IMCI Review

7/31/2019 IMCI Review

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Community Health Nursing

Board Review

Integrated Management for

Childhood Illnesses (IMCI)

Prepared by:

Kit S. Lagliba, RN


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At the start of a sick child

(2 months to 5 years) consultation

Determine if this is an initial or follow-up visit for this problem.

Ask the mother what the childs

problems are.

Kit Lagliba, RN


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IMCI Case Management

Danger signsMain Symptoms

Nutritional statusImmunization status

Other problems

Need to Refer

Specific treatment

Homemanagement

ClassificationFocused Assessment

Identify treatmentTreat

Counsel caretakersFollow-up

TreatmentCounsel & Follow-up


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Check for general danger signs

Ask: Not able to drink or breastfeed, Vomits everything,

Convulsions, orLook: Abnormally sleepy or difficult

to awaken

Need to Refer

(except in severe dehydration)


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Ask about the main symptoms

Cough or difficulty in breathing

Diarrhea Fever

Ear problem


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Cough or difficulty in breathing

Ask:

For how long?

Look: Count RR

Chest indrawing

Stridor

The child

must be calm.


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SEVERE PNEUMONIA ORVERY SEVERE DISEASE

1st dose of antibiotic Vitamin A Breastfeeding/sugar water

URGENT REFERRAL

Any general danger sign or Chest indrawing or

Stridor


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PNEUMONIA

Antibiotic for 5 days Relieve cough with safe remedy Advise mother on danger signs

Follow up in 2 days

Fast breathing

2 12 months old: 50/minute

1 year or older: 40/minute


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NO PNEUMONIA: COUGH OR COLD

If cough

30 daysrefer to hospital for assessment Relieve cough with safe remedy Advise mother on danger signs

Follow up in 5 days if no improvement

No signs of pneumoniaor a very severe disease


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Diarrhea: Classify

For dehydration

Persistent diarrhea

Blood in the stool


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SEVERE DEHYDRATION

2 or more of the following:

Abnormally sleepy/difficult to wake Sunken eyes Not able to feed/drinking poorly Skin pinch goes back very slowly

Classify for dehydration

Plan C


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IV treatment within 30 minutes

IV fluid: LRS 100 ml/kg body weight(in 6 hrs for infants; 3 hrs for children)

Plan C: To treat dehydration quickly

NO

NO

Oresol/NGT


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Oresol p.o.

Plan C: To treat dehydration quickly

NO

NO

Oresol/NGT

URGENT REFERRAL


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SOME DEHYDRATION

2 of the following:

Restless, irritable

Sunken eyes Skin pinch goes back slowly


Plan B


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Age < 4 mos 4-12 mos

Amount 200-400 400-700

Determine the amount (in ml) of Oresolto be given in 4 hours

= weight of the child (in kg) X 75, orif weight is unknown, use this chart.

Plan B: Treat some dehydration with ORS


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Age 12 mos-2 yrs 2-5 yrs

Amount 700-900 900-1400

Determine the amount (in ml) of Oresolto be given in 4 hours

= weight of the child (in kg) X 75, orif weight is unknown, use this chart.



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Show the mother how to give Oresol tothe child: frequent sips from a cup

If the child vomits, wait for 10 minutes.

Then continue, but more slowly. Continue breastfeeding if the child

wants to breastfeed. If the child develops puffy eyelids, stop

ORS.



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After 4 hours: Reassess the child & classify for

dehydration.

Select appropriate plan. Begin feeding the child in the health

center.



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NO DEHYDRATION

Not enough signs to classify asSEVERE DEHYDRATION or

SOME DEHYDRATION


Plan A


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Give extra fluid.

Plan A: Treat diarrhea at home

Up to 2 yrs 50 100 ml after each LBM

2 -4 yrs 100 200 ml after each LBM

Continue feeding.

Know when to return.


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Persistent diarrhea: 14 days or more

Treat dehydration

Give Vitamin A

Refer to hospital

+ Dehydration=severe persistent diarrhea


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Persistent diarrhea: 14 days or more

Advise regarding feeding

Give Vitamin A

Follow up in 5 days

No dehydration=persistent diarrhea


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Blood in the stool = dysentery

Oral antibiotic for shigella for5 days

Follow up in 2 days


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Fever: (history/temperature 37.5C or above)

Malaria risk?

Measles now or w/in last 3 mos

Dengue risk?


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Fever: Ask about malaria risk

Residing in endemic area?OR:

Travel & overnight

stay in endemic area, or Blood transfusion

w/in past6 mos


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Malaria risk +

Blood smear

Ask: Duration of fever?Present everyday?

Look: Stiff neck

Runny noseOther signs of measles


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Malaria risk +any general danger sign or stiff neck

Quinine (under med. supervision)

1st dose of antibiotic, Paracetamol

Urgent referral

Very severe febrile disease/malaria


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Malaria risk +, blood smear +No runny nose, no measles

Oral antimalarial

Paracetamol

Follow up in 2 days

> 7 days fever hospital for

assessment

Malaria


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No malaria riskAny general danger sign or stiff neck

1st dose of antibiotic, Paracetamol

Urgent referral

Very severe febrile disease


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Measles now or w/in last 3 mosClouding of cornea or

Deep or extensive mouth ulcers

1st dose of antibiotic, Vitamin A

Urgent referral

Severe complicated measles


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Measles now or w/in last 3 mosPus draining from the eye or

Mouth ulcers

Vitamin A Tetracycline eye ointment

Gentian violet

Follow up in 2 days

Measles with eye or

Mouth complications


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Measles now or w/in last 3 mosNo other signs

Vitamin A

Measles


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If there is Dengue risk

Bleeding gums, nose, in vomitus orstools

Black vomitus or stools

Persistent abdominal painPersistent vomiting

Skin petechiae

Slow capillary refillNo signs, but fever > 3 days

Tourniquet test


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Any of the danger signsor + tourniquet test

If skin petechiae, persistent abdominalpain or vomiting, or + tourniquet test

only signs, give ORS Any other signs of bleeding Plan C

Urgent referral

Do not give aspirin

Severe Dengue hemorrhagic fever


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Ear problem:tender swelling behind ear

1st dose of antibiotic

Paracetamol for pain

Urgent referral

Mastoiditis


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Ear discharge < 14 days orEar pain

Antibiotic for 5 days Paracetamol for pain

Wicking

Follow up in 5 days

Acute ear infection


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Ear discharge for 14 days or more

Wicking Follow up in 5 days

Chronic ear infection


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Visible severe wasting orEdema on both feet or

Severe palmar pallor

Vitamin A

Urgent referral

Severe malnutrition orsevere anemia


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Some palmar pallor orVery low weight for age

Assess for feeding problem Pallor: iron & Albendazole

Wt for age very low: Vitamin A

Anemia or very low weight for age

Ki L lib RN

IMCI Review

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