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CARIDAD C. LINTAO , RN.

, MAN
School of Nursing
Emilio Aguinaldo College – Cavite
Integrated Management and
Childhood Illnesses
WHO in collaboration with UNICEF develop a
strategy to address aspect of ;
 Nutrition

 Immunization

 Disease prevention

 Health promotion

Objective ; to reduce death, severity of illness


and improved growth & development
Three Components of the IMCI

1. Upgrading the case management and


counseling skills of health care provider.
2. Strengthening the health system for
effective management of childhood illness.
3. Improving family and community practices
related to child health and nutrition.
COLOR CODE TRIAGE SYSTEM

PINK = urgent pre – referral treatment & referral

YELLO W = specific medical treatment

GREEN = home management


Elements of IMCI Case Management Process

1. ASSESS
2. CLASSIFY
3. IDENTIFY
4. TREATMENT
5. COUNSEL
6. GIVE FOLLOW UP CARE
Assess Cough or Difficulty of Breathing

 Fast breathing
 Chest indrawning
 Stridor
 Swollen larynx, trachea or epiglottis
Elements of IMCI Case Management Process
Assess Diarrhea

 Blood in the stool


 How long did the child defecate and how many times
in a day?
 Look for the signs of dehydration
 Abnormally sleepy or difficulty to awake
 Restless or irritable
 Sunken eyes
 If the child can able to drink
 Skin turgor
Guidelines based on the
Principles of Integrated Care

1. Assess the major symptoms


 aged 2 mos. 5 year old = cough, DOB, diarrhea,
fever
 Aged 1 week to 2 mos. = bacterial infection, diarrhea
2. Selected clinical signs used
3. Classified color code
4. Address most but not all
5. Used limited number of essential drugs and
encourage active participation of caretakers in
treatment
6. Counseling of care takers about care management
The Integrated case Management Process

Out Patient facility


1. Check for Danger Signs
= Convulsion, Lethargy/ unconsciousness, inability to drink/ breastfeed, vomit
2. Assess Main Symptoms
= cough/ DOB. Diarrhea, Fever, Ear Problem
3. Assess nutrition and immunization
4. Check for other problems
5. Classify condition and identify treatment actions according to color coded triage
PINK YELLOW GREEN
OUT patient Treat local infection Counsel caretaker
Referral treatment Home mgt.
Complications of Measles

Diarrhea
Pneumonia
Mouth ulcer
Ear infection
Severe eye infection
Encephalitis
Check for Malnutrition and Anemia

Severe wasting
Palmar pallor
Edema of both feet
Low weight for age
Contraindication to immunization

 Do not give BCG to a child known to have AIDS


 Do not give DPT to a child who had convulsion
 Do not give DPT to a child with active
neurological disease
When to Return Immediately

Cough and cold


Diarrhea
Fever

Malaria = Quinine/ Primaquine/ Sulfadoxine


Bacterial meningitis, cerebral malaria, corneal rupture
= Vitamin A
Fever = Paracetamol
Diarrhea = ORS
Pus in the Ear = Tetracycline
Deworming = Mebendazole/ albendazole
Four steps to refer the child to the hospital;

1. Parent consent
2. Calm the mother’s fears & help her to resolve problem
3. Write a referral note for the mother
4. Give mother supplies and instructions needed to care
for her child
Referral Note

Urgent Referral to;


Arnel Delos Santos, age 18 months
Referred for ; Severe dehydration
Severe malnutrition
with cough, no fast breathing,
no chest indrawing
Treatment given at Health Center
Vitamin A 200,000 IU
ORS mothers to give sips on the way to the hospital
Irene Carlos, RN
MCI Practitioner
Barangay Malitlit Health Center
Possible reason why some parents don’t
want to go to the hospital:

1. Place people often die, and the mother fear


that her child will die to.
2. No one took care of child once it was
admitted in the hospital .
3. Cannot leave the home.
4. Parents cannot leave the work.
5. Parents does not have money to pay for
transportation , hospital bills, medicines, or
food for them during the hospital stay.
Use Good Communication Skills

ASK QUESTIONS
LISTEN
PRAISE
ADVISE
CHECK understanding

3 BASIC STEPS
GIVE INFORMATION
SHOW EXAMPLES
LET HER PRACTICE
Diarrhea and Dehydration should be treated
using either of the following treatment plan

I. Plan A= treat diarrhea at home


three rules; give extra fluid, continue
feeding and when to return
II. Plan B = treat some dehydration with ORS
III. Plan C = treat severe dehydration quickly
Steps in making ORS

1. WASH YOUR HANDS EITH SOAP AND WATER.


2. POUR ALL THE POWER FROM ONE PACKET
INTO A CLEAN CONTAINER.
3. MEASURE ONE LITER OF CLEAN WATER.
4. MIX WELL UNTIL THE WATER IS COMPLETELY
DISSOLVED.
5. EXPLAIN TO THE MOTHER THAT SHE SHOULD
MIX FRESH ORS EACH DAY, KEEP THE
CONTAINER COVERED.
Give ORS after each loose stool

Up to 2 years = 50 to 100 ml
2 years or older = 100 to 200 ml

Breastfeed nutrient contains;


Protein, fat, lactose, Vitamins A and C, iron,
fatty acids for growing brain, eyes, and blood
vessels
Counsel the mother about her own health

Provide care for her


When she has a breast problem
Advise her to eat well for her own strength and health
Advise the mother about immunization status
Care for Child Development
Rouena S. Villarama,(2007) , Integrated Managemnt
of Childhood Illness Condensed Module, C&E
Publishing.

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