MANAGEMENT OF THE SICK CHILD AGED 2 MONTHS UP TO 5 YEARS Name ge_So__Welght agk_Helghengtn ome Temperatures |ASK: What ar ha cde probane? nave Followup vier? One ASSESS (Cl a sgn reson) cuassiry ‘CHEEK FOR GENERAL DANGER SIG ‘Gal ng AT 2 yours evervinne Teommusne non ‘Renamer io ne Sane in 2 _convasions ‘thon snleing auc | BOES Te CHILD HAVE COUGH GR BFFIGULY BREATHING? VEE_— Wo 1s Fernowierg? Doe * Coutne bess oemnute__ Wet per ming. Fe ating | BS We CHI Wave RARER? YEE ——Wa + Fertowirg?__Oaye naa chs ge candi ee 2 Phecueed nde oar (Cistageceniont Ret ca? hate keting pany? Dik ape ay? Protea he sasmer beet 89 tak eset fener 3c? Soy? | BES Tae CLD ave VERT Toy NaTeds Nationa 3.5 a abo] YES NO ‘yee smartest eel? + ina tl tn oe sre L000 rsa Meats (cr) ec) Meso) eres aah ard Farhan aso ote? je ccf are sugh ny oe, ore ree {morn ays tote oe pers evo 7? “Lao ay enue ee 1 ite et hadmada wn eyo ihe i ths meses nw owt ha at “oak iormaahlar. ‘ya iy oo nd sane 1 Hose fan Saag fm thre Leak eng om nace gut fone navn oe 1 uterine 1 fata nari stool pa? Cec expt sco 1 Hote chd magpie crn? “Petomoumauttl ale more el AND ot nother 2 tere sr dct? Yes rho? "Serpe? Same pana ter? ‘os ar WAG ae tan 11S se wr “ete any mesa angston Gana anger a? (eet 32 caren! hoy ewe dato Prana ih cet nding? chute tar ¢ mann ar renin poi? [ Sic Te rics MaMUEATION STATUS Ee minstans nad oy Vann A Stun devoming ttn Seta Shc Clef ended tay verso oT ona va eerdandaWbannie ror Pova Py Dorlebeses Ratu for next Immunizavon on: Bae | ASSESS FEEDING Whe Gls ieos than 2 years ol has MODERATE ACUTE WALNUTRITION, ANEW ‘+ Doyou eressteed your cis? Yor NO yes how many tmosin 2¢ ho?__timgs Do yeu bresstend xing he righ? Yes_ No + Docs th cid ake anther lode oid? Yes ND 1 yen wat ood or ie? © How many nes per 497?__Smes. What do you us to fed he chit? {> MODORATE AGUTE MALNUTRITION: How large are wrongs? © Dose he cil receive his own sorvig? Wheat te chi and how? + During tines, hs the chi seeing change? Ves No_ 2 Yes, How? [ ASSESS OTHER PROBLENWS? ASK ABOUT WOTHERS OWN HEALTH Page 61 of 77 RECORDING FORMS.Retum for follow-up in, Advise mother when to return immediatel Give any immunization needed. ‘And feeding advice today Page 62 0 77ART INITIATION RECORDING FORM FOLLOW THESE STEPS TO INITIATE ART IF CHILD DOES NOT NEED URGENT REFERRAL Nan noe wei Temperate) oa ASSESS (Cle al ndings) reear STEP 1: CONFIRM HIV INFECTION es no * Chil under Bron: Vogl et pouve + Santas tht ae ears is ‘heck ha chia a reat rates Gwecks =, Send confemaon at | S"Ghts 18 montane ovr Sect oceans, MVintcton confined, and cl ln stabe condor, GO TO STEP 2 | Second sola tas | pose ‘Check ha chi 0s a roast aes 6 weeks STEP 2: CAREGIVER ABLE TO GIVE ART a) Carpe aeitie ad rg ove meseaton yes: 60 TO STEP es * Seeger as dosed nate aut crispy; COUNSEL AND SUPPORT THE CAREGIVER, STEP 3: DECIDE IF ART GAN BE INITIATED AT FIRST LEVEL Neen Wh under 3g tran pase REFER ees 1 Gnas ttnone present G0 TO STEP 4 (STEP 4: RECORD BASELINE INFORMATION ‘© Weight | kg ‘+ Send tests that are required and GO TO STEP 5 | DASgtiome om | 1 Fossrg reton 5 Wo cnc slag ty { cbtcomt ——ealamma DH Veter tHe ot ‘STEP &: START ART AND COTRIMOXAZOLE PROPHYLAXIS | * Leshan joni ABC “STCSLPVE. oF RECORD ARVS & DOSAGES HERE: | cher rosminaned tet ine regan fi | « Syeumandaserimmte SCSSTO ERY, oraher ‘Comrade tine z [PROVIDE FOLLOW-UP CARE Fano aor aa pS ir Fottow.ue | pares Page 63 0f 7[RECORD ACTIONS ANO TREATMENTS HERE: ALWAYS REMEMBER TO COUNSEL THE MOTHER AND PROVIDE ROUTINE CARE. Page 64 0f 77FOLLOW-UP CARE FOR CONFIRMED HIV INFECTION ON ART: SIX STEPS None: hoe Wit ta Heighlegh (on): Temperature} Date: Chee a dings _ 2 STEP 1: ASSESS AND CLASSIFY RECORD ASK. does the chi have ay robin? yes cash ACTIONS ‘A5ihesthe chi receved cae at anatherhesth —YES__NO_ ‘TAKEN: fecy since the lst ist? * Chock for general danger signs © NOT ABLE TO DRINK OR BREASTFED © Vounsevervming toonral danger sa or ART severe ide fect, pride proeleral teatent convutsions SnOREFER URGENTLY © LETHARGIC OR UNCONSCIOUS ‘CONVULSNGNOW + Chock for ART severe side eects: © Sverskinah Yelow eyes Asses, assy, vet, ad flonup nin syrpime searing a MC: audlnes © Diicity beating and severe abana pan Age Cosel. cr : « Fever voring, a ony ton Abaca) + Check or main symptoms © Cough or dtcty beating ° Banos * Foor © Earproblen 2 Other proba ‘STEP 2: MONITOR ARV TREATMENT RECORD Assess adherence: 4. REFER NONURGENTLY IF ANY OF THE FOLLOWING ARE PRESENT: | ACTIONS = Toes al does ~Froquenty miss doses Nat gating weigh for months a ‘Occasinaty manes ase 1 Lees tmiostones Noting nedaon 1 Poor adherence despite adherence counsling Iyphaiscbivson=sig + Slaten St afc epi epopiteraageer Neutea- Ting rum orphans ear | Hate aagetan an ie Sar ts 1 Cothagner ns me [Dlamona<"Biziness - Abnormal tibuton t > Trsycenaee (Te) her an mmol —— 2 Seno veers mar ARE OE 'Progressed higher sage ea ‘Sage uhen ART nies! 1=2 = 9 - 4 - Unknown CD42 2 Virion avatatle “iota teed nite Tou chuse ret Wein Haale, OTHERWISE, GO TO STEP 3 [fen |LPV- LDL Cholesterot Tos: ‘STEP 3: PROVIDE ART AND OTHER MEDICATION ASCeaTCLPV RECORD ART DOSAGES: ABCHSTCHERV * Covmoxaze 2 aaa iain ee Other Nedaton + COTRIMOXAZOLE DOSAGE: ran DOSAGE: 2 OTHER MEDICATION DOSAGE ‘ 2 STEP 4: COUNSEL DATE OF Use aren vit aes te corpiverandprouie RECORD ISSUES DISCUSSED: Next Visrr survey sacs cue How's chic progressing. - Adherence Support to Jaregrer =" scosue (o abers& chs) = Sao tec an eed manogeror Page 68 of 77RECORD ACTIONS TAKEN: Page 6608 7MANAGEMENT OF THE SICK YOUNG INFANT AGED UP TO 2 MONTHS Name Age:__Sex:_Weight(kg);__Temperature (¢: ‘Ask: What are the infant's problems? Initial Visit? Follow-up visit?__ Date: ASSESS (Circle all signs present) CLASSIFY ‘CHECK FOR SEVERE DISEASE AND LOCAL BACTERIAL INFECTION ‘+ Is the infant having difficulty in feeding? * Count the breaths in one minute.__ breaths per minute ‘= Has the infant had convulsions? Repeat if elevated: ___ Fast breathing? + Look for severe chest indrawing + Look at the umbiculus. Is it red or draining pus? + Fever (temperature 37.5'C or above fells hot) or low body temperature (below 35.5°C or feels cool) | + Look for skin pustules. ‘+ Movement only when stimulated or no movement even when stimulated? THEN CHECK FOR JAUNDICE - ‘+ When did the jaundice appear frst? + Look for jaundice (yellow eyes or skin) + Look at the young infant's palms and soles. Are they yellow? 1BOES THE YOUNG INFANT HAVE DIARRHEA = Lookat the young infant's General candiion, Doss th fant | Ves No * move only when stimulated? * not move even when stimulated? isthe infant restless and table? + Look fr sunken eyes. = Pinch the skin of the abdomen, Does it go back Very stow? | < stom? |"THEN CHECK FOR FEEDING PROBLEM OR LOW WEIGHT | the intent has no cation to be refred urgent to hosp = Detomine weight forage. Low not ow__ + Isthere any ciffiulty feeding? Yes_No__ + Look for ulcers or white patches in the mouth (thrush) ‘Is the infant breastfed? Yos_No_ yes, how many times in 24 hours?___ times ‘+ Does the infant usualy receive any cther foods or drink? Yes_No__ tyes, how often? |» What do you se to feed the child? ‘ASSESS BREASTFEEDING ‘Has the infant breasted i the previous hour? | fhe infant has ot fod in the previous hour, ak he mothe to put hr infant tothe breast (Observe the breastfeed for 4 minutes, “ls the infant abot attach? To check ata * Chin touching breast Yes No, * Mouth wide open: Yee No_- * Lome ip tured outward: Yes No__ * More areola above than below te moi: Ye not wal attached good attachment “Is the infant sucking eftectvely (hats, Sow deop sucks, emetmes pausing)? ot sucking efecvely —eicking efactvely look for: CHECK THE INFANT'S INMUNIZATION STATUS ( Circle immunization needed Today) aa BCG Penta 1 Pevt 200,000 I.U Vitamin A ‘ ae HEBD OPv.1 to mother et ‘ASSESS OTHER PROBLEMS: ASK ABOUT MOTHERS OWN HEALTH = Page 67 0f 7TREAT Retum for follow-up in, Advise mother when to return immediately: Page 68 0f 77