IMCI Exerclses (20 points each)

Read the followlng case study. Recoi d the Informatlon and assessment results on the Young d t
Recording Form. Refer to the classifi atlon tables whenever
appropriate
NOTE: Be sure to tick (/) "initial visif" o i the top part of the Recoring Form.
A. EloIis a tiny baby who was born axactly two weeks ago. His weight is 2.5 kg. His äxillary tëmperature is

36.5C. His mother says that he vas born prematurely, at home, and was much smaller than her other
babies were when they were born. She is worried because his umbilicus is infected. She says he has
had no convulsions. The health worker counts his breaths and finds he is breathing at a rate of 55
breaths per minute. He has no chest in draing, no nasal flaring, and no grunting. His fntanele is not
bulging. There is no pus drainir g from his ears. His umbilicus has some pus at the tip, and has a little
redness only at the tip. The health worker looks over his entire body and finds no skin pustules. He is
awake and seems content. He ls moving as normal bables do. He does not have diarrhea.

Elb's mother says that she has had no proble m breastfeeding him, and that he breastfeeds 6 or 7 times
in 24 hours. She has not given him any other milk of drink.

The health worker decides to assess Eloi's breastfeeding. His mother says that he is probably hungry
now, and positions him against her breast. The heath worker observes that Eloi's chin touches his
mother's breast, his mouth is wide, and his lower lip is turnied outward. More areola is visible above than
below the mouth. He is suckling with slow, deep sucks, sometimes pausing. His mother continues
ucers white patches in
longer wants to breastfeed. The health worker sees
no or
feeding him until he no

his mouth.

MANAGEMENT OFTHE SICK YOUNGINFANT AGED UP TO2MONTHS HeightiLe ngth (cm): uA

Namre oWo Age: d s Welght (kg): S
Follow-up vsit M
Ask What are the infene's problems ? InidalVisit?
CLASSIFY
ASSESS (Circleallsigns presen) General danger sign
CHECK FOR SEVERE DISEASE AND LOCAL Count the breaths in gn9 minute. 9breaths per minute present?
BACTERIAL INFECTION Yes No
Is he infant having difficuty in feeding? Repeat it elevated: F a s t breathing
Remember to use
Has he infant had conulsions? Look for severe chest indraing. hk Danger skgn when
Look and isten for gruntng.ne
Look at the umbiculus. Is it red or draining pus? sele cting
Fever (temperature 38 'C or above fells hot) or lbw body classifications
femperature (below 35 Cor feel cool) 6r.
Look for skin pustules. Are there many or severe
p wa
Pustules?
no movement even
kOOvementony when stmulated
whentshTUaeu
THEN CHECK FOR JAUNDICE Look for jaundice (yelkow eyes or skin) Yes No
Look at the young infant's palms and soles. Are they
When did the jaundice appears frst?Ae
yelow?
Look at the young infant's general conditon. Yes No
DOES THEYOUNGNFANT HAVEDIARRHOEA Does he cDIN
Move only when sümulated?
Not move even when stmulated? n uaybanm
Look for sunken eyes.
Pinch the skin of the abdomen. Doesit goek
Very wy (longer then 2 seconds)?Sowty?
Determine welght for age. LOW Not low_2 Yes No
THEN CHECK FOR FEEDING PROBLEM OR LOW Look for ucers or white patches in the mouth (hrush)
WEEIGHT
If the infant has no indication to refer urgenty to hospltal
ls there any difficulty feeding? Yes No
ls the infant brøasted? Yes NO
If yes, how many tmes in 24 hours? dmes
Does the infant usualy recelve any oher foods

drinks? Yes -
or
f yes, how often?
bretmla mkshe
CHECK hat
do you use tofeedthe chik?
FOR HN INFECTION
Note mother's and/or child's HiV status
AN.br
Moher's HIV test NEGATIVE POSITIVE NOT DONE/KNOWN
Cld's irological test NEGATVE POSITIVE NOT DONE
Child's serobgical test NEGATIVE POSITIVE NOT DONE
nnkly
test in chikd:
If mother HV-positvea NO positdve irological
is id
Ishe Infant breastfeeding now?. it?
weeks before
Was the chikd breasfeeding at the tme of test 6
or

f breastieeding: Is the mother and child on ARV prophylaxs ask the her to
Ifthe Infant has not fed in the prevous hour,
m

ASSESS
Ha BREASTFEEDING
s he Infant breastfed in the prevous hour? put her
Infant to the breast. Observe the breastfeed for 4 minut s.
ls the infant able to attach? To check attachment, look
Chin touching breast Yes No
Mouth ide open: Yes No Z
NUR 193 RLE Clinical Instructor' Guide 33 | 59
 Lower ip turned outward: Yes No
More areola above than bebw the mouth: Yes No Z
ot well atiached good attachment
IsTheIntant SuGking effecively (that is, sow deep sucks,
sometmespausing)?
Mot suckiñng sucking efectvely
effectveby
CHECK THE CHILD'S IMMUNIZATION STATUS(Crlo Immunirattons noodod today) Return for nex
BCG DPT+HIB-1 DPT HIB-2 Hep B1
immunizatonon

OPV-O OPV-1 OPV-2

Hep B2 200,0001.U
Hep 80 Wtamin to (Date)
ASSESS OTHER PROBLEMS: Ask about mother's own health
mother

Reme mber to refer any child who has TREAT

a danger sign and no other severe classiffcation

rd hmdh n hurg_rakre

Return for follow-up in... days. Advise mother when to return

advice needed today.
immediately. Give any immunization and feeding