Is the integrated

strategy that combines

and links together existing child health

programs.

Is an evidenced based,
syndrome approach to case management that supports the rational, effective and affordable use of drugs and

diagnostic tools.

To reduce significantly

mortality and morbidity

associated with the major cause of diseases in children

To promote improved growth and development of children.

Basic Integrated Management of Childhood illness (12 days) IMCI follow up Course (5 days) (Supervisors/)PHNs) IMCI On the Job Training IMCI Supervisory Skills Trainings (days)

(Follow after training is an essential activity to all IMCI Trainings 1 month after and 3 months after)

IMCI Chart Booklet IMCI Patients Logbook Sick Child Recording Forms: 1. Age 2 months up to 5 years old
2. Sick young infant age 1 week up to 2 months

Mothers Counselling Card

Oresol Oral antibiotics (1st line Cotrimoxazole Oral anti malarial 1st line-Chloro quine and Primaquine 2nd line Aretemether Lumefrantine Nalidixic Acid Tablets Tetracycline tablets

Iron Vitamin A Paracetamol Vaccine Mebendazole / Albendazole Tetracycline eye ointment Gentian violet Vitamin A Chloramphenicol IM (optional) Gentamicin IM (optional) Benzyl Penicillin IM (Optional)

Equipments: 1-weighing scale 2-timing devices 3-refrigerator with voltage regulator 4-sterilizers 5-BP apparatus 6-pediatric cuff 7-oral thermometer

Supplies: 1-cold chain supplies and immunization supplies 2-ORT supplies 3-water jars 4-IV fluid (plain LR and insertion sets 0 5-sterile water for dilutions 6-plaster, cotton swab, tongue depressors 7-70% ethyl alcohol

A CLASSIFICATION THAT NEEDS URGENT REFERRAL AFTER FIRST DOSE OF APPROPRIATE ANTIBIOTIC

A CLASSIFICATION THAT NEEDS TREAMENT AT HOME AND HEALTH EDUCATION

A CLASSIFICATION THAT NEEDS HEALTH EDUCATION

 NAME

OF THE CHILD

AGE

WEIGHT

TEMPERATURE

CHILDS PROBLEMS

INITIAL OR FOLLOW UP VISIT

Not able to drink or breastfeed

VOMITS EVERYTHING

CONVULSIONS

ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN

QUESTIO N
IN ELICITING THE SIGN ABLE TO DRINK OR BREASTFEED, THE NURSE ASKED THE MOTHER THIS QUESTION?
A. DESCRIBE WHAT HAPPENS WHEN YOU OFFER THE CHILD FLUID B. IS THE CHILD ABLE TO SWALLOW THE FLUID?

C. DO YOU OFFER HIM FLUID? D. IS THE CHILD THIRSTY?

QUESTIO N
BABY WIMBO, A TEN MONTH OLD BABY CAME IN FOR CONSULTATION, SLEEPING VERY SOUNDLY . WHEN THE MOTHER IS ASKED ABOUT THE CHILDS PROBLEMS , SHE SAID COUGH AND DIFFICULT BREATHIN G; WHAT WILL BE THE NURSE FIRST ACTION?

A. CHECK FOR GENERAL DANGER SIGNS (GDS) B. OBSERVE THE CHILDS GENERAL CONDITION

C. COUNT THE NUMBER OF BREATHS FRST BEFORE TRYING TO WAKE THE CHILD D. REFER THE CHILD URGENTLY

QUESTIO N
BABY WIMBO HAD CONVULSION IN THIS CURRENT ILLNESS, WHAT WILL THE HEALTH WORKER DO NEXT?

A. REFER THE CHILD URGENTLY ON THE HOSPITAL B. CONTINUE WITH THE ASSESSMENT
C. COMPLETE THE REST OF THE ASSESSMENT IMMEDIATELY AND FACILITATE TREATMENT WITH OUT DELAY

D. MAKE A REFERRAL NOTE

MAKE SURE CHILD WITH ANY GENERAL DANGER SIGN IS REFERRED After first dose of an appropriate antibiotic and other urgent treatments. Exception: Rehydration of the child according to Plan C may resolve danger signs so that referral is no longer needed.

* Any general danger sign or * Chest indrawing or * Stridor in calm child.

SEVERE PNEUMONIA OR VERY SEVERE DISEASE

Give first dose of an appropriate antibiotics. Give Vitamin A. Treat the child to prevent low blood sugar. Refer URGENTLY to hospital. Give an appropriate antibiotic for 5 days. Soothe throat and relieve the cough with a safe remedy. Advise mother when to return immediately Follow-up in 2 days. If coughing more than 30 days, refer for assessment. Soothe the throat and relievee the cough with a safe remedy. Advise mother when to return immediately. Follow-up in 5 days if not improving.

* Fast breathing

PNEUMONIA

No signs of pneumonia or every severe disease

NO PNEUMONIA COUGH OR COLD

MAKE SURE CHILD WITH ANY GENERAL DANGER SIGN IS REFERRED After first dose of an appropriate antibiotic and other urgent treatments. Exception: Rehydration of the child according to Plan C may resolve danger signs so that referral is no longer needed.

FASTBREATHING

CHEST INDRAWING

STRIDOR

* Any general danger sign or * Chest indrawing or * Stridor in calm child.

SEVERE PNEUMONIA OR VERY SEVERE DISEASE

PNEUMONIA

Give first dose of an appropriate antibiotics. Give Vitamin A. Treat the child to prevent low blood sugar. Refer URGENTLY to hospital.
Give an appropriate antibiotic for 5 days. Soothe throat and relieve the cough with
a safe remedy. Advise mother when to return immediately Follow-up in 2 days. If coughing more than 30 days, refer for assessment. Soothe the throat and relievee the cough with a safe remedy. Advise mother when to return immediately. Follow-up in 5 days if not improving.

* Fast breathing

No signs of pneumonia or every severe disease

NO PNEUMONIA COUGH OR COLD

QUESTION
OMAR IS 18 MONTHS OLD. HE WEIGHS 11.5 KG. HIS TEMPERATURE IS 37.5 C. HIS MOTHER BROUGHT HIM TO THE HEALTH CENTER BECAUSE HE HAS COUGH . THE HEALTH WORKER COUNTER HE NUMBER OF BREATHS THE CHILD TOOK IN A MINUTE .THE COUNTED THE BREATHS IN ONE MINUTE .ITS 4O . THERE IS NO CHEST INDRAWING AND NO STRIDOR.WHAT WIL BE OMARS CLASSIFICATON FOR COUGH?

A. NO PNEUMONIA: COUGH OR COLD B. PNEUMONIA C. SEVERE PNEUMONIA D. COUGH

QUESTION
LUPITA IS 8 MONTHS OLD , SHE HAD COUGH FOR 3 DAYS. THE MOTHER TOLD THE HEALTH WORKER THAT LUPITA WILL NOT BREASTFEED. FURTHER ASSESSMENT SHOWED THAT LUPITA AS 55 BREATHS PER MINUTE. WHAT WILL BE THE CHILDS CLASSIFICATION?

A.

SEVERE PNEUMONIA OR VERY SEVERE DISEASE PNEUMONIA

B.

C. NO PNEUMONIA; COUGH OR COLD D. NONE OF THE ABOVE

BLOOD IN STOOLS

GENERAL CONDITION ABNORMALLY SLEEPY RESTLESS OR IRRITABLE NORMAL

SUNKEN EYES

OBSERVE THE CHILD AS HE DRINKS - NORMALLY - THIRSTY /EAGERLY - WEAKLY

PINCH THE SKIN OF THE ABDOMEN - GOES BACK VERY SLOWLY - GOES BACK SLOWLY - GOES BACK NORMALLY

Two of the following signs:

* Abnormally sleepy or difficult to awaken * Sunken eyes
* Not able to drink or drinking poorly

SEVERE DEHDRATION

* Skin pinch goes back very slowly

If child has no other severe classification: -Give fluid to severe dehydration (Plan C.) OR If child also has another severe classification: -Refer URGENTLY to hospital with mother giving frequent slps 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 mother to continue breastfeeding. Advise mother when to return immediately. Follow-up in 5 days if not improving. Give fluid and food to treat diarrhea 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.

SOME DEHYDRATION

Not enough signs to classify as some or severe dehydration.

NO DEHYDRATION

* Dehydration present

SEVERE PERSISTENT DIARRHEA PERSISTENT DIARRHEA

Treat dehydration before referral unless the child has another severe classification. Give Vitamins A. Refer to hospital Advise the mother on feeding a child who has PERSISTENT DIARRHEA. Give Vitamin A. Follow-up in 5 days.

* No Dehydration.

* Blood in the stool

DYSENTERY

Treat for 5 days with an oral antibiotic recommended for Shigella in your area. Follow-up in 2 days.

Two of the following signs:

* Abnormally sleepy
or difficult to awaken

SEVERE DEHYDRATION

* Sunken eyes
* Not able to drink or drinking poorly

If child has no other severe classification: -Give fluid to severe dehydration (Plan C.) OR If child also has another severe classification: -Refer URGENTLY to hospital with mother giving frequent slps 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.

* Skin pinch goes

back very slowly

Two of the following signs:

* Restless,

irritable

SOME DEHYDRATION

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 mother to continue breastfeeding. Advise mother when to return immediately. Follow-up in 5 days if not improving.

* Sunken eyes * Drinks eagerly, thirsty * Skin pinch goes back slowly.

Not enough signs to classify as some or severe dehydration.

NO DEHYDRATION

Give fluid and food to treat diarrhea at home (Plan A).

Advise mother when to return immediately. Follow-up in 5 days if not improving.

* Dehydration present

SEVERE PERSISTENT DIARRHEA

Treat dehydration before referral unless the child has another severe classification. Give Vitamins A. Refer to hospital Advise the mother on feeding a child who has PERSISTENT DIARRHEA. Give Vitamin A. Follow-up in 5 days.

* No Dehydration

PERSISTENT DIARRHEA

* Blood in the stool

DYSENTERY

Treat for 5 days with an oral antibiotic recommended for Shigella in your area. Follow-up in 2 days.

QUESTION
JOEL , 11 MONTHS OLD, WEIGH S 8 KG . HE HAS NO BLOOD IN THE STOOL . HE IS IRRITABLE. HIS EYES ARE SUNKEN. HIS MOTHER AND FATHER ALSO THINKS THAT HIS EYES ARE SUNKEN.THE HEALTH WORKER OFFERS THE CHILD FLUID , AND THE CHILD DRINKS EAGERLY . WHEN THE HEALTH WORKER PINCJES THE SKIN OF THE ABDOMEN , IT GOES BACK SLOWLY. WHERE DOES THE HEALTH WORKER PUTS JOEL?

A.

SEVERE DEHYDRATION SOME DEHYDRATION NO DEHYDRATION

B.

C.

D. GENERAL DANGER SIGN

QUESTION
JASMIN HAS HAD DIARRHEA FOR 3 DAYS. THERE WAS NO BLOOD IN THE STOOL. THE CHILD WAS NOT ABNORMALL SLEEPY OR DIFFICULT TO AWAKEN. SHE WAS NOT IRRITABLE OR RESTLESS. ER EYES WERE SUNKEN. SHE WAS ABLE TO DRINK , BUT SHE WAS NOT THIRSTY. THE SKIN PINCH GOES BACK IMMEDIATELY. WHERE DOES THE HEALTH WORKER PUTS HER?

A.

SEVERE DEHYDRATION SOME DEHYDRATION NO DEHYDRATION

B.

C.

D. PERSISTENT DIARRHEA

STIFF NECK

RUNNY NOSE

GENERALIZED RASH - WITH RUNNY NOSE, COUGH AND RED EYES

 MOUTH

ULCERS

- DEEP - EXTENSIVE

PUS DRAINING FROM THE EYES

CLOUDING OF THE CORNEA

BLEEDING FROM NOSE OR GUMS

SKIN PETICHIAE

COLD AND CLAMMY EXTREMITIES

CAPILLARY REFILL

TORNIQUET TEST POSITIVE

* Any general danger sign or * Stiff neck.

VERY SEVERE FEBRILE DISEASE/ MALARIA

Give first dose of quinine (under medical supervision or if a hospital is not accessible within 4 hours. Give first dose of an appropriate antibiotic. Treat the child to prevent low blood sugar. Give one dose of paracetamol in health center for high fever (38.5 0C or above). Send a blood smear with the patient. Refer URGENTLY to hospital.

* Blood smear (+) If blood smear not done: * NO runny nose, and * NO measles, and * NO other causes of fever

MALARIA

Treat the child with an oral antimalarial. Give one dose of paracetamol in health center for high fever (38.5 0C or above). Advise mother when to return immediately. Follow-up in 2 days if fever persists. If fever is present every day for more than 7 days, refer for assessment.

* Blood smear (-), or * Runny nose, or * Measles, or * Other causes of fever * Any general danger sign or * Stiff neck.

FEVER: MALARIA UNLIKELY

VERY SEVERE FEBRILE DISEASE FEVER: NO MALARIA

Give one dose of paracetamol in health center for high fever (38.5 0C or above). Advise mother when to return immediately. Follow-up in 2 days if fever persists. If fever is present every day for more than 7 days, refer for assessment.
Give first dose of an appropriate antibiotic. Treat the child to prevent low blood sugar. Give one dose of paracetamol in health center for high fever (38.5 0C or above). Refer URGENTLY to hospital. Give one does of paracetamol in hrealth center for high fever (38.5 0C or above). Advise mother when to return immediately. Follow-up in 2 days if fever persists. If fever is present every day for more than 7 days, refer for assessment.
Give vitamin A. Give first dose of an appropriate antibiotic. If clouding of the cornea or pus draining from the eye, apply tetracycline eye ointment. Refer URGENTLY to hospital. Give Vitamin A. If pus draining from the eye, apply tetracycline eye ointment. If mouth ulcers, teach the mother to treat with gentian violet. Follow-up in 2 days

* No signs of very severe febrile disease

* Clouding of cornea or * Deep or extensive mouth ulcers

SEVERE COMPLICATED MEASLES ***

*Pus draining from the eye or * Mouth ulcers

MEASLES WITH EYE OR MOUTH COMPLICATIONS ***

*Measles now or within the last 3 months * *Bleeding from nose or gums or *Bleeding in stools or vomitus or *Black stools or vomitus or *Skin petechiae or *Cold and clammy extremities or *Capillary refill more than 3 seconds or *Abdominal pain and vomiting * Tourniquet test positive.

MEASLES

Give Vitamin A.
If skin petechiae or positive tourniquet tests are the only positive signs give ORS. If any other signs are positive, give fluids rapidly as in Plan C. Treat the child to prevent low blood sugar. Refer all children URGENTLY to hospital. DO NOT GIVE ASPIRIN.

SEVERE DEGUE HEMORRHAGIC FEVER

FEVER: DEGUE HEMORRHAGIC FEVER UNLIKELY

*No signs of severe dengue hemorrhagic fever

Advise mother when to return immediately. Follow up in 2 days if fever persists or child shows signs of bleeding. DO NOT GIVE ASPIRIN.

* Any general danger sign or * Stiff neck.

VERY SEVERE FEBRILE DISEASE/ MALARIA

Give first dose of quinine (under medical supervision or if a hospital is not accessible within 4 hours. Give first dose of an appropriate antibiotic. Treat the child to prevent low blood sugar. Give one dose of paracetamol in health center for high fever (38.5 0C or above). Send a blood smear with the patient. Refer URGENTLY to hospital. Treat the child with an oral antimalarial. Give one dose of paracetamol in health center for high fever (38.5 0C or above). Advise mother when to return immediately. Follow-up in 2 days if fever persists. If fever is present every day for more than 7 days, refer for assessment.

* Blood smear (+) If blood smear not done: * NO runny nose, and * NO measles, and * NO other causes of fever

MALARIA

* Blood smear (-), or * Runny nose, or * Measles, or * Other causes of fever

FEVER: MALARIA UNLIKELY

Give one dose of paracetamol in health center for high fever (38.5 0C or above). Advise mother when to return immediately. Follow-up in 2 days if fever persists. If fever is present every day for more than 7 days, refer for assessment.

* Any general danger sign or * Stiff neck.

VERY SEVERE FEBRILE DISEASE

Give first dose of an appropriate antibiotic. Treat the child to prevent low blood sugar. Give one dose of paracetamol in health center for high fever (38.5 0C or above). Refer URGENTLY to hospital.

* No signs of very severe febrile disease

FEVER: NO MALARIA

Give one does of paracetamol in hrealth center for high fever (38.5 0C or above). Advise mother when to return immediately. Follow-up in 2 days if fever persists. If fever is present every day for more than 7 days, refer for assessment.

* Clouding of cornea or * Deep or extensive Mouth ulcers

SEVERE COMPLICATED MEASLES ***

Give vitamin A. Give first dose of an appropriate antibiotic. If clouding of the cornea or pus draining from the eye, apply tetracycline eye ointment. Refer URGENTLY to hospital.

*Pus draining from the eye or * Mouth ulcers

MEASLES WITH EYE OR MOUTH COMPLICATIONS ***

Give Vitamin A. If pus draining from the eye, apply tetracycline eye ointment. If mouth ulcers, teach the mother to treat with gentian violet. Follow-up in 2 days Give Vitamin A.

*Measles now or within the last 3 months

MEASLES

* *Bleeding from nose or gums or *Bleeding in stools or vomitus or *Black stools or vomitus or *Skin petechiae or *Cold and clammy extremities or *Capillary refill more than 3 seconds or *Abdominal pain and vomiting * Tourniquet test positive.

SEVERE DENGUE HEMORRHAGIC FEVER

*No signs of severe dengue hemorrhagic fever

If skin petechiae or positive tourniquet tests are the only positive signs give ORS. If any other signs are positive, give fluids rapidly as in Plan C. Treat the child to prevent low blood sugar. Refer all children URGENTLY to hospital. DO NOT GIVE ASPIRIN.

FEVER: DENGUE HEMORRHAGIC FEVER UNLIKELY

Advise mother when to return immediately. Follow up in 2 days if fever persists or child shows signs of bleeding. DO NOT GIVE ASPIRIN.

EAR PAIN

EAR DISCHARGE

PUS DRAINING FROM THE EARS

TENDER SWELLING BEHIND THE EARS

VISIBLE SEVERE WASTING

EDEMA OF BOTH FEET

PALMAR PALLOR - SEVERE - SOME

DETERMINE WEIGHT FOR AGE - VERY LOW WEIGHT FOR AGE - LOW WEIGHT FOR AGE

IMMUNIZATION

VITAMIN A

ASSESS OTHER PROBLEMS

* Visible severe wasting or * Edema of both feet or * Severe palmar pallor

SEVERE MALNULTRITION OR SEVERE ANEMIA

Give Vitamin A. Refer URGENTLY to hospital.

Assess the childs feeding and counsel the mother on feeding according to the FOOD box on the COUNSEL THE MOTHER chart. -if feeding problem, follow-up in 5 days.
If some pallor: - Give Iron. - Give mebendazole if child is 2 years or older and has not had a dose in the previous 6 months. - Follow-up in 14 days. If very low weight for age; - Give Vitamin A. Follow-up in 30 days. Advise mother when to return immediately.

* Some palmar pallor or * Very low weight for age

ANEMIA OR VERY LOW WEIGHT

* Not very low weight for age and no other signs of malnutrition.

NO ANEMIA AND NOT VERY WEIGHT

If the child is less than 2 years old, assess the childs feeding and counsel the mother on feeding according to the FOOD box on the COUNSEL THE MOTHER chart. -if feeding is a problem, follow-up in 5 days.
Advise mother when to return immediately.

Grace is 4 months old. She weighs 5.5kg. Her temperature is 38.0C. She is in the health center today because she has diarrhea. She does not have any General Danger Signs. She is not coughing and does not have difficult breathing. The health worker assessed her further for signs of diarrhea. She has had diarrhea for 2 days and there is blood in the stool, said the mother. Grace was not restless or irritable;she was not difficult to awaken or abnormally sleepy. Her eyes were not sunken. She drank normally,. Did not seem to be thirsty. Her skin pinch went back immediately. The health worker next assessed for fever . The Malaria risk is high in this area. Grace has had fever for 2 days, said the mother.She has not had measles in the last 3 months. She does not have stiff neck or runny nose. There are no signs suggesting measles. It was not possible to take a blood smear. There is no dengue risk in the area.

Grace does not have an ear problem. The health wOrker checkeD for malnutrition and anemia. She does not have visible severe wasting. There is no palmar pallor and no edema of both feet. The health worker determined weight for age. At birth Grace received BCG and HEP B1. At six weeks , she received HEPA B2, DPT1 and OPV1 .

SEVERE CHEST INDRAWING

NASAL FLARING

GRUNTING

BULGING FONTANELL

UMBILICAL REDNESS EXTENDING TO THE SKIN RED UMBILICUS OR DRAINING PUS

MANY SKIN PUSTULES SKIN PUSTULES

LESS THAN NORMAL MOVEMENT

* Convulsion or * Fast breathing (60 breaths per minute or more) or * Severe chest indrawing or * Nasal flaring or * Grunting or * Bulging fontanelle or * Pus draining from ear of * Umbilical redness extending to the skin or * Fever (37.5C* or above or feels hot) or low body temperature (less than (35.5C* or feels cold) or * Many or severe skin pustules or * Abnormally sleepy or difficulty to awaken or * Less than normal movement

POSSIBLE * Give first dose of an SERIOUS appropriate BACTERIAL antibiotics. INFECTION * Give Vitamin A.

* Treat the child to prevent low blood sugar. * Refer URGENTLY to

hospital.

LOCAL * Red umbilicus or draining pus or BACTERIAL INFECTION * Skin pustulres

* Give an appropriate oral antibiotic * Treat local infection in the health center and teach the mother to treat local infections at home * Advise mother to give home care for the young infant * Follow up in 2 days

DIARRHEA BLOOD IN THE STOOL RESTLESS AND IRRITABLE SUNKEN EYES VERY SLOW SKIN PINCH

Two of the following signs:

* Abnormally sleepy or difficult to awaken * Sunken eyes
* Not able to drink or drinking poorly

SEVERE DEHDRATION

* If infant does not have POSSIBLE SERIOUS BACTERIAL INFECTION nor DYSENTERY - Give fluid for severe dehydration (Plan C) OR * If infant also has POSSIBLE SERIOUS BACTERIAL INFECTION or DYSENTERY - Refer URGENTLY to hospital with mother giving frequent sips or ORS on the way. Advise mother to continue breastfeeding * Give fluid and food for some dehydration (Plan B). * If infant also has POSSIBLE SERIOUS BACTERIAL INFECTION or DYSENTERY - Refer URGENTLY to hospital with mother giving frequent sips or ORS on the way. Advise mother to continue breastfeeding

* Skin pinch goes back very slowly

Two of the following signs:

* Restless, irritable * Sunken eyes * Drinks eagerly, thirsty * Skin pinch goes back slowly.

SOME DEHYDRATION

Not enough signs to classify as some or severe dehydration.

NO DEHYDRATION

Give fluid and food to treat diarrhea at home (Plan A).

* Dehydration lasting 14 days or more

SEVERE PERSISTENT DIARRHEA

* If young infant is dehydrated, treat dehydration before referral unless the infant has also POSSIBLE SERIOUS BACTERIAL INFECTION * Refer to hospital.

* Blood in the stool

DYSENTERY

* Refer URGENTLY to hospital with mother giving frequent sips or ORS on the way. Advise mother to continue breastfeeding

Two of the following signs: * Abnormally sleepy or difficult to awaken * Sunken eyes * Not able to drink or drinking poorly * Skin pinch goes back very slowly
Two of the following signs: * Restless, irritable * Sunken eyes * Drinks eagerly, thirsty * Skin pinch goes back slowly.

SEVERE DEHYDRATION

* If infant does not have POSSIBLE SERIOUS BACTERIAL INFECTION nor DYSENTERY - Give fluid for severe dehydration (Plan C) OR * If infant also has POSSIBLE SERIOUS BACTERIAL INFECTION or DYSENTERY - Refer URGENTLY to hospital with mother giving frequent sips or ORS on the way. Advise mother to continue breastfeeding

SOME DEHYDRATION

* Give fluid and food for some dehydration (Plan B). * If infant also has POSSIBLE SERIOUS
BACTERIAL INFECTION or DYSENTERY - Refer URGENTLY to hospital with mother giving frequent sips or ORS on the way. Advise mother to continue breastfeeding

Not enough signs to classify as some or severe dehydration.

NO DEHYDRATION

Give fluid and food to treat diarrhea at home (Plan A).

* Dehydration lasting 14 days or more

SEVERE PERSISTENT DIARRHEA

* If young infant is dehydrated, treat dehydration before referral unless the infant has also POSSIBLE SERIOUS BACTERIAL INFECTION
* Refer to hospital. * Refer URGENTLY to hospital with mother giving frequent sips or ORS on the way. Advise mother to continue breastfeeding

* Blood in the stool

DYSENTERY

CHECK IF AN INFANT:

HAS ANY DIFFICULTY FEEDING BREASTFEEDING LESS THAN 8 TIMES IN 24 HOURS TAKING OTHER FOODS OR FLUIDS LOW WEIGHT FOR AGE

* Not able to feed or * No attachment at all or * Not sucking at all

NOT AB LE TO FEED _ POSSIBLE SERIOUS BACTERIAL INFECTION

* * * *

Give first dose of intramuscular antibiotics Treat to prevent low blood sugar Advise the mother how to keep the young infant warm on the way to the hospital Refer URGENTLY to hospital

* Not well attached to breast of * Not suckling effectively or * Less than 8 breastfeedings in 24 hours or * Receives other foods or drinks or * Low weight for age or * Trush (ulcers or white patches in mouth)
* Not low weight for age and no other signs of inadequate feeding

FEEDING PROBLEM OR LOW WEIGHT

* Advise the mother to breastfeed as often and for as long as the infant wants, day and night - If not well attached or not suckling effectively, teach correct positioning and attachment. - If breastfeeding less than 8 times in 24 hours, advise to increase frequency of feeding * If receiving other foods or drinks, counsel mother about breastfeeding more, reducing other foods or drinks, using a cup - If not breastfeeding at all: 1. Refer for breastfeeding counselling and possible relactation 2. Advise about correctly preparing breastmilk substitutes and using a cup * If thrush, teach the mother to treat thrush at home * Advise mother to give home care for the young infant * Follow-up any feeding problem or thrush in 2 days Follow-up low weight for age in 14 days

NO FEEDING PROBLEM

* Advise mother to give home care for the young infant * Praise the mother for feeding the infant well

* Not able to feed or * No attachment at all or * Not sucking at all

NOT ABLE TO FEED POSSIBLE SERIOUS BACTERIAL INFECTION

* Give first dose of intramuscular antibiotics

* Treat to prevent low blood sugar

* Advise the mother how to keep the young infant warm on the way to the hospital
* Refer URGENTLY to hospital

* Not well attached to breast of * Not suckling effectively or * Less than 8 breastfeedin gs in 24 hours or * Receives other foods or drinks or * Low weight for age or * Trush (ulcers or white patches in mouth)

FEEDING PROBLEM OR LOW WEIGHT

* Advise the mother to breastfeed as often and for as long as the infant wants, day and night - If not well attached or not suckling effectively, teach correct positioning and attachment. - If breastfeeding less than 8 times in 24 hours, advise to increase frequency of feeding * If receiving other foods or drinks, counsel mother about breastfeeding more, reducing other foods or drinks, using a cup - If not breastfeeding at all: 1. Refer for breastfeeding counselling and possible relactation 2. Advise about correctly preparing breastmilk substitutes and using a cup * If thrush, teach the mother to treat thrush at home * Advise mother to give home care for the young infant * Follow-up any feeding problem or thrush in 2 days Follow-up low weight for age in 14 days

* Not low weight for age and no other signs of inadequate feeding

NO FEEDING PROBLEM

* Advise mother to give home care for the young infant * Praise the mother for feeding the infant well

IMMUNIZATION

ASSESS OTHER PROBLEMS

Ann is 5 weeks old and weighs 4 kg. she is afebrile.She was brought to the health center because the umbilicus is red and draining pus.She also has diarrhea, there is blood in the stool ,slow skin inch and crying relentlessly .When checked for a feeding problem , she is being fed 6 times in a day and is low weight for age.

SITUATION
Jasmine is a 2 year old child.He has diarrhea for 3 days. There was no blood in the stool .The child was not abnormally sleepy or difficult to awaken.He was not irritable or restless,his eyes were sunken.He was able to drink ,but he was not thirsty .The skin pinch went back immediately. Jasmin has no other severe classification.

QUESTION #1

How many signs does a health worker need to classify under one classification?
A. One B. Two C. Three D. All

QUESTION #2

What classification of Jasmine for the diarrhea? A. B. C. D. Severe Dehydration Some dehydration No dehydration None of the above

QUESTION #3
Given the classification identified above, what will the health worker do? A. Give fluid as in plan C B. Give fluid and food as in plan B

C. Treat the diarrhea at home as in plan A

D. Refer the child urgently

SITUATION
Sally, a 3 year old 10 kg child.They came in for check up of her ear problem.The mother said she is sure,Sally has ear pain.The mother said that there was on and off ear discharges for about a year.When the health worker felt for Sallys ear,there was tender swelling behind it.

QUESTION #1

What would be the best classification for Sally? A. B. C. D. Mastoiditis Acute Ear Infection Chronic Ear Infection No Ear Infection

QUESTION #4
What is the classification of a child with diarrhea who has one sign in the pink row and one sign in the yellow row? A. Severe Dehydration B. Some Dehydration C. No Dehydration D. All of the above

QUESTION #2
What would be the management of the above classification?
A. Give first dose of an appropriate antibiotic, paracetamol for pain and refer urgently B. Antibiotic, treat at home

C. No treatment
D. All of the above

SITUATION
Sally has been assessed for MALNUTRITION AND ANEMIA, the health worker noticed that Sally has severe palmar pallor and baggy pants.

QUESTION #1

What would be the classification of Sally for malnutrition?

A. Severe malnutrition or sever anemia B. Anemia or very low weight C. No anemia and not very low weight

QUESTION #2
Given the classification above,what would be the nurse action?

A. Give Vitamin A then refer

B. Give Vitamin A then counsel

C. Advise according to foodbox

SITUATION
Sashie is 5 weeks old .Her weight is 4 kg. Her axillary temperature is 37 C .Her mother brought her to the clinic because she has rashes. The nurse assesses Sashie for signs of possible bacterial infection. Sashies mother says that she has not had convulsions.Breathing is 55 breaths per minute.She has no chest indrawing , no nasal flaring,and no grunting. Her fontanelle is not bulging. There is no pus in her ears ,and her umbilicus is normal. The nurse examines her entire body and finds red rashes with just a few skin pustules on her buttocks.

QUESTION #1

What would be Sashies classification?

A. Pneumonia B. Possible Bacterial Infection C. Local Bacterial Infection D. None of the above

QUESTION #3
A mother is using Oresol in the management of diarrhea of her 3-year old child. She asked you what to do if her child vomits. The nurse would be right if she advised the mother to. A. Bring the child to the nearest hospital for further assessment B. Bring the child to the health centerfor IV therapy

C. Bring the child to the health center for assessment by the physician
D. Let the child rest for 10 minutes then continue giving Oresol more slowly

QUESTION #2
What is the treatment for some skin pustles? A. Gentian Violet B. Oral antibiotic then gentian violet C. Refer urgenty D. All of the above

QUESTION #4
To prevent xerophthalmia, young children are given Retinol capsule every 6 months. What is the dose given to preschoolers supplementation every 6 months?
A. 10,000 I.U. B. 20,000 I.U. C. 100,000 I.U. D. 200,000 I.U.