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A highly communicable disease with the history of Duration of Natural Immunity - Usually
the following: lifelong
Risk Factors for Infection – Young age
- Generalized blotchy rash, lasting for three of crowding
more days
- Fever (above 38⁰C or “hot” to touch and EPI | NEONATAL TETANUS
Any of the ff: Cough, Runny nose, Red A newborn with history with all three of the
eyes/conjunctivitis following:
Agent - Rubeola virus 1. Normal suck for the first two days of life.
2. Onset of illness between 3 to 26 days.
3. Inability to suck followed by stiffness of the Duration of Natural Immunity – If develops,
body and/or convulsions lifelong
Transmissible Period
- Infants born to immune mothers may be
Agent - Clostridium Tetani protected up to 5 months
Reservoir – soil, intestinal canals of animals (esp. - Recovery from clinical attack is not always
horses), man followed by lasting immunity
Sources of Infection - Unhygienic cutting of - Immunity is often acquired through inapparent
umbilical cord, improper handling of cord stump infection or complete immunization series with
esp. when treated with contaminated substance diphtheria toxoid.
Hepatitis B RNA- Cloudy, liquid, in an auto- BCG vaccine At birth 0.05 ID Right
vaccine recombinant, disable injection syringe if ml deltoid
using available region
Hepatitis B (arm)
surface
antigen (HBs Hepatitis B At birth 0.5 ml IM Anterol
Ag) vaccine ateral
thigh
DPT-HepB- Diphtheria Liquid, in an auto-disable muscle
Hib toxoid, injection syringe
inactivated DPT-HepB-Hib 6 weeks, 0.5 ml IM Anterol
(Pentavalent pertussis 10 ateral
vaccine) (Pentavalent weeks, thigh
bacteria,
vaccine) 14 weeks muscle
tetanus toxoid,
recombinant
DNA surface Oral polio 6 weeks, 2 Oral Mouth
antigen, and vaccine 10 drops
synthetic weeks,
conjugate of 14 weeks
Haemophilus
influenzae B Anti-measles 9-11 0.5 ml SUBQ Outer
bacilli vaccine months part of
the
Oral polio Live, Clear, pinkish liquid (AMV1) upper
vaccine attenuated arm
virus
(trivalent) Measles- 12-15 0.5 ml SUBQ Outer
mumps-rubella months part of
Anti-measles Live, Freeze-dried, vaccine the
vaccine attenuated reconstituted with a (AMV2) upper
(AMV1) virus special diluent arm
Measles- Live, Freeze-dried, Rotavirus 6 weeks, 1.5 ml Oral Mouth
mumps- attenuated reconstituted with a vaccine 10 weeks
rubella viruses special diluent
vaccine
(AMV2)
HEAT SENSITIVITY
the higher the temperature, the faster the color
change.
Load front-loading refrigerator with freezer
on top as follows:
1. Measles, MR, MMR, BCG and OPV on the
top shelf
2. DTP, DT, Td, TT, HepB, DTP-HepB, Hib,
DTP-HepB+Hib, meningococcal, yellow
fever, and JE vaccines on the middle
shelves
3. Diluents next to the vaccine with which
they were supplied
Loading ice-lined refrigerators (ILR) Reconstitute freeze-dried vaccines – Discard
reconstituted freeze-dried vaccines 6 hours after
All the vaccines should be stored in the basket reconstitution or at the end of immunization
provided with the refrigerator session, whichever comes sooner.
1. Measles, MR, MMR, BCG and OPV in the OPEN-VIAL POLICY (DOH)/ MULTI –
bottom only DOSE VIAL
- Any vial of the applicable vaccines opened/used in
2. Freeze-sensitive vaccines (DTP, TT, HepB,
a session (fixed or outreach) can be used at more
DTP-HepB, Hib, DTP- hepB+Hib,
than one immunization session up to four weeks
meningococcal, yellow fever, and JE
(28 days) provided.
vaccines) in the top only.
MULTI DOSE LIQUID VACCINES:
Other considerations to maintain potency
1. Observe the first expiry- first out (FEFO) policy. OPV, Pentavalent vaccine, Hepatitis B vaccine, and
TT *
2. Duration of storage & transport: health from which one or more doses have been taken
center/RHU with a refrigerator – storage should following standard sterile procedures
not exceed one month
MULTI DOSE VIAL may be opened for 1 or 2
3. Duration of storage & transport: Transport clients if the health worker feels that a client cannot
boxes, vaccines can be kept only up to maximum of come back for the scheduled immunization session,
5 days. following standard sterile procedures
Vaccine Carriers MULTI DOSE LIQUID VACCINES may be used
in the next immunization sessions for up to
• Smaller than cold boxes; maximum of 4 weeks, provided …. that all
• Easier to carry if walking conditions are met:
• They do not stay cold as long as a cold box – expiry date has not passed.
maximum for 48 hours with the lid closed. vaccine not been contaminated.
VACCINE VIAL MONITOR (VVM) vials have been stored under appropriate
VVM is a round disc of heat-sensitive material cold chain conditions.
placed on a vaccine vial to register cumulative heat vaccine vial septum has not been submerged
exposure. in water.
VVM – Direct relationship exists between rate of VVM on the vial, if attached, has not reached
color change and temperature: the discard point
the lower the temperature, the slower the color
change;
PROTECT BCG FROM SUNLIGHT and placing the vials on table and not moving them
ROTAVIRUS VACCINE FROM LIGHT further.
Exposure to Ultraviolet Light Causes Loss of
Potency.
- must always be protected against sunlight or
fluorescent (neon) light.
- BCG, measles, MR, MMR and rubella vaccines
- These are equally sensitive to light (as well as
to heat)
- Normally, these vaccines are supplied in vials
made from dark brown glass
Procedure:
1. Prepare a frozen control sample
- Take a vial of vaccine same type /batch of
vaccine you want to test. FREEZE vial until
the contents are solid (at least 10 hours at -
10°C). Then let it thaw.
- This is the control sample. Mark the vial
clearly.
2. Choose a test sample Take a vial (s) of
vaccine from the batch (es) that you suspect
has been frozen.
- This is the test sample.
Shake the control and test samples
- Hold the control sample and the test sample
together in one hand and shake vigorously for 10–
15 seconds.
- Allow to rest Leave both vials to rest by
CHN 211 Community Health Nursing What is IMCI?
– A strategy for reducing mortality and morbidity
(DOH PROGRAMS) Integrated associated with major causes of childhood illness.
Management of Childhood Illness – A joint WHO/UNICEF initiative since 1992.
– Currently focused on first level health facilities.
INTRODUCTION – Comes as a generic guideline for management which
The WHO/UNICEF guidelines for Integrated been adapted to each country.
Management of Childhood Illness (IMCI) offer simple INTEGRATED MANAGEMENT OF CHILDHOOD
and effective methods to prevent and manage the ILLNESS
leading causes of serious illness and mortality in young Pneumonia, diarrhea, dengue hemorrhagic fever,
children. malaria, measles and malnutrition cause more than
The clinical guidelines promote evidence-based 70% of the deaths in children under 5 years of age. All
assessment and treatment, using a syndromic approach these are preventable diseases in which when managed
that supports the rational, effective and affordable use and treated early could have prevented these deaths.
of drugs. The guidelines include methods for checking a There are feasible and effective ways that health worker
child’s immunization and nutrition status; teaching in health centers can care for children with these
parents how to give treatments at home; assessing a illnesses and prevent most of these deaths. WHO and
child’s feeding and counselling to solve feeding UNICEF used updated technical findings to describe
problems; and advising parents about when to return to management of these illnesses in a set of integrated
a health facility. The approach is designed for use in guidelines for each illness. They then developed this
outpatient clinical settings with limited diagnostic tools, protocol to teach the integrated case management
limited medications and limited opportunities to process to health worker who see sick children and
practice complicated clinical procedures. know which problems are most important to treat.
In each country, the IMCI clinical guidelines are Therefore, effective case management needs to
adapted: consider all of a child’s symptoms.
- To cover the most serious childhood illnesses OBJECTIVES
typically seen at first-level health facilities – To reduce significantly global morbidity and
- To make the guidelines consistent with national mortality associated with the major causes of illnesses
treatment guidelines and other policies in children.
- To make the guidelines feasible to implement – To contribute to healthy growth and development of
through the health system and by families caring for children.
their children at home. The CASE MANAGEMENT PROCESS is used to assess
Foreword and classify two age groups:
Since the 1970s, the estimated annual number of - age 1 week up to 2 months
deaths among children less than 5 years old has - age 2 months up to 5 years
decreased by almost a third. This reduction, however, And how to use the process shown on the chart will
has been very uneven. And in some countries rates of help us to identify signs of serious disease such
childhood mortality are increasing. In 1998, more than pneumonia, diarrhea, malaria, measles, DHF,
50 countries still had childhood mortality rates of over meningitis, malnutrition and anemia.
100 per 1000 live births.1 Altogether more than 10
million children die each year in developing countries THE CASE MANAGEMENT PROCESS
before they reach their fifth birthday. •The charts describes the following steps;
Seven in ten of these deaths are due to acute 1. assess the child or young infant
respiratory infections (mostly pneumonia), diarrhoea, 2. classify the illness
measles, malaria, or malnutrition— and often to a 3. identify the treatment
combination of these conditions. 4. treat the child
5. counsel the mother
6. give follow up care
THE CLASSIFICATION TABLE WHY NOT USE THIS PROCESS FOR YOUNG INFANTS
– The classification tables on the assess and classify AGE < 1 WEEK OLD?
have 3 ROWS. – The process on young infant chart is designed for
– COLOR of the row helps to IDENTIFY RAPIDLY whether infants age 1 week up to 2 months. It greatly differs
the child has a SERIOUS DISEASE requiring URGENT from older infants and young children. In the first week
ATTENTION. of life, newborn infants are often sick from conditions
– Each row is colored either: related to labor and delivery. Their conditions require
PINK – means the child has a severe classification and special treatment.
needs urgent attention and referral or admission for IDENTIFICATION AND PROVISION OF TREATMENT
inpatient care. - Curative component adapted to address the most
YELLOW – means the child needs a spec eds a specific common life- threatening conditions in each country
medical treatment such as an appropriate antibiotic, an - Rehydration (diarrhea, DHF)
oral anti-malarial or other treat other treatment; also - Antibiotics (pneumonia, “severe disease”)
teaches the mother how to give oral drugs l drugs or to - Antimalarial treatment
treat local infections at home. The health worker - Vitamin A (measles, severe malnutrition)
teaches the mother how to care for her child at home PROMOTIVE AND PREVENTIVE ELEMENTS
and when she should return. - Reducing missed opportunities for immunization
GREEN – not given a specific medical treatment such (vaccination given if needed)
as t such as antibiotics or treatments. The health - Breastfeeding and other nutritional counseling
worker h worker teaches the mother how her how to - Vitamin A and iron supplementation
care for her child at home. - Treatment of helminth infections
Always start at the top of the classification table. If the
child has signs from more than 1 row always select the
The Integrated Case Management Process
more serious classification. Overall Case Management Process
WHY NOT USE THE PROCESS FOR CHILDREN AGE 5 Outpatient
YEARS OR MORE? 1 – assessment
– The case he cases management process is designed 2 - classification and identification of treatment
for children < 5yrs of age, although. Much of the advice 3 - referral, treatment or counseling of the child’s
on treatment of pneumonia, diarrhea, malaria, measles caretaker (depending on the classification identified)
and malnutrition, is also applicable to older children, 4 - follow-up care
the ASSESSMENT AND CLASSIFED CLASSIFICATION of Referral Health Facility
older children would differ. For example, the cut off 1 - emergency triage assessment and treatment
rate for determining fast breathing would be d would be 2 - diagnosis, treatment and monitoring of patient’s
different because normal breathing rates are slower in progress
older chi older children. Chest indrawing is no indrawing SUMMARY OF THE INTEGRATED CASE
is not a reliable sign of severe pneumonia as children MANAGEMENT PROCESS
get older and the bones of the chest become more firm. For all sick children age 1 week up to 5 years who are
– In addition, certain treatment recommendations or brought to a first level health facility.
advice to mothers on hers on feeding would differ for ASSESS the Child:
>5yrs r >5yrs old. The drug dosing, he drugs dosing Check for danger signs (or possible bacterial
tables only apply to chi ply to children up to 5yrs old. infection).
The feeding advice for older children may differ and Ask about main symptoms.
they may have ay have different feeding problems. If a main symptom is reported, assess further.
– Because of differences in the clinical signs of older and Check nutrition and immunization status.
younger children who have these illnesses, the
Check for other problems
assessment and classification process using these Classify the child’s illness:
clinical signs is not recommended for older children. Use a color-coded triage system to classify the
child’s main symptoms and his or her nutrition or
feeding status.
IF URGENT: REFERRAL is needed and possible THE SICK CHILD AGE 2 MONTHS TO 5 YEARS:
IDENTIFY URGENT PRE- REFERRAL TREATMENT(S) ASSESS AND CLASSIFY
Needed prior to referral of the child according to
classification. SUMMARY OF ASSESS AND CLASSIFY
TREAT THE CHILD: Give urgent pre-referral treatment(s) Ask the mother or caretaker about the 4 main
needed. symptoms:
REFER THE CHILD: cough or difficult breathing
Explain to the child’s caretaker the need for diarrhea
referral. fever, and
Calm the caretaker’s fears and help resolve any ear problem
problems. Write a referral note. When a main symptom is present:
Give instructions and supplies needed to care for Assess the child further for signs related to the
the child on the way to the hospital. main symptom, and
IF NO URGENT REFERRAL is needed or Possible Classify the illness according to the
IDENTIFY TREATMENT needed for the child’s signs which are present or absent
classifications: identify specific medical treatments When a child is brought to the clinic
and/or advice. Use Good Communication Skills:
TREAT THE CHILD: Listen carefully to what the mother tells you
Give the first dose of oral drugs in the clinic and/or Use words the mother understands
advice the child’s caretaker. Give mother time to answer questions
Teach the caretaker how to give oral drugs and Ask additional questions when mother not sure of
how to treat local infections at home. answer
If needed, give immunizations. Record important information
COUNSEL THE MOTHER: GENERAL DANGER SIGNS
Assess the child’s feeding, including breastfeeding When a child is brought to the clinic
practices, and solve feeding problems, if present. ASK:
Advise about feeding and fluids during illness and Is the child able to drink or breastfeed?
about when to return to a health facility. Does the child vomit everything?
Counsel the mother about her own health. Has the child had convulsions?
FOLLOW-UP CARE: Give follow-up care when the child LOOK:
returns to the clinic and, if necessary, reasses the child See if the child is lethargic or unconscious
for new 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 child’s general condition, is the child:
Lethargic 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 abdomen.
Does it go back: Very slowly (> than 2 secs)? Slowly? CLASSIFICATION TABLE FOR DEHYDRATION
CLASSIFICATION TABLE FOR PERSISTENT
DIARRHEA
FEVER
Does the child have FEVER?
IF YES, decide the malaria risk: high or low THEN ASK:
For how long?
If more than 7 days, has fever been present every
day?
Has the child had measles within the last 3
months?
If the child LOOK AND FEEL:
Look for runny nose
Look or feel for stiff neck
LOOK FOR SIGNS OF MEASLES
has measles now or within the last 3 months
-Rash -Mouth ulcers
-Pus from eyes -Runny nose
-Red eyes -Clouding of cornea
-Runny nose -Cough
-Red eyes
LOOK FOR SIGNS OF DENGUE/DHF
-----bleeding tendencies
flushing
(+) tourniquet test
rash
CLASSIFICATION TABLE FOR NO MALARIA RISK
AND NO TRAVEL TO A MALARIA RISK AREA
SUMMARY TREATMENT
EXPANDED NEWBORN SCREENING
– The expanded newborn screening program will
increase the screening panel of disorders from six(6)
to twenty eight (28).
– Expanded newborn screening will screen for
additional disorders falling under various groups of
conditions namely:
• HEMOGLOBINOPATHIES
• DISORDER OF AMINO ACID
• ORGANIC ACID METABOLISM
• DISORDERS OF FATTY ACID OXIDATION
• DISORDERS OF CARBOHYDRATE METABOLISM
• DISORDER OF BIOTIN METABOLISM
• CYSTIC FIBROSIS
ESSENTIAL INTRAPARTAL NEWBORN Time Bound and Non-immediate NBC
• Immediate and Thorough Drying
CARE • Early Skin-to-Skin Contact
– An evidence based standards for safe quality care of • Properly Timed Cord Clamping
birthing mothers and their newborns within 48 hours • Non-separation of Newborn from Mother for Early
of intrapartum period and a week of life for the Breastfeeding.
newborn.
Immediate and Thorough Drying
PURPOSES: Within 1st 30 secs (Immediate Thorough Drying)
Assess and evaluate the newborn as he or she Call out the time of birth
transitions from intrauterine life to extrauterine life. Dry the newborn thoroughly for at least 30seconds
Evaluate and monitor the newborn, system- by- Wipe the eyes, face, head, front and back, arms
system for normal versus abnormal functioning, Remove the wet cloth
providing maintenance of normal and potential Do a quick check of breathing while drying.
treatment of abnormal findings. (do not suction unless the mouth or nose is blocked)
Foster bonding between infant and parent/s.
Provide a safe environment at all times. WHEN TO DO THE AGPAR SCORING?
1st Minute – to assess the general condition of the
EINC practices during Intrapartum Period: Newborn
1. Continuous maternal support, by a companion of 5th Minute - to assess Newborn’s adaptation
her choice, during labor and delivery 10th Minute - if the 5th minute APGAR is score
2. Mobility during labor – the mother is still mobile, is less than 4
within reason, during this stage
3. Position of choice during labor and delivery AGPAR SCORING
4. Non-drug pain relief, before offering labor
anesthesia
5. Spontaneous pushing in a semi-upright position
6. Episiotomy will not be done, unless necessary
7. Active management of third stage of labor (AMTSL)
8. Monitoring the progress of labor with the use of
partograph
MEDICATIONS
CREDE'S PROPHYLAXIS BCG (BACILLUS CALMETTE GUERINE)
– ERYTROMYCIN/ TERAMYCIN OPTHALMIC OINTMENT – 0.01 ML INTRADERMAL DELTOID (LEFT)
– TO PREVENT OPTHALMIA NEONATORUM – TO PREVENT FROM LUNG PROBLEM
– applied from inner to outer canthus of the eyes
VITAMIN K ANTHROPOMETRIC MEASUREMENT
PURPOSE:
– Promote blood clothing.
– Prevent bleeding.
– Prevent Hypofibrenogenimea.
– DRUG OF CHOICE: PHYTOMENADIONE,
AQUAMEPHYTON.
– ROUTE: IM (90%)
– SITE: Left-Vastus lateralis (common) Rectus Femoris
(alternative site)
– DOSSAGE:
PRE TERM - 0.05 CC VITAL SIGNS
FULLTERM - 0.1 CC > Check patency of the anus
POST TERM – 0.1 CC > Weight: 2.5kg-3.5kg
HEPA B. > Check vital signs
– 0.5ML INTRAMUSCULAR INJECTION. Temperature: 37.2
– VASTUS LATERALIS Pulse rate: intrauterine: 120-160 beats per min
right after birth: 180
1 hour after birth: 120-140
Respiration: at birth: 80 cycles per min at rest: 30-
60 cycles per min BP 80/46-100/50