DAVAO DOCTORS COLLEGE

General Malvar St. Davao City

NURSING PROGRAM

FOLLOW-UP CARE FOR CONFIRMED HIV INFECTION ON ART: SIX STEPS

NAME OF STUDENT: ________________________ DATE: ___________
YR./SEC.: ___________ GRP No.: ______ RATING: _________

Date:
Child's Name: Age: Sex: Ht.____cm. Weight:_____Kg. Temp ________° C
Address: ____________________________________________________________________________________
Encircle findings

STEP 1: ASSESS AND CLASSIFY RECORD

ACTIONS
ASK: does the child have any problems? If yes, record here: _________________________ TAKEN:
ASK: has the child received care at another YES___ NO___
health facility since the last visit?
• Check for general danger signs:
® NOT AVAILABLE TO DRINK OR BREASTFEED
® VOMITS EVERYTHING If general danger signs or ART severe side effects,
® CONVULSIONS provide pre-referral treatment and REFER URGENTLY
® LETHARGIC OR UNCONSCIOUS
® CONVULSING NOW
• Check for ART severe side effects:
® severe skin rash
® Yellow eyes
® Difficulty breathing and severe abdominal pain Assess, classify, treat, and follow-up main symptoms
® Fever, vimitting, rash (only if on Abacavir) according to IMCI guidelines. Refer if necessary.
• Check for main symptoms:
® Cough or difficulty breathing
® Diarrhea
® Fever
® Ear problem
® Other problem

STEP 2: MONITOR ARV TREATMENT RECORD

ACTIONS
Assess adherance: 1. REFER NON-URGENTLY IF ANY OF THE FOLLOWING TAKEN:
• Take all doses - Frequently misses doses - ARE PRESENT:
Occasionally misses a dose - • Not gaining weight for 3 months
Not taking medication • Loss of milestones
• Assess side-effects • Poor adherence counselling
Nausea - Tingling, numb, or painful hands, feet • Significant side-effects despite appropriate management
Legs - Sleep disturbances- • higher clinical stage than before
Diarrhea - dizziness - Abnormal distribution • CD4 count significantly lower than before
of fat - Rash - Other • LDL higher than 3.2 mmol/L
• Assess clinical condition: • Triglycerides (TGs) higher than 5.6 mmol/L
Progressed to higher stage 2. MANAGE MILD SIDE-EFFECTS
Stage when ART initiated: 1 - 2 - 3 - 4 - Unknown 3. SEND TESTS THAT ARE DUE
•Monitor blood results: Tests should be sent • CD4 count
after 6 months on ARVs, then yearly. Record • Viral load, if available
latest results here: • LDL cholesterol and triglycerides
DATE: _____ CD4 COUNT: _________CELLS/,,3 OTHERWISE, GO TO STEP 3
CD4%: __________
Viral load: _________
If on LPV/r: LDL Cholesterol: ___________
TGs: ____________

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STEP 3: PROVIDE ART AND OTHER MEDICATION
ABC+3TC+LPV/r RECORD ART DOSAGE
ABC+3TC+EFV 1. ____________________________________________________
Cotrimoxazole 2. ____________________________________________________
Vitamin A 3. ____________________________________________________
Other medication • COTRIMOXAZOLE DOSAGE: _____________________________
• VITAMIN A DOSAGE: ___________________________________
• OTHER MEDICATION DOSAGE:
1. ____________________________________________________
2. ____________________________________________________
3. ____________________________________________________

STEP 4: COUNSEL DATE OF

NEXT VISIT:
Use every visit to educate the caregiver and provide RECORD ISSUES DISCUSSED:
support, key issued include:
How is child progressing - adherence - support to
caregiver - Disclosure (to others & child) - side-
effects and correct management

TREAT
Remember to refer any child who has danger sign and no other severe classification

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DATE: ___________
RATING: _________

Temp ________° C

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 DAVAO DOCTORS COLLEGE
General Malvar St. Davao City

NURSING PROGRAM

ART INITIATION RECORDING FORM

NAME OF STUDENT: ________________________ DATE: ___________

YR./SEC.: ___________ GRP No.: ______ RATING: _________

FOLLOW THESE STEPS TO INITIATE ART IF CHILD DOES NOT NEED URGENT REFERAL
Date:
Child's Name: Age: Sex: Ht.____cm. Weight:_____Kg. Temp ________° C
Address: ____________________________________________________________________________________
ASSESS: (Encircle all signs present)

STEP 1: CONFIRM HIV INFECTION YES___ NO___

• Child under 18 months: Virological test positive • Send tests that ere required
Check that child has not breastfed for at least 6 weeks • Send confirmation test
• Child 18 months and over: serological test positive
Second serological test If HIV infection confirmed, and child is in stable
positive condition, GO TO STEP 2
Check that child has not breastfed for at least 6 weeks

STEP 2: CAREGIVER ABLE TO GIVE ART YES___ NO___

• Caregiver available and willing to give medication If yes: GO TO STEP 3.
• Caregiver has disclosed to another adult, or is If no: COUNSEL AND SUPPORT THE CAREGIVER
part of a support group

STEP 3: DECIDE IF ART CAN BE INITIATED AT FIRST LEVEL YES___ NO___

• Weight under 3 kg. If any present: REFER

• Child has TB If none present: GO TO STEP 4

STEP 4: RECORD BASELINE INFORMATION

• Weight: ______kg • Send tests that are required and GO TO STEP 5
• Height/length ______cm.
• Feeding Problem
• WHO clinical stage today: _______
• CD4 count: ____cells/mm2
• VL (if available): ____
• Hb: _____ g/dl

STEP 5: START ART AND COTRIMOXAZOLE PROPHYLAXIS

• Less than 3 years: initiate ABC +3TC+LPV/r, or RECORD ARV & DOSAGES HERE:
other recommended first-line regimen 1
• 3 years and older: initiateABC+3TC+EFV, or 2
other recommended first-line 3

NEXT FOLLOW-UP
PROVIDE FOLLOW-UP CARE • Follow-up according to national guidelines DATE: ___________

YES___ NO___

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TREAT
Remember to refer any child who has danger sign and no other severe classification

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DATE: ___________
RATING: _________

Temp ________° C

YES___ NO___

YES___ NO___

YES___ NO___

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MANAGEMENT OF THE SICK CHILD AGED 2 MONTHS UP TO 5 YEARS
Date:
Child's Name: Age: Sex:
Address: ____________________________________________________________________________________
ASK: What are the child's problems?
ASSESS: (Encircle all signs present)
CHECK FOR GENERAL DANGER SIGNS
NOT AVAILABLE TO DRINK OR BREASTFEED
VOMITS EVERYTHING
CONVULSION (during the present illness)
DOES CHILD HAVE COUGH OR DIFFICULT BREATHING?
• For how long? days
DOES THE CHILD HAVE DIARRHEA?
• For how long? ________Days
• Is there blood in the stools?
DOES THE CHILD HAVE FEVER? (by history/feels hot/temperature 37.5 °C or above)
Decide malaria risk.
• Does the child live in a malaria area?
• Has the child visited or stayed overnight in
a malaria area in the past 4 weeks?
If malaria risk, obtain blood smear
(+) (PT) (Pv) (-) (not done)
• For how long has the child have fever? ____days
• If more than 7 days, has the fever been
present every day?
• Has the child had measles within the past 3 months?
If the child has measles now or
within 3 months.
DOES THE CHILD HAVE AN EAR PROBLEM?
• Is there ear pain?
• Is there ear discharge?
If yea, for how long? ___days
ASSESS DENGUE HEMORRHAGIC FEVER
ASK:
• Has the child had any bleeding from the nose
or gums or in the vomitus or stools?
• Has the child had black vomitus pr black stools?
• Has the child had persistent abdominal pain?
• Has the child had persistent vomitting?
DAVAO DOCTORS COLLEGE
General Malvar St. Davao City
NURSING PROGRAM
Ht.____cm. Weight:_____Kg. Temp ________° C
Initial visit: Follow-up visit:
CLASSIFY
General Danger Signs
ABNORMALLY SLEEPY OR DIFFICULT TO AWAKEN Present?
YES___ NO___
YES___ NO___
• Count the breaths in one minute.
breaths per minute. Fast breathing?
• Look for chest indrawing.
• Look & listen for stridor.
• Look & listen for wheeze
YES___ NO___
• Look at the child's general condition. Is the child:
Abnormally sleepy or difficult to awaken?
Lethargic or unconscious?
Restless or irritable?
• Look for sunken eyes.
• Offer the child fluid. Is the child:
Not able to drink or drinking poorly?
Drinking eagerly, thirsty?
• Pinch the skin of the abdomen. Does it go back:
Very slowly (longer than 2 seconds)?
Slowly?
YES___ NO___
LOOK and FEEL:
• Look or feel for stiff neck
• Look for runny nose.
Look for signs of MEASLES.
• Generalized rash and
• One of these: cough, runny nose or red eyes
• Look for any other cause of fever.
• Look for mouth ulcers. If yes, are they deep and extensive?
• Look for pus draining from eyes.
• Look for clouding of the cornea.
• Look for pus draining from the ear YES___ NO___
•Feel for tender swelling behind the ear
LOOK and FEEL: YES___ NO___
• Look for bleeding from the nose or gums.
• Look for skin petechiae.
• Feel for cold & clammy extremities.
• Check capillary refill. ______seconds
• Perform tourniquet test if child is 6 months or older AND
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 has no other signs AND has fever for more than 3 days.

THEN CHECK FOR ACUTE MALNUTRITION

AND ANEMIA • Determine WFH/L z-score:
® Less than -3? Between -3 and -2? -2 or more?
• Look for visible severe wasting.
• Child 6 months or older measure MUAC ______ mm.
• Look for edema of both feet.
• Look for palmar pallor.
Severe palmar pallor? Some palmar pallor?

If child has MUAC less than 115 mm of
wfh/l less than -3 z-scores:
• Is there any medical complication: General danger sign?
Any severe classification? Pnueumonia with chest indrawing?
• Child 6 months or older. Offer RUTF to eat. Is the child:
® Not able to finish? Able to finish?
• Child less than 6 months: Is there a breastfeeding problem?

CHECK FOR HIV INFECTION

• Note mother's and/or child's HIV status:
® Mother's HIV test: NEGATIVE POSITIVE NOT DONE/KNOWN
® Child's virological test: NEGATIVE POSITIVE NOT DONE
® Child's serological test: NEGATIVE POSITIVE
• If mother is HIV positive and No positive virological test in young infant:
® Is the infant breastfeeding now?
® Was yhe infant breastfeeding at the time of test or 6 weeks before it?
® If breastfeeding: is the mother and infant on ARV prophylaxis?

CHECK THE CHILD'S IMMUNIZATION? Encircle immunizations needed today. Return for next
immunization on
BCG HEP B1
DPT1 OPV 1 HEP B2 Hib 1 ___________
DPT2 OPV 2 Hib 2 MEASLES MMR (date)
DPT3 OPV 3 HEP B3 Hib 3

CHECK THE VITAMIN A SUPPLEMENTATION STATUS for children 6 months or older

Is the child six months of age or older? Yes_____ No_______ Vitamin A needed today
YES___ NO___
Has the child received Vitamin A in the past 6 months< Yes_____ No_______
CHECK FOR DEWORMING STATUS for children 12 months or older Albendazole/
Mebendazole needed today
Is the child 12 months of age or older? Yes_____ No_______
Has the child receivedalbendazole for the past 6 months? Yes_____ No_______ YES___ NO___

ASSESS CHILD'S FEEDING If child has ANEMIA OR VERY LOW WEIGHT or is less than 2 years old.
• Do you breastfeed your child? Yes_____ No_______ Feeding Problems
If yeas, how many times in 24 hours? ______times. Do you brestfeed during the night? Yes_____ No_______
• Does the child take any other food or fluids? Yes_____ No_______
If yes, what food or fluids? _____________________________________________________________________________
How many times per day? ______times. What do you use to feed the child?
If very low weight for age, how large are the servings?
Does the child receive his/her own serving? ______ Who feeds the child and how?
• During the illness, has the child's feeding changes? Yes_____ No_______
If yes, How?

ASSESS CARE FOR DEVELOPMENT:

Ask questions about how the mother cares for the child. Compare the mother's annswers to the recommendations Care for Development
for the child's age. Problems
• How do you play with your child?
• How do you communicate with your child?

ASSESS OTHER PROBLEMS: Ask about mother's own health

NAME OF STUDENT: ________________________ DATE: ___________

YR./SEC.: ___________ GRP No.: ______ RATING: _________
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TREAT

Return for follow-up in:

Advise mother when to return immediately:
Give any immunizations today:
Give Vitamin A if needed today:
Give Albendazole/Mebendazole if needed today:

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 Care for Development Advice:

dts/BBN/01.08.20

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Temp ________° C

YES___ NO___

YES___ NO___

YES___ NO___

YES___ NO___

YES___ NO___

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 DAVAO DOCTORS COLLEGE
General Malvar St. Davao City

MANAGEMENT OF THE SICK YOUNG INFANT FROM BIRTH UP TO 2 MONTHS
Date:
Child's Name:
Address:
ASK: What are the child's problems?
ASSESS: (Encircle all signs present)
CHECK FOR VERY SEVERE DISEASE AND LOCAL BACTERIAL INFECTION
• Is the infant having difficulty in feeding?
• Has the infant had convulsions? (fits)
(during the present illness)
NURSING PROGRAM
Age: Sex: Ht. ____cm. Weight:_______Kg. Temp:_____° C
_____________________ Initial visit: Follow-up visit: _____________
CLASSIFY
classify all young
• Count the breaths in one minute. ______breaths per minute. infants
Repeat if 60 breaths or more. ____ Fast breathing?
• Look for severe chest indrawing.
• Fever (temp. 37.5°C or feels hot)
• Look and listen for grunting
• Low body temperature (below 35.5°C)
• Look at the umbilicus. Is it red or draining pus?
• Look for skin pustules. Are they many or severe pustules?
• Look at the young infant's movements. Does the infant move
on his/her own? Less than normal?
Does the infant move only when stimulated?
Does the infant not move at all?

THEN CHECK FOR JAUNDICE

• If jaundice present, when did jaundice first • Look for jaundice (yellow eyes or skin)
appear? • Look at the young infant's palms and soles.
Are they yellow?

DOES THE YOUNG INFANT HAVE DIARRHEA? YES___ NO___

• For how long? ___ days • Look at the young infant's general condition.
• Is there blood in the stool? Does the infant move only when stimulated?
Does the infant not move at all?
Is the infant restless or irritable?
• Look for sunken eyes.
• Pinch the skin of the abdomen. Does it go back:
very slowly (longer than 2 seconds)?
Slowly?

THEN CHECK FOR FEEDING PROBLEM OR LOW WEIGHT FOR AGE

If the infant has no indication to refer urgently to hospital
• Is there any difficulty in feeding? YES ____ NO ____ • Determine weight for age.
• Is the infant breastfed? YES ____ NO ____ LOW________ NOT LOW _________
If yes, how many times in 24 hours? _______times
• Look for ulcers or white patches in the
mouth (thrush).
• Does the infant usually receive any other
foods or drinks? YES ____ NO _____
If yes, how often? _______________________________
• What do you use to feed the child? ________________

CHECK FOR HIV INFECTION

• Note mother's and/or child's HIV status:
® Mother's HIV test: NEGATIVE POSITIVE NOT DONE/KNOWN
® Child's virological test: NEGATIVE POSITIVE NOT DONE
® Child's serological test: NEGATIVE POSITIVE
• If mother is HIV positive and No positive virological test in young infant:
® Is the infant breastfeeding now?
® Was yhe infant breastfeeding at the time of test or 6 weeks before it?
® If breastfeeding: is the mother and infant on ARV prophylaxis?

NAME OF STUDENT: ________________________ DATE: ___________

YR./SEC.: ___________ GRP No.: ______
dts/BBN/01.08.20 RATING: _________ 15
 NAME OF STUDENT: ________________________ DATE: ___________
YR./SEC.: ___________ GRP No.: ______ RATING: _________

If the infant has any difficulty feeding, is feeding less than 8 hours in 24 hours, is taking any other food or drinks,
or ia low weight for age AND has no indications to refer urgently to hospital:

ASSESS BREASTFEEDING If the infant has not fed in the previous hour, ask the mother
Has the infant breastfed in the previous hour? to put her infant to the breast. Observe the breastfeed for
4 minutes.

• Is the infant able to attach? To check attachment, look for:

→ Chin touching breast. YES___ NO___
→ Mouth wide open YES___ NO___
→ Lower lip turned outward YES___ NO___
→ More areola visible above than below YES___ NO___
the mouth

Not well attached Good attachment

• Is the infant sucking effectively (that is, how deep sucks,
sometimes pausing)?

Not sucking effectively Sucking effectively

ASSESS CARE FOR DEVELOPMENT

Care for development
Ask questions about how the mother cares for her child. Compare the mother's answer to the recommendations for problems
care for Development for the child's age.
• How do you play with your child? _______________________________________________________________________
• How do you communicate with your child? ______________________________________________________________

CHECK THE YOUNG INFANT'S IMMUNIZATION STATUS (Circle immunizations needed today)
Return for next
BCG HEP B1 immunization on:

OPV 1 DPT 1 HEP B2 Hib1 (date)

ASSESS OTHER PROBLEMS: Ask about mother's own health

TREAT

Return for follow-up in:

Advise mother when to return immediately:
Give any immunizations today:
Give Vitamin A if needed today:
Give Albendazole/Mebendazole if needed today:

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 Care for Development Advice:

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 _____° C

_____________

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