Professional Documents
Culture Documents
Main Symptoms
- cough or difficult breathing - diarrhea - fever - ear problems
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Learning Objectives
By the end of this session, the students will be able to:
(1) recall the anatomy and pathophysiology; (2) recognize the symptoms and signs; (3) assess and classify symptoms and signs; (4) identify the correct treatment and when to refer; (5) provide counseling; and (6) specify necessary follow-up care
Session 4-a
If the child is: Fast breathing is: 2 mos 12 mos. 50 breaths/min or more 12 mos 5 yrs 40 breaths/min or more
Classify childs illness using the color-coded classification table for cough or difficult breathing
Fast breathing
PNEUMONIA
Give an appropriate oral antibiotic for 5 days Soothe the throat and relieve the cough with a safe remedy Advise mother when to return immediately Follow-up in 2 days If coughing > 30 days, refer for assessment Soothe the throat and relieve the cough with a safe remedy Advise mother when to return immediately Follow-up in 5 days if not improving
Treatment
Soothe the Throat, Relieve the Cough with a Safe Remedy
Safe
infant
Harmful
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remedies to discourage: Codeine cough syrup Other cough syrups Oral and nasal decongestants
1/2 1
5.0 ml 10 ml.
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1 capsule 2 capsules
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Session 4-b
DIARRHEA
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Diarrhea
For ALL sick children ask the mother about the childs problem, check for general danger signs, ask about cough or difficult breathing and then ASK: DOES THE CHILD HAVE DIARRHOEA?
If NO
If YES
CLASSIFY the childs illness using the colour-coded classification tables for diarrhoea.
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Then ASK about the next main symptoms: fever, ear problem, and CHECK for malnutrition and anaemia, immunization status and for other problems.
DIARRHEA
Does the child have diarrhea? IF YES, ASK: For how long? Is there blood in the stool? LOOK, LISTEN, FEEL: Look at the childs general condition, is the child:
Look for sunken eyes Offer the child fluid. Is the child:
Not able to drink or drinking poorly? Drinking eagerly, thirsty?
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17
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SEVERE DEHYDRATION
Two of the following signs: Restless, irritable Sunken eyes Drinks eagerly, thirsty Skin pinch goes back slowly Not enough signs to classify as some or severe dehydration.
SOME DEHYDRATION
NO DEHYDRATION
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No Dehydration
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Some Dehydration
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Severe Dehydration
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No Dehydration
Tell the Mother: (a) Breastfeed frequently and longer for each feed. (b) If the child is exclusively breastfed, give ORS or clean water in addition to breastmilk. (c) If the child is NOT exclusively breastfed, give 1 or more of the following: ORS Food-based fluids Clean Water
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No Dehydration
Treatment Plan A
< 2 yrs 2-10 yrs
Age Amount of Fluid of Fluid 50-100 ml (- cup) after each loose stool
Type
ORS, rice water, 100-200 ml (-1 cup) after each loose yogurt, stool soup with salt
Give frequent small sips from a cup. If the child vomits, wait 10 minutes. Then continue, but more slowly.
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Some Dehydration
Give
frequent small sips from a cup. If the child vomits, wait 10 minutes. Then continue, but more slowly. Continue giving extra fluids until the diarrhea stops. Reassess after 4 hours and classify the child for dehydration.
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Some Dehydration
If the mother must leave before completing treatment: show her how to prepare the ORS solution at home. show her how much to give to finish the 4 hour treatment at home give her enough ORS packets to complete rehydration.
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Some Dehydration
Treatment Plan B
(Determine amount of ORS to be given in 4 hours)
Age Up to 4 mos WEIGHT In ml 4mos - 12mos 12mos 2years
2 years 5
10 - <12kg 700-900
12-19kg 900-1400
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The approximate amount of ORS can also be calculated by multiplying the childs weight (in kg) by 75.
Severe Dehydration
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Severe Dehydration
Treatment Plan C
To treat severe dehydration (IV fluid: pLRS) Age Initial Phase Subsequent Phase (30 ml/kg) (70 ml/kg)
Infants (<12 mos) 1 hour 5 hours Older children 30 minutes* hours * 2
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Severe Dehydration
Reassess
the child every 1-2 hours. If hydration status is not improving, give the IV drip more rapidly. give ORS (5ml/kg/hr) as soon as the child can drink. the infant after 6 hours & a child after 3 hours. Classify dehydration.
Also
Reassess
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Severe Dehydration
Severe Dehydration
Start
hydration by tube (or mouth) with ORS solution. Give (20ml/kg/hr) for 6 hours. (Total of 120ml/kg) Reassess the child every 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
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SIGNS
CLASSIFY AS
present
dehydration before referral unless the child has another severe classification. Refer to hospital.
Advise No
dehydration
PERSISTENT DIARRHOEA
the mother on feeding a child who has PERSISTENT DIARRHOEA. Follow-up in 5 days.
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Persistent Diarrhea
After
5 days:
Ask:
If
the diarrhoea has NOT stopped (3 or more stools) do a full reassessment, give the treatment, then refer to hospital. the diarrhoea has stopped (< 3 stools per day) Tell the mother to follow the usual feeding recommendations for the childs age.
If
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SIGNS
CLASSIFY AS
Treat Blood
for 5 days with an oral antibiotic recommended for Shigella in your area. Follow-up in 2 days.
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Dysentery
After
2 days:
Ask:
if if
the number of stools, amount of stools, fever, abdominal pain or eating is same or worse: Change to 2nd line antibiotics & give for 5 days. Advise to return in 2 days.
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Dysentery
EXCEPTIONS:
If the child is less than 12 months old or was dehydrated on the 1st visit or had measles within the last 3 months. REFER TO HOSPITAL. If fewer stools, less blood in stools, less fever, less abdominal pain & eating better, continue antibiotics.
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Session 4-c
Fever
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Assess FEVER
A
child has the main symptom of fever if: the child has history of fever the child feels hot the child has an axillary temperature of 37.5 or above
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Has the child visited malaria area in the past 4 weeks? If yes to either, obtain a blood smear. Look and Feel: Look and feel for stiff neck. Look for runny nose Look for signs of Measles: Generalized rash. One of these: cough, runny nose or red eyes
Then Ask: For how long does the child has fever?
If >7 days, has the fever been present everyday? Has the child had measles within the last 3 months?
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If the child has measles now or within the last three months:
Look
for mouth ulcers. Are they deep and extensive? for pus draining from the eye. for clouding of the cornea.
Look Look
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Has the child had black vomitus or stools? Has the child had abdominal pain? Has the child been vomiting?
If none of the above ASK or LOOK and FEEL signs are present and the child is 6 months or older and fever present for more than 3 days. Perform Torniquet Test.
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Classify FEVER
Malaria Risk
(including travel to malaria area)
the child has measles now or within the last three months:
No Malaria Risk
43 If Dengue Risk:
is caused by parasites in the blood called plasmodia Plasmodium falciparum by Anopheles mosquito
Transmitted Know
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Palawan Davao Oriental Davao del Norte Compostela Valley Tawi-tawi Sulu Agusan del Sur Mindoro Occidental Kalinga Apayao Agusan del Norte
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Isabela Cagayan Quezon Ifugao Zamboanga del Sur Bukidnon Misamis Oriental Quirino Mountain Province Basilan
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Classify FEVER
Malaria Risk
Malaria Risk
(including travel to malaria area) Any general danger sign or Stiff Neck
Blood
Classify FEVER
smear (+) If blood smear not done: NO runny nose and, NO measles, and NO other causes of fever
Blood
MALARIA
No Malaria Risk
VERY SEVERE FEBRILE DISEASE FEVER: NO MALARIA No sign of very severe febrile disease
No Malaria Risk
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Malaria Risk
Any general danger sign or Stiff Neck
Give
first dose of Quinine (under medical supervision or if a hospital is not accessible withing 4 hours) Give first dose of appropriate antibiotics. Treat the child to prevent low blood sugar. Give one dose of Paracetamol in health center for high fever (38.5C or above.) Send a blood smear with the patient.
Refer
URGENTLY to a hospital.
Blood
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smear (+) If blood smear not done: NO runny nose and, NO measles, and NO other causes of fever
Treat
MALARIA
the child with an oral antimalarial. Give one dose of Paracetamol in health center for high fever (38.5C or above.) Advise mother when to return immediately. Follow up in 2 days if fever persists. If the fever is present every day for more than 7 days, refer for assessment.
Malaria Risk
Blood smear (-), or FEVER: Runny nose, MALARIA UNLIKELY or Measles or Other causes of fever.
Give one dose of Paracetamol in health center for high fever (38.5C or above.) Advise mother when to return immediately. Follow up in 2 days if fever persists. If the fever is present every day for more than 7 days, refer for assessment. Treat other causes of fever.
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Give an Oral Antimalarial 1st line Antibiotics: Chloroquine and Primaquine 2nd line Antibiotics: Sulfadoxine and Pyrimethamine If Chloroquine: The child should be watched closely for 30 minutes. If the child vomits, give another dose. Itching is a possible side effect of the drug.
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Antimalarial Agents
CHLOROQUINE Give for 3 days PRIMAQUINE Single dose for P. falciparum PRIMAQUINE Daily for 14 days for P. vivax SULFADOXINE + PYRIMETHAMINE Single dose
AGE
Tablet
(150mg base)
Tablet
(15mg base)
Day 1 Day 2 Day 3
Tablet
(15mg base)
Tablet
(500mg Sulfadoxine 25mg Pyrimethamine)
1/4
1/2
1/2
1/4
3/4
50
3/4
1/2
to the mother that itching is a possible side effect. It is NOT dangerous. The mother should continue to give the drug.
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If the species of malaria is identified through blood smear, give the following:
P. falciparum single dose Primaquine with the first dose of Chloroquine P. vivax first dose of Primaquine with Chloroquine and give mother enough for one dose each day for the next 13 days.
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you do not have the blood smear or you do not know which species of malaria is present, treat as P. falciparum. not give Primaquine to children under 12 months of age.
Do
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intramuscular antibiotic if the child cannot take an oral antibiotic for severe malaria or sugar to prevent low blood sugar.
Quinine
Breastmilk
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CHLORAMPHENICOL
Dose: 40 mg/kg Add 5 ml sterile water to vial containing 1000mg = 5.6 ml at 180mg/ml
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is the preferred because it is rapidly effective. Quinine is more safe and effective than intramuscular Chloroquine. Possible side effects of Quinine injections are: sudden drop in blood pressure, dizziness, ringing in the ears and a sterile abscess.
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Give the 1st dose of IM Quinine and refer the child urgently to the hospital Give the 1st dose of IM Quinine The child should remain lying down for 1 hour Repeat the Quinine injection 4 to 8 hours later, and 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 MONTHS OF AGE.
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Age or Weight
4 months 12 months (6 - <10kg) 12 months 2 years (10 - <12kg) 2 3 years (12 - <14kg) 3 5 years (14 19kg)
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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 breastmilk substitute. If neither is available, give sugar water. Give 30 50 ml of milk or sugar water before departure.
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4 level teaspoons of sugar (20 grams) in a 200 ml cup of clean water. the child is not able to swallow:
Give 50 ml of sugar water by nasogastric tube.
If
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1/4
5ml (1 tsp)
1/2
10 ml (2 tsp)
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No Malaria Risk
Any general danger sign or Stiff Neck
Give
first dose of appropriate antibiotics. Treat the child to prevent low blood sugar. Give one dose of Paracetamol in health center for high fever (38.5C or above.) Refer URGENTLY to a hospital.
FEVER: NO MALARIA
Give
one dose of Paracetamol in health center for high fever (38.5C or above.) Advise mother when to return immediately. Follow up in 2 days if fever persists. If the fever is present every day for more than 7 days, refer for assessment.
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Decide Malaria Risk: If the child has measles now or within the last three months: Decide Dengue Risk: Yes or No
Classify FEVER
Measles If dengue Risk, classify page 77 of the module Assess and Classify the Sick Child Age 2 months up to 5 years
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If Dengue Risk:
If the child has measles now or within the last three months:
Look for mouth ulcers: are they deep and extensive Look for pus draining from the eye Look for clouding of the cornea
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Measles
Fever
and generalized rash are the main signs of measles. Highly infectious. Over crowding and poor housing increases the risk of developing measles. Caused by a virus that infects the layers of cells that line the lung, gut, eye, mouth and throat.
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Measles
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Complications of measles occur in about 30% of all cases diarrhea (including dysentery and persistent diarrhea) pneumonia and stridor mouth ulcers ear infection severe eye infection (which may lead to corneal ulceration and blindness) Encephalitis occurs in about 1/1000 cases. (look for danger signs such as convulsions, abnormally sleepy or difficult to awaken)
Classify MEASLES
Clouding
of the
Give
Vitamin A Give first dose of an appropriate antibiotics If clouding of the cornea or pus draining from the eye, apply Tetracycline eye ointment Refer URGENTLY to the hospital
Give
Pus
Vitamin A Give first dose of an appropriate antibiotics If pus draining from the eye, apply Tetracycline eye ointment If mouth ulcers, teach the mother to treat with gentian violet Follow up in two days
Give
Measles
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MEASLES
Vitamin A
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Kopliks spots
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Vitamin A Capsule 100,000 IU 50,000 IU 1 cap 2 caps 1/2 cap 1 cap 200,000 IU
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Decide Malaria Risk: If the child has measles now or within the last three months:
Severe DHF
Classify FEVER
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Tourniquet Test
Inflate blood pressure cuff to a point midway between systolic and diastolic pressure for 5 minutes Positive test: 20 or more petechiae per 1 inch (6.25 cm)
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or gums Bleeding in the vomitus or stools Skin petechiae Cold clammy extremities Capillary refill more than 3 seconds abdominal pain or Vomiting or Positive torniquet test
No
If
skin petechiae or abdominal pain or vomiting or positive torniquet test are the only positive signs, give ORS If any other signs of bleeding are present, give fluids rapidly as in Plan C Treat the child to prevent low blood sugar Refer all chioldren URGENTLY to the hospital DO NOT GIVE ASPIRIN
Advise
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mother when to return immediately Follow up in 2 days if fever persists or child shows signs of bleeding. DO NOT GIVE ASPIRIN
Delayed capillary refill may be the first sign of intravascular volume depletion. Hypotension usually is a late sign in children. This child's capillary refill at 6 seconds was delayed well beyond a normal duration of 2 seconds.
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Session 4-d
Ear Problem
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child with ear problem is assessed for: Ear pain Ear discharge If present, how long has the child has had ear discharge Tender swelling behind the ear, a sign of mastoiditis
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swelling behind
MASTOIDITIS
Give
the ear
the first dose of an appropriate antibiotics Give first dose of Paracetamol for pain Refer URGENTLY to hospital
Give
Pus
is seen draining from the ear and discharge is reported for less than 14 days, or Ear pain
Pus
an antibiotic for 5 days. (Amoxicillin)* Give Paracetamol for pain. Dry the ear by wicking. Follow up in 5 days.
topical
is seen draining from the ear and discharge is reported for 14 days or more.
quinolone ear drops for at least two weeks Dry the ear by wicking. Follow up in 5 days.
No
No
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NO EAR INFECTION
additional treatment.
*Oral amoxicillin is a better choice for the management of suppurative otitis media in countries where antimicrobial resistance to cotrimoxazole is high.
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the ear at least 3 times daily. Roll a clean absorbent cotton or soft tissue paper into a wick. Place the wick in the childs ear. Remove the wick when wet. Replace the wick with a clean one and repeat these steps until the ear is dry. Do not use a cotton-tipped applicator, a stick or a flimsy paper that will fall apart in the ear.
the ear 3 times daily. Use this treatment for as many days as it takes until the wick no longer gets wet when put in the ear and no pus drains from the ear. Do not place anything (oil, foil or other substances) in the ear between wicking treatments. Do not allow the child to go into swimming.
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