DESCRIBE THE FOUR MAIN SYMPTOMS OF IMCI

-COUGH OR DIFFULTY BREATHING

When the child presents with difficult breathing by the mother or guardian the nurse must ask
how long it has been (duration), proceed to taking the respiration rate per minute, inspect for
chest indrawing then inspect and auscultate for stridor and wheezes, while advising the child
to remain calm. If wheezes and fast breathing or chest indrawing are present respiration rate
per minute should be repeated with 15-20 minutes apart and look for chest indrawing again
then the nurse should classify the cough. If the child has stridor, it is classified as severe
pneumonia, when there is chest indrawing/fast breathing it is pneumonia and if the child does
not have any signs of pneumonia or very severe disease it can be just cough or cold. In 2
months to 12 months children fast breathing is 50 bpm or more while in 12 months to 5 years
fast breathing is 40 bpm or more.

-DIARRHOEA

If the child presents with diarrhoea the nurse should ask how long, it has been and if there is
any blood in stool noticed. The nurse should proceed into assessing by inspecting and
palpating for turgor and motility by pinching the skin in the abdomen, inspect for any sunken
eyes, level of consciousness and restlessness of the child. Diarrhoea can be classified into
severe dehydration if the child has sunken eyes, is unable to drink or drinks poorly with the
abdomen skin goes back very slowly when pinched and unconscious. And when the child has
sunken eyes, drinks eagerly and the abdomen skin goes back slowly when pinched it can be
some dehydration, and when the child has none of these signs then there is no dehydration.
Diarrhoea can also be classified with duration, if the diarrhoea has been over 14 days or more
it is classified as severe persistent diarrhoea with dehydration/ and it can be persistent
diarrhoea with no dehydration. If blood is present in stool it is classified as dysentery.

-FEVER

Becomes a concern when the temperatures of a child are 37.5℃ or above or the child feels
hot to touch. Firstly, the nurse should determine the risk of malaria (high or low) in that area,
then ask the duration of fever and the patient’s history of measles in the last 3 months. Then
the nurse should proceed by inspecting and palpating for stiff neck, inspect for runny nose
and any signs of measles (rash, cough, runny nose or red eyes). A test for malaria should be
conducted in order to classify the fever. If the child presents stiff neck or any general danger
signs it can be a very severe febrile disease, and if the malaria test is positive then the fever is
caused by malaria and if its negative then it is not caused by malaria. If the child has not
travelled to malaria risk areas or there is no malaria risk and presents with stiff neck, then the
fever is classified as very severe febrile disease. When chid has no stiff neck and no general
danger signs then it is just fever. In cases of measles present or with the past 3 months, then
the nurse must inspect for mouth ulcers, pus drainage from the eyes, it classified as severe
complicated measles if there is clouding of cornea and deep or extensive mouth ulcers
present. If pus drainage from eyes or mouth ulcers are present, then it is measles with eye/
mouth complications. And if there is history with measles within the past 3 months or present
then the fever is classified as measles.

-EAR PROBLEM/INFECTION

When the child comes with ear pain or ear discharge the nurse must ask about the duration of
these, then inspect for pus drainage in the ear and palpate for any swelling behind the ear.
When there is tender swelling behind the ear it is classified as mastoiditis. When the ear pain
and ear drainage has been present for 14 days or less it is classified as acute ear infection if it
has been present for 14 days and more it is then classified as chronic ear infection. In cases of
no ear pain or no ear drainage reported then there is no ear infection.