Post on 31-Mar-2015
1. mortality & morbidity2. Healthy growth & development
To Improve:
C-ase management skills; D-elivery system (health
care) ; E-ncourage family &
community practice
A- assessC- classifyT- treat/ identify
C- counselF- follow up care
C- cough/ Dif. Of breathing
D- diarrhea
F- fever
E- ear pain
Initial
Follow up
1.Young infant to 2 mos
2.2 mos up to 5 yrs
V- vomitA-abnormally sleepyC-convulsionU- unable to feed
**severe at least 1DANGER
SIGNSCONVULSIONS
INABILITY TO DRINKOR BREASTFEED
VOMITING
LETHARGYUNCONSCIOUSNESS
URGENT REFERRALURGENT REFERRAL
TREATMENT AT OUT-PX HEALTH FACILITY
HOME MANAGEMENT
PNEUMONIA MASTOIDITIS ACUTE EAR INFECTION VERY SEVERE DISEASE
FIRST LINE ANTIBIOTICS: AMOXICILLIN
SECOND LINE ANTIBIOTICS: COTRIMOZAXOLE
CIPROFLOXACIN
CHOLERA:
TETRACYCLINE
GENTAMICINBENZYL PENICILLIN
PARACETAMOL 38.5 CEVERY 6 HOURS UNTIL GONE
FIRST LINE ANTIMALARIAL:
ARTEMETHER-LUMEFANTRINE
SECOND ANTIMALARIAL:CHLOROQUINE, PRIMAQUINE, SULFADOXINE AND PYRIMETHAMINE
May have pneumonia Streptococcus pneumoniae/ H. influenza
ASSESS:a. How long is the cough/ DOB; wof:>30daysb. Fast breathingc. Chest indrawing – lying flat d. Stridor when calm
If child is: Fast breathing
12 mos – 5yo 40bpm & >
2 mos up to 12 mos
50bpm & >
Any general danger sign VACU or
Chest indrawing or
Stridor in calm child
severe pneumonia
or
very severe disease
•First dose antibiotics•Vit A•HOSP!!•Tx child to x hypoglycemia
Fast breathing pneumonia 3days anitibiotics
Soothe throat
F.up = 2days
bronchodilator
No signs of pneumonia or very severe disease
no pneumonia:
cough or cold
Soothe throat
F.Up in 5 days
Refer if (+) >30days cough
bronchodilator
Ingestion of contaminated food/ water 3&> watery stool /day Tx: ORESOL infant = AM Home made:1Lt water, 1 tsp salt, 8tsp sugar
ASSESSMENT:a. Irritableb. Sunken eyesc. Skin pinchedd. thirst
<14days diarrhea: DEHYDRATION>14days diarrhea: DIARRHEABlood in the stool: DYSENTERY
VACUSKIN PINCHED SLOWLY
severe DHN
PLAN CREFERFREQUENT SIP OF ORS<2YO (CHOLERA)
2 SIGNS:RESTLESS, IRRITABLESUNKEN EYESDRINKS EAGERLYPINCHED SLOW
Some DHN PLAN BF.UP 5 DAYSSIP OF ORS
NOT ENOUGH SIGN OF DHN
No DHN PLAN AF.UP 5 DAYS
1.E-xtra fluid2.F-eeding3.G-ive zinc4.wH-en to return
PLAN C:Two of the following signs:
Lethargic or unconscious
Sunken eyes
Not able to drink or drinking poorlySkin pinch goes back very slowly
PLAN B:Two of the following signs:
Restless, irritable
Sunken eyes
Drinks eagerly, thirsty
Skin pinch goes back
slowly
PLAN A:
Not enough sign of dehydration
Urgent!
Refer to hosp= IVF
NGT
Oresol:
wt in kg x 75
4 rules of home treatment
4 rules of home treatment
(+) dehydration
Sever, persistent diarrhea
•tx dehyration
•Vit A
•Refer
(-) dehydration
Persistent diarrhea
•Feed
•Vit A
•zinc
•Ff up 5 days
DYSENTERY: BLOOD IN STOOL3 DAYS ORAL ANTIBIOTICS = CIFPROFLOXACIN
SHIGELLA: FF UP IN 2 DAYS
FIRST LINE ANTIBIOTICS: TETRACYCLINE 2X DAILY FOR 3 DAYS 2-5YO
ASSESS:a. Ear pain?b. Ear discharge?c. How long?d. Pus?e. Tender swelling behind ears?
Tender swelling behind the ear
mastoiditis •1st dose antibiotics•1st dose paracetamol•URGENT TO HOSP
Ear discharge for <14 days or
Ear pain
acute ear infection
•Antibiotics for 5 days•Paracetamol•Ear wink•Ff up 5 days
Ear discharge for > 14 days
chronic ear infection
•Dry ear wink•QUINOLONE OTIC DROP FOR 2 WEEKS
Ff up 5 daysNO ear pain and NO ear discharge seen draining from the ear
no ear infection
No additional tx
Dry 3x/dayRoll clean absorbentwink; when wet –repeat until dry
Instill quinolone otic drops after ear wink 2-3 drops, 3x/day for 2 weeks
Lived in malaria area?
Visited / overnight in malaria area past 4 wks?
Fever for how long?
Measles for last 3 mos?
Stiff neck? Runny nose?
Any danger sign or
Stiff neck
very severe febrile disease
•1st dose: quinine
•Antibiotics
•Prevent low blood sugar
•Paracetamol
•URGENT TO HOSP
Fever (by history or feels hot or temperature 37.5°C or above)
malaria •Oral antimalarial
•Paracetamol
•Ff up 2 days
•If + fever >7 days, refer for assessment
NO runny nose and NO measles and NO other causes of fever
Fever: unlikely malaria
•Paracetamol
•Ff up 2 days persistent fever
•If + fever >7 days, refer for assessment
1. Able to swallow=Breastfeed
2. (-)breastfeed + swallow= GIVE expressed breastmilksugar water; 30-50ml milk/ sugar water before departure
SUGAR WATER: 4 tsp sugar in 200ml cup
3. (-) swallow: 50 ml milk/sugar water NGT Difficult to awaken: START IV
**
•Any danger sign
•Stiff neck
Very severe febrile disease
•Antibiotics
•Prevent low blood sugar
•Paracetamol
•URGENT to HOSP
•(-) sign of very severe malaria
Fever: no malaria
•Paracetamol
•Ff up 2 days
•If + fever >7 days, refer for assessment
Now or w/in last 3 mos: Mouth ulcer? Deep/extensive Pus/drainage eye Clouding of cornea
Generalized rashes Cough Runny nose Red eyes
Any danger sign orClouding of cornea orDeep or extensive mouth ulcers
severe complicated measles
•Vit A•1st dose antibiotics•If + pus & clouding; tetracycline•URGENT TO HOSP
Pus draining from the eye or
Mouth ulcers
measles with
eye or mouth complications
•Vit A•If + pus in eyes; tetracycline•If + mouth ulcer; gential violet•Ff up 2 days
Measles now or within the last three months
measles Give vit A
Clean both eyes 4x/daywipe pusApply eye ointment both eyes 3x/day
Squirt amount in lower lidTx until redness is gone
2x/dayWash handsWash child’s mouth; using soft cloth around fingers wet with salt water
+cotton buds; paint mouth w/ 0.25% Gentian Violet
Wash hands againCont 48 hrs after ulcer has been cured
ASSESS:Bleeding?nose,gums, vomit; stoolBlack vomitusBlack stool+ abdominal pain+ persistent vomitingTourniquet test, petichiae; cold clammy extremities; slow capillary refill
•Bleeding from nose, gums, •(+) black stool;•Vomit; + tourniquet•Petichiae•Abdo pain; cold clammy skin
Severe:DHF
•(+) vomit=PLAN B•(+) bleeding= plan C•Tx prevent low blood sugar•URGENT TO HOSP•X aspirin
(-) sign of severe DHF Fever:
DHF unlikely
•Ff up 2 days•X give aspirin
ASSESS:a. Look for severe wastingb. + edema (feet)c. Palmar pallor? Severe/
somed. Determine weight for age
IF AGE UP TO 6 MOS & VISIBLE SEVERE WASTING, (+) EDEMA BOTH IF AGE 6 MOS AND ABOVE:MUAC IS <115 MM/HAS EDEMA BOTH FEET(+) SEVERE WASTING
SEVEREMALNUTRI-TION
PREVENT LOW BLOOOD SUGARVIT AREFER
VERY LOW WEIGHT FOR AGE
VERY LOW WEIGHT
ASSESS CHILD’S FEEDINGGIVE VIT AFOLLW UP 30 DAYS
NOT VERY LOW WEIGHT FOR AGE AND NO OTHER SIGNS OF MALNUTRITION
NOT VERY LOW WEIGHT
ID CHILD <2YO, ASSESS CHILD’S FEEDING\FF UP 5 DAYS
Visible severe wasting or
Severe palmar pallor or
edema of both feet
severe malnutrition
or severe anaemia
•Vit A•Urgently refer to hospital
Some palmar pallor or
(Very) low
weight for
age
anaemia or
(very) low weight
•Paracetamol;Food box- counsel mother•+feeding problem, ff up 5 days•(Some pallor) Iron, mebendazole/ abendazole if 12mos & up; x take dose 6mos previous= ff up 14days•Weight, ff up in 30days= very low weight
NOT (very) low weight for age and no other signs of malnutrition
no anaemia and not
(very) low weight
If child is <2yo; food box
Ff up 5 days
1ST dose: 6mos & up
Subsequent: q 6 mos.
6 months up to 12 months
100,000 IU
12 months up to 5 years
200,000 IU
AGE VACCINE
Birth BCG HepaB-1
6 wks DPT1 OPV 1 HepaB-2
10 wks DPT2 OPV 2 --
14 wks DPT3 OPV3 HepaB-3
9 mos Measles
FOLLOW UP 2 DAYS
FOLLOW UP 5 D AYS
MALARIA PERSISTENT DIARRHEA
MEASLES with complication ACUTE & CHRONIC EAR INFECTION
FEVER: MALARIA ANY OTHER ILLNESS, if not improving
FEVER: no MALARIA
FEVER: DHF UNLIKELY
PNEUMONIIA and WHEEZE
DYSENTERY
ANEMIA 14 DAYS
VERY LOW WEIGHT FOR AGE
30 DAYS