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2224624 Handouts IMCI

2224624 Handouts IMCI

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Published by chzychz

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Published by: chzychz on Jun 19, 2012
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Steps in the IMCI Case Management Process:1.Assess and Classify2.Identify Treatment3.Treat4.Counsel the Mother 5.Follow-Up
A. Assess and Classify Sick Children 2 months up to 5 Years
1. Determine which age group the child belongs:1 week up to 2 months2 months up to 5 years2. Record the child’s data :
Name, Age in months, Weight in kg., temperature, etc.
 Ask the mother what the child’s problems are.4. Determine if this is an initial or follow – up visit:
Initial visit 1
visit for this episode of an illness or problemFollow-up visit- the child has been seen a few days ago for the same illness
if the child’s condition improved, still the same or is getting better 4.
Check for general danger signs:
a.not able to drink or breastfeed
too weak to drink and is not able to suck or swallow when offered adrink or Breast-feed
if not sure: ask mother to offer child a drink of clean water or breastmilk
 A child may have difficulty sucking when his nose is blocked. If thenose is blocked, clean it.b.vomits everything
a child is not able to hold anything down at all
if in doubt, offer the child water c.convulsions (during this illness)
arms and legs stiffen because muscles are contracting
the child may lose consciousness or not be able to respond tospoken directions or handling, even if eyes are open
“fits” or “spasms” or “jerky movements”Note: Shiver is not convulsion. There is no loss of consciousness.d.abnormally sleepy or difficult to awaken
drowsy and does not show interest in what is happening around him
stare blankly and appear no to notice what is going on around him
does not respond when touched, shaken or spoken toNote: 1. If the child is asleep and has cough or difficult breathing, count the number of breaths first before you try to wake the child.2. If there is any general danger sign, complete the assessment and anypre-referral treatment immediately so referral is not delayed. 5.
 Assess and classify cough or difficult breathing 
2 Common Causes of Pneumonia
Stretococcus pnemoniae
Hemophilus influenzae
2 Causes of Death
1.hypoxia too little oxygen2.sepsis generalized infection
Health workers can identify almost all causes of pneumonia bychecking for 2 clinical signs: 1.
fast breathing
– body’s response to stiff lungs andhypoxia2.
chest indrawing
 Assess cough or difficult breathing:
Does the child have cough or difficult breathing? “fast” or “noisy” or “interrupted”?* If the answer is NO, look back to see if you think the child has cough or difficult breathing.
how long?chronic cough – more than 30 days- may be sign of tuberculosis, asthma, whooping cough or another problem
fast breathinga.count the breaths in one minute1.child must be quiet and calm2.no feeding, crying or angry  Ask the mother to lift the child’s shirt. If you are not sure about the number of breaths you counted, repeat the count.b.cut-off for fast breathing:
if the child is:fast breathing is:
2 months up to 12 months50 breaths/ minute or more12 months up to 5 years40 breaths/ minute or more Determine if the child is breathing IN or breathing OUT
chest indrawing the lower chest wall goes IN when the childbreaths INNORMAL: the whole chest wall and abdomen move OUT when the child breathsINBest position: lying downConditions: clearly visibleNote: intercostals indrawing or intercostals retractions and subcostal indrawing are notchest indrawing.
Look or listen for stridor.Stridor – harsh noise made when the child breaths IN- happens when there is swelling of the larynx, trachea, or epiglottis Put your ear near the child’s mouth and look at the movement of the abdomen todetermine if child is breathing IN or OUTwet noise- blocked nosewheezing - harsh noise while breathing OUT; not stridor CLASSIFY COUGH OR DIFFICULT BREATHING6.
 Assess and classify diarrhea
diarrhea – loose or watery stool
defined as 3 or more loose or watery stools in a 24 – hour periodAssess:
how long?
blood in stool
signs of dehydrationIf YES, asses for:
persistent diarrhea – 14 days or more
Asses for dehydration:
 Abnormally sleepy or difficult to awaken
Restless and irritable: (all the time)
Sunken eyes: If not sure, ask the mother if the child’s eyes lookunusual.
Offer the child fluid :Not able to drink - if he is not able to take fluid in his mouth and swallow itDrinking poorly – if the child is weak and cannot drink without help.Drinking eagerly, thirsty – reaches out for the cup or spoon when you offer water.
Pinch the skin of the abdomen:Goes back very slowly – longer than 2 secondsGoes back slowly – the skin stays up for even a brief time after release.CLASSIFY DIARRHEA FOR ;: DEHYDRATIONPERSISTENT DIARRHEADYSENTERY7.
 Assess Fever 
: A child has the main symptom fever if:
the child has history of fever – no fever now but had fever within 72 hours or 
the child feels hot or 
the child has an axillary temperature of 37.5 C or above Decide malaria risk:
child lives in malarious area or 
has been in a malaria risk area in the past 4 weeks.Look or feel for stiff neck:
look to see if the child moves and bends his neck easily as he looks around or 
draw the child’s attention to his toes or 
gently support his back and bend the head forward toward hid chest.Look for runny nose ( not history of runny nose)Look for signs of Measles: generalized rash and any one of the following: cough, runnynose, or red eyes. Measles rash: begins behind the ears and on the neck, spreads tothe face, and to the rest of the body; does not have vesicles or pustules; does not itch.If the child has measles now or within the last 3 months, assess for:
mouth ulcers – painful open sore on the inside of the mouth and lips or tongue
pus draining from the eye
clouding of the cornea – hazy area in the cornea Assess for Dengue Hemorrhagic Fever all children two months of age or older.-Look and feel for signs of bleeding and shock:
bleeding from the nose and gums
skin petechiae – small hemorrhages in the skin; look like small dark red spotsor patches in the skin; not raised, not tender; if you stretch the skin they do notlose their color.
Cold and clammy extremities
If with cold and clammy extremities, check for slow capillary refill ( longer than3 seconds
Perform the tourniquet test if: there are no signs in the ASK or LOOK andFEEL, the child is 6 months or older, and the fever is present for more than 3days.CLASSIFY FEVER

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