASSIFY


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signs:

Drowsy or unconscious Sunken eyes

Not able to drink or

drinking poorly

Skin pinch goes back very

slowly

SEVEREDEHYDRATION

Refer URGENTLY to hospitalIf child has no other severe classification:

- Give fluid for severe dehydration (Plan C)

OR

If child also has anoth er severe classif ication:

- Give frequent sips of ORS on the w ay

-Advise the mother to cont inue breastfeeding

If chi ld is 2 years or older and there ischolera in your area, give ant ibiot ic for

cholera after taking rectal swab


signs:

Restless, irritable

Sunken eyes

Drinks eagerly, thirsty

Skin pinch goes back

slowly

SOME

DEHYDRATION

Give fluid, zinc supplements and food for somedehydration (Plan B)

If child also has a severe classif ication:

- Refer URGENTLY to hospital with m other

giving frequent sips of ORS on the way

-Advise the mother to cont inue

breastfeeding



Not enough signs to classify

as some or severe

dehydration

NO

DEHYDRATION

Give fluid, zinc supplements and food to treat

diarrhoea at home (Plan A)



TREATMENT


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4.2.2 Classify Persistent Diarrhoea

After you classify the child's dehydration, classify the child for persistent diarrhoea if the child has had

diarrhoea for 14 days or more. There are two classifications for persistent diarrhoea.

SEVERE PERSISTENT DIARRHOEA

PERSISTENT DIARRHOEA

Dehydration present SEVERE

PERSISTENT

DIARRHOEA

Treat dehydration before referral unless the child has another

severe classification

Refer to Hospital

No dehydration PERSISTENT

DIARRHOEA

Advise the mother on feeding a child who has

PERSISTENT DIARRHOEA

Give multivitamins and minerals (including zinc) for 14 days Follow-up in 5 days


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4.2.3 Classify Dysentery

There is only one classification for dysentery:

DYSENTERY

Blood in thestool

DYSENTERY

Treat with an oral antibio tic

for 5 daysFollow-up in 2 days


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DIARRHOEA TREATMENT PLAN

Plan A - Treat Diarrhoea at Home

Plan B - Treat Some Dehydration with ORS Plan C - Treat Severe Dehydration Quickly


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PLAN A: TREAT DIARRHOEA AT

HOME


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PLAN A: TREAT DIARRHOEA AT HOME

The 4 Rules of Home Treatment are:

GIVE EXTRA FLUID (as much as the child will take)

GIVE ZINC

CONTINUE FEEDING

WHEN TO RETURN


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GIVE EXTRA FLUID

TELL THE MOTHER

TEACH THE MOTHER HOW TO MIX AND GIVEORS. GIVE THE MOTHER 8 PACKETS OF ORS

TO USE AT HOME. SHOW THE MOTHER HOW MUCH FLUID TO

GIVE IN ADDITION TO THE USUAL FLUID

INTAKE: Use a Mother's Card and Check the Mother's

Understanding


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TELL THE MOTHER

Give as much fluid as the child will take. Purpose is to replace the fluid lost in diarrhoea and thus to prevent

dehydration.

The critical action is to give more fluid than usual, as soon as the

diarrhoea starts.

To breastfeed frequently and for longer at each feed.

Also explain that she should give other fluids.

ORS solution is one of several fluids recommended for home

use to prevent dehydration.


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TELL THE MOTHER ( Cont.)

If the child is exclusively breastfed,Important for this child to be breastfed more frequently than

usual.

Also give ORS solution or cool boiled water.

Breastfed children under 4 months should first be offered abreastfeed then given ORS.

If a child is not exclusively breastfed, give one or more of the

following:*ORS solution

*Food-based fluids

*Cool boiled water


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TELL THE MOTHER ( Cont.)

In most cases a child who is not dehydrated does not really need ORSsolution. Give him extra food-based fluids such as soups, rice water andcooled boiled water(preferably given along with food).

Plan A lists 2 situations in which the mother should give ORS solution athome.

1. The child has been treated on Plan B or C during this visit.child has just been rehydrated.

drinking ORS solution will help keep the dehydration from coming back.

2. The child cannot return to a clinic if the diarrhoea gets worse.For example, the family lives far away or the mother has a job that she cannot

leave.


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TEACH THE MOTHER HOW TO MIX

AND GIVE ORS.

When you give the mother ORS,

show her how to mix the ORS solution

and give it to her child.

Ask the mother to practice doing it herself while

you observe her.


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The steps for making ORS solution are:

* Wash your hands with soap and

water

* Pour all the powder from one

packet into a clean container.

Use any available container,

such as a jar, bowl or bottle.

*Measure 250 ml of cool boiled

water (or correct amount for packet

used). It is best to boil and coolthe water, but if this is not possible,

use the cleanest drinking water

available.

*Pour the water into the container.

Mix well until the powder is

completely dissolved.

* Taste the solution so you knowhow it tastes.


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Explain to the mother that

she should mix fresh ORS solution each day in aclean container,

keep the container covered,

and throw away any solution remaining from theday before.

Give the mother 8 packets of ORS to use athome. (Give 250 ml packets)


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SHOW THE MOTHER HOW MUCH FLUID TO GIVE IN

ADDITION TO THE USUAL FLUID INTAKE:

Explain to the mother that her child should drink the usual fluids that thechild drinks each day andextra fluid.

Show the mother how much extra fluid to give after each loose stool:

Up to 2 years 50 to 100 ml after each loose stool

2 years or more 100 to 200 ml after each loose stool

Explain to the mother that the diarrhoea should stop soon.

ORS solution will not stop diarrhoea.

The benefit of ORS solution is that it replaces the fluid and salts that the childloses in the diarrhoea and prevents the child from getting sicker.


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Tell the mother to:

* Give frequent small sips

from a cup or spoon.

Use a spoon to give fluid Illustration #16to a young child. from Mother's Card,

mother giving fluid to her child

* If the child vomits, wait10 minutes before giving

more fluid. Then resume

giving the fluid, but

more slowly.

* Continue giving extra fluid

until the diarrhoea stops.


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Use a Mother's Card and Check the Mother's

Understanding

To indicate the type of fluids a mother should give her child, tick the

appropriate box or boxes in the card's "Fluid" section.

If the child is not exclusively

breastfed, all 3 boxes get ticked.If the child is exclusively breastfed,

only 2 boxes get ticked.


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Before the mother leaves, check her understanding of how to give extra fluid according

to Plan A. Use questions such as:

* What kinds of fluid will you give?

* How much fluid will you give your child?

* How often will you give the ORS solution to your child?

* Show me how much water you will use to mix ORS.

* How will you give ORS to your child?

* What will you do if the child vomits?

Ask the mother what difficulties she expects when she gives fluid to her child.

For example,

if she says that she does not have time, help her plan how to teach someone

else to give the fluid.If she says that she does not have a 250 ml container for mixing ORS, show her

how to measure 250 ml using a smaller container. Or, show her how to

measure 250 ml in a larger container and mark it with an appropriate tool.

Use a Mother's Card and Check the Mother's

Understanding ( Cont.)


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The Second, Third and Fourth Rules of

Home Treatment for DiarrhoeaGIVE ZINC (Age 2 months up to 5 years).

Giving Zinc supplement will promote bowel mucosa healing.

Tell the mother how much to give (20mg/tab):

2 months up to 6 months

tablet daily for 14 days6 months or more 1 tablet daily for 14 days

Show the mother how to give Zinc supplement

Infants dissolve tablet in a small amount of expressed breastmilk, ORS or cool boiled water in a

cup

Older children

tablet can be chewed or dissolved in a small amount of cool boiled water in acup

CONTINUE FEEDING.

In the module, Counsel the Mother, you will learn to counsel on feeding. If a child is classified as

PERSISTENT DIARRHOEA, you will teach the mother some special feeding recommendations.


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WHEN TO RETURN.

Tell the mother of any sick child that the signs to return are:

* Not able to drink or breastfeed

* Becomes sicker

* Develops a fever

If the child has diarrhoea, also tell the mother to return if the child has:

* Blood in stool

* Drinking poorly

"Drinking poorly" includes "not able to drink or breastfeed.

The Second, Third and Fourth Rules ofHome Treatment for Diarrhoea ( Cont.)


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PLAN B: TREAT SOME

DEHYDRATION WITH ORS


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PLAN B: TREAT SOME DEHYDRATION WITH ORS

Treatment of a child who has diarrhoea with SOME DEHYDRATION.

Includes an initial treatment period of 4 hours in the clinic.

the mother slowly gives a recommended amount of ORS solution.

spoonfuls or sips.

It is helpful to have an ORT corner in your clinic.

A child who has a severe classification and SOME DEHYDRATION needs

urgent referral to hospital.

After 4 hours,

Reassess and classify the child for dehydration using theASSESS AND CLASSIFYchart.

If the signs of dehydration are gone, the child is put on Plan A.

If there is still some dehydration, the child repeats Plan B.

If the child now has SEVERE DEHYDRATION, the child would be put on Plan C.


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Plan B: Treat Some Dehydration with ORS

Give in cl inic recomm ended amount of ORS over 4-hour per iodDETERMINE AMOUNT OF ORS TO GIVE DURING FIRST 4 HOURS.

AGE*Up to 4 months 4 months up to

12 months12 months up to

2 years2 years up to

5 years

WEIGHT < 6 kg 6 - < 10 kg 10 - < 12 kg 12 -

003 assesment for diarrhea plan a and b

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