Imci day 2

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  • 1. IMCI Day 2 Nelia B. Perez RN, MSN PCU - MJCN

2. Features of IMCIFeatures of IMCI not necessarily dependent on the use of sophisticated and expensive technologies a more integrated approach to managing sick children move beyond addressing single diseases to addressing the overall health and well-being of the child 2 3. Features of IMCIFeatures of IMCI careful and systematic assessment of common symptoms and specific clinical signs to guide rational and effective actions integrates management of most common childhood problems (pneumonia, diarrhea, measles, malaria, dengue hemorrhagic fever, malnutrition and anemia, ear problems) includes preventive interventions3 4. Features of IMCIFeatures of IMCI adjusts curative interventions to the capacity and functions of the health system (evidence-based syndromic approach) involves family members and the community in the health care process 4 5. Objectives of IMCIObjectives of IMCI (1) reduce deaths and the frequency and severity of illness and disability; and (2) contribute to improved growth and development 5 6. IMCI ComponentsIMCI Components 1. Improving case management skills of health workers standard guidelines training (pre-service/in-service) follow-up after training role of private providers 6 7. IMCI ComponentsIMCI Components 2. Improving the health system to deliver IMCI essential drug supply and management organization of work in health facilities management and supervision referral system 7 8. IMCI ComponentsIMCI Components 3. Improving family and community practices for physical growth and mental development for disease prevention for appropriate home care for seeking care 8 9. IMCI ComponentsIMCI Components 3. Improving family and community practices -For physical growth and mental development Breastfeeding Complementary feeding Micronutrient supplementation Psychosocial stimulation 9 10. IMCI ComponentsIMCI Components 3. Improving family and community practices - For disease prevention immunization handwashing sanitary disposal of feces use of insecticide-treated bednets dengue prevention and control 10 11. IMCI ComponentsIMCI Components 3. Improving family and community practices - For appropriate home care continue feeding increase fluid intake appropriate home treatment 11 12. IMCI ComponentsIMCI Components 3. Improving family and community practices - For seeking care Follow health workers advice When to seek care Prenatal consultation Postnatal (postpartum) consultation 12 13. The Integrated Case Management ProcessThe Integrated Case Management Process 13 Treatment treat local infection give oral drugs advise and teach caretaker follow up Outpatient Health Facility Home Caretaker is counselled on: home treatment feeding &fluids when to return immediately follow-up check for danger signs assess main symptoms assess nutrition and Immunization status and potential feeding problems Check for other problems classify conditions and identify treatment actions Outpatient Health Facility Urgent referral pre-referral treatment advise parents refer child Outpatient Health Facility emergency triage & treatment Diagnosis & treatment monitoring & ff-up Referral facility 14. Sick young infant 1 week up to 2 months Sick young children 2 months up to 5 years 14 15. Assessing the Sick ChildAssessing the Sick Child 15 General Danger Signs lethargy or unconsciousness inability to drink or breastfeed vomiting convulsions 16. Checking the Main SymptomsChecking the Main Symptoms - cough and difficult breathing - diarrhea - fever - ear problem 16 17. Checking the Main SymptomsChecking the Main Symptoms 1. Cough or difficult breathing 3 clinical signs Respiratory rate Lower chest wall indrawing Stridor 17 18. Checking the Main SymptomsChecking the Main Symptoms 2. Diarrhea Dehydration General condition Sunken eyes Thirst Skin elasticity Persistent diarrhea Dysentery 18 19. Checking the Main SymptomsChecking the Main Symptoms 3. Fever Stiff neck Risk of malaria and other endemic infections, e.g. dengue hemorrhagic fever Runny nose Measles Duration of fever (e.g. typhoid fever) 19 20. Checking the Main SymptomsChecking the Main Symptoms 4. Ear problems Tender swelling behind the ear Ear pain Ear discharge or pus (acute or chronic) 20 21. Checking Nutritional Status, Feeding,Checking Nutritional Status, Feeding, Immunization StatusImmunization Status Malnutrition visible severe wasting edema of both feet weight for age Anemia palmar pallor Feeding and breastfeeding Immunization status 21 22. Assessing Other ProblemsAssessing Other Problems Meningitis Sepsis Tuberculosis Conjunctivitis Others: also mothers (caretakers) own health 22 23. IMCI Essential Drugs and SupplyIMCI Essential Drugs and Supply Appropriate antibiotics Quinine Vitamin A Paracetamol Oral antimalarial Tetracycline eye ointment ORS Mebendazole or albendazole Iron Vaccines Gentian violet23 24. 24 Overall Case Management ProcessOverall Case Management Process Outpatient 1 - assessment 2 - classification and identification of treatment 3 - referral, treatment or counseling of the childs caretaker (depending on the classification identified 4 - follow-up care Referral Health Facility 1 - emergency triage assessment and treatment 2 - diagnosis, treatment and monitoring of patient progress 25. 25 SUMMARY OF THE INTEGRATED CASE MANAGEMENT PROCESS For all sick children age 1 week up to 5 years who are brought to a first-level health facility ASSESS the child: Check for danger signs (or possible bacterial infection). Ask about main symptoms. If a main symptom is reported, assess further. Check nutrition and immunization status. Check for other problems. CLASSIFY the childs illnesses: Use a colour-coded triage system to classify the childs main symptoms and his or her nutrition or feeding status. IF URGENT REFERRAL is needed and possible IF NO URGENT REFERRAL isneeded or possible IDENTIFY URGENT PRE-REFERRAL TREATMENT(S) needed for the childs classifications. . IDENTIFY TREATMENT needed for the childs classifications: Identify specific medical treatments and/or advice. TREAT THE CHILD: Give urgent pre- referral treatment (s) needed. TREAT THE CHILD: Give the first dose of oral drugs in the clinic and/or advise the childs caretaker. Teach the caretaker how to give oral drugs and how to treat local infections at home. If neede give immunizations. REFER THE CHILD: Explain to the childs caretaker the need for referral. Calm the caretakers fears and help resolve any problems. Write a referral note. Give instructions and supplies needed to care for the child on the way to the hospital. COUNSEL THE MOTHER: Assess the childs feeding, including breastfeeding practices, and solve feeding problems, if present. Advise about feeding and fluids during illness and about when to return to a health facility. Counsel the mother about her own health. FOLLOW-UP care: Give follow-up care when the child returns to the clinic and,if necessary, reassess the child for new problems. 26. 26 Summary of the Integrated caseSummary of the Integrated case Management ProcessManagement Process For all sick children age 1 week up to 5 years who are brought to a first-level health facility 27. 27 Summary of the Integrated caseSummary of the Integrated case Management ProcessManagement Process ASSESS the Child: Check for danger signs (or possible bacterial infection). Ask about main symptoms. If a main symptom is reported, assess further. Check nutrition and immunization status. Check for other problems 28. 28 Summary of the Integrated CaseSummary of the Integrated Case Management ProcessManagement Process Classify the childs illness: Use a color-coded triage system to classify the childs main symptoms and his or her nutrition or feeding status. 29. 29 Summary of the Integrated CaseSummary of the Integrated Case Management ProcessManagement Process IF URGENT REFERRAL is needed and possible 30. 30 Summary of the Integrated CaseSummary of the Integrated Case Management ProcessManagement Process IDENTIFY URGENT PRE- REFERRAL TREATMENT(S) Needed prior to referral of the child according to classification 31. 31 Summary of the Integrated CaseSummary of the Integrated Case Management ProcessManagement Process TREAT THE CHILD: Give urgent pre-referral treatment(s) needed. 32. 32 Summary of the Integrated CaseSummary of the Integrated Case Management ProcessManagement Process REFER THE CHILD: Explain to the childs caretaker the need for referral. Calm the caretakers fears and help resolve any problems. Write a referral note. Give instructions and supplies needed to care for the child on the way to the hospital 33. 33 Summary of the Integrated CaseSummary of the Integrated Case Management ProcessManagement Process IF NO URGENT REFERRAL is needed or possible 34. 34 Summary of the Integrated CaseSummary of the Integrated Case Management ProcessManagement Process IDENTIFY TREATMENT needed for the childs classifications: identify specific medical treatments and/or advice 35. 35 Summary of the Integrated CaseSummary of the Integrated Case Management ProcessManagement Process TREAT THE CHILD: Give the first dose of oral drugs in the clinic and/or advice the childs caretaker. Teach the caretaker how to give oral drugs and how to treat local infections at home. If needed, give immunizations. 36. 36 Summary of the Integrated CaseSummary of the Integrated Case Management ProcessManagement Process COUNSEL THE MOTHER: Assess the childs feeding, including breastfeeding practices, and solve feeding problems, if present. Advise about feeding and fluids during illness and about when to return to a healthy facility. Counsel the mother about her own health. 37. 37 Summary of the Integrated CaseSummary of the Integrated Case Management ProcessManagement Process FOLLOW-UP CARE: Give follow-up care