pedia imci lec final

8/19/2019 Pedia Imci Lec Final

1/42

Topic: Integrated Management of Childhood Illnesses

Lecturer: Dra. Gillian

I. Understand the IMCI approach to commonpediatric illnesses

II. Recognize the general danger signs in sickchildren

III. Demonstrate knowledge on when to refer asick child to the hospital

IV. Be able to assess and provide initialmanagement for the sick child

roblem! "ver# #ear$ more than %& million children in

developing co'ntries$ like the hilippines$ die before the#

reach their (th birthda#

)ol'tion! Integrated Management of Childhood

Illness (IMCI)

- * strateg# for red'cing mortalit# and morbidit#associated with ma+or ca'ses of childhood illness.

- * +oint ,-/U0IC"1 initiative since %223

OBJECTIVES

WHAT IS IMCI?


2/42



- IMCI clinical g'idelines target children 4 ( #ears old 5 the age gro'p the highest b'rden of deaths fromcommon childhood diseases

%. rioritizes! most fre6'ent and serious health problems

3. rovides a link to real-life sit'ations7. romotes rapid recognition and rapid action8. 9inks preventive and curative care(. rovides additional skills

:. "mphasizes action-oriented and affordable intervention

;. 9inks health professionals and the health s#stem

IMCI Strateg Com!onentsWh is IMCI needed in medi"al ed#"ation?


3/42



*ssess and Classif# the )ick Child! 3months


4/42



• not able to drink

• has conv'lsion

• abnormall# sleep#

• vomits ever#thing

M*>" )UR" * C-I9D ,I?- *0@ ="0"R*9

D*0="R )I=0 I) R"1"RR"D ? * -)I?*9

-. Che"/ for 0eneral anger Signs


5/42



Main )#mptom! Co#gh1iffi"#lt of Breathing

*fter first dose of an appropriate antibiotic and

other 'rgent treatments

Main )#mptoms

• co'ghing/diffic'lt# of breathing

• diarrhea

• fever

• ear problem

CASE 2-& *nne is an -3+month old infant$ weighing

%%.(kg. -er mother bro'ght her to the health cente

beca'se of "o#gh for - 4ee/ with fe5er . -e

res!irator rate is ,6. -er mother also reported that

she 5omited *7 b't is still able to drink fl'id. ,hat is

*nneAs classification for co'gh

• *sk for! D'ration

*. As/ a8o#t Main Sm!toms


6/42



9ook and 1eel!

Respirator# rate

Chest indrawing

)tridor

$ne#monia& Treatment

$9E:MO9IA& ;ollo4 :!


7/42




8/42



*dditional Recommendation!

• Children with wheeze and fast breathing and/or

lower chest indrawing! a trial of rapid acting

inhaled bronchodilator 'p to 7 c#cles$ before the#

are classified as pne'monia and prescribed

antibiotics.

*fter 3 da#s$ *nne was bro'ght back to the health center

d'e to persistent co'gh. -er respirator# rate is :&. -er

mother also reported that she vomits ever# time she is

fed. @o' noted chest indrawing$ alar flaring$ and head

nodding. ,hat is *nneAs classification for co'gh

CASE 2*& Eoel$ an --+month old$ 4eighing 3 /g$ has

diarrhea 7 < das. -e has no blood in the stool$ is

irritable$ and has s#n/en ee8alls. -e drinks eagerl#

when offered R). @o' did skin pinch test and it went

back slowl#. ,hat is the classification of EoelAs diarrhea

Main )#mptoms! IA%%HEA


9/42



*sk!

D'ration

Is there blood in stool

9ook and 1eel!

=eneral condition/ )ensori'm

)'nken e#es

*bilit# to drink

)kin pinch

$I9CH TEST


10/42



%. inch the skin of the abdomen halfwa# between the'mbilic's and the side

3. inch for % second$ then release and observe ver# slow F longer than 3 seconds


11/42



IA%%HEA& Management


12/42



,eight kg G ;( F amo#nt of O%S

IA%%HEA& Se5ere ehdration ($lan C)


13/42



If #o' can give IV fl'ids!

F : ho'rs

F 7 ho'rs

If #o' cannot give IV fl'ids and IV treatment is

available nearb# w/in 7& min'tes travel!

• R"1"R UR="0?9@

• rovide R) if child can drink$ show mothe

how to give fre6'ent sips d'ring the trip If 0 IV treatment is available nearb# and #o' are

trained to insert nasogastric t'be or if child can drink


14/42



0?"HH

• M*>" )UR" * C-I9D ,I?- DI*RR-"* ,-

-*) *0?-"R )"V"R" C9*))I1IC*?I0 ie

)evere pne'monia I) R"1"RR"D ? *

-)I?*9

• *dvice mother to give fre6'ent sips of R) on

the wa# and contin'e breastfeeding

:se of o4 Osmolarit O%S


15/42



• Co'ntries sho'ld now 'se and man'fact're the low

sodi'm R) for all children with diarrhea b't keep

the same label to avoid conf'sion

• Composition of R)

=in" in the Management of iarrhea

• *long with increased fl'ids and contin'ed feeding$

all children with diarrhoea sho'ld be given zinc

s'pplementation for %&


16/42



n follow 'p! >SE9TE%> (SHI0EA)n follow 'p! $E%SISTE9T IA%%HEA


17/42



• Ci!roflo7a"in

- most appropriate dr'g in place of 0alidiGic acid

which leads to rapid development of resistance

CASE 2& Eo#$ a +ear old@ 4eighing - /g$ has fe5er

7 < das. )he 5omited 7 and has a8dominal !ain.

n follow 'p! BOO I9 STOO


18/42



Mother reports she noticed red flat s!ots on her "hilds

arms and legs that morning. ,hat is Eo#As most likel#

diagnosis

*sk!

• Does the child feel hot or has temp 7;.( &C

• ?ravel to a Malaria area

• -istor# of measles within the last 7 months

9ook and 1eel!

• )tiff neck

• R'nn# nose$ co'gh$ red e#es

• =eneralized rash

Decide!

• Malaria

• Measles

• Deng'e 1ever

Main s#mptoms! ;EVE%


19/42



MAA%IA


20/42



• ;ACI$A%:M MAA%IA most co'ntries

A%TEMISI9I9


21/42



• Bleeding from nose or g'ms

• Bleeding in stools or vomit's

• Black stools or vomit's

• )kin petechia

• Cold clamm# eGtremities

• Capillar# refill 3secs

• ersistent abdominal pain

• ersistent vomiting

• If persistent vomiting$ abdominal pain$ skin petecia$

or positive torni6'et test are the onl# present signs

=IV" R) 9*0 B

• If with other signs of bleeding

=IV" 19UID) 9*0 C

• ?reat to prevent low blood s'gar

• R"1"R *99 C-I9DR"0 UR="0?9@ ? *

-)I?*9HHH

SEVE%E E90:E HEMO%%HA0IC ;EVE%


22/42



• D 0? give *spirinHHH

$E%SISTE9T ;EVE%


23/42



CASE 2


24/42



%. *CU?" "*R I01"C?I0- "*R DI)C-*R="$ not ear pain$ sho'ld be 'sed

in the classification of ac'te ear infection

- Management! ral AMOICII9 is a B"??"R C-IC"

for ac'te ear infection where antimicrobial

resistance to CotrimoGazole is high3. C-R0IC "*R I01"C?I0

- Dail# TO$ICA A9TISE$TICS R

A9TIBIOTICS after a'ral toilet for 3 weeks!

most "ost+effe"ti5e treatment for otorrhoea- TO$ICA :I9OO9ES& effe"ti5e in resolving

otorrhoea witho't the risk of ototoGicit#

TECH9ICA :$ATES O9 EA% I9;ECTIO9S


25/42



- *ddition of oral antibiotics has 0 RV"0

B"0"1I?

CASE 2,& Dan is -+ear old 8o$ 4eighing D /g. -is

tem!erat#re is D.3 C. -e has had diarrhoea for ,

das$ and is classified as diarrhoea 4ith SOME

EH>%ATIO9. ?he child visible se5ere 4asting.

?here is some !almar !allor . -e does not have edema

of both feet. Use the ,eight for *ge chart to determine

classification of DanAs weight : kg. for his age % #ear.

9ook and 1eel!

• Visible signs of severe wasting

- "dema of both feet- Determine weight for age

. Che"/ for Maln#trition and Anemia

Main )#mptoms! MA9:T%ITIO9


26/42



Marasm's >washiorkor


27/42



* child who was classified with V"R@ 9, ,"I=-?

sho'ld ret'rn for follow


28/42



9ook and 1eel!

• almar pallor$ classif# as!

o severe palmar pallor

o some palmar pallo

Iron treatment

• 1or treatment of anemia! give one dose dail# for

%8 da#s$ then reassess.

Iron s'pplement

A9EMIA& ?reatment


29/42



Mebendazole treatment

• =ive (&& mg mebendazole tablets as a single

dose in clinic if !o hookworm/whipworm are a problem in

children in #o'r areao the child is 3 #ears of age or older

o the child has not had a dose in the previo's

: months 1ollow


30/42



• =ive the mother additional iron for the child and

advise her to ret'rn in %8 da#s for more iron.

• Contin'e to give the mother iron when she

ret'rns ever# %8 da#s for 'p to 3 months.

• If after 3 months the child still has palmar pallor$

refer the child for assessment.

IMMU0IK*?I0

(. *ssess other problems


31/42



*ssess and Classif# the )ick Infant! %week 5 3

months old%. Check for ossible B*C?"RI*9 I01"C?I03. Check for 1""DI0= RB9"M or 9,

,"I=-?7. Check Imm'nization )tat's8. *ssess other problems

*sk! -istor# of conv'lsion

9ook and 1eel!

• 0asal flaring or gr'nting

• 1ast breathing :& bpm

• )evere chest indrawing

• 's draining from ear

• Umbilical redness eGtending to skin

• Man# skin p'st'les

$A%T II& THE SIC' I9;A9T (- 4ee/ F * months old)

%. Check for possible B*C?"RI*9 I01"C?I0

SE%IO:S BACTE%IA I9;ECTIO9


32/42



• 9ess than normal activit#

• 1ever or h#pothermia

• B'lging fontanelle

• 9ethargic or 'nconscio's

?R"*?M"0?!

• R"1"R UR="0?9@ to a hospital after first dose

of intram'sc'lar antibiotics

• revent low blood s'gar

• >eep bab# warm

9ook and 1eel!

• Umbilical redness

• Draining p's from 'mbilic's

• )kin p'st'les

?R"*?M"0?!

• =ive appropriate antibiotic

• ?each mother how to treat local infection

OCA BACTE%IA I9;ECTO9


33/42



• 1ollow


34/42



1eeding roblem or 9ow ,eight for *ge

• *sk!

- diffic'lt# in feeding

- breastfed -ow often in 38 hrs- breastfed at night- given other food -ow often- what do #o' feed the infant

• 9ook and 1eel!

- determine weight for age- determine birth weight for newborns

3. Check for 1""DI0= RB9"M or 9, ,"I=-?


35/42



If an infant!

• -as an# diffic'lt# feeding

• Is breastfeeding less than L times in 38 ho'rs

• Is taking an# other foods or drinks$ or

• Is low weight for age$ or low birth weight 3(&&

grams or less

• Is in the first week of life


36/42



*0D -as 0 indications to refer 'rgentl# to hospital!

Assess B%EAST+ ;EEI90

9ook for!

%. "11"C?IV" )UC>9I0=

*ssess BR"*)?< 1""DI0= for =D *??*C-M"0?


37/42



- )low deep s'cks with occasional pa'se

- Clear blocked nose

3. ?RU)-

- ,hite patches in the mo'th

:!date on Infant ;eeding&

- "Gcl'sive breastfeeding for : months sho'ld be

strongl# promoted

;eeding $ro8lem or o4 Weight for Age


38/42



Weight+for+Age Chart for Bos


39/42



C*)" :! Mico is a D+4ee/+old infant. -is 4eight is

*., /g. -e is bro'ght to the clinic beca'se of #m8ili"a

redness and !#s which 8egan das ago.

lot MicoAs weight for age ang classif#.

,hat will #o' advice regarding MicoAs feeding


40/42



Imm'nization

7. Check IMMU0IK*?I0 )tat's


41/42




42/42



8. *ssess other problems

pedia imci lec final

Documents