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Imci Summary Toprank by Jade
Imci Summary Toprank by Jade
N
Integrated Management of Childhood Illness
Objectives:
1. Reduced death and frequency of severity of illness
2. And disability.
3. Improved growth and development.
Components:
1. Improving case mgt skills of health workers.
2. Overall health systems.
3. Family & Community health practices.
3. Refer
Explain the need for referral, to agree
Calm fears
Write referral note for mom to take the child in hospital
Give mother instructions/supplies needed.
1. Any General danger signs 1. Severe pneumonia 1. Give the first dose of antibiotic
2. Stridor in a calm child 2. Very severe pneumonia ampicillin or gentamicin.
2. Refer Urgently to hospital
Practice:
1. Any danger signs -
2. Stridor in calm child -
3. RR of child 12 mos to 5 years -
4. Yellow classification -
5. Green classification -
6. Antibiotic for pneumonia -
TOP RANK REVIEWER SUMMARY BY RESURRECCION, CRYSTAL JADE R.N
7. Antibiotic for severe pneumonia -
8. Fast breathing -
9. Refer urgently to hospital -
Two of the following signs: Severe dehydration ● Give fluid for severe DHN
PLAN C or
● Lethargic or unconscious ● If a child has Severe
● Sunken eyes classification.
● Not able to drink or drinking Refer urgently to the
poorly. hospital with mother
● Skin pinch goes back very giving frequent ors otw
slowly. Advise mother continue
BF
● If a child is 2 years old and
there’s cholera in your area,
give antibiotics for cholera.
Two of the following signs: Some dehydration ● Give fluid, Zinc supplements
and food for some DHN PLAN
● Restless, Irritable B
● Sunken eyes ● If a child also has a severe
● Drinks Eagerly, Thirsty classification
● Skin pinch goes back slowly. Refer and give him ORS on
the way.
Continue breastfeeding.
● Follow up in 5 days if not
improving.
Practice:
10. Some dehydration -
11. No dehydration -
12. Unconscious -
13. Plan C -
14. Drinks eagerly -
15. Sunken eyes -
16. Skin pinch goes back slowly -
17. Skin pinch goes back very slowly -
18. Plan A -
19. Not enough signs -
20. Pink classification -
21. restless/irritable -
22. Refer -
TOP RANK REVIEWER SUMMARY BY RESURRECCION, CRYSTAL JADE R.N
If Diarrhea 14 days or more
● Any danger signs - Very severe Febrile Disease ● Treat dehydration before
convulsions, vomits, lethargy referral unless the child has
or unable to eat. another classification.
● Stiff neck ● Refer to the hospital
COMMUNICABLE DISEASE
- Caused by infectious agents whether bacteria /virus spread from person to person.
“All contagious diseases are infectious but not all infectious are contagious”
CHAIN OF INFECTION
Mode of transmission:
Communicable Diseases
DIPHTHERIA
● Pathognomonic sign: Pseudomembrane (A thick, gray membrane covering the throat and tonsils.)
● Laryngeal Diphtheria
Ex: Gradually increasing hoarseness, cough, stridor
● Nasal Diphtheria
Ex: Clear nasal discharge but every becomes blood stained
Cutaneous Diphtheria
Skin ulcers commonly in the legs.
Diagnostic test:
● Nose/throat swab
● Moloney’s test – a test for hypersensitivity to diphtheria toxin
● Schick’s test – determines susceptibility to bacteria
Interventions:
1. Isolate the child until two negative nose and throat culture are negative (24 hours apart)
2. Bed rest is necessary (except for nasal diphtheria)
3. Oral hygiene (warm mouth wash, NEVER TOOTHBRUSH)
Prevention:
● Active immunization: DPT immunization
● Passive immunization: Anti-toxin
Three stages:
1. Catarrheal or Prodromal stage:
● 7-14 days
● Mild fever, headache, colds
● Persistent cough
2. Paroxysmal stage (Spasmodic or whooping stage)
● 14-28 days
● Paroxysmal cough (Several sharp coughs in one expiration, followed by deep inspiration, which
● may be accompanied by. Whoop)
● Cough is worse at night
● Anorexia
3. Convalescent stage:
● Lasts 21 days
● Less cough and vomiting
Diagnostic Test:
Bordet-gengou agar test - is an enriched, casein peptone medium with potato infusion and glycerol to
supply the nutrients necessary to support the growth of B. pertussis. Defibrinated sheep blood supplies
additional nutrients and enables the detection of hemolytic reactions, which aid in the identification of B.
Management:
● Drug of choice: Erythromycin or Penicillin 20,000 - 100,000units
● Isolation and complete bed rest
● For paroxysmal stage: Avoid dust pollutants, oxygenation, calm atmosphere
● Watch out for airway obstructions
Prevention:
• Active immunization: DPT immunization
• Booster: 2 years and 4-5 years
• Patient should be segregated until after 3 weeks from the appearance of paroxysmal cough
• Passive immunization: Gamma globulin IgG No toxins
TETANUS “Lockjaw”
● Etiologic agent: Clostridium tetani – anaerobic spore-forming heat- resistant and lives in soil or intestine
Neonate: umbilical cord
Children: dental caries
Adult: puncture wound; after septic abortion
● Mode of transmission: Indirect contact – inanimate objects, soil, street dust, animal and human feces,
puncture wound
● Incubation Period: Varies from 3 days to 1 month, falling between 7– 14 days
● Signs and symptoms
● Convulsion is the first warning symptom among children
● Restlessness and irritability
TOP RANK REVIEWER SUMMARY BY RESURRECCION, CRYSTAL JADE R.N
● Muscular stiffness progresses
● Trismus : Tight jaw, inability to open mouth
● Stiff arm and legs, then whole body
● Resus sardonicus: Facial muscle spasm
● Opisthotonus: Backward arching of the back as a result of dominance of extensor muscles of the
spine, head draws back.
No specific test, only a history of puncture wound
Treatment:
● Antitoxin anti tetanus serum (ATS)
● Tetanus immunoglobulin (TIG) (if the patient has allergy, should be administered in fractional doses)
● Antibiotics (Penicillin G)
● Diazepam – for muscle spasms
Prevention:
● Active immunization: DPT immunization
● Tetanus toxoid (artificial active) immunization among pregnant women
● Passive immunization: Tetanus immuno-globulin or antitoxin
Coryza
Common colds and occur before rash appearance
Fever (Highest just before the appearance of the rash)
Barking cough
Conjunctivitis and photophobia; Enlarged posterior cervical lymph nodes
Koplik’s spots: Appear on day before rash. Whitish spots with reddish base on the
inside of the mouth
Rash: Appears on 2nd to 5th day and remain about a week
Appears first on the face, behind the ears, on the neck, forehead or cheeks then spread downwards over the
rest of the body (Trunk, arms, legs)
Itchy rash
Prevention:
• Active immunization: Live attenuated vaccine
• Passive immunization: Newborn through the mothers; Gamma globulin
• Disinfection of soiled articles Isolation of cased from diagnosis until about 5-7 days
after onset of rash
MUMPS
● Etiology: Paramyxovirus
● Incubation Period: 14-21 days
● Communicability Period: One to six days before the first symptoms appears until swelling disappears
● Mode of transmission: Droplet; Direct or indirect contact
Prodromal Phase:
● Coryza
● Low grade fever
● Vomiting, headache, malaise
TOP RANK REVIEWER SUMMARY BY RESURRECCION, CRYSTAL JADE R.N
Acute Phase:
● Pain in or behind ears; Pain on swallowing or chewing
● Swelling and pain in glands (unilateral or bilateral)
● Orchitis and mastitis may occur
Complication: Sterility
Management:
● Symptomatic treatment
● Isolation and bed rest until swelling disappears
● Encourage fluids and soft foods
● Apply hot or cold compress for swelling.
● Orchitis: Support scrotum, use cold compress for 20 minutes.
Prevention:
● Active immunization: Live attenuated vaccine
● Passive immunization: Gamma-globulin
CHICKEN POX
Prodromal stage:
● Mild fever, anorexia, headache
Acute Phase:
Vesiculo-pustular rashes
● Centrifugal appearance of rashes – rashes which begin on the trunk and spread peripherally and
more abundant on covered body parts
Pruritus
Prodromal stage:
● Mild fever (Disappears when rash appear)
● Malaise, headache, anorexia
● Runny nose, sore throat
● Forscheimer spots – red pinpoint patches on the oral cavity
● Faint maculopapular rashes. Small pinpoint pink or pale red macules which fades on pressure.
● Enlargement of posterior cervical and postauricular lymph nodes
Diagnostic Test: Rubella Titer (Normal value is 1:10); below 1:10 indicates susceptibility to Rubella.
● Instruct the mother to avoid pregnancy for three months after receiving the MMR vaccine.
● MMR is given at 15 months of age and is given intramuscularly.
Prevention:
● MMR vaccine (live attenuated virus) - Derived from chick embryo
● Contraindication: Allergy to eggs