SUMMARY NOTES.
IMCI/ETAT UNIT CODE:NRS-2/005
• PRE REQUISITE: Communication Skills, Anatomy and
Physiology, Fundamentals of Nursing,
Pharmacology
... [Show More] I, Pharmacology II, Basic Nutrition
• CORE REQUISITE: Pediatric Nursing
• PURPOSE: The student will acquire knowledge on IMCI
strategy, develop skills and attitudes to enable him/her to
promote health, prevent illness and manage children less than
5 years suffering from common childhood diseases.
UNIT CONTENT
: How to apply
- Pediatric Emergency Triage, Assessment and Treatment
(ETAT), principles in management of childhood illnesses and
Integrated Management of Childhood Illnesses (IMCI)
Assess, classify and manage a young infant with:
• cough and difficulty in breathing
• very severe disease
• fever
• diarrhea
• ear problems
• malnutrition
• HIV/AIDS
• meningitis
• jaundice
• eye infection.
Resuscitate a sick young infant; Check for:
• A feeding problem.
• Low weight or low birth weight.
• Young infant and mother’s HIV status.
• Teach the mother to treat local infections at home
• INSTRUCTIONAL METHODOLOGY: Probing questions, Lecture,
Brain storming, Small questions, discussion,
Assignments, Self-directed studies and Video Shows
• TEACHING MATERIALS: models, Charts, Videos, Computers,
Textbooks, ICATT
• MEANS OF EVALUATION: C.A.T. SandEnd of block examination
• REFERENCE MATERIAL:
• Ministry of health IMCI module book
• Ministry of health 2017 basic pediatric protocol 4th edition
• World health organization2014 IMCI chart booklet.
INTRODUCTION
• Children are not just little adults!!
• An adult gives you the history directly – a child needs his parents to
relay the history
• Adult somatic growth is complete – a child’s growth is constantly
changing in predictable ways.
• An adult has completed all stages of development – a child’s
development and age are integrally related and impact all aspects of
her physical and emotional states.
DIFFERENCES BETWEEN PAEDIATRIC HISTORY AND ADULT HISTORY.
• Content Differences
– Prenatal and birth history
– Developmental history I'm
– Social history of family
– Environmental risks
– Immunization history
• Parent as Historian
– Parent’s interpretation of signs, symptoms
• Children above the age of 4 may be able to provide some of their
own history .
• Reliability of parents’ observations varies.
• Adjust wording of questions - “When did you first notice Johnny was
limping”? instead of “When did Johnny’s hip pain start”?
–Observation of parent-child interactions
• Distractions to parents may interfere with history taking .
• Quality of relationship.
–Parental behaviors/emotions are important.
• Parental guilt -nonjudgmental/reassurance.
Outline of the Pediatric History
• Chief Complaint.
– Brief statement of primary problem (including duration) that caused
family to seek medical attention.
• History of Present Illness
– Initial statement identifying the historian, that person’s relationship to
patient and their reliability.
– Age, sex, race, and other important identifying information about
patient.
– Concise chronological account of the illness, including any previous
treatment with full description of symptoms.
• Past Medical History
– Major medical illnesses.
– Major surgical illnesses-list operations and dates.
– Trauma-fractures, lacerations .
– Previous hospital admissions with dates and diagnoses.
– Current medications.
– Known allergies (not just drugs) .
• Immunization status - be specific, not just up to date.
• Pregnancy and Birth History.
– Maternal health during pregnancy: bleeding, trauma, hypertension,
fevers, infectious illnesses, medications, drugs, alcohol, smoking,
rupture of membranes.
– Gestational age at delivery.
– Labor and delivery - length of labor, fetal distress, type of delivery
(vaginal, cesarean section), use of forceps, anesthesia, breech delivery.
– Neonatal period - Apgar scores, breathing problems, use of oxygen,
need for intensive care, hyperbilirubinemia, birth injuries, feeding
problems, length of stay, birth weight.
• Developmental History
– Ages at which milestones were achieved and current developmental
abilities - smiling, rolling, sitting alone, crawling, walking, running, 1st
word, toilet training, riding tricycle, etc. (see developmental charts)
– School-present grade, specific problems, interaction with peers
– Behavior - enuresis, temper tantrums, thumb sucking, pica, nightmares
etc.
• Feeding History
– Breast or bottle fed, types of formula, frequency and amount, reasons
for any changes in formula
– Solids - when introduced, problems created by specific types
– Fluoride use
• Family History
– Illnesses - cardiac disease, hypertension, stroke, diabetes, cancer,
abnormal bleeding, allergy and asthma, epilepsy
– Mental retardation, congenital anomalies, chromosomal problems,
growth problems, ethnic background
• Social
– Living situation and conditions - daycare, safety issues
– Composition of family
– Occupation of parents
Review of Systems:
• Weight - recent changes, weight at birth.
• Skin and Lymph - rashes, adenopathy, lumps, bruising and bleeding,
pigmentation changes.
• Headaches, concussions, unusual head shape, strabismus, conjunctivitis,
visual problems, hearing, ear infections, draining ears, cold and sore
throats, tonsillitis, mouth breathing, snoring, apnea, oral thrush, epistaxis,
caries.
• Cardiac - cyanosis and dyspnea, heart murmurs, exercise tolerance, chest
pain, palpitations.
• Respiratory - pneumonia, bronchiolitis, wheezing, chronic cough, sputum,
hemoptysis, TB
• GI - stool color and character, diarrhea, constipation, vomiting,
hematemesis, jaundice, abdominal pain, colic, appetite.
• GU - frequency, dysuria, hematuria, discharge, abdominal pains, quality of
urinary stream, polyuria, previous infections, facial edema.
• Musculoskeletal - joint pains or swelling, fevers, scoliosis, myalgia or
weakness, injuries, gait changes.
• Allergy - urticarial, hay fever, allergic rhinitis, asthma, eczema, drug
reactions.
Integrated Management of Childhood illness.
(IMCI)
23
Definition
• Is the integrated strategy that combines and links together existing
child health programs?
• Is an evidenced based, syndrome approach to case management
that supports the rational, effective and affordable use of drugs and
diagnostic tools.
• A joint WHO/UNICEF initiative since 1992.Currently focused on first
level health facilities
OBJECTIVES OF IMCI
• To reduce significantly mortality and morbidity associated with the
major cause of diseases in children
• To promote improved growth and development of children under 5
years of age.
PRINCIPLES OF IMCI CASE MANAGEMENT
• All sick children aged up to 5 years are examined for general danger
signs and all sick young infants are examined for very severe
disease. These signs indicate immediate referral or admission to
hospital [Show Less]