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IMCI-INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS

-1992
-2 Pilot areas are in zamboanga del norte and sarangani
-strategy in reducing mortality and morbidity rate caused by a common childhood illness .
Pneumonia
Diarrhea
Dengue
Malaria
Measles
Malnutrition/Anemia
Ear Problems

Objectives of IMCI strategies:


1. To reduce death
2. To reduce severity and frequency of illness disabilities
3. to contribute in the improvement of growth and development of a child.

Major Components of IMCI:


1.Improve case management skills of Healthcare provider
2.Improving the health system to deliver IMCI
3.Improving the family and the community health practice.

Target Age:
1wk old age – 5y/o

Young Infant – 1 wk old - <2mos old


Common illness/Problem:
1.Possible serious bacterial Infection/ Local bacterial Infection
2.Diarrhea – Dehydration
3.Feeding Problems- death/low wt.

Young Child – 2 mos old – 5 y/o


Common illness:
Pneumonia
Diarrhea
Dengue
Malaria
Measles
Malnutrition/Anemia
Ear Problems

8 Important Guidelines base on the following Principles:


***before the IMCI strategy you have to ask the mother what is the problem of the child?”
IMCI case also called SICK CHILD.
1. All sick children must be examined for General Danger Sign:
C-onvulsion (fits,jerky movements,spasm)
U-nable to drink/breast feed (unable to swallow but not unable to eat)
To verify: offering a fluid or observe the mother to breastfeed her child.
V-omits everything
A-bnormally sleepy(difficulty to awaken,unconscious,lethargy)

2.Assess the childs main symptoms:


Breathing difficulty
Coughing
Diarrhea
Fever
Ear problems

3.Assess Nutritional status Malnutrition and Anemia


Assess Immunization status
Assess vitamin A status
Assess feeding problem
Assess other potential problems (ex.allergy)

4.Only a limited number of selected clinical signs are used


Readings: ASK, LOOK,LISTEN and FEEL
Ask: mouth; EBSA-Evidenced base syndromic approach supports the rational and effective
and affordable use of drugs
and diagnostic tools.It is also serve as a clinical sign.
LOOK:eyes
LISTEN:ears
FEEL:hands

5.A combination of individual signs leads to childs classification and not for diagnosis.
***classify illness is classification right!!!
But identify illness is diagnosis its wrong!!

6.IMCI management procedures use limited essential drugs means low cost but high
effective and we need active participation of care takes is needed.
a.Antibiotics (PO,IM,APPLIED)
b.Anti malarial (PO,IM)
c.Anti Helmentics (PO)

7.The guidelines do not describe the management of trauma and other emergency.

8.An essential component of IMCI is counseling the caretaker about recommended


treatment,feeding,play and communication skills.

DRUGS USE IN IMCI:


ANTIBIOTICS
Per orem/PO
1st line:Cotrimoxazole ***except in CHOLERA 1st line is tetracycline 2nd line cotrimoxazole
3rd line amoxicillin
2nd line:Amoxicillin *** except in Dysentery 1st line is cotrimoxazole 2nd lineis Nalidixic

Intramascular/IM
1st line:chlorampenicol
2nd line:Benzylpenicillin (Procaine penicillin)

Applied:
Eyes: Tetracycline ointment
Skin, mouth and umbilicus: Gentian violet
Half strength of Gentian Full strength of Gentian
Violet Violet
.25% concentration .5% concentration
1 ml GV + 3 mil distilled 1 ml GV + 1ml distilled
water water

How to apply Gentian Violet:


Mouth Ulcers/Oral trush Skin Infection Umbilical Infection
Half strength Full strength Full strength
1.Wash Hands 1.Wash Hands 1.Wash Hands
2.Clean affecting area using 2. Clean affecting area using 2. Clean affecting area using
soft cloth dipped in salt soft cloth soaked in soap soft cloth using 70% alcohol.
water and water. 3.Paint Gentian
3.Paint Gentian 3.Paint Gentian 4.Wash Hands
4.Wash Hands 4.Wash Hands

ANTI MALARIALS
PER OREM/PO
1ST line: Sulfadoxine(pyrimethamine), Chloroquine, Primaquine
2nd line: Arthemeter (Lumefantrine)
Intramascular/IM
Quinine- use for severe cases of malaria

ANTI HELMENTICS
PER OREM/PO
Albendazole
Mebendazole
Reminders in giving anti helmentics:
Only 12mos age and above
With 6 months interval after the last deworming
STEP BY STEP PROCESS: INTEGRATED CASE MANAGEMENT PROCESS
1.Assess s/s
2.Classify illness: Severe- pink
Moderate – yellow
Mild – green
3.Identify treatment- color code treatment:
Pink: referral or admission but with pre referral management or treatment in Health
Center.
Yellow: well enough to go home but with specific management/treatments like
antibioticspo, anti malaria po
Green: well enough to go home but with simple home care or home management like safe
remedies,TSB, paracetamol
4.Treat the child –the first dose of any drugs is given in health center
5.Counsel the mother
6.Give follow care commonly 2 days, 5 days, 14 days or 30 days.

Assess and classify the chart:use to sick child only


Chart should not use to children brought at the health center d/t immunization and
emergency conditions.
-for immunization use Growth Monitoring Chart
-for emergency use first aid chart like trauma, injury, fracture, burn.

Good Communication skills:


L-istening attentively
U-se understandable words
G-ive time to answer questions
A-sk additional questions
W-ag!!! Or don’t use checking question only if the counseling was done to verify.

How to treat the child in lowering of blood sugar:


1.If child is able to breastfeed: Breastfeed the child
2.If child is unable to breastfeed but can swallow: give 30-50cc of express breastmilk or
sugar water by mouth.
Sugar water = 4 tsp sugar in 200cc of water
3.I child is unable to Breastfeed and unable to swallow but conscious: give 50 ml express
breastmilk or sugar water through NGT.
4. I child is unable to Breastfeed and unable to swallow but unconscious:Insert IVF (d10w-
KVO)
PNEUMONIA
2 Common virus:
1.Streptoccocus Pneumoniae
2.Haemophilus Influenzae
P-neumonia
B-ronchitis
A-sthma
P-ertussis
O-her upper and LRI Program
Except TB bec of separate program: NTCP or National Tuberculosis Control Program
An d DOTS or tutok gamutan is their treatments partners or strategies
***review for CARI
Main Focus: To reduce Mortality rate through early detection
Contributory factors:
Mainor priority factor:Mother’s failure to recognized s/s of pneumonia
Indescriminate use of antibiotics
Not standardized management to pneumonia by HC providers.
Primary Role:
-to reduce morbidity d/t pneumonia
-teaching the parents and also the community members on how to recognize s/s of
pneumonia.
Important responsibility of CHN
-prevention of unnecessary deaths d/t pneumonia
-probation of careful assessment

PNEUMONIA PINK YELLOW GREEN


Assess: Severe Pneumonia or Pneumonia No Pneumonia
1.acute - <30 Very Severe Disease
days Signs & symptoms: Signs & symptoms:
chronic- >30 Signs & Symptoms: (+) Fast Breathing Cough/Colds
days Any of these
C-onvulsion Treatment: Treatment:
2.Count RR for FB U-nable to drink 1.Give 5 days of 1.Give safe
<2mos V-omitting antibiotic remedies
=60 A-bnormally sleep Cotri BID TLC Juice
2 mos – 12 mos C-hest Indrawing Amox TID 2.Advise when to
=50 S-tridor 2.Give safe remedies return
12 mos – 5 y/o Tamarind juice 3.follow up 5 days.
=40 Treatment: Luya juice
Pre referral…. Calamansi juice
3.Look for chest 1.1st dose of ***never give
Indrawing – IN-IN- antibiotic antitussive because of
IN Give Vitamin A sedative effect like
-when the lower <6mos decongestant,mucolytic,
chest wall goes IN -50,000 IU cough syrup.
during breaths IN 6 mos-12mos- 3.Advise to return
lead to INdrawing 100,000 IU blue immediately
d/t stiffness of 12 mos-5y/o 4.follow up 2 days
lungs -200,000 IU red Re-assessment:
3.Treat child to 1.CUVACS is (+) the
4.Look for Stridor prevent lowering of REFER
-harsh noise blood sugar. 2.same FB- change
during breaths 4.REFER!!! antibiotic
in.severe 3.im improving-continue
pneumonia but if
Wheezing- harsh
noise during
breaths out is for
asthma
DENGUE
-By temperature: Axilla-37.5 C Rectal- 38 C
-By touch/feel: abdomen or axilla (warm to touch or feels hot)
-By history within 72 hours or 2-3 days fever

Dengue celebrated every june


MOT: bite of a mosquito
Sources of Infection: Aedes Aegypti
Characteristic: Tiger mosquito because of white patches at the legs and back.
D-ay biting
L-ow flying
S-tagnant water
U-rban areas
Important responsibilities of a CHN
-Explaining to individual-Family and Community the Nature of the disease and its
causation.

DENGUE PINK YELLOW GREEN


Assess: SEVERE DENGUE FEVER:DENGUE
1.Travel, living or HEMORRHAGIC FEVER UNLIKELY
visit dengue S/S
endemic area? B-leeding S/S
If YES!!! C-old clammy Fever only
C-appiliary refill
Checking A-bdominal pain
Capilliary Refill: persistent
1.apply 2 sec P-ersistent headache
pressure on the P-ersistent vomiting
nailbed. P-ositive tourniquet
test TREATMENT:
2.Then release. S-kin petichae >20
TREATMENT: 1.Give paracetamol
3.If it takes < w/o aspirin or TSB
3sec adequate but 1.Rapid Fluid only
if >3seconds Replacement-the most
means important tx. 2.Advise when to
(+)circulatory a.PlanC if child has return immediately.
failure any of the ffng
signs:BCC give IVF
Reminders!!!
1.truly (+) signs of b.PlanB if child has
dengue: any of the ffng
Increase bleeding signs:APPPS give ORS
time
Increase hct count 2.Give Paracetamol
Decrease platelet w/o aspirin if temp is
count 38.5 C

2.Immediate 3. Treat child to


control of bleeding prevent lowering of
by: blood sugar.
-keeping the
patient at rest. 4.REFER!!!

3.To determine
shock: vital signs
DIARRHEA
-occurs when stool contains more water than normal
-consistensy of stool: watery loose stool.
-frequency of bowel movement: 3 or more within a day
-Clinical Manifestation: 3 or more of loose/watery stool within a day according to WHO and
DOH.
Program:CDD (Control of diarrheal disease)
Main objective:to reduce mortality rate d/t diarrhea among children 5years of age through
extensive care management.
Extensive care management: Oresol rehydration Therapy
ORS:1.oresol pocket/hydrite
2.home made ORS
3. AM- Rice water

DIARRHEA PINK YELLOW GREEN


Assess: SEVERE DHN SOME DHN NO DHN
1.For how long? S/S S/S S/S
Acute <14 days C-T-E-S-T C-T-E-S-T C-T-E-S-T
Persistent >14 2 signs of DHN or 1pink and other signs
days above of yellow or above.
TREATMENT: TREATMENT:
2.Blood on stool? TREATMENT: PLAN B PLAN A
PLAN C 1.Give ORS every 4 1.ORS given
3.Assess signs of 1.IVF=D5LR hours 1wk old-2y/o=50cc-
Dehydration/DHN Exemption to the rule (wt by kg) x 75 = #cc 100cc
if no other severe <4mos = <400 2y/o-5y/o=100cc-
disease and 4mos-1y/o= 400-700 200cc
***1st sign of DHN availability of 1y/o-2y/o = 700-900 2. 4home rule mgt
Thirs,irritable and resources. 2y/o-5y/o = >900 3.follow up 5 days
drinks eagerly 2. REFER!!! 4-1-2-5-4-7-9
***after 4 hrs re- REMINDERS IN
assess the child: ORS!!!
Severe=plan C and a.severe vomits-
refer!!! stop ORS then start
Same=repeat plan B IVF
No DHN=shift to plan b.Mild Vomits – Stop
A ORS in 10 mins then
2. 4 home rule continue slowly
management c.Puffiness of
a. continue feeding/BF eyelids – means
b. give extra overhydration give
fluid(juices,soup) 1 milk or 1 glass of
c.give zinc water.
supplemet(10-14
days)
d.Instruct the mother
to s/s to know when to
return the child
3.Follow up 5 days
SEVERE PERSISTENT PERSISTENT (YC)
(YC&YI) No signs of DHN
2 or more signs of 1.Give Vit.A
DHN 2.Proper feeding
1.PLAN C (Same recommendation
exemption) If still BF:
2. Vitamin A is given a.frequent BF day and
night
If milk supplement:
a.replace milk
supplement to breast
milk.
b.replace half of the
milk with nutrient rich
semi solid food.
c.do not use condense
or evaporated milk.
3.Follow up 5 days
DYSENTERY (YI) DYSENTERY (YC)
No exemption referral 1.5 days antibiotic
is needed!!! 1st line:Cotrimoxazole
2nd line:nalidixic
2.follow up 2 days

C-T-E-S-T PINK YELLOW GREEN


C-ONDITION ABNORMALLY SLEEP RESTLESS/IRRITABLE WELL AND ALERT

T-ONGUE VERY DRY DRY MOIST

E-YES SUNKEN EYES SUNKEN EYES NORMAL EYES

S-KIN VERY SLOWLY SLOWLY QUICKLY


> 2seconds <2seconds 1seconds or less
T-HIRST DRINKS POORLY DRINKS EAGERLY than
DRINKS NORMALLY

How To Pinch in Preventive measure: Home made


Abdomen: a. Breast feeding Oresol:
1.Lying on his -effective and practical – 1L of water
back/supine way. 1 tsp salt
2.use thumb and 1st -Breastmilk include 8 tsp sugar
finger Lactalbumin -1 glass of water
3.do not use fingertips (for easily digestion) 1pinch salt
4.Location:halfway b.Handwashing 2 tsp of sugar
between umbilicus & c.Measles vaccine that
side of abdomen. can reduce incidence
of diarrhea to children.
Malaria
-2 category: Malaria risk and non malaria risk
Provinces with Malaria situation:
Category A-no significant improvement in malaria case in the last 10 years.
Category B-has improvement in the last 5 years.
Category C-with significant reduction in malaria cases in the last 5 years.
Category D- malaria free but still potentially malarious

Malaria Risk PINK YELLOW GREEN


Assess : Very severe febrile Malaria Fever:malaria
1.Travel,visit or disease:Malaria unlikely
living? s/s: s/s:
YES!!! any of these (+)Blood stream s/s:
C-onvulsion (-)runny nose (-)Blood stream
***Reminders U-nable to drink (-)measles (+)runny nose
1.In giving Quinine: V-omitting (-)other infection (+)measles
-use tuberculine A-bnormally sleep that may cause fever (+)other infection
syringe S-tiff neck/Nuchal like wounds…. that may cause fever
.2, .3, .7 rigidity like wounds….
-s/e:dizziness or treatment:
hypotension or treatment: a.give antimalarial treatment:
sudden drop of BP a.Give IM quinine per orem: 1ST a.give paracetamol
-IM only never IV b.Give 1st dose of line:Sulfadoxine or TSB only
-Mgt: lying down for antibiotic because of (pyrimethamine), b.advise when to
1 hour if dizziness prone infection. Chloroquine, return immediately
occur. c.give paracetamol if Primaquine c.follow up 2 days
with 38.5 C temp 2nd line: Arthemeter
2.How to check stiff d.treat the child to (Lumefantrine)
neck? prevent lowering of b.give paracetamol
-tickle his toe or blood sugar or TSB only
umbilicus e.REFER!!! c.Advise when to
-shine flashlight on return immediately.
his toes or umbilicus. d.follow up 2 days.
(+)pain – stiffneck
(-)pain – no stiff neck
-last option:Lie child
on his back then flex
his head toward
chest.

3.Side effects of oral


anti malarials
-chloroquine-
itchiness

No Malaria Risk PINK YELLOW GREEN


1.Travel,visit or Very severe febrile Fever:no malaria
living? dse s/s:
NO!!! s/s: (+)runny nose
any of these (+)measles
. C-onvulsion (+)other infection
U-nable to drink that may cause fever
V-omitting like wounds….
A-bnormally sleep
S-tiff neck/Nuchal
rigidity treatment:
a.give paracetamol
treatment: or TSB only
a.Give 1st dose of b.advise when to
antibiotic because of return immediately
prone infection. c.follow up 2 days
b.give paracetamol if
with 38.5 C temp
c.treat the child to
prevent lowering of
blood sugar
d.REFER!!!
MEASLES PINK YELLOW YELLOW GREEN
Assess: Severe Measles w/ eye Measles w/ mouth Measles
(+)fever and complicated complication complication
(+)generalize measles s/s: s/s: s/s:
rashes s/s: pus draining on (+)mouth ulcer same in
In addition to any C-U-V-A eyes but not deep & assessment
of these: (+)cloudy non extensive
(+)Coughing cornea d/t
(+)Runny nose severe vitamin
(+)Red eyes A deficiency
(+)mouth ulcer
with deep or
extensive treatment:
mouth ulcers. treatment: 1.give vit.A
1.give vit.A 2.apply gentian treatment:
treatment: 2. apply violet half 1.give vit.A
1.give vit.A tetracycline strength on mouth
2.give 1st dose ointment both BID
of antibiotic eyes TID until 3.follow up 2 days
3.Apply redness or pus is
tetracycline gone
ointment both 3.Follow up 2
eyes if with eye days
complication
4.REFER!!!

MEASLES

EAR PROBLEM/ INFECTION

EAR PROBLEM PINK YELLOW YELLOW GREEN


Assess: Mastoiditis Acute ear Chronic ear No ear
1.Ear pain? infection/ infection/ chronic Infection
(irritability,rubbin s/s: Acute otitis media otitis media
g or tagging his -Tender swelling s/s: s/s: s/s:
ear) behind the ear -<14 days ear ->14 days ear -no ear
discharges or ear discharges or ear problem
2.ear discharges? pain pain proceed to
If yes how long? next
<14 days- acute treatment: assessmen
> 14 days- a.give 1st dose of treatment: t in IMCI
chronic antibiotic a.give 5 days treatment: guidelines
b.if with pain give antibiotic a.Dry the ear by
3.is there any paracetamol b.Dry the ear by wiching. treatment:
swelling behind c.REFER!!! wiching. b.follow up 5 days a.no
the ear? c.follow up 5 days treatment
needed

SUMMARY OF FOLLOW UP CARE

AFTER 2 DAYS AFTER 5 DAYS AFTER 14 DAYS AFTER 30 DAYS


Pneumonia Persistent diarrhea Anemia Very low wt.
Dysentery Feeding problems
Malaria Some/no DHN
Measles with Chronic ear infection
eye/mouth Acute ear infection
complications No pneumonia
Fever:dengue
unlikely
Fever:Malaria
unlikely
Fever:No malaria
Check Nutritional Status:

Nutritional Status PINK YELLOW GREEN


Assess: Severe Malnutrition Very low wt Not very low wt
-wt if appropriate to s/s: s/s: s/s:
childs age. Marasmus below the bottom on or above the
-visible severe curve in wt by age bottom curve in wt
On the curve- wasting treatment: by age
appropriate wt -skinny & bonny type 1.assess childs treatment:
according to age -baggy pants on feeding 1.assess childs
buttocks 2.immediate feeding to children
Above the curve- Kwashiorkor counsel the mother below 2y/o
appropriate wt -moonface about the 2.counsel the mother
according to age -edema on both feet recommended that the high
-simply known as feeding incidence of
Below the buttom “jollibee” 3.Give Vitamin A malnutrition and
curve-below normal treatment: 4.follow up 30 days anemia starts from
wt accdg to age 1.Give vitamin A to 6mos upto 2years of
increase immune age
system.
2.REFER!!!!
PINK YELLOW GREEN
Asses: Severe Anemia Anemia No anemia
-palm of hand s/s: s/s: no s/s proceed to
-severe palmar pallor -some palmar pallor next assessment in
or white paper palm treatment: IMCI guidelines
treatment: 1.give 14 days iron treatment:
1.Give vitamin A to 2.give anti same in not very low
increase immune helmentics with wt.
system. reminders.
2.REFER!!!! 3.follow up 14 days

Check immunization status:


Immunization OLD NEW
At birth BCG BCG,HEPA B1
6wks old DPT 1, OPV1, HEPA B1 DPT 1, OPV1, HEPA B2
10wks old DPT 2, OPV2, HEPA B2 DPT 1, OPV1,
14wks old DPT 3, OPV3, HEPA B3 DPT 1, OPV1, HEPA B3
9mos old Measles Measles

Contraindications in giving vaccine:


1. Do not immunize a child that is candidate for referral
2. Do not give life attenuated vaccine to an immunocompromise child such as:
symptomatic AIDS/HIV
3. Do not give DPT if the child has a history of recurrent convulsion. Because of the P
instead give DT vaccines that are available in private clinic.
4. Do not give DPT 2 & DPT 3 if the child had convulsion within 3 days after previous
dose was given. Again that is because of the P instead give DT vaccine that are
available in private clinic.

Reminders!!!
1. A child with diarrhea who is due for OPV should receive a dose of OPV but it is not
counted.
Example: baby jane visited health center to receive OPV1 but she is (+) for
diarrhea.
What will the nurse do? You may still give the OPV1 vaccine to jane but her visit is
not counted, after 4 wks baby jane has no diarrhea so the nurse will give OPV1 to
baby jane because her 1st visit is not counted due to her diarrhea.
2. If only one child at the health center needs immunization, you may do so open vial
vaccine and give it to the child because of the principle. ”life before resources”

Open vaccines should be discarded after:


4-6 hours for BCG and Measles
8 hours(duty hours) for DPT,OPV,Hepa B and TT

You may keep open vials of OPV for the next immunization if:
a. The expiry date has not yet passed.
b. Vaccine stores at 0-8 degree Celsius.
c. And must not taken out of the health center for outreach activities
d. No changes in color (VVM) vaccine vial monitor a device to determine color in vial.
CLASSIFICATIONS NEEDING VITAMIN A:
1. Severe Pneumonia
2. Severe persistent diarrhea
3. Persistent diarrhea
4. Severe complicated measles
5. Measles with eye or mouth complications
6. Measles
7. Severe malnutrition
8. Severe anemia
9. Very low wt.

CHECK FEEDING PROBLEMS:

BABY A BABY B
At birth – 6 mos old At birth – 4 mos old
-exclusive BF -exclusive BF
-8-12x BF within 24 hours -8-12x BF within 24 hours
4 mos – 6 mos old
-BF + once a day or 2x a day
complementary foods
if child shows:
a. interest to semi solid food
b.appears hungry after BF
c.not gaining weight appropriately
6 mos – 12 mos old 6 mos – 12 mos old
-BF + complementary foods 3x a day -BF + complementary foods 3x a day
-if no BF complementary foods 5x a day -if no BF complementary foods 5x a day
12 mos – 2 y/o 12 mos – 2 y/o
- BF + complementary foods 5x a day - BF + complementary foods 5x a day
-if no BF complementary foods 5x a day -if no BF complementary foods 5x a day
2y/o and above 2y/o and above
-5x a day family food -5x a day family food

BREASTMILK:
1.it contains the ffng:
Macronutrie Micronutrien Minerals
nts: ts: Antibodies
Lactose Vit. A igA
Proteins Vit.C
fats Iron

2.Milk formula should be given through cups or spoon and never bottle.
3.Complementary foods must be energy rich,nutrient rich,locally affordable. Like mashed
potato,bananansquash,tokwa,egg,bulanglang,lugaw rcipes are: pulverize dilis,mongo or
shrimp for protein,iodized salt for iodine and malungay or horse radish for iron.
4.Signs of hunger:
a. beginninng to fuss
b.sucking of thumb or fist
c. movements of lips
YOUNG INFANT COMMON ILLNESS/PROBLEMS

POSSIBLE SERIOUS LOCAL BACTERIAL INFECTION REMINDERS!


BACTERIAL INFECTION (PINK) (YELLOW)
Danger sign C-U-A no voits -Umbilical redness or pus a.In assessing chest
F-ever Axilla:37.5 C Rectal:38 -skin pustules indrawing,nasal
C if hyperthermia flaring,fast breathing the
If hypothermia Axilla:35.5 C TREATMENT: infant must be calm.
Rectal: 36 C below a.give 5 days oral antibiotics b.avoid cotrimoxazole to
F-ast breathing RR=60bpm PO young infant < 1 month
U-mbilical cord redness b.treat the local infection appy old age,premature and
(extended upto near skin) gentian violet in affected area with jaundice because of
N-asal Flaring c.follow up 2 days premature liver but you
C-hest indrawing severe in Re assessment after 2 days… may give the 2nd line of
characteristic If pus or redness antibiotic.
E-ar pus or discharges remains:refer!!! c.if RR on the first count
S-kin pustules (severe and If pus or redness is 60bpm repeat again.
many) worse:refer!!! d.If thermometer is not
B-ulging Fontanels If pus or redness improves: available, touch or feel
continue antibiotic the axilla or abdomen.
TREATMENT:
a.give 1st dose of antibiotic IM Nasal Flaring-widening of
gentamycin IM and nostrils during breaths
benzylpenicillin in.
b.keep infant warm
c.treat infant to prevent low Grunting-soft,short
blood sugar sound of a young infant
d.REFER!!! during breaths out.

FEEDING PROBLEMS:

POSSIBLE SERIOUS FEEDING PROBLEM REMINDERS!


BACTERIAL INFECTION (YELLOW)
(PINK)
-not able to feed -receives other foods and 3 signs of good sucking:
-no sucking at all fluids a.slow sucking
-no attachment at all in -<8x BF within 24 hrs b.deep sucking
mother’s breast. -oral trash c.with some pausing
TREATMENT: -not sucking effectively 4 signs of good attachment:
a.give 1st dose of antibiotic -not well attach on mothers a.chin touching the breast
IM breast b.mouth widely open always
gentamycin IM and c.lower lip turns outward
benzylpenicillin TREATMENT: d.more areola visible above
b.keep infant warm -counsel the mother to the below part.
c.treat infant to prevent low reduce other food and Correct attachment:
blood sugar increase BF a.touch infants lip with her
d.REFER!!! -8-12x BF within 24 hours nipple
-applied antibiotic with b.wait unti the infants mouth
gentian violet half strength is opening widely
-teach the mother regarding c.move her infant quickly
correct position/attachment onto her breast.
Correct positioning:
NO FEEDING a.show the mother how to
PROBLEM(GREEN) hold her infant
b.with the infants head and
body straight
c.facing her breast,with
infants nose opposite to her
nipple
d.hold infants wholebody,not
just neck and shoulder
e.infants body close to her
body
CO-PAR COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH
(Book of MAGLAYA)
COMMUNITY ORGANIZING -CO PARTICIPATORY ACTION RESEARCH - PAR
Community organizing-process by which Participatory action research
health services,agencies and peoples of the -an investigation
community are brought together to: -on problems and issues of the community
-identify their own problem -by way of research
-plan activities -representatives of the community
-act on this basis participate in the actual research
-evaluate activities -act as researcher themselves,doing
CO emphasis: strengthening the community research of their own problem
members in the capability of problem -essential element of PAR is
solving and decision making skills. the”PARTICIPATION”
(necessary for the self reliant development) PAR Objectives:
CO main objectives/aims: 1.To encourage consciousness(aware) of the
1.Transform the PULUVI into SUPER ACTIVE suffering
community. 2.To empower people to determine the
P-assive S-ystematic ( APIE) cause of their problem
U-nresponsive U-nited 3.To analyze this problems
L-azy P-articipative 4.To develop competence for changing their
U-nderserved E-nergetic own situation
V-oiceless, poor R-esponsive 5.To act by themselves in responding to
I-ndividualistic A-ctive their own problem.
Ideal Participatory research process involves
2.CO process plays the role of community the community in all research aspects:
organizer 1.Identification of research problem
3.The person who mobilizes I-F-C 2.Formulation of research design
4.to come together in unity and 3.Data Gathering
5.collectively address a given issue,need or 4.Data analysis
problem 5.Data presentation
Roles and Responsibility of a CHN 6.Planning
MGA CHN ROLES: 7.Action/Mobiliztaion
M-anager PAR involves REA
G-uide R-esearch
A-dovacate E-ducation
A-ction
C-ounselor,coordinator,change agent
H-ealth care provider Phases in Organizing Community
N-urse trainer “POTIP”
P-reparatory phase
R-esearcher O-rganizational phase
O-rganizer T-raining/educational phase
L-eader I-ntersectoral/collaborative phase
E-ducator*primary role P-hase out
S-upervisor of midwife

Phases in Organizing Community=“POTIP”


PREPARATORY PHASE
Pre entry Entry
A.area selection A.Community Integration(establishing rappor
criteria in selecting community & imbile their community life)
-site must be depressed/poor and -courtesy call to barangay
underserved captain:considered as the father of the
-area must not have a serious peace and community.
order problem -Immerse yourself/live with them
-willingness to be organized -Reside on the designated area
-needing health assistance main objective:to gain trust and cooperation.
-counterpart of the community (support Guidelines in conducting Integration work:
commitment and resources) 1.Recognize the role and position of local
-accesible to transportation and authorities.
communication 2.choose a modest center dwelling which the
B.Communkty Profiling people will not hesitate to enter.
-Identify Contact person 3.Make house calls (home visit)and seek out
-Gather overview of the demographic people where they usually gather.
characteristics and health services or 4.Participate in some social activities.
facilities of the community. 5.Avoid raising expectations of the
people.Be clear with your objectives and
limitations.

ORGANIZATIONAL PHASE
Social preparation Spotting & Core group Setting up
developing potential formation community org
leaders or committee
-continously learning -person who have -core group consist -when all sectoral
more about the deep concern and of the identified organization have
conditions of the understanding on potential leaders. been put up.
community. the conditions of the -Main role:represents -This organization
-Main Objectives: to community the different sectors will facilitate wider
deepen and CHARACTERISTICS of the community participation and
strengthen ties with OF A POTENTIAL like: collective action on
the community LEADERS: -Elder sector community
1.respected of -Youth sector problems.
community members -Children sector
2.has wide influence -Handicapped sector
to elite & poor -Fisherman/farmer
community sector
members. -Women sector
3.responsible & -Livelihood sector
committed. -Health sector
4.has good
communication
skills.
5.willing to work for
a desired change.

TRAINING/EDUCATIONAL PHASE
-To strengthen the organization and develop its capability to attend the community basic
healthcare needs.
Conducting Health Services and Leadership- Training of
Community mobilization of formation activities community health
diagnosis resources workers
-done to come up -actual exercises of -constant meetings - village or grassroot
with the profile of people power and -different activities workers lik BHW,hilot
the community confidence. (APIE) -Conduct training
needs, issues and -team building needs assessment
problems. exercises to enhance (TNA)
-Social Investigations cohesiveness -to determine the
is collecting level of health skills
collating, analyzing and knowledge the
& understanding trainees possess.
data to draw a clear -result of the
picture of the assessment serves
community. as basis for the
-known as the health skills training
community study. and curriculum.
2 types of
community Dx:
1.comprehensive
community
diagnosis:aims to
obtain general
information about
the community
2.Problem oriented
community diagnosis
-particular need
-particular group
INTERSECTORAL/ COLLABORATION PHASE:
-Facilitate and collaborate with:
-Institution
-Agencies
-Other key people
-Articulate the communities for support and assistance

PHASE OUT
-After 5 years of activities the nurse gradually prepares for:
a. Turnover of work
b. Develops a plan for monitoring or action plan
c. Subsequent follow up of the organizations activities

When to phase out:


a. Objectives have been attained.
b. Impact of the project has become visible or change has been made.
c. Community members can take over the APIE of the project
d. Community resources can already be maximize by the people
e. Community base organization has been established

Phase of strategy
1. Impact assessment
URBAN- rapid urban appraisal
RURAL- rapid rural appraisal
2. Phase out action plan
3. Gradual pull out of intervention
4. Institutionalization of the community organization with other agencies who provided
support of
(SEC) security exchange committee.
5. Provision of consultancy services.

Critical steps in building people’s organization


1. Integration
2. Social Investigation
3. Tentative program planning
4. Groundwork-going around motivating/inviting people in a one on one basis
5. Meeting-present of needs and problem and their opinion with their decision about it.
6. Role Playing – meansto act out on the meeting
7. Action/mobilization-Implementation of the role played
8. Evaluation-to review the success and failure of activities
9. Reflection-they talk about what happen
10.Organization

EPIDEMIOLOGY:
- Study on disease occurrence or distribution
- Backbone on disease prevention
Endemic- constant and always present
Sporadic- occasional, irregular
Epidemic – sudden increase or in excess of “expected level”
- outbreak
Pandemic – worldwide distribution

DEMOGRAPHY:
- Study on human population size, distribution & composition
Census-complete enumeration of the population

2 ways of assigning people:


1.DeJure
- people were assigned to the place where they usually live regardless of where they are
at the time of census.
-bilang sila kahit wala sa bahay.
2.Defacto
-people were assigned to the place where they are physically, present at the time of
census regardless of their usual place of residence.
-kapag present ka sa loob ng bahay kahit di ka nakatira don kasama ka sa bilang ng
census.

VITAL HEALTH STATISTICS


- Study on vital events such as birth, death, illness or disease.

Roles/responsibility of CHN:
C-ollect data
A-nalyze data
T-abulate data
E-valuate data
R-ecommended programs

Formula: