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IMCI TECHNICAL UPDATES:

Preparedby:

RHEA G. MALLARI RN,MAN

COUGHING

Previous:

Updated:

No assessment for wheezing

Inclusion of wheezing during assessment

 

If wheezing is present:

 

*

Give a trial of rapid acting inhaled

bronchodilator for upto 3x with 15 to 20 minutes interval 0.5ml salbutamol diluted in 2 ml sterile water per dose

*

Bronchodilator for 5 days

 

Antibiotic treatment (pneumonia only)

 

Previous:

Updated:

 

First line: Cotrimoxazole

First line: Amoxicillin

 
 

2x a day for 5 days

 

2x a day for 3 days

Second line:Amoxicillin

Second line: Cotrimoxazole

 

3x a day for 5 days

 

2x a day for 3 days

First line:Chloramphenicol

First line: Gentamicin plus

Second line: Benzylpenicillin and Gentamicin

 

Benzyl penicillin

Second line: Chloramphenicol

DIARRHEA

Use of antibiotics in the management of dysentery

 

Previous:

Updated:

First line: Cotrimoxazole

First line: Ciprofloxacin

 

2x a day for 5 days

2x a day for 3 days

Second line:Nalidixic acid

 

3x a day for 5 days

Diarrheal diseases treatment

 

Previous:

 

Updated:

Persistent diarrhea treatment

Persistent diarrhea treatment:

1.Give vit. A 1 dose only

1.Give multivitamins and minerals with

2.Advise recommended feeding

zinc supplement for 14 days

3.Follow up 5 days

 

2.Advise recommended feeding

 

3.Follow up 5 days

FEVER

Treatment of Malaria:

 

Previous:

Updated:

First line: Sulfadoxine-Pyrimethamine

First line: Artemether-Lumefantrine

 

Chloroquine

Primaquine

Second line:Sulfadoxine-Pyrimethamine

Second line:Artemether-Lumefantrine

Chloroquine

Primaquine

EAR PROBLEM

Treatment of Chronic ear infections:

 

Previous:

Updated:

Chronic ear infection treatment;

Chronic ear infection treatment;

1.Dry the ear by wicking

1.Instill otic drops(quinolone)

2.Follow up 5 days

 

2-3 drops 3x daily for 2 weeks

 

2.Dry the ear by wicking

3.Follow up 5 days

NUTRITIONAL STATUS: Malnutrition And Anemia

 

Previous:

 

Updated:

SEVERE MALNUTRITION: PINK

SEVERE MALNUTRITION: PINK

Visible severe wasting

Visible severe wasting

or

or

Edema on both feet

Edema on both feet

or

If age 6 mos. and above

with

MUAC less than 115 mm

*MUAC(Mid Upper Arm Circumference)

MANAGEMENT OF SICK YOUNG INFANT

 

Previous:

Updated:

Young infant age:

 

Young infant age:

 

1wk old upto 2 months old

At birth upto 2 months old

Any of the ff. 12 signs and symptoms

Any of the ff. 7 signs and symptoms

 

Very Severe Disease

Possible Serious Bacterial Infection

Convulsions

CUA-FFUNCES and

Unable to feed or not feeding well

Low body temperature

Abnormally sleepy or no movement at all

Bulging of Fontannels

F

ever and L ow body temperature

F

ast breathing

Chest Indrawing ( severe)

Classifications:

Classifications:

Possible Serious Bacterial Infection (PINK)

Very Severe Disease (PINK)

Local Bacterial Infection (YELLOW)

Local Bacterial Infection (YELLOW)

Severe Disease or Local Bacterial Infection unlikely (GREEN)

Updated:

Inclusion of jaundice during assessment

ASSESSMENT

CLASSIFICATION

 

TREATMENT

Jaundice appearing less than 24hours

SEVERE JAUNDICE

Keep the infant warm

Or

(PINK)

Treat to prevent low blood sugar

Yellow palms at any age

Refer urgently to hospital

 

JAUNDICE

Advise mother to give home care

(YELLOW)

Jaundice appearing after 24 hours

Breastfeed frequently:

as often, and for as long as the infant wants day and night,

 

during sickness and

 

health

No jaundice

NO JAUNDICE

Advise mother to give home care: Breastfeed frequently

(GREEN)

IMNCI

INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS

Home visits for young infants: Schedule

All newborns:

3 visits :

within 24 hours of birth,

day 3 and

day 7

Newborns with low birth weight:

3 more visits :

day 14,

day 21 and

day 28.

Home visits for young infants:

Objectives:

Promote & support exclusive breastfeeding

Teach the mother how to keep the young infant warm

Teach the mother to recognize signs of illness for which to seek care

Give advise on cord ,skin and eye care and hand washing

Classify illness at visit and facilitate referral

Advise mother to go to the hospital if infant has any of the following:

Jaundice of the soles

Convulsions

Difficulty of feeding

Movementonly when stimulated

Fast breathing

Fever

Low bodytemperature

Chest indrawing

Kangaroo mother care (KMC) is an effective way to care for a small baby weighing

between 1,000 and 2,000 grams who has no major illness

1.Dress the infant in a warm shirt open at the front, with cap, nappy, and socks

2. Place the infant in skin to skin contact

3. Place the infant in upright betweenthe mother’s breasts, with headturned to one side.

4.The baby is then tied to the mother’s chest with a cloth and coveredwith the mother’s clothes.

Research has shown that for preterm babies, KMC is at least as effective

as incubator care.