Integrated Management Of Childhood Illnesses

I.

Every year almost

INTRODUCTION

million of children under the age of five in developing

countries die from readily preventable and treatable illness such as diarrheal dehydration, acute respiratory infection, measles and malaria. Parents seek help care for their sick children, taking them to the hospitals, health centers, pharmacist, doctors or even traditional healers. Survey reveals that many sick children are not properly assessed and treated by these health care providers, and that their parents are poorly advised.

Primarily health care staffs are trained to identify children who have these illnesses. Sick children are assessed according to their signs and symptoms. The treatment is given if necessary and the caregiver and parents is counselled and is advised on the follow-up of the patient. Severely ill patients are urgently referred to the hospital, while moderately ill children get specific treatment at primary health care level and at home and those are mildly are given supportive measures, therapy and counselling.

Integrated Management of Childhood Illnesses or IMCI is currently regarded as the most efficient strategy for the burden of disease and disability among the population in this age group. This main goal is to contribute to healthy growth and development during the first years of life.

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IMCI has important objectives; one is to reduce infant mortality, second for reducing the incidence and seriousness of illnesses and health problems that affect boys and girls.

With regards to improve the performance of health workers, IMCI offers a number of practical tools, including modules foe the evaluation, classification and treatment of children; Guides for health care workers to provide support in effective IMCI application, training materials on how to improve communications with the parents during their child’s evaluation, diagnosis, treatment, and telling them how to deal with problems and promoting practices for healthy growth and development.

This will also benefit us to further expand our knowledge and practices regarding Integrated Management of Childhood Illnesses. IMCI helps to improve the overall functioning of health services by giving guidelines for evaluating the care provided to children under five in primary health care services and in hospitals, training materials on how to develop local plans for the IMCI implementation, training courses to improve the availability of attention and medications needed for the IMCI application, and guidelines to evaluation of the applying IMCI.

What does IMCI means? IMCI is an integrated approach to child health that focuses on the well being of the whole child. IMCI aims reduce death, illness and disability among children, and to promote and improved growth and development.

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II. SEMINAR OBJECTIVES

General: A five-hour seminar that aims to discuss the pediatric case management process and apply the integrated management of childhood illnesses concept given a specific situation.

Specific: Specifically, the learners will be able to; •

Identify the important elements in IMCI case management such as;  Out-patient Health Facility  Referral Health Facility  Appropriate Home Management

•

Know the Out-patient management of;  Young infants age 1 week up to 2 months.  Children age 2 months up to 5 years.

•

Determine nursing responsibilities on counselling mothers and/or primary health care providers.

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III.

INVOCATION LEAD ME LORD

Lead me Lord, lead me by the hand

Let me stay

And make me face the rising sun

By Your guiding love

Comfort me through all the pain

All through my life

That life may bring

Lead me Lord

There's no other hope

Lead me Lord Even though at times

That I can lean upon

I'd rather go alone my way

Lead me Lord Lead me all my life

Help me take the right direction

Walk by me, walk by me across

Take Your road Lead me Lord

The lonely road that I may face

And never leave my side

Take my arms and let your hadn

All my days

Show me the way

All my life

Show the way to live inside your heart

You are my light

All my days, all my life

You're the lamb upon my feet All the time my Lord

Refrain: You are my light

I need You there

You're the lamb upon my feet

You are my light I (just) cannot live

All the time my Lord

alone

I need You there

Let me stay By Your guiding love

You are my light I (just) cannot live

All through my life

alone

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All through my days Lead me, O Lord Lead me Lord

IV.

OPENING REMARKS

To our guest speaker, Mr. Tim C. Concepcion, our Dean, Prof. Neil G. Cabbo, Ms. Lualhati H. Angel, fourth year coordinator, Ms. Naihla O. Balleta, fourth year section B

adviser and to you my fellow nursing students, good

morning.

Every year, more than 10 million children all over the world die before they reach their fifth birthday. Studies show that 7 out of 10 of these deaths are due to acute respiratory infections, diarrhea, measles, malaria or malnutrition and often to a combination of these conditions. However, the annual number of deaths among children less than five years old has decreased by almost 20% since the 1970’s still; this reduction has not been evenly distributed throughout the world.

Today, many well known prevention and treatment strategies have already proven effective for saving young lives and different interventions have shown great success. These form part on proper management of childhood illnesses which is the topic of our today’s seminar. We strongly believe that integrated approach to managing sick children is needed to achieve better outcome. Our main goal is to educate and enlighten each one of us on managing of childhood illnesses in order for us to contribute to improved growth and development.

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I, Gersie Rose Toribio, the president of fourth year section B together with the whole class welcome all of you to this day’s seminar entitled “ INTEGRATED MANAGEMENT OF CHILHOOD ILLNESSES; Help to save thousand lives.” So sit down and relax while listening, once again, a pleasant morning to each and everyone.

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V.

PRESENTATION OF PARTICIPANTS

Honored resource speaker, Mr. Tim C. Concepcion, energetic Dean of the College of Nursing, Prof. Neil G. Cabbo, Level IV coordinator, Ms. Lualhati H. Angel, Ms. Naihla O. Balleta, fourth year section B – adviser, our clinical instructors, to our guests and fellow students, a pleasant morning to each and everyone.

This seminar, INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES: Help to Save Thousand Lives, is very much grateful to present to you our participants today. May we request each delegate to please stand once your section is called, to be recognized.

Fourth year section A headed by their president, Ms. Jhona Maria Bautista. Fourth year section C headed by their president, Mr. Edver Galecia. Fourth year section D headed by their president, Ms. Raquel Villanueva. Fourth year section E headed by their president, Ms. Jomalyn Lobo. Fourth year section F headed by their president, Mr. Joel dela Cruz. Fourth year section G headed by their president, Ms. Lovely Grace Valdez.

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Fourth year section H headed by their president, Ms. Geralyn Francisco.

VI.

INTRODUCTION OF THE GUEST SPEAKER

A man of honour and achievement need not to have an idiomatic and sophisticated description for a simple word of success describes it all.

Introducing a high calibre figure is indeed of great pride for committing an speaking engagement is an difficult as putting a thread into a needle’s eye.

A consistent dean’s lister with the degree of BSN at the royal and pontifical University of Santo Thomas graduated 2000. Purely academically inclined he then pursued his Masters of Arts in Nursing Major in Adult Health Nursing at the renowned University of the Philippines, Manila, where his basic course degree in Education and Certificate in Test Making and Test Taking Strategy was also earned.

Currently, a university scholar of the same prestigious university, the University of the Philippines, Manila, with his doctorate degree.

Because of this strong educational foundation and back bone he then founded on June 2007 The Saint Thomas Review Centre where he is at the

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same time the president and C.O.O. a highly conceptualized institution then awarded as the “Most Innovative Reviewer” by the Marketing Excellence Award.

Gloriously as it seemed, he was hailed as the Most Outstanding member of the academe of La Consolacion College, Mendiola.

Presently, another feather is added to his lap. He gained a continues education program in Diabetic Nursing from the California Board of Nursing, United State of America.

To add it up he is a CGFNS, IELTS and NCLEX, California, United State of America score.

Ladies and gentlemen, an author, an educator, an inspiration….. A young and vibrant achiever a national figure…

MR. PRIMITIVO “TIM” C. CONCEPCION.

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INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES: “HELP TO SAVE THOUSAND LIVES.”

MR. TIM C. CONCEPCION, PRN, CCN, USRN

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Integrated Management of Childhood Illnesses “Help To Save Thousand Lives.”

Elements of IMCI Case Management Process I - Immediately ask M - Mother (assessment) C - Classify (used color coded triage system) •

Green

•

Yellow

•

Pink

I - Identify appropriate treatment

 Immediately ask the mother Remember: Gloria Macapagal Did not First Enter Malacanang In Victory 1. General danger sign 2. Main symptoms (ask) 3. Diarrhea (ask) 4. Fever (ask) 5. Ear infection (ask) 6. Malnutrition/anemia 7. Immunization

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8. Vitamin A status

1. GENERAL DANGER SIGNS ASK:  Is the child able to drink or breast feed?  Has history of convulsion  Vomits everything LOOK: see if abnormal sleepy or difficult to awaken 4S’s (danger signs) S Seizure Sunken eyeballs Sleepiness Suka (vomit)

2. MAIN SYMPTOMS ASSESS:  cough and cold COUNT:  fast breathing = abnormal Less than 2 months = 60bpm 2 - 11 months = 50bpm 12

1 - 5 years old = 40bpm LOOK:  Chest indrawing - always check if child is CALM STEP:

Lift the shirts Breaths IN Chest goes IN

Remember: 4C’s (main signs) C Cough and cold Count breathing Stridor Chest indrawing

LOOK and LISTEN:  Stridor - inspiration o Calm the patient o Put your ear to the mouth of the client o Harsh noise upon inspiration

3. Classify Green - simple advice on home management Yellow - specific medical treatment advice health care management Pink - seek urgent and referral to hospital 13

4. Identify •

soothe the throat – breast milk (for less than 2 months old) * Tamarind (for less than 2 months old)

•

follow up - advice mother when to return

•

antibiotic therapy 1st line: Co-trimoxazole Dose: 2 months to 11 months – 5ml 1 year old to 5 years old – 10ml 2nd line: Amoxicillin (same dose)

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PNEUMONIA ASK ABOUT THE MAIN SYMPTOMS: Does the child have cough or difficulty in breathing? IF YES,ASK: • For how long has the child had it?

LOOK,LISTEN: • Count the child’s breaths in 1 minute. • Look for indrowning. • Look and listen for stridor. >the child must be calm

Classify cough or difficulty in breathing: • • •

SIGNS Any general danger sign or Chest indrawing or Stridor in a calm child

•

Fast breathing

•

No signs of pneumonia or a very severe disease

CLASSIFY AS SEVERE PNEUMONIA OR VERY SEVERE DISEASE

PNEUMONIA

NO PNEUMONIA: COUGH OR COLD

TREATMENT > Give the first dose of an appropriate antibiotic. > Give Vitamin A. > Treat a child to prevent the lowering of his or her blood sugar level. > Refer the child URGENTLY to the hospital. > Give the child an appropriate antibiotic for 5 days. > Soothe the throat and relieve the cough with a safe remedy. > Advise the mother regarding when to return immediately to the health center. > Follow-up in 2 days. > If coughing has been present for more than 30 days, refer the child to a hospital for assessment. > Soothe the throat and relieve the cough with a safe remedy. > Advise the mother regarding

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when to return immediately to the health center. > Follow-up in 5 days if the child’s condition is not improving. PATHOPHYSIOLOGY For children ages less than 2 months old

PNEUMONIA

>2months old

(+) Fast breathing

No Pneumonia

Green: Home Management (SAFE) S- Soothe the throat A- Advice the mother when to return F- Follow up for 5 days E- Excessive coughing more than 3 days referral again

Cough/ cold

Severe Pneumonia

“4S’s” danger sign

Very Severe Pneumonia

Pink: Hospital (SAFE) S- Send to hospital A- Vit. A given F- First dose antibiotic E- Eliminate hypoglycemia > Give breast milk

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PATHOPHYSIOLOGY For children ages more than 2 months old PNEUMONIA

< 2monthsold

Cough/ cold

No Pneumonia

Green: Home Management (SAFE) S- Soothe the throat A- Advice the mother when to return F- Follow up for 5 days E- Excessive coughing more than 3 days referral again

(+) Fast breathing

(+) Fast breathing (+) Chest indrawing

Pneumonia

Yellow: (SAFE) S- Soothe the throat A- Advice the mother when to return F- Follow up for 2 days E- Engage antibiotic therapy

Danger sign

Very Severe Pneumonia Severe Pneumonia

Pink: (SAFE) S- Soothe the throat A- Advice the mother when to return F- First dose E- Eliminate hypoglycemia

Pink: (SAFE) S- Soothe the throat A- Advice the mother when to return F- First dose E- Eliminate hypoglycemia

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EAR INFECTION ASK: Does the child have an ear infection If yes, ASK: • Is there ear infection? • Is there ear discharge? • If yes, for how long has it been present?

Look and Feel: • Look for pus draining from the ear. • Feel if there is tender swelling behind the ear.

Classify the EAR PROBLEM SIGNS

CLASSIFY AS

•

Tender swelling behind the ear

MASTOIDITIS

•

Pus is seen draining from the ear, and there has been discharge for less than 14 days or Ear pain

ACUTE EAR INFECTION

• •

• •

Pus in seen draining from the ear, and there has been discharge for 14 days or more. No ear pain and No pus is seen draining from the ear

CHRONIC EAR INFECTION

TREATMENT > Give the first dose of an appropriate antibiotic. > Give the first of Paracetamol for pain. > Refer the child URGENTLY to a hospital. > Give an antibiotic for 5 day > Give paracetamol for pain. > Dry the ear by wicking. > Follow up 5 ays.

> Dry the ear by wicking. > Follow up in 5 days.

> No additional treatment needed. NO EAR INFECTION

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PATHOPHYSIOLOGY

EAR INFECTION Ear Pain/ Drainage/ How long

> No ear pain > No drainage > No infection

(+) Ear pain (+) Drainage

(+) swelling of the back (Mastoiditis) Pink

Green < 14 days Acute Ear Infection

> 14 days Chronic Ear Infection

Yellow: > give anti - biotic >

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DIARRHEA ASK: Does the child have diarrhea? If yes, ASK: • For how long has the child had it? • Is there blood in the stool?

Look and Feel: • Look at the child’s general condition. Is the child: - Abnormally sleepy or difficult to awaken? - Restless and 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 to its original state: - Very slow (longer than 2 seconds)? - Slowly?

Signs and Symptoms D rink poorly (Pink) E levated cardiac rate H and pinch goes back slowly (Yellow), very slowly (Pink) Y D rink eagerly (Yellow) R estless A bnormally sleepy T hirsty 20

I rritable O liguria N ote for sunken eyeballs Classify DIARRHEA for DEHYDRATION SIGNS Two or more of the following signs: • Abnormally sleepy or difficult to awaken • Sunken eyes • Not able to drink or drinking poorly • Pinched skin goes back to its original state very slowly Two of the following signs: • Restless, irritable • Sunken eyes • Pinched skin goes back to its original state, very slow

CLASSIFY AS

TREATMENT > (PlanC)If the child has no other severe classification: • Give fluid for severe dehydration If the child has another severe classification: SEVERE • Refer him/her URGENTLY to a DEHYDRATION hospital with the mother giving the child frequent sips of ORS on the way. • Advise the mother to continue breastfeeding the child. > If the child is aged 2 years or older and there is cholera in your area give an antibiotic for cholera. > (PlanB)Give fluid and food for some dehydration > If the child also has a severe classification: • Refer him/her URGENTLY to a SOME hospital with the mother giving DEHYDRATION the child frequent sips of ORS on the way. • Advise the mother to continue breastfeeding the child. > Advise the mother regarding when to return immediately to the health center. > Follow up in 5 days if the child’s condition is not improving.

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•

> (PlanA)Give fluid and food to treat Not enough signs NO diarrhea at home. to allow DEHYDRATION > Advise the mother regarding when to classification as return immediately to the health some or severe center. dehydration. > Follow up in 5 days if the child’s condition is not improving.

And if there has been diarrhea for 14 days or more SIGNS CLASSIFY AS TREATMENT > Treat dehydration before referral to a SEVERE hospital unless the child has another severe • Dehydration PERSISTENT classification. present DIARRHEA > Give Vitamin A > Refer the child to a hospital > Advise the mother regarding the feeding of PERSISTENT a child who has persistent diarrhea. • No > Give Vitamin A Dehydration DIARRHEA > Follow up in 5 days And if there is blood in the stool SIGNS CLASSIFY AS •

Blood in the stool

DYSENTERY

TREATMENT > Treat the child for 5 days with an oral antibiotic recommended for shigella in your area > Follow up in 2 days

MANAGEMENT: Plan A

:

Treat diarrhea at home (Green)

Plan B

:

Treat some dehydration with ORS (Yellow)

Plan C

:

Treat severe dehydration quickly (Pink)

Plan A (Green) 1. Fluids

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2 years old = 50 to 100 ml* More than 2 years old = 100 to 200 ml* *For each watery stool

2. Feeding Lugaw (rice porridge) with pulverized Dilis or Bananas 3. Follow up check up

Plan B (Yellow) 1. Oral Rehydration Salt (ORS) Remember: 4411225 2447799 loc.14 Age 0-4 months

ORS 200 - 400 ml

4 months - 1 year old

400 - 700 ml

1 - 2 years old

700 - 900 ml

2 - 5 years old

900 - 1400 ml

Plan C (Pink) 1. Start Intravenous Fluid 100 ml per kg Lactated Ringer’s Solution (fluid of choice) Normal Saline Solution 2. Oral Rehydration Salt (ORS) 3. Nasogastric T ube (NGT)

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PATHOPHYSIOLOGY

DIARRHEA

“duration”

< 14 days “Dehydration”

No signs of Dehydration

No Dehydration

Green/ Plan C

T hirsty H and pinch goes back slowly I rritability Restlessness S unken eyeballs T akes water eagerly

> 14 days Diarrhea”

Skin pinch goes back slowly, Sunken eyeballs, Abnormally sleepy, and Drink poorly

No dehydration

Persistent diarrhea

(+) dehydration

Severe persistent diarrhea

Yellow/ plan B Severe dehydration

Pink/ Plan C

Some dehydration Pink/ Plan C Yellow/ Plan B

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•

(+) bloody stool = dysentery

VII.

CLOSING REMARKS

To our honourable and lively resource speaker, Mr. Tim C. Concepcion, Our ever compassionate and respected Dean of the college, Dean Neil Gaddi Cabbo, Our ever most beloved and supportive Clinical Instructors. My fellow Nursing students and participants, a pleasant morning to each and every one.

We are very grateful and privilege to gain an understanding on how to facilitate a seminar like this. At first, it seems that this festivity is a difficult event to organize, especially for a Novice Nursing Students like us.

But we believe

that with enough courage, patience and hard work, nothing is impossible, we work hand in and to achieve our goal, and that is, to make this seminar a success. With the proper guidance of course of our supportive and devoted seminar adviser, Ms. Naihla O. Balleta.

May this seminar “INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESESS” served as an instrument for us skills for better quality and effective Nursing care that will contribute to the preservation of life.

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In behalf of the BSN Level IV section B, We would like to extend our heartfelt gratitude and appreciation to the learning Endeavour that is undeniably worth keeping and remembering.

Thank you and God Bless!

IX.

SUMMARY

In view with Nursing Care Management 105 basic requirements, we the Bachelor of Science in Nursing batch 2009 sponsored a seminar entitled: “INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES: Help to Save Thousand Lives.” Held at Martinez Memorial Colleges Auditorium last February 12, 2009.

The seminar was envisioned to convey new information on childhood illnesses, vital for each and every partaker that will served as their anchor for future nursing practice.

Organization and the whole event, was subject headed by Mr. P-Jay D. Fortes, the over-all-chairman, different working committees under the direction and supervision of our humble seminar adviser, Ms. Naihla O. Balleta and the persistent support of our honoured Level IV coordinator Ms. Lualhati H. Angel and erudite dean Mr. Neil G. Cabbo, whom we give our recognition for the triumph of this occurrence.

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Achievement of this affair is equated with the numerous partaker whom themselves grace the event with fervent interest to gain knowledge on childhood illnesses, these are Bachelor of Science in Nursing Level III and Level IV students, Bachelor on Science in Midwifery students, clinical instructors and members of the faculty of Martinez Memorial Colleges

The

successful-organized-envisioned

colloquium

on

“INTEGRATED

MANAGEMENT OF CHILDHOOD ILLNESSES: Help to Save Thousand Lives.”, was made uniformly evocative by our seminar Resource Speaker Mr. Tim C. Concepcion an alumni of Bachelor of Science in Nursing at the University of Santo Tomas and currently working as head reviewer of Saint Thomas Review Center.

Last of all, the preferred theme: “INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES: Help to Save Thousand Lives.” Have truly lifted a mark to everyone to be more vigilant and watchful on matters pertaining to childhood illnesses and their welfare.

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