CHN Notes - Pulmano
CHN Notes - Pulmano
CHN Notes - Pulmano
HEALTH
NURSING
Community
- a group of people with common
characteristics or interest living together withina
territory or geographical boundary.
Classifications of Communities:
1.URBAN
- increased in population; industrial-type of work
2. RURAL
- decreased in population; agricultural-type of work
3. RURBAN
- combination of rural and urban
4. SUBURBAN
- periphery around the urban areas
5. METROPOLITAN
- expanding urban areas
4 Aspects of Community:
1.Social
- communication and interaction of the people.
2. Cultural
- norms, values and beliefs of the people.
3. Political
- governance and leadership of the people.
4. Geographical
- boundaries of the community.
Components of a Community:
A. PEOPLE
B. 8 SUBSYSTEMS
1. Housing
2. Education
3. Fire and Safety
4. Politics and Environment
5. Health
6. Communication
7. Economics
8. Recreation
Health
- is the state of complete physical, mental and
social well-being and not merely the absence of
disease or infirmity. (World Health Organization)
Determinants of health
- factors or things that make people healthy or not.
1. Income and social status
2. Education
3. Physical environment
4. Employment and working conditions
5. Social support network
6. Culture
7. Genetics
8. Personal behavior and coping skills
9. Health services
10. Gender
New concept in determinants of health
- OLOF (Optimum Level Of
Functioning) Factors that affects OLOF:
- Ecosystem
Composition of Ecosystem:
1. Political – power, authority, empowerment, safety
2. Behavior – lifestyle related such as diet, exercise
3. Heredity – genes, familial history
4. Environment – air, water, garbage, food, noise
5. Socio-Economic – education, employment, housing 6.
Health Care Delivery System – availability, accessibility
and affordability of services and facilities
Nursing
- an art and science of rendering care to
individual, families and community.
Public Health
- the science and art of preventing disease, prolonging
life and promoting life and efficiency. (C. E. Winslow)
- is the art of applying science in the context of politics to
reduce inequalities while ensuring the best health for the
greatest number. (WHO)
B. School Health Nursing
> Home Visitation – effective implementation of total school
program
> RA 124 – it mandates the school to provide clinics for the
minor treatment and attendance to emergency cases >
Assessment:
1. Arms 5. Ears
2. Eyes and Visual Acuity 6. Neck and Chest
3. Nose 7. Hair
4. Mouth and Teeth 8. Lower extremities
> Feeding Program
- Should run for 120 days
- Deworming with consent
C. Occupational Health Nursing
> RA 1054
– Occupational Health Act
Purposes:
1. To give nursing care to the sick, post partum mother &
her newborn with the view to teach a responsible
member of a family to give subsequent care.
2. To assess living condition of client and his family and
their health practices in order to provide an appropriate
health teachings.
3. To Give health teachings regarding the prevention and
control of diseases.
4. To establish relationship with health agency and public
for the promotion of public health.
5. To make use of inter-referral system and to promote the
utilization of community services.
Principles:
1. Must have a purpose and objective.
2. Make use available information about the patient and his
family.
3. Consider and prioritize essential needs of the individual
and family.
4. Should involve the individual and family in planning and
delivery of care.
5. Plan should be flexible.
Preparation:
1. Assemble records of the cases to be visited and
investigated for health supervision and nursing care.
2. List their names and address in duplicate form in order of
visit. Take one list with you for your guide and leave in
your box the copy to acquaint the supervision of your
whereabouts.
Example;
Name Address Purpose of visit
Pacarasia Duforte Millora, Lucao dst To give nursing care
To ppartum mother
And health teachings
3. Clip the list on cover of bag for your guide.
4. Provide yourself with ballpen with ink or pencil and
eraser, watch with second hand, information about the
prevailing condition in the district and an umbrella,
raincoat and rubber shoes during the rainy season.
Arrangement of visit:
1. Nursing care to postnatal cases.
2. Health supervisionvisit to prenatals and infants.
3. Visit to patients with communicable diseases.
Priorities:
a. Expectant mothers who do not have a prenatal
check up.
b. Those who do not visit a clinic for one reason or
another.
c. Those which the clinic Dr. requested for a follow
up home visit
Rationale :
- Helps render effective nursing care to clients.
Principles:
1. Minimize if not totally prevent the spread of infection.
2. Save time and effort.
3. To systematize the procedure so as to give care and
adeptness for effective performance.
*** Open bag TWICE during home visit.
Special Consideration:
B
- bag and its contents must be free from any
contamination.
A
- always perform handwashing.
G
- gather necessary equipments to render effective
nursing care.
•
Steps in Performing The Bag Technique Actions:
1. Upon arrival, place the bag on the table lined with a clean
paper. (the clean side must be out and folded part,
touching the table)
2. Ask for a basin of water.
3. Open the bag and take out the towel and soap.
4. Wash hands.
5. Take out the apron and put it on with the right side.
6. Put out all the necessary articles needed for the specific
care.
7. Close the bag and put it in one corner of the working area.
8. Perform nursing care and treatment.
9. After giving the treatment, clean all things that were used
and perform handwashing.
10. Open the bag and return all things that were used in their
proper place
11. Remove apron, folding it away fro the person, the soiled
side in and the clean side out. Place it in the bag.
12. Fold the lining, place it inside the bag. Close the bag.
13. Take the record and have a talk with the mother.
14. Make an appointment for the next visit.
II. CLINIC VISIT
Advantage:
- it is inexpensive in time and usually in cost both for the
service and for the family.
Standard Procedure in Conducting Clinic Visit:
I. Registration/Admission
1. Greet the client and establish rapport
2. Prepare records
3. Elicit client’s chief complaint and clinical history
4. Perform PEII. Waiting Time
* Implement the “first come”, “first served” except for
emergency and urgent cases
III. Triaging
* Manage program-based cases
* Refer all non-program based cases
IV. Clinical Evaluation
* Validate clinical history and PE
* Inform client of the nature of the illness, treatment,
prevention and control measures
V. Laboratory and other diagnostic examinations
* Identify a designated referral laboratory when needed
VI. Referral System
1. Refer if needs further management (BHS to RHU,
RHU to RHU, RHU to Hospital)
2. Accompany patient if it is an emergency
referralVII. Prescription/ Dispensing
* Give proper instructions on drug intakeVIII. Health
Education
1. Conduct one-on-one counseling with the patient
2. Reinforce health education and counseling messages
3. Give appointments for the next visit
Phases:
1. Pre-consultation
a. establish relationship
b. assessment on chief complaint, VS, PE
2. Consultation
A. Medical Consultation
B. Nursing Intervention
3. Post-consultation
a. explaining intervention to be done at home
b. follow-up care
c. referral (if possible)
PRIMARY HEALTH CARE
- is an essential health care made universally
accessible to individuals and families in the community by
means acceptable to them.
*** in Sept. 6-12, 1978 : UNICEF and WHO held the First
International Conference on Primary Health Care in Alma
Ata, USSR
Legal Basis:
LOI 949 : was signed by Pres Marcos on Oct 19, 1979
making Primary Health Care the thrust of the
Department of Health.
Vision :
Health for All Filipinos
Goal :
Health for All Filipinos and Health in the Hands of the
people by the Year 2020
Mission :
In partnership with the people, provide equity, access
and quality health care especially to the marginalized
Principles:
1. 4 A’s; Accessibility, Availability, Affordability and
Acceptability of health services
2. Community Participation
- is the heart and soul of PHC
3. People are the center, object and subject of development
4. Self – reliance
5. Partnership between the community and the health
agencies in provision of quality life
6. Recognition of interrelationship between the health and
development
7. Social mobilization
8. Decentralization
RA 7160 :
The Local government Code of 1991 which
resulted in devolution, which transferred the
power and authority from the national to the
local government units, aimed to build their
capabilities for self-government and develop
them fully as self-reliant communities.
- Devolution Code (Mandate of Devolution)
Local Government Code
Primary Health Care Team:
1. Local Chief Executive
2. Physician
3. Nurse
4. Medical technologist
5. Midwife
6. Sanitary Inspector
7. Auxiliaries
- BHW
- PHW
4 Pillars/Cornerstones:
1. Active community participation
2. Intra and inter- sectoral linkages
3. Use of appropriate technology
4. Support mechanisms made available
Legal Basis:
RA 8423 – Traditional and Alternative Medicine Act
Mission:
- Guarantee equitable, sustainable and quality
health for all Filipinos, especially the poor and shall
lead the quest for excellence in health.
3 Roles and Functions of DOH:
- Executive Order 102
1. Leadership in health
- serves as an advocate in the adoption of health
policies, plans and programs to address national and sectoral
concerns.
2. Administrator of Specific Service
- administer health emergency responsive services
including referral and networking system.
3. Enabler and Capacity Builder
- innovates new strategies in health to improve the
effectiveness of health programs.
Overriding Goal of DOH:
- Health Sector Reform Agenda (HSRA) Framework
for its Implementation:
- FOURmula One for Health --- *Arroyo
- Universal HealthCare (Kalusugan Pangkalahatan)
---*Aquino ( Executive Order 36)
---Phil. Health Agenda (Pres. Duterte)
ALL FOR HEALTH TOWARDS HEALTH FOR ALL
Goals:
1. Financial Protection
2. Better Health Outcomes
3. Responsiveness
Values:
1. Equitable and inclusive to all
2. Transparent and accountable
3. Uses resources efficiently
4. Provides high quality servicesStrategies:
1. Advance quality, health promotion and primary care.
2. Cover all Filipinos against health-related financial risk.
3. Harness the power of strategic HRH development.
4. Invest in eHealth and data for decision-making.
5. Enforce standards, accountability and transparency.
6. Value all clients and patients, especially the poor, marginalized
and vulnerable.
7. Elicit multi-sectoral and multi-stakeholder support for health.
8 MILLENIUM DEVELOPMENT GOALS
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development
Goal:
- To achieve “Better Quality Life among Filipinos”
Goal:
-To improve the quality life of Filipinos through
better nutrition, increased productivity and improved
health.
U – unexplained anemia
S – sudden unexplained weight loss
Specific Guidelines for Early Detection of Common Cancers
1. Breast Cancer
A. BSE - cheapest and most affordable
- done 1 week after menstrual period while
taking a shower
B. Mammography
- if a mass detected and confirmed
2. Cervical CancerA. Pap Smear
- primary screening tool for women over age 18
3. Colon Rectal Cancer
A. Annual digital rectal exam starting at age 40
B. Annual stool blood test starting at age 50
C. Annual inspection of colon
4. Prostate Cancer
A. Digital rectal exam
B. PSA (prostate Specific Antigen) – confirms
diagnosis
5. Lung CancerA. Chest X-ray
B. Sputum Cytology
LEVELS OF PREVENTION:
Primary Prevention:
- elimination of conditions causing cancer
Secondary Prevention:
- Definitive Treatment and Management
(a.) Chemotherapy, (b.) Radiation, (c. )Surgery
Tertiary Prevention:
- Supportive or Palliative Care
a. Physical
b. Psychological, Social, Spiritual
National Voluntary Blood Services Program
- promotes voluntary blood donation to provide
sufficient supply of safe blood and to regulate blood
banks.
Legal basis:
RA 7719 “Blood Services Act of 1994”
Criteria for Eligible donor:
B = BP 90/60 – 160/100mmHg
A. = 16 – 65 years old
W = 45 – 50 kgs minimum
A = At least 12.5 hemoglobin
S = Status in good condition
Main Objectives:
1. to promote and encourage voluntary blood donation
by the citizenry and to instill public consciousness of the
principle that blood donation is a humanitarian act
Mission:
- Ensure that TB DOTS services are available, accessible and
affordable to the communities.
Treatment:
- Quality of SDF (Single Dose Formulation) & FDC (Fixed
Dose Combination)
Case Finding:
1. DSSM ( Direct Sputum Smear Microscopy)
- 3X collection
1st specimen – SPOT specimen collected on the day of
consultation
2nd specimen – early morning specimen on the next day
3rd specimen – SPOT specimen collected on the 2nd day after
submission of early morning specimen
2. Chest X-ray
- to identify the extent of the disease
3. Tuberculin Testing/Mantoux Test/PPD Testing
TB Treatment:
TB Abbreviation
SDF OLD NEW
Rifampicin R R
Isoniazid INH H
Pyrazinamide PZA Z
Ethambutol E E
Streptomycin S S
# of Tablets of FDC of Patient per Body Weight
Body Weight (kg) # of Tablets
30-37 2
38-54 3
55-70 4
>70 5
Category I: Newly Diagnosed TB Patient
- - - ( + ) DSSM, ( + ) CXR
Intensive Phase 2 months
HRZE
Maintenance Phase 4 months
HR
1. Political will
2. Sputum microscopy service
3. Regular drug supply
4. Record of patient’s progress
5. Supervision of drug intake
Leprosy Control Program
Leprosy
- known as Hansen’s Disease
- cause: Mycobacterium leprae
- MOT: prolonged intimate skin to skin
contact; droplet infection Diagnostic procedure:
= Slit Skin Smear
Preventive Measures:
- BCG immunization
- Health education on the MOT
DOMICILLARY TREATMENT:
(Republic Act 4073)
PAUCIBACILLARY : 6-9 months
A. Intermediate type
- flat, with not well defined patches, with slight to no
sensory loss and pale in color.
B. Tuberculoid type
- flat, with some raised patches, definite sensory loss
and rough to touch.
Treatment:
Day 1: Rifampicin and Dapsone
Succeeding days (2-28 days): Dapsone
MULTIBACILLARY: : 24-30 months
A. Borderline type
- many raised patches at different sizes and shapes,
usually enlarged nerves and occasionally with
deformities.
B. Lepromatous type
- thickened skin and earlobes and with hair loss in
eyebrows.
Treatment:
Day 1: Rifampicin, Dapsone, Clofaximine or Lamprene
Day 2-28: Dapsone, Clofaximine or Lamprene
THE MATERNAL and CHILD HEALTH PROGRAM
Overall Goal:
- To improve the survival, health and well being of
mothers and unborn through a package of services
for the pre pregnancy, prenatal, natal and post natal
stages.
Benefits of BF to Infants:
1. Increases immune system resistance
2. Provides complete nutrition
3. Increases IQ pointsBenefits of BF to mothers:
1. Prevent unplanned pregnancy
2. Prevent post partum bleeding
3. Prevent occurrence of cancer
New Breastfeeding Act….
REPUBLIC ACT 10028
Storage Full-term Pre-term
Room Temperature 8-10 hours 4 hours
Refrigerator 48 hours 24 hours
Freezer 3 months 3 months
G. Family Planning Counseling-
right choice of FP methods -
birth spacing is …..
3-5 years
Expanded Program on Immunization
(EPI)
Legal Basis: PD No. 996
– providing for compulsory basic immunization for
infants and children below 8 yrs old. ( September 16, 1976)
> launched in July 1976
> free vaccines: BCG, DPT, OPV, Measles
Pregnant mothers:
- 5 Tetanus Toxoid
- RA 1066 (tetanus elimination)
3 Principles of EPI:
1. Based on epidemiological situation
2. Main focus: eligible population
3. Immunization is a basic health serviceElements of
EPI: Target setting: calculation of eligible population
Formula: EP = total population x constant percentage
Constant percentage:
Infants = 3% or .03
School Entrants = 3% or .03
Pregnant Mothers = 3.5% or .035
Cold Chain System
- to maintain potency of the vaccine
Refrigerator:
Freezer:
(-15° to -25 °C) – OPV, Measles
Body:
(2° to 8°C) - DPT, Hepa B, BCG, TT
HEALTH CENTER
* Health centers using cold box or transport boxes
- 5 days
* Check temperature 2x a day: first and last hour of the
clinic
Vaccine Age Doses Interval ROUTE Dosage
Pentavalent – Hib
(Penta – hib)
1. Diptheria
2. Pertussis or whooping cough
3. Tetanus
4. Hepatitis – B
5. Hemaphilus influenza type B
- to prevent
pneumonia and
meningitis to babies
- injected
intramuscularly
- given at age 6
weeks up to 11 months
CONTENT OF VACCINES:
BCG:
- live attenuated
bacteria OPV and
MEASLES:
- live attenuated
virus DIPTHERIA & TT:
- weakened
bacterial toxins
PERTUSSIS:
- killed bacteria
HEPA B:
- derived from
plasma (plasma
derivatives)
RNA recombinants
PRINCIPLES OF VACCINATION…
Legal Mandate:
1. PD 1566 (1978)
- creation of the National Disaster Coordinating Council
- creation of the Multi-level Organization
- funding for a 2% reserve for calamities
2. RA 7160
- transfer of responsibilities from the national to local
government units giving more power, authority and
resources
- allocation of 5% calamity fund for emergency operations
Terms:
1. Disaster
- is a serious disruption of the functioning of a society,
causing wide spread human, material or environmental
losses
2. Emergency
- as any occurrence, which requires an immediate response
3. Hazards
- any phenomenon, which has the potential to cause
disruption or damage to humans and their environment
4. Risk
- the level of loss or damage that can be predicted from
a particular hazard affecting particular place at a
particular time from the point of view of the community.
2 components:
A. Susceptibility
- the factors which allows a hazard to cause an emergency
B. Vulnerability
- the factors which allows a hazard to cause a disaster
Classification of disaster
A. According to its Cause
1. Natural disaster – force of nature
2. Human generated/Manmade –
transportation/technological disasters
B. According to Onset
1. Acute or sudden impact events
2. Slow or chronic genesis (Creeping disaster)
Contributing factors to Disaster:
1. human vulnerability resulting from poverty and social
inequality
2. environmental degradation resulting from poor land use
3. rapid population growth especially among the poor
General Principles of Disaster Management:
1. The first priority is the protection of people who are at risk.
2. The second priority is the protection of critical resources and
systems on which communities depend.
3. Disasters management must be an integral function of national
development plans and objectives.
4. Disaster management relies upon an understanding of hazard
risks.
5. Capabilities must be developed prior to the impact on a hazard.
6. Disaster management must be based upon interdisciplinary
collaboration.
7. Disaster management will only be as effective as the extent to
which commitment, knowledge and capabilities ca be applied.
The Disaster Spectrum Cycle
1. Disaster Impact
2. Relief
3. Rehabilitation
4. Prevention
5. Mitigation
6. Readiness
More Specific within Preparedness includes:
1. vulnerability assessment and dissemination of information
related to particular hazards and emergencies.
2. emergency planning
3. training and education
4. warning system
5. specialized communication system
6. resources and information databases and management
systems and resource stocks
7. emergency exercises/drills
Principles of Emergency Preparedness:
1. It is the responsibility of all.
2. Should be woven into the community and administrative levels
of both government and government organizations.
3. It is an important aspect of emergency management.
4. It is connected to other aspects of emergency management.
5. Should concentrate on process and people rather than
documentation.
6. Should not be done in isolation.
7. Should not concentrate only on disasters but integrate
prevention and response strategies for any scale of emergency.
8. Hospital plays a very vital role in the management of disaster.
9. The main objective is to decrease mortality, morbidity and to
prevent disaster.
10. Every hospital should have a regular updated disaster plan.
PURPOSE OF THE DISASTER PLAN:
1. To provide policy for effective response to both internal and
external disaster situations that can create impact to the
operation of the hospital and may affect hospital staff, patients,
visitors and the community.
2. Identify hospital capability to handle mass casualty.
3. Identify responsibilities of individuals and departments in the
event of a disaster situation.
4. Identify standard operating guidelines for emergency activities
and responses.
VITAL STATISTICS
- refers to the systematic study of vital events such as births,
illnesses, marriages, divorce, separation and deaths.
5 Components:
1. demographic, social and economic profile
2. health risk profile
3. health/wellness outcome profile
4. survey of current health promotion programs
5. studies conducted in certain target groups
Steps:
1. Define the community.
2. Collect data.
3. Assess community capacity.
4. Assess community barriers.
5. Assess readiness for change.
6. Synthesis data and set priorities
Stage 2. Design and Initiation
PHASES OF COPAR
A. Pre-Entry Phase
> Community consultation/dialogues
> Setting of issues/considerations related to site location
> Development of criteria for site selection
1. high percentage of the family income is below the
national poverty threshold
2. high malnutrition rate
3. lack of primary or secondary hospital within a 30minute
ride from the area
4. area must not have relative peace and order problem
5. acceptance of the community > Site selection
> Preliminary social investigation
>Networking with LGU’s, NGO’s and other departments
B. Entry Phase
> Integration with the community
> Sensitization of the community; information campaign
> Continuing/Deepening social investigation
> Core group formation
1. belongs to the poor sector of the society
2. responsible and committed
3. able to communicate
> Coordination with other community organization
> Self-Awareness and Leadership Training (SALT)/
Action Planning
Best technique to identify potential leaders:
- observe people who are active in small
mobilization activities that motivate residents to start
working.
C. Community Study/Diagnosis Phase
1. Young Infant
– up to less than 1 week up to 2 months
(1 week up to 1 month and 29 days)
2. Young Child
– 2 months up to 5 years
(2 months up to 4 years and 11 months)
Principles in IMCI:
1. All sick children must be examined for
GENERAL DANGER SIGNS:
C
> convulsions (fits, jerky movement, spasm)
U
> unable to drink or breastfeed (not eat)
V
> vomiting
A
> abnormally sleepy (difficult to awaken)
2. Assess for MAIN SYMPTOMS:
For Older children For Young infants:
a. Cough/DOB a. Local bacterial infection
b. Diarrhea b. Diarrhea
c. Fever c. Jaundice
d. Ear problems
3. Assess for nutritional status, immunization status, vitamin
A status, feeding problems and other potential problems.
Identify Treatment
urgent pre-referral treatment and referral,
or
specific medical treatment and advice, or
simple advice on home management
Treat the Child
Follow - up
health-care provider gives appropriate follow-
up
care, as indicated in IMCI guidelines
If necessary, reassess the child for any new
problems.
Assess and Classify A Sick Child
Aged 2 months to 5 years
1. Ask the mother what the child’s problems
are?greet the mother appropriately
use good communication skills
listen carefully to what the mother tells you
use words that the mother will understand
give the mother time to answer questions ask
additional questions if the mother is not
sure about her answer
2. Determine if it is an initial visit
For ALL sick children ask the mother about the child’s problem, check for general danger signs
and then
ASK: DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING?
If YES
If NO
Then ASK about the next main symptoms: diarrhoea, fever, ear problems. CHECK for malnutrition and anaemia,
immunization status and for other problems
Classify Cough
SEVERE
• Any general danger sign or PNEUMONIA
• Lower chest indrawing or OR
• Stridor in calm child VERY SEVERE
DISEASE
PNEUMONIA
Fast Breathing (if wheezing,
go directly to treat
wheezing)
No signs of pneumonia or NO PNEUMONIA:
very severe disease COUGH OR COLD
Treatment
CLASSIFY the child's illness using the color-coded classification tables for
diarrhea.
Then ASK about the next main symptoms: fever, ear problem, and CHECK for malnutrition and
anaemia, immunization status and for other problems.
Classify Diarrhea
SIGNS CLASSIFY AS
Two of the following signs: SEVERE DEHYDRATION
• Lethargic or unconscious
• Sunken eyes
• Not able to drink or drinking poorly
• Skin pinch goes back very slowly
SIGNS CLASSIFY AS
Dehydration present SEVERE PERSISTENT DIARRHEA
Treatment:
Severe Dehydration
PINK
PLAN C
Give IVF : D5LR
< 12 mos. old : 100ml/kg within 6 hrs
12 mos. up to 5 y.o. : 100ml/kg within 3 hrs
Some Dehydration
YELLOW
PLAN B
Green
PLAN A
Yellow
1. Give Vit. A
2. Advise mother recommended feeding
3. Follow-up after 5 days → if still breastfeeding:
= breastfeed day and night
→ if taking milk supplements:
= replace milk supplements with increased breastfeeding
= replace half of the milk & nutrient rich, semi-solid foods
* Do not use condensed or evaporated milk
= because it is high in CASEINE
SEVERE PERSISTENT DIARRHEA
Pink
1. Give Vitamin A
2. Give IVF = Plan C
Pink Yellow
IF YES:
If No Decide the Malaria Risk: Yes or No
THEN ASK: LOOK AND FEEL:
If the child has measles now or within the last 3 months: Look for mouth ulcers.
Are they deep and extensive?
Look for pus draining from the eye.
Look for clouding of the cornea.
Decide Dengue Risk : Yes or No
Ask: Look and Feel:
o Has the child had any bleeding from the nose or gums, or •Look for bleeding from the nose or gums?
in the vomitus or stool? •Look for skin petechiae
o Has the child had black vomitus ? •Feel for cold and clammy?
o Has the child evacuated black stool? •Check for slow capillary refill .
o Has the child had persistent abdominal pain? •If none of the above ask , look and feel signs are
o Has the child been persistent vomiting? present and the child is 6 months and older and fever
has been present for more than 3 days, perform
tourniquet test.
Malaria Risk
Signs Classification
Signs Classification
Any general danger signs Stiff Very Severe Febrile Disease/Malaria
neck
Blood Smear (+)
If Blood smear is not done; Malaria
No runny nose, and
No measles, and
No other cause of fever
Blood Smear (-) or
Runny nose, or Fever: Malaria Unlikely
Measles, or
Other cause of fever
No Malaria Risk
Signs Classification
Signs Classification
Any general danger sign Stiff Very Severe Febrile Disease
Neck
No signs of very febrile disease Fever: No Malaria
Measles
Signs Classification
If No If Yes
IF YES, ASK: LOOK AND FEEL:
CLASSIFY the child's illness using the color-coded classification table for
ear problem.
Then CHECK for malnutrition and anemia, immunization status and for other problems.
Classify Ear Problem
SIGNS CLASSIFICATION
If Yes
If No Check for Malnutrition
Not very low weight for age and no other signs NOT VERY LOW WEIGHT
or malnutrition.
Classify Anemia
Severe palmar pallor SEVERE ANEMIA
Some palmar pallor ANEMIA
For ALL sick children ask the mother about the child’s problem, check for general danger signs,
ask about cough or difficult breathing, diarrhoea, fever, ear problem, and then check for
malnutrition and anaemia and
CHECK IMMUNIZATION STATUS.
AGE VACCINES
IMMUNIZATION Birth BCG OPV- Hep B 1
SCHEDULE: 6 weeks DPT-1 1 Hep B 2
10 weeks DPT-2 OPV-
14 weeks DPT-3 2 Hep B 3
9 months Measles OPV-
3
DECIDE if the child needs an immunization today, or if the mother should be told to
come back with the child at a later date for an immunization.
Note: Remember there are no contraindications to immunization of a sick child if the
child is well enough to go home.
CLASSIFY the infant's illness using the colour-coded classification table for possible
bacterial infection.
Then ASK about diarrhoea. CHECK for feeding problem or low weight, immunization status
and for other problems.
TREATMENT
Pre-referral treatment: VERY SEVERE
1. Give first dose antibiotic: DISEASE
Gentamycin - (IM) Right
Vastus lateralis
Benzyl penicillin: Left
Vastus lateralis
2. Keep warm
3. Treat child to prevent hypoglycemia
4. Refer.
Classify Jaundice
Signs Classification
Any jaundice if age less than 24 hours or
Yellow palms and soles at any age SEVERE JAUNDICE
Jaundice appearing after 24 hours of age JAUNDICE
and
Palms and soles are not yellow
No Jaundice NO JAUNCICE
ASSESS BREASTFEEDING:
Has the infant breastfed in the If the infant has not fed in the previous hour, ask the mother to put her infant to
previous hour? the breast. Observe the breastfeed for 4 minutes.
(If the infant was fed during the last hour, ask the mother if she can wait and tell
you when the infant is willing to feed again.)
Is the infant able to attach?
no attachment at all not well attached good attachment
TO CHECK ATTACHMENT, LOOK FOR:
Chin touching breast
Mouth wide open
Lower lip turned outward
More areola visible above then below the mouth
(All these signs should be present if the attachment is good.)
Is the infant suckling effectively (that is, slow deep sucks, sometimes
pausing)?
Classify the Feeding Problem
Signs Classification
SIGNS OF HUNGER:
1. Beginning to fuss.
2. Sucking fingers and fist
3. Sucking movements with their lips.
>6 months up to 12 months:
breastfeeding + 3 times a day complementary food.
If not on breastfeeding:
5 times a day complementary food.