Community Health Nursing Board Review

Integrated Management for Childhood Illnesses (IMCI)

Prepared by: Kit S. Lagliba, RN

Kit Lagliba, RN
At the start of a sick child (2 months to 5 years) consultation

Determine if this is an initial or followup visit for this problem. Ask the mother what the childs problems are.

IMCI Case Management

Focused Assessment Danger signs Main Symptoms Nutritional status Immunization status Other problems Classification

Need to Refer
Specific treatment

Home management
Treatment Identify treatment Treat

Counsel & Follow-up Counsel caretakers Follow-up

Check for general danger signs

Ask: Not able to drink or breastfeed, Vomits everything, Convulsions, or Look: Abnormally sleepy or difficult to awaken
Need to Refer (except in severe dehydration)

Ask about the main symptoms

Cough or difficulty in breathing Diarrhea Fever Ear problem

Cough or difficulty in breathing

Ask: For how long? Look: Count RR Chest indrawing Stridor

The child must be calm.

 Any general danger sign or Chest indrawing or Stridor

SEVERE PNEUMONIA OR VERY SEVERE DISEASE

1st dose of antibiotic Vitamin A Breastfeeding/sugar water URGENT REFERRAL

 Fast breathing 2 12 months old: 50/minute 1 year or older: 40/minute

PNEUMONIA

Antibiotic for 5 days Relieve cough with safe remedy Advise mother on danger signs Follow up in 2 days

No signs of pneumonia or a very severe disease

NO PNEUMONIA: COUGH OR COLD

If cough 30 days refer to hospital for assessment Relieve cough with safe remedy Advise mother on danger signs Follow up in 5 days if no improvement

Diarrhea: Classify For dehydration

Persistent diarrhea Blood in the stool

Classify for 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

SEVERE DEHYDRATION

Plan C

Plan C: To treat dehydration quickly

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

NO
IV treatment within 30 minutes

NO
Oresol/NGT

Plan C: To treat dehydration quickly

Oresol/NGT

NO
Oresol p.o.

NO
URGENT REFERRAL

Classify for dehydration

2 of the following:
Restless, irritable Sunken eyes Skin pinch goes back slowly

SOME DEHYDRATION

Plan B

Plan B: Treat some dehydration with ORS

Determine the amount (in ml) of Oresol to be given in 4 hours = weight of the child (in kg) X 75, or if weight is unknown, use this chart.
Age < 4 mos 4-12 mos

Amount

200-400

400-700

Plan B: Treat some dehydration with ORS

Determine the amount (in ml) of Oresol to be given in 4 hours = weight of the child (in kg) X 75, or if weight is unknown, use this chart.
Age 12 mos-2 yrs 2-5 yrs

Amount

700-900

900-1400

Plan B: Treat some dehydration with ORS

Show the mother how to give Oresol to the 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.

Plan B: Treat some dehydration with ORS

After 4 hours: Reassess the child & classify for dehydration. Select appropriate plan. Begin feeding the child in the health center.

Classify for dehydration

Not enough signs to classify as SEVERE DEHYDRATION or SOME DEHYDRATION

NO DEHYDRATION

Plan A

Plan A: Treat diarrhea at home

Give extra fluid.

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.

Persistent diarrhea: 14 days or more

+ Dehydration=severe persistent diarrhea

Treat dehydration Give Vitamin A Refer to hospital

Persistent diarrhea: 14 days or more

No dehydration=persistent diarrhea

Advise regarding feeding Give Vitamin A Follow up in 5 days

Blood in the stool = dysentery

Oral antibiotic for shigella for 5 days Follow up in 2 days

Fever: (history/temperature 37.5C or above)

Malaria risk?

Measles now or w/in last 3 mos Dengue risk?

Fever: Ask about malaria risk

Residing in endemic area? OR: Travel & overnight w/in past stay in endemic area, or 6 mos Blood transfusion

Malaria risk +

Blood smear Ask: Duration of fever? Present everyday? Look: Stiff neck Runny nose Other signs of measles

Malaria risk + any general danger sign or stiff neck

Very severe febrile disease/malaria

Quinine (under med. supervision) 1st dose of antibiotic, Paracetamol Urgent referral

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

Malaria

Oral antimalarial Paracetamol Follow up in 2 days > 7 days fever hospital for assessment

No malaria risk Any general danger sign or stiff neck

Very severe febrile disease

1st dose of antibiotic, Paracetamol Urgent referral

Measles now or w/in last 3 mos Clouding of cornea or Deep or extensive mouth ulcers

Severe complicated measles

1st dose of antibiotic, Vitamin A Urgent referral

Measles now or w/in last 3 mos Pus draining from the eye or Mouth ulcers

Measles with eye or Mouth complications

Vitamin A Tetracycline eye ointment Gentian violet Follow up in 2 days

Measles now or w/in last 3 mos No other signs

Measles

Vitamin A

If there is Dengue risk

Bleeding gums, nose, in vomitus or stools Black vomitus or stools Persistent abdominal pain Persistent vomiting Skin petechiae Slow capillary refill No signs, but fever > 3 days Tourniquet test

Any of the danger signs or + tourniquet test

Severe Dengue hemorrhagic fever

If skin petechiae, persistent abdominal pain or vomiting, or + tourniquet test only signs, give ORS Any other signs of bleeding Plan C Urgent referral Do not give aspirin

Ear problem: tender swelling behind ear

Mastoiditis

1st dose of antibiotic Paracetamol for pain Urgent referral

Ear discharge < 14 days or Ear pain

Acute ear infection

Antibiotic for 5 days Paracetamol for pain Wicking Follow up in 5 days

Ear discharge for 14 days or more

Chronic ear infection

Wicking Follow up in 5 days

Visible severe wasting or Edema on both feet or Severe palmar pallor

Severe malnutrition or severe anemia

Vitamin A Urgent referral

Some palmar pallor or Very low weight for age

Anemia or very low weight for age

Assess for feeding problem Pallor: iron & Albendazole Wt for age very low: Vitamin A

Kit Lagliba, RN