IMCI SEssion 4 - Main Symptoms
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Session 4Main Symptoms- cough or difficult breathing - diarrhea - fever - ear problems1
Learning ObjectivesBy the end of this session, the students will be able to:(1) recall the anatomy and pathophysiology; (2) recognize the symptoms and signs; (3) assess and classify symptoms and signs; (4) identify the correct treatment and when to refer; (5) provide counseling; and (6) specify necessary follow-up care
Cough or Difficult Breathing
Parts of the Respiratory SystemNasal passages Windpipe or trachea Lungs
Inside the alveolus
Cough or Difficult BreathingASK: Does the child have cough or difficult breathing?If NO IF YES, ASK: For how long? If YES LOOK, LISTEN, FEEL: Count the breaths in one minute Look for chest indrawing Look and listen for stridor Child must be calm
Ask about next main symptoms: diarrhea, fever, ear problems
If the child is: Fast breathing is: 2 mos 12 mos. 50 breaths/min or more 12 mos 5 yrs 40 breaths/min or more
Classify childs illness using the color-coded classification table for cough or difficult breathing
Video of child with chest indrawing
Video of child with stridor
Cough or Difficult BreathingSIG N Any general danger S CLASSIF Y A SSEVERE PNEUMONIA OR VERY SEVERE DISEASE
sign or Chest indrawing or Stridor in a calm child
ID EN TIF Y Give TR EA TM ENT first dose of an
appropriate antibiotic Refer URGENTLY to hospital
Give an appropriate oral antibiotic for 5 days Soothe the throat and relieve the cough with a safe remedy Advise mother when to return immediately Follow-up in 2 days If coughing > 30 days, refer for assessment Soothe the throat and relieve the cough with a safe remedy Advise mother when to return immediately Follow-up in 5 days if not improving
No signs of pneumonia or very severe disease
NO PNEUMONIA: COUGH OR COLD
TreatmentSoothe the Throat, Relieve the Cough with a Safe RemedySafe
remedies to recommend: Breastmilk for exclusively breastfed tamarind, calamansi, ginger
remedies to discourage: Codeine cough syrup Other cough syrups Oral and nasal decongestants
Treatment for Pneumonia or Very Severe DiseaseAge or Weight Cotrimoxazole Give 2 times daily for 5 days Adult Syrup tab. 40 mg 80mg TMP TMP 200 mg 400 mg SMX SMX 1/2 1 5.0 ml. 7.5 ml Amoxycillin Give 3 times daily for 5 days Tablet Syrup 250 mg 125 mg/ 5 ml
2 -12 mos 12mos-5yrs
5.0 ml 10 ml.
Vitamin A Supplementation for Severe Pneumonia or Very Severe DiseaseAge Vitamin A Capsule 100,000 I U6 to 12 mos. 12 mos-5 yrs
200,000 I U capsule 1 capsule
1 capsule 2 capsules
Anatomy of the Gastrointestinal System
DiarrheaFor ALL sick children ask the mother about the childs problem, check for general danger signs, ask about cough or difficult breathing and then ASK: DOES THE CHILD HAVE DIARRHOEA?
Does the child have diarrhoea?IF YES, ASK:For how long? Is there blood in the stool
LOOK, LISTEN, FEEL:Look at the childs general condition. Is the child: Lethargic or unconscious? Restless or irritable? Look for sunken eyes. Offer the child fluid. Is the child: Not able to drink or drinking poorly? Drinking eagerly, thirsty? Pinch the skin of the abdomen. Does it go back: Very slowly (longer than 2 seconds)? Slowly? Classify DIARRHOEA
CLASSIFY the childs illness using the colour-coded classification tables for diarrhoea.
Then ASK about the next main symptoms: fever, ear problem, and CHECK for malnutrition and anaemia, immunization status and for other problems.
DIARRHEADoes the child have diarrhea? IF YES, ASK: For how long? Is there blood in the stool? LOOK, LISTEN, FEEL: Look at the childs general condition, is the child:
Lethargic or unconscious? Restless or irritable?
Look for sunken eyes Offer the child fluid. Is the child:Not able to drink or drinking poorly? Drinking eagerly, thirsty?
Pinch the skin of the abdomenDoes it go back: Very slowly (> than 2 secs)? Slowly?
Video of a child with sunken eyes
Video of Skin Pinching
CLASSIFICATION TABLE FOR DEHYDRATIONSIGNS Two of the following signs: Lethargic or unconscious Sunken eyes Not able to drink or drinking poorly Skin pinch goes back very slowly CLASSIFY AS IDENTIFY TREATMENT (Urgent pre-referral treatments are in bold print.) If child has no other severe classification: Give fluid for severe dehydration (Plan C). OR If child also has another severe classification: Refer URGENTLY to hospital with mother giving frequent sips of ORS on the way. Advise the mother to continue breastfeeding If child is 2 years or older and there is cholera in your area, give antibiotic for cholera. Give fluid and food for some dehydration (Plan B). If child also has a severe classification: Refer URGENTLY to hospital with mother giving frequent sips of ORS on the way. Advise the mother to continue breastfeeding Advise mother when to return immediately. Follow-up in 5 days if not improving. Give fluid and food to treat diarrhoea at home (Plan A). Advise mother when to return immediately. Follow-up in 5 days if not improving.
Two of the following signs: Restless, irritable Sunken eyes Drinks eagerly, thirsty Skin pinch goes back slowly Not enough signs to classify as some or severe dehydration.
No DehydrationTell the Mother: (a) Breastfeed frequently and longer for each feed. (b) If the child is exclusively breastfed, give ORS or clean water in addition to breastmilk. (c) If the child is NOT exclusively breastfed, give 1 or more of the following: ORS Food-based fluids Clean Water
No DehydrationTreatment Plan A< 2 yrs 2-10 yrs
Age Amount of Fluid of Fluid(- cup) after each loose stool 50-100 ml
ORS, rice water, 100-200 ml (-1 cup) after each loose yogurt, soup with stool salt
Give frequent small sips from a cup. If the child vomits, wait 10 minutes. Then continue, but more slowly.
Continue giving extra fluids until the diarrhea stops.
Some Dehydration Give
frequent small sips from a cup. If the child vomits, wait 10 minutes. Then continue, but more slowly. Continue giving extra fluids until the diarrhea stops. Reassess after 4 hours and classify the child for dehydration.25
Some DehydrationIf the mother must leave before completing treatment: show her how to prepare the ORS solution at home. show her how much to give to finish the 4 hour treatment at home give her enough ORS packets to complete rehydration.26
Some DehydrationTreatment Plan B(Determine amount of ORS to be given in 4 hours)Age Up to 4 mos WEIGHT In ml 4mos - 12mos 12mos 2years
2 years 5
< 6kg 200-400
6 - < 10kg 400-700