Laboratory 03: Integrated Management of Childhood Disease (IMCI) - FOCUS ON DISEASES Flashcards
What are the treatment options for cough or difficulty breathing in a sick child?
(A) Soothe the throat, relieve the cough with a safe remedy
(B) Safe remedies to recommend:
1. Breastmilk for exclusively breastfed infants
2. Tamarind, calamansi, ginger
(C) Harmful remedies to discourage:
1. Codeine cough syrup
2. Other cough syrups
3. Oral and nasal decongestants
Explain the assessment process when assessing if the child have a cough or difficulty breathing.
(A) If NO: Proceed to the next symptom.
(B) If YES, ask: For how long?
How do you assess cough or difficulty breathing?
LOOK, LISTEN, FEEL:
(A) Count the breaths in one minute.
(B) Look for chest indrawing.
(C) Look and listen for stridor.
What should you do if the child is fast breathing?
Fast breathing is defined as:
(A) For 2 months to 12 months: 50 breaths/min or more
(B) For 12 months to 5 years: 40 breaths/min or more
How do you classify the child’s illness?
Classify the illness using the color-coded classification table for cough or difficulty breathing.
What are the signs that indicate the need to classify as SEVERE PNEUMONIA or VERY SEVERE DISEASE?
(A) Any general danger sign
(B) Chest indrawing
(C) Stridor in a calm child
What is the treatment for SEVERE PNEUMONIA or VERY SEVERE DISEASE?
(A) First dose of an appropriate antibiotic
(B) Urgent referral to the hospital
What are the signs that indicate PNEUMONIA?
Fast breathing
What is the treatment for PNEUMONIA?
(A) Give an appropriate oral antibiotic for 5 days
(B) Soothe the throat and relieve the cough with a safe remedy
(C) Advise the mother when to return immediately
(D) Follow-up in 2 days
What are the signs that indicate NO PNEUMONIA (COUGH OR COLD)?
No signs of pneumonia or very severe disease
What is the treatment for NO PNEUMONIA (COUGH OR COLD)?
(A) If coughing for more than 30 days, refer for assessment
(B) Soothe the throat and relieve the cough with a safe remedy
(C) Advise the mother when to return immediately
(D) Follow-up in 5 days if not improving
What is the treatment for PNEUMONIA OR VERY SEVERE DISEASE when the child is under ages 6 to 12 months old?
(A) Cotrimoxazole 1/2 tablet (80mg TMP, 400mg SMX) 2x daily for 5 days
(B) Amoxycillin 1/2 teaspoon (125mg/5ml) 3x daily for 5 days
What is the treatment for PNEUMONIA OR VERY SEVERE DISEASE when the child is under ages 12 months old to 5 years old?
(A) Cotrimoxazole 1 tablet (80mg TMP, 400mg SMX) 2x daily for 5 days
(B) Amoxycillin 1 1/2 teaspoons (125mg/5ml) 3x daily for 5 days
What is the Vitamin A supplementation for SEVERE PNEUMONIA or VERY SEVERE DISEASE based on age?
6 to 12 months:
(A) 100,000 IU: 1 capsule
(B) 200,000 IU: 1/2 capsule
12 months to 5 years:
(A) 100,000 IU: 2 capsules
(B) 200,000 IU: 1 capsule
What do you do when the child shows NO symptoms of diarrhea?
(A) Classify the child’s illness using the color-coded classification tables for diarrhea.
(B) Ask about the next main symptoms: fever, ear problems, and check for malnutrition, anemia, immunization status, and other problems.
What do you do when the child shows YES symptoms of diarrhea?
A) Ask:
How long has the child had diarrhea?
Is there blood in the stool?
How do you assess the child’s general condition during diarrhea?
(A) Look for signs such as:
Is the child lethargic or unconscious?
Is the child restless or irritable?
What do you check when assessing the child for signs of dehydration during diarrhea?
(A) Look for sunken eyes.
(B) Offer the child fluids:
Is the child unable to drink or drinking poorly?
Is the child drinking eagerly and thirsty?
(C) Pinch the skin on the abdomen and check if it returns:
Very slowly (longer than 2 seconds)?
Slowly?
What do you do after assessing the child for diarrhea?
(A) Classify the child’s illness using the color-coded classification for diarrhea.
(B) Ask about the next main symptoms: fever, ear problems, and check for malnutrition, anemia, immunization status, and other problems.
How do you classify a child with two of the following signs:
(A) Lethargic or unconscious
(B) Sunken eyes
(C) Not able to drink or drinking poorly
(D) Skin pinch goes back very slowly?
Severe Dehydration (Pink).
What is the treatment for severe dehydration?
(A) If no other severe classification:
Give fluid for severe dehydration (Plan C).
(B) If the child has another severe classification:
Refer urgently to the hospital and give frequent sips of ORS on the way.
How do you classify a child with two of the following signs:
(A) Restless, irritable
(B) Sunken eyes
(C) Drinks eagerly, thirsty
(D) Skin pinch goes back slowly?
Some Dehydration (Yellow)
What is the treatment for some dehydration?
(A) Give fluid, zinc supplements, and food for some dehydration (Plan B).
(B) If the child has another severe classification:
(C) Refer urgently to the hospital with mother giving frequent sips of ORS on the way.
(D) Advise the mother when to return immediately and follow up in 5 days if not improving.
What is the treatment for no dehydration?
(A) Give fluid, zinc supplements, and food to treat diarrhea at home (Plan A).
(B) Advise the mother when to return immediately and follow up in 5 days if not improving.
What do you do if there are not enough signs to classify as severe or some dehydration?
No Dehydration: If there are not enough signs to classify as severe or some dehydration, classify the child as No Dehydration (Green).
What do you do if the child has diarrhea lasting 14 days or more?
Classify the child under Persistent Diarrhea (Yellow)
What is the treatment for persistent diarrhea?
(A) Treat dehydration before referral unless the child has another severe classification.
(B) Give multivitamins and minerals (including zinc) for 14 days.
(C) Follow up in 5 days.
What should you do if blood is found in the stool?
Classify the child under Dysentery: If there is blood in the stool, classify as Dysentery (Yellow).
What is the treatment for dysentry?
(A) Refer to the hospital.
(B) Give ciprofloxacin for 3 days.
(C) Follow up in 3 days.
What do you do if the child has severe persistent diarrhea (pink)?
(A) Treat dehydration before referral unless the child has another severe classification.
(B) Refer to hospital
What should the nurse ask or assess for when the child has suspected measles?
(A) Does the child have a fever? (by history or feels hot or temperature 37.5 C or above)
(B) Travel history to malaria prone places
What if the child has been confirmed that he has measles?
If YES:
Ask:
(A) For how long?
(B) If more than 7 days, has fever been present every day?
(C) Has the child had measles within the last 3 months?
Look and feel:
(A) Look or feel for stiff neck
(B) Look for runny nose
Does the child show signs of measles?
Signs of Measles:
(A) Generalized rash
(B) Cough
(C) Runny nose
(D) Red eyes
If the child has measles now or within the last 3 months, check for:
(A) Mouth ulcers: Are they deep and extensive?
(B) Pus draining from the eye
(C) Clouding of the cornea
How do you classify a child with any general danger sign or a stiff neck?
Very Severe Febrile Disease (Pink)
What is the treatment for Very Severe Febrile Disease?
(A) Give first dose of artesunate or quinine for severe malaria.
(B) Give first dose of an appropriate antibiotic.
(C) Treat the child to prevent low blood sugar.
(D) Give one dose of paracetamol in clinic for high fever (38.5°C or above).
(E) Refer URGENTLY to hospital
How do you classify a child with a positive malaria test?
Malaria (Yellow)
What is the treatment for Malaria?
(A) Give the recommended first-line oral antimalarial.
(B) Give one dose of paracetamol in clinic for high fever (38.5°C or above).
(C) Give appropriate antibiotic treatment for an identified bacterial cause of fever.
(D) Advise the mother when to return immediately.
(E) Follow-up in 3 days if fever persists.
(F) If fever is present every day for more than 7 days, refer for assessment.
How do you classify a child with a negative malaria test but another identified cause of fever?
(A) Fever: No Malaria (Green)
What is the treatment for Fever: No Malaria?
(A) Give one dose of paracetamol in clinic for high fever (38.5°C or above).
(B) Give appropriate antibiotic treatment for an identified bacterial cause of fever.
(C) Advise the mother when to return immediately.
(D) Follow-up in 3 days if fever persists.
(E) If fever is present every day for more than 7 days, refer for assessment.
What is the treatment for Very Severe Febrile Disease?
(A) Give first dose of an appropriate antibiotic.
(B) Treat the child to prevent low blood sugar.
(C) Give one dose of paracetamol in clinic for high fever (38.5°C or above).
(D) Refer URGENTLY to hospital.
How do you classify a child with a very severe febrile disease?
Very Severe Febrile Disease (Pink)
How do you classify a child with no general danger signs and no stiff neck?
Fever (Green)
What is the treatment for Fever?
(A) Give one dose of paracetamol in clinic for high fever (38.5°C or above).
(B) Give appropriate antibiotic treatment for any identified bacterial cause of fever.
(C) Advise the mother when to return immediately.
(D) Follow-up in 2 days if fever persists.
(E) If fever is present every day for more than 7 days, refer for assessment.
How do you classify a child with any general danger sign, clouding of the cornea, or deep and extensive mouth ulcers?
Severe Complicated Measles (Pink)
What is the treatment for Severe Complicated Measles?
(A) Give Vitamin A treatment.
(B) Give first dose of an appropriate antibiotic.
(C) If clouding of the cornea or pus draining from the eye, apply tetracycline eye ointment.
(D) Refer URGENTLY to hospital.
How do you classify a child with measles and pus draining from the eye or mouth ulcers?
Measles with Eye or Mouth Complications (Yellow)
What is the treatment for Measles with Eye or Mouth Complications?
(A) Give Vitamin A treatment.
(B) If pus draining from the eye, treat with tetracycline eye ointment.
(C) If mouth ulcers, treat with gentian violet.
(D) Follow-up in 3 days.
How do you assess a child for an ear problem?
(A) Ask if the child has an ear infection.
(B) Ask if there is ear pain.
(C) Ask if there is ear discharge and for how long.
(D) Look for pus draining from the ear.
(E) Feel for tender swelling behind the ear.
How do you classify a child with tender swelling behind the ear?
Mastoiditis (Pink)
What is the treatment for mastoiditis?
(A) Give the first dose of an appropriate antibiotic.
(B) Give the first dose of paracetamol for pain.
(C) Refer URGENTLY to the hospital.
How do you classify a child with pus draining from the ear for less than 14 days or ear pain?
Acute Ear Infection (Yellow)
What is the treatment for acute ear infection?
(A) Give an antibiotic for 5 days.
(B) Give paracetamol for pain.
(C) Dry the ear by wicking.
(D) Follow-up in 5 days.
. How do you classify a child with pus draining from the ear for 14 days or more?
Chronic Ear Infection (Yellow)
What is the treatment for chronic ear infection?
(A) Dry the ear by wicking.
(B) Treat with topical quinolone eardrops for 14 days.
(C) Follow-up in 5 days.
How do you classify a child with no ear pain and no pus seen draining from the ear?
No Ear Infection (Green)
What physical sign should you look for to assess severe acute malnutrition?
Edema in both feet
What measurements help determine acute malnutrition in children?
(A) Weight-for-Height/Length (WFH/L) z-score
(B) Mid-Upper Arm Circumference (MUAC)
What WFH/L z-score indicates severe acute malnutrition?
Less than -3 z-scores.
What MUAC measurement indicates severe acute malnutrition?
Less than 115 mm.
What should you check if a child has WFH/L < -3 z-scores or MUAC < 115 mm?
(A) Any medical complications
(B) Any general danger signs
(C) Any severe classification
(D) Pneumonia with chest indrawing
What should be done if a child has severe acute malnutrition but no medical complications?
(A) If 6 months or older, offer Ready-to-Use Therapeutic Food (RUTF).
(B) If less than 6 months, assess breastfeeding.
How do you classify a child with oedema of both feet OR WFH/L less than -3 z-scores OR MUAC less than 115 mm AND any one of the following:
(A) Medical complication present
(B) Not able to finish RUTF
(C) Breastfeeding problem?
Complicated Severe Acute Malnutrition (Pink)
What is the management for Complicated Severe Acute Malnutrition?
(A) Give first dose of appropriate antibiotic.
(B) Treat the child to prevent low blood sugar.
(C) Keep the child warm.
(D) Refer URGENTLY to hospital.
How do you classify a child with WFH/L less than -3 z-scores OR MUAC less than 115 mm AND able to finish RUTF?
Uncomplicated Severe Acute Malnutrition (Yellow)
What is the management for Uncomplicated Severe Acute Malnutrition?
(A) Give oral antibiotics for 5 days.
(B) Give Ready-to-Use Therapeutic Food (RUTF) for children aged 6 months or more.
(C) Counsel the mother on feeding the child.
(D) Assess for possible TB infection.
(E) Advise mother when to return immediately.
(F) Follow up in 7 days.
How do you classify a child with WFH/L between -3 and -2 z-scores OR MUAC between 115 and 125 mm?
Moderate Acute Malnutrition (Yellow)
What is the management for Moderate Acute Malnutrition?
(A) Assess the child’s feeding and counsel the mother on feeding recommendations.
(B) If feeding problem is found, follow up in 7 days.
(C) Assess for possible TB infection.
(D) Advise mother when to return immediately.
(E) Follow-up in 30 days.
How do you classify a child with WFH/L -2 z-scores or more OR MUAC 125 mm or more?
No Acute Malnutrition (Green)
What should you do for a child classified as No Acute Malnutrition?
(A) If the child is less than 2 years old, assess feeding and counsel the mother according to feeding recommendations.
(B) If there is a feeding problem, follow up in 7 days.
What does a MUAC measurement of less than 115 mm indicate?
Severe acute malnutrition and threat of death
What does a MUAC measurement between 115 mm and 125 mm indicate?
Moderate acute malnutrition
What does a MUAC measurement of 125 mm or more indicate?
No malnutrition
How should the nurse check for anemia?
(A) Check for palmar pallor? Is it some pallor or severe pallor?
(B) Assess for sickle cells anemia if common in their area.
(C) If the child has severe acute malnutrition and is receiving RUTF, do not give IRON.
What does severe palmar pallor indicate?
Severe Anemia (Pink Classification)
What is the management for Severe Anemia?
Refer Urgently to Hospital
What does some pallor indicate?
Anemia (Yellow Classification)
What is the management for Anemia?
(A) Give iron supplements.
(B) Give mebendazole if the child is 1 year or older and has not received a dose in the past 6 months.
(C) Advise the mother when to return immediately.
(D) Follow-up in 14 days.
What does no palmar pallor indicate?
No Anemia (Green Classification)
What is the management for No Anemia?
(A) If the child is less than 2 years old, assess feeding and counsel the mother on proper nutrition.
(B) If feeding problems are present, follow up in 5 days.
