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Virtual Eli - IMCI (www.virtualeli.net)
 

Virtual Eli - IMCI (www.virtualeli.net)

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  • Danger sign  main symptoms  nutritional status  immunization status  vitamin A status  feeding problems
  • Child’s classification Not diagnosis
  • IMCI mgt uses  Essential drugs (cheaper, more effective, research based) An essential component of IMCI guideline is the counseling of caregivers
  • Pneumonia Diarrhea Dengue Malaria Measles Ear infection Malnutrition/anemia
  • *ear infection: is the only one that can only cause morbidity (not mortality) Started: 1992 (promoted by WHO and UNICEF Originated from: Medicine Nature: Case Management Approach: Evidence-Based Syndromic Approach
  •  
  • Calm Goes IN as child breaths IN Inhalation
  • Refer  . 6 hours to hospital
  • 1 week – 2 mos  60 bpm 2 months – 12 months  50 bpm 12 months – 5 years  40bpm
  • Pneumonia  ff-up 2 days No pneumonia  ff-up 5 days
  • 1P + 1Y = P (all other illness) 1P + 1Y = Y (Diarrhea or DHN)
  • 2P + 2Y = P 2P + 3Y = P 0P + 0Y = G
  • Severe Persistent  may DHN Persistent  no DHN
  • PLAN A 3F’s PLAN B – ORS PLAN C – D5LR Infant (<12mos): IVF within 6 hrs 1hr=30 ml/kg 5hrs=70ml/kg 6hrs=100ml/kg   Child (12 mos up to 5 yrs): IVF within 3 hrs 30 mins=30 ml/kg 2.5 hrs=70ml/kg 3 hrs=100ml/kg
  • Infant (<12mos): IVF within 6 hrs 1hr=30 ml/kg 5hrs=70ml/kg 6hrs=100ml/kg   Child (12 mos up to 5 yrs): IVF within 3 hrs 30 mins=30 ml/kg 2.5 hrs=70ml/kg 3 hrs=100ml/kg
  • ORS formula calculation: >If wt is given: wt(Kg) x 75 >if wt is not given: -1 wk up to 4 mos: 200-400ml -4mos up to 12 mos: 400-700ml -12mos up to 2 yrs: 700-900ml -2 yrs up to 5 yrs: 900-1400ml (technique: x3x2x3/ +3+2+3) Commercial Oresol: -Glucose -NaCl -NaHCO3 (sodium bicarbonate) -KCL (for smooth muscle contraction)
  • Exclusively BF (+)= ORS + clean water -Exclusively BF (-)=ORS + Clean water + Food-based fluids (Soups, Rice water, Buko juice)
  • >Give zinc supplements (10-14 days) -10mg/day infants -20mg/day children
  • If able to BF: BF the child for at least 30 mins If not able to BF, but can swallow : -give 30-50ml expressed breast milk using breast pump or sugar water thru PO If not able to BF or swallow: -give 50 ml of expressed breast milk or sugar water thru NGT If unconscious, and NGT is not possible: -insert IVF: give 5ml/kg D10W via slow IV
  • >14 days diarrhea  severe persistent diarrhea and persistent diarrhea -Severe Persistent Diarrhea (+)DHN (P) (Infant and Child) -Persistent Diarrhea (-)DHN (Y) (Child)
  • Blood in the stool
  • Have child lie on his back Use thumb and 1 st finger Do not use fingertips Location: halfway between the umbilicus and site of d insertion ( @ +) Pinch for hydration assessment: -child: abdomen -pregnant woman: inner forearm
  • -Sorsogon -Eastern Samar -Albay -Marinduque -Surigao del Norte
  • Malaria Risk: (SEAMS) -Sorsogon -Eastern Samar -Albay -Marinduque -Surigao del Norte
  • Pink  Very Severe Febrile Disease  LEVOCOIN + S(stiff neck) Yellow  Malaria  (+) Blood smear Green  Fever: Malaria Unlikely  (+) Runny nose / (+) measles
  • Pink  Very Severe Febrile Disease  LEVOCOIN +S (stiff neck)
  • P  clouding of the cornea -deep extensive mouth ulcers Y  pus draining from the eye -mouth ulcers G  measles now or within the last 3 mos Measles: Aka: 7 day measles (Rubeola) Signs: -Koplik spots (like tiny grains of rice) with a red ring inside the cheeks -Cephalocaudal rashes (head-to-foot rashes)
  • B-CASTS -Bleeding -Cold clammy skin -Abdominal pain -Slow capillary refill -(+)Tourniquet -Skin petechiae

Virtual Eli - IMCI (www.virtualeli.net) Virtual Eli - IMCI (www.virtualeli.net) Presentation Transcript

  • Elizalde Bana CMT, RN,MAN(o) www.msu-chs.ning.com www.virtualeli.net
  •  
    • COUNSELLING
    Checking for general danger signs; Checking main symptoms; Classify Counseling caretakers Give follow-up care
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  •  
    • All sick children must be assessed for  DANGER SIGNS
    • All sick children must be routinely assessed for __Main Symptoms_
    • All sick children must be assessed for: Nutritional status, Immunization status , A vitamin status, feeding problems
    • Only a limited number of clinical signs are used
    • -no sophisticated instruments
    • -IMCI designed for poor countries
    • A combination of individual signs leads to a Child’s classification
    • , not DIAGNOSIS .
    • IMCI mgt uses - Essential drugs (cheaper, more effective, research based)
    • An essential component of IMCI guideline is the __ counseling _ of caregivers
  • Checking for general danger signs; Checking main symptoms; Classify Treat according to classification
    • P- Pneumonia
    • Di- arrhea
    • De- ngue
    • Ma- laria
    • Me- asles
    • Ear- infection
    • Ma – lnutrition/anemia
    • * __ ear infection __: is the only one that can only cause morbidity (not mortality)
    • IMCI Started: 1992 (promoted by WHO and UNICEF)
    • Originated from: _Medicine_____
    • Nature: __ Case Management ______
    • Approach: Evidence-Based Syndromic Approach
    • Target age for IMCI: 1 wk up to 5 yo
    • 2 age categories for IMCI: >young infant age: 1 wk old up to 2 mos old
    • >young child age: 2 mos old up to 5 yrs old
  • LE VO CO IN
    • LE –thargy
    • VO- miting
    • CO-nvulsion
    • IN – abilibity to drink or breastfeed
  • Checking for general danger signs; ASK LOOK NOT ABLE TO DRINK OR BREASTFEED VOMITS EVERYTHING CONVULSIONS ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN
  •  
    • Remember: Child must be _____ during assessment
    • Chest indrawing: the lower chest wall of the child ______ as the child _____
    • Stridor: a harsh sound heard during _____________
  • C ough/DOB D iarrhea F ever E ar infection
  •  
    • ASK
    • LOOK
    NOT ABLE TO DRINK OR BREASTFEED VOMITS EVERYTHING CONVULSIONS ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN
  • Checking main symptoms ; C D F E ough iarrhea ever ar infection
  • COLOR PRESENTATION CLASSIFICATION OF DISEASE LEVEL OF MANAGEMENT Green Yellow Pink
  •  
    • Classify according to severity
    • Treatment according to classification
    • COUGH AND COLDS
    • Cough – if >30 days  REFER (TB/PERTUSSIS)
    • - if <30 days  CLASSIFY (P,Y,G)
    • Chest Indrawing
    • Stridor
    • Fast Breathing (Common Board Question)
        • 1 week – 2 mos  60 cpm
        • 2 months – 12 months  50 cpm
        • 12 months – 5 years  40 cpm
    • Treatment: Give Oral Antibiotic (Same with Pneumonia,Acute Ear Infection, Very servere disease at Mastoiditis)
    • 1 st line  AMOXYCILLIN
    • 2 nd line  CONTRIMOXAZOLE
        • Same with (P-V-A-M)
          • P - neumonia,
          • A - cute Ear Infection,
          • V - ery servere disease’
          • M - astoiditis
    • Severe Pneumonia
    • Very Severe disease
    • Pneumonia
    • No Pneumonia
    Any danger sign Stridor in a calm child Chest indrawing Fast breathing Cough or colds
    • Pneumonia  ff-up 2 days
    • No pneumonia  ff-up 5 days
    • COUGH OR DIFFICULTY OF BREATHING
    • Respiratory rate
    • Lower chest wall indrawing
    • Stridor in a calm child
    • SEVERE PNEUMONIA
  •  
  •  
  •  
    • Situation: Bayani is 18 months old. He weighs 11.5 kg and temperature is 37.5. His mother brought him to the RHU complaining that Bayani has cough, harsh noise and wheezing problem.
  •  
  •  
  •  
    • Severe Pneumonia
    • Very Severe disease
    • Pneumonia
    • No Pneumonia
    Any danger sign Stridor in a calm child Chest indrawing Fast breathing Cough or colds
    • If the child has signs from more than 1 row, select the more serious classification, except for DIARRHEA (DHN)
    • Common Board Question (Classify)
    • 1Pink + 1Yellow = Pink classification (all other illness)
    • 1Pink + 1Yellow = Yellow classification (Diarrhea or DHN only)
    • >2 signs are used to classify DHN
    • DIARRHEA
    • F
    • C
    • D
    • Frequency
    • Consistency
    • Duration
    • F
    • C
    • D
    • 3 or more
    • Watery stool
    • Within 24hrs
    • Severe Persistent  merong DHN
    • Persistent  no DHN
    TYPES ACUTE Diarrhea <14 days PERSISTENT Diarrhea >14days
  • COLOR PRESENTATION CLASSIFICATION OF DISEASE LEVEL OF MANAGEMENT Green PLAN A (3F’s) Yellow PLAN B – (ORS ) Pink PLAN C – (D5LR)
    • Infant (<12mos): IVF within __ 6 ___ hours
    • 1hr=__ 30 ___ ml/kg
    • 5hrs=__ 70 ___ml/kg
    • 6hrs= __ 100 ___ml/kg
    •  
    • Child (12 mos up to 5 yrs): IVF within __ 3 __ hrs
    • 30 mins= _ 30 ____ ml/kg
    • 2.5 hrs= _ 70 _____ml/kg
    • 3 hrs= __ 100 _____ml/kg
    • Give ORS
    • ORS formula calculation:
      • If wt is given: __ wt(Kg) x 75 ____________
      • if wt is not given:
    • 1 wk up to 4 mos: ____ 200-400mL ________
    • 4mos up to 12 mos: __ 400-700m L_______
    • 12mos up to 2 yrs: _ 700-900mL _________
    • 2 yrs up to 5 yrs: __ 900-1400mL __________
    • HOME MADE ORESOL: 1-2-1 and 1-8-1 (CBQ)
      • 1 glass water, 2 tsp of sugar , 1pinch salt
      • 1 Liter of water, 8tsp of sugar, 1 tsp of salt
    • COMMERCIAL MADE ORESOL:
      • Glucose,
      • NaCl ,
      • NaHCO3 (sodium bicarbonate)
      • KCL (for smooth muscle contraction)
    • FLUID (Soup, Rice water, Buko juice)
    • FEEDING (Exclusive Breastfeeding)
    • FAST REFERRAL
    • +
    • ZINC
  • DURATION DOSAGE
    • If able to BF: BF the child for at least _________
    • If not able to BF, but can swallow :
    • -__________________________________________
    • If not able to BF or swallow:
    • -__________________________________________
    • If unconscious , and NGT is not possible :
    • -__________________________________________
    • How to make sugar water:
    • _____tsp sugar + _____ ml water
  •  
    • 1. Severe Dehydration
    • 2. Some Dehydration
    • 3. No Dehydration
    • 4. 1 Severe persistent diarrhea
    • 4.2 Persistent Diarrhea
  • COLOR PRESENTATION CLASSIFICATION OF DISEASE S/SX Pink Yellow
  • COLOR PRESENTATION CLASSIFICATION OF DISEASE S/SX Pink Blood in stool Yellow Blood in stool
    • Two of the following signs :
      • n ot able to drink or drinking poorly
      • a bnormally sleepy or difficult to awaken
      • s unken eyes
      • s kin pinch goes back very slowly
    • Two of the following signs :
      • d rinks eagerly, thirsty
      • re stless, irritable
      • s unken eyes
      • s kin pinch goes back slowly
    • not enough signs to classify as some or severe dehydration
    • Have child lie on his back
    • Use _ thumb _____ and __ 1 st finger _______
    • Do not use fingertips
    • Location: halfway between the umbilicus and site of d insertion
    • Pinch for hydration assessment:
    • -child: __ abdomen ______________
    • -pregnant woman: __ inner forearm __
    • Situation: A 4 months old child named Fatima was brought to the Health Center because she had diarrhea for 5 days . She did not have danger signs and she was not coughing.
  •  
  •  
  •  
  •  
  •  
    • Malaria
    • Measles
    • Dengue
    • - S orsogon
    • - E astern Samar
    • - A lbay
    • - M arinduque
    • - S urigao del Norte
    • IMCI Classification:
    • Malaria Risk:
      • 1. Very Severe Febrile Disease/Malaria
      • 2. Malaria
      • 3. Fever/Malaria Unlikely
    • No Malaria Risk:
      • 1. Very Severe Febrile Disease
      • 2. Fever/ No Malaria
  • COLOR PRESENTATION CLASSIFICATION OF DISEASE Signs/symptoms Pink LEVOCOIN + S (stiff neck) Yellow (+) Blood smear Green (+) Runny nose / (+) measles
  • COLOR PRESENTATION CLASSIFICATION OF DISEASE S/SX Pink LEVOCOIN +S (stiff neck) Green
  • Drugs 1 st line ARTIMETER 2 nd line CHLOROQUINE
  • COLOR PRESENTATION CLASSIFICATION OF DISEASE Signs/symptoms Pink clouding of the cornea -deep extensive mouth ulcers Yellow pus draining from the eye -mouth ulcers Green measles now or within the last 3 mos
  • COLOR PRESENTATION CLASSIFICATION OF DISEASE S/SX Pink B-CASTS B - bleeding C – clammy skin A – abd’l pain S – slow capillary refill T – (+) Torniquet S- skin petechiae Yellow
    • PAIN?
    • DISCHARGES?
    • HOW LONG?
    1 st line AMOXYCILLIN 2 nd line COTRIMOXAZOLE
    • Detect Marasmus – skin and bones
    • Detect Kwashiorkor – edematous, moonface, “kokey”,
    • NOTE:
    • KWASHIORKOR  lack of protein
    • MARASMUS  lack of carbohydrates and protein
    • LEVOCOIN
    • Fever
    • Fast Breathing
    • Umbilical redness (60 cpm and above)
    • Nasal flaring
    • Chest indrawing
    • Ear pus
    • Skin pustules (severe)
    • Bulging fontanels
    • Grunting (harsh sound heard on expiration)
  • Mastery Drills
  • LE VO CO IN
  • C D F E
  • Checking for general danger signs; Checking main symptoms; Classify Treat according to classification
    • COUNSELING
  • COLOR PRESENTATION CLASSIFICATION OF DISEASE LEVEL OF MANAGEMENT Green Yellow Pink