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IMNCI-LESSON-PLAN. Disease conditions...

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MRS.CHANDRALEKHA.E PROFESSOR ICON S.N O TIME SPECIFIC OBJECTIVE CONTENT TEACHER`S &LEARNER`S ACTIVITY AV AIDS EVALUATION The students will be able to explain about the IMCI INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS  Almost 19000 children under 5 years of age, died everyday across the world. 50% of its occurs in just five countries i.e. India, Nigeria, Congo, Pakistan and China.  World health organization (WHO), UNICEF & other international Partner came out with a new strategy known as INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI) in 1995.  IMCI mainly concentrate in 2 months to 5 years  An effort to bring health equity for child health.  The strategy emphasizes on integrated approach for treating the sick children.  Emphasizes on improving the family and community practices as well as care provided by the health system for better care of child. Integrated: different independent services and Teacher: teaching Student: listening B L A C K B O A R D What is the IMCI?
MRS.CHANDRALEKHA.E PROFESSOR ICON administrative structure are complemented to achieve the common goal of Health (Multiple interventions are provided through one delivery channel eg. Vaccination) The objectives are to reduce deaths and frequency and severity of illness and disability and to contribute to improved growth and development. IMCI is the only child health strategy that aims for improvement  Children are not properly assessed and treated and their parents are poorly advised  Sick children present with sign and symptoms related to more than one condition (eg; bronchopneumonia, malnutrition, diarrhea)  Single diagnosis may not be possible or appropriate  So needs combined therapy for several condition. The core of the IMCI strategy is integrated case management of the most common childhood problems, with a focus on the most important causes of death i.e. diarrhoea, ARI,, Teacher: teaching Student: listening B L A C K B O A R D
MRS.CHANDRALEKHA.E PROFESSOR ICON malaria, measles and malnutrition. A guided process of adaptation ensures that guidelines, and the learning materials that go with them, reflect the epidemiology within a country and are tailored to fit the needs, resources and capacity of a country’s health system. When assessing a sick child, a combined of individual signs leads to one or more classifications, rather than to a diagnosis. IMCI classification are action oriented and allow a health care provider to determine if a child should be urgently referred to another health facility, if the child can be treated at the first-level facility (e.g. with oral antibiotic, antimalarial, ORS, etc.) or if the child can be safely managed at home. The complete IMCI case management process involves the following elements: 1. Assess 2. Classify 3. Identify 4. Treatment 5. Counsel Teacher: teaching Student: listening B L A C K B O A R D
MRS.CHANDRALEKHA.E PROFESSOR ICON 6. Follow up INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS The generic IMCI guidelines were adapted and the Indian version was named Integrated Management of Neonatal and childhood Illness (IMNCI). IMNCI strategy is one of the main interventions under RCH-II/ NRHM, that focuses on preventive, promotive and curative aspects of program. In India, common illnesses in children under 3 years of age include fever (27%), acute respiratory infections (17%), diarrhoea (13% ) and malnutrition (43%) – and often in combination (National Family Health Survey2. Infant Mortality Rate continues to be high at 68/1000 live births and Under Five Mortality Rate at 95/1000 live births per year. Neonatal mortality contributes to over 64% of infant deaths and most of these deaths occur during the first week of life. Mortality rate in the second month of life is also higher than at later ages. Any health program that aims at reducing Infant Teacher: teaching Student: listening L C D Tell about the what you about IMNCI?
MRS.CHANDRALEKHA.E PROFESSOR ICON define the IMNCI Mortality Rate needs to address mortality in the first two months of life, particularly in the first week of life. DEFINITION: IMNCI is an Integrated approach to child health that focuses on the well being of the whole child. It focused primarily on the most common causes of child mortality – diarrhea, pneumonia, measles, malaria, and malnutrition illness affecting children aged 1 week- 2months, 2 months – 5 year including both preventive and curative elements to be implemented by families and communities as well as by health facilities. IMNCI aims to reduce death, illness and disability and to Teacher: teaching Student: listening L C D What is meant by IMNCI?
MRS.CHANDRALEKHA.E PROFESSOR ICON list out the high lights of IMNCI enlist the objectives of IMNCI promotes improved growth and development among children under five years of age. HIGHLIGHTS OF IMNCI:  0-7 days  Incorporating national guidelines on malaria, anemia, Vit-A supplementation & immunization schedule.  Training of the health personnel begins with sick young infants upto 2 months  Proportion of training time devoted to sick young infant and sick child is almost equal and  It is skill based. OBJECTIVES: 1. To determine baseline mortality among children under 5 years of age (NMR, IMR, USMR). 2. To determine prevalence of fever, loose stools, cough and any other illness (morbidity density) in two weeks prior to day of field survey among children under 5 years of age. Teacher: teaching Student: listening L C D Enlist the highlights of IMNCI? list the objectives of IMNCI?
MRS.CHANDRALEKHA.E PROFESSOR ICON enumerate the beneficiaries and care of children in IMNCI 3. To assess effective programme coverage for specified disease condition (cough with fast breathing) occurring in two weeks prior to day of field survey. 4. contribute to improve the growth and development BENEFICIARIES OF IMNCI:  Care of young infants for newborns (under 2 months)  Young children (2 months - 5years) Care of Newborns and Young Infants (infants under 2 months) • Keeping the child warm • Initiation of breastfeeding • Counseling for exclusive breastfeeding • Cord, skin and eye care • Recognition of illness in newborn and management and/or referral • Immunization and Home visits in the postnatal period Care of Infants (2 months to 5 years)  Management of diarrhoea, ARI, malaria, measles, acute ear infection, malnutrition and anemia Teacher: teaching Student: listening Tell the beneficiaries of IMNCI and care of children?
MRS.CHANDRALEKHA.E PROFESSOR ICON discuss the principles of IMNCI  Recognition of illness and risk  Prevention and management of Iron and Vitamin A deficiency  Counseling on feeding for all children below 2 years  Counseling on feeding for malnourished  Immunization PRINCIPLES: Depending on a child’s age, various clinical signs and symptoms differ in their degrees of reliability and diagnostic value and importance. Therefore, the IMNCI guidelines recommend case management procedures based on two age categories:  Young infants age up to 2 months  Children age 2 months up to 5 years The IMNCI guidelines are based on the following principles:  All sick young infants up to 2 months of age must be assessed for “possible bacterial infection / jaundice”. Then they must be routinely assessed for the major symptom “diarrhoea”.  All sick children age 2months up to 5 years must be examined for “general danger signs” which indicate the Teacher: teaching Student: listening L C D discribe the principles of IMNCI?
MRS.CHANDRALEKHA.E PROFESSOR ICON need for immediate referral or admission to a hospital. They must then be routinely assessed for major symptoms: cough or difficult breathing, diarrhoea, fever and ear problems.  All sick young infants and children 2 months up to 5 years must also be routinely assessed for nutritional and immunization status, feeding problems, and other potential problems.  Only a limited number of carefully selected clinical signs are used, based on evidence of their sensitivity and specificity to detect disease. These signs were selected considering the conditions and realities of first-level health facilities.  A combination of individual signs leads to an infant’s or a child’s classification rather than a diagnosis. Clinical guidelines:  Prepared based on expert clinical opinion and research result (child health, researchers, academics, IAP and NNF)  To promote evidence based assessment and management using syndrome approach that support Teacher: teaching Student: listening L C D
MRS.CHANDRALEKHA.E PROFESSOR ICON find out the component of IMNCI list out the classification of IMNCI the rationale, effective and affordable use of drug.  Counselling the parents to solve feeding problems, advising parents about when to return to a health facility.  Showing them how to administer the first dose of the treatment eg: first give the medicine and tell how to give the medicine.  Checking parents understanding of the advice given COMPONENTS: IMNCI includes both preventive and curative interventions. The strategy has the following three components: 1. Health- worker component: Improvements in the case- management skills of health through the provision of locally adapted guidelines 2. Health-service component: improvements in the overall health system required for effective management of neonatal and childhood illness 3. Community component: improvement in family and community health care practices. IMNCI CLASSIFICATION: Teacher: teaching Student: listening L C D Tell the components of IMNCI ?
MRS.CHANDRALEKHA.E PROFESSOR ICON explain about elements and process of IMNCI In IMNCI, only a limited number of carefully- selected clinical signs are considered, based on their sensitivity and specificity, to detect the disease. A combination of these signs helps in arriving at the child’s classification, rather than a diagnosis. 1. Pink : child needs urgent referral 2. Yellow: child needs specific medical treatment and advise 3. Green: child needs no medicine, advise home care. ELEMENTS: 1. Assess: - Danger signs, nutrition and immunization status - Other problems 2. Classify: -Using “Color coded” triage system Pink: urgent referral Yellow: specific medical treatment and advise Green: advise home care. 3. Identify: Teacher: teaching Student: listening L C D Discuss the elements and process of IMNCI?
MRS.CHANDRALEKHA.E PROFESSOR ICON - Specific treatment 4. Treatment: - Pre referral - Medical treatment - Home management 5. Counsel: - Feeding problems - Mother’s health 6. Follow-up care Teacher: teaching Student: listening L C D
MRS.CHANDRALEKHA.E PROFESSOR ICON Teacher: teaching Student: listening L C D
MRS.CHANDRALEKHA.E PROFESSOR ICON describes the assess and classify the sick infant age up to 2 months ASSESS AND CLASSIFY THE SICK INFANT AGE UPTO 2 MONTHS CHECK FOR POSSIBLE BACTERIAL INFECTION / JAUNDICE ASK • has the infant had convulsions? LOOK, LISTEN, FEEL: • Count the breaths in one minute. Repeat the count if elevated • Look for serve chest indrawing • Look for nasal flaring • Look and listen for grunting • Look and feel for bulging fontanelle. • Look for pus draining from the ear • Look at the umbilicus. Is it red or draining pus? • Look for skin pustules. Are there 10 or more skin pustules or big boil? Teacher: teaching Student: listening L C D How to assess and classify the sick infant age up to 2 months?
MRS.CHANDRALEKHA.E PROFESSOR ICON • Measure axillary temperature (if not possible, feel for fever or low body temperature) • See if the young infant’s movements. Are they less than normal? • Look for jaundice? • Are the palms and soles yellow? Teacher: teaching Student: listening L C D
MRS.CHANDRALEKHA.E PROFESSOR ICON DOES THE YOUNG INFANT HAVE DIARRHOEA? Teacher: teaching Student: listening L C D
MRS.CHANDRALEKHA.E PROFESSOR ICON IF YES, ASK: • For how long? • Is there blood in the stool? LOOK AND FEEL: • Look at the young infant’s general condition. Is the infant: - Lethargic or unconscious? - Restless and irritable? • Look for sunken eye. • Pinch the skin of the abdomen. -Does it go back: very slowly (longer than seconds)? slowly? Teacher: teaching Student: listening L C D
MRS.CHANDRALEKHA.E PROFESSOR ICON Teacher: teaching Student: listening L C D
MRS.CHANDRALEKHA.E PROFESSOR ICON CHECK FOR FEEDING PROBLEM AND MALNUTRITION ASK: • If there any difficulty feeding? • Is the infant breastfeed? If yes, how many times in 24 hours? • Does the infant usually receive any other foods or drinks? - If yes, how often? • What do you use to feed the infant? LOOK, FEEL: • Determine weight for age Not able to feed or No attachment at all or Not sucking at all or Very low weight for age NOT ABLE TO FEED POSSIBLE SERIOUS BACTERIAL INFECTION OR SEVERE MALNUTRIT ION Give first dose of intramuscular ampicillin and gentamicin Treat to prevent low blood sugar Warm the young infant by skin to skin contact if temperature less than 36.5C (or feels cold to touch) while arranging referral Advice mother how to keep the young infant warm on the way to the hospital. Refer URGENTLY to hospital Teacher: teaching Student: listening L C D
MRS.CHANDRALEKHA.E PROFESSOR ICON Not well attached to breast or Not sucking effectively or Less than 8 breastfeeds in 24 hours or Receive other foods or drinks or Thrush (ulcers or white patches in mouth) or Low weight for age FEEDING PROBLEM OR LOW WEIGHT If not well attached or not sucking effectively, teach correct positioning and attachment. If breastfeeding less than 8 times in 24 hours, advise to increase frequently of feeding. If receiving other foods or drinks counsel mother about breastfeeding more, reducing other foods or drinks, and using a cup and spoon. - if not breastfeeding at all, advise mother about giving locally appropriate animal milk and teach the mother to feed with a cup and spoon. If thrush, teach the mother to treat thrush at home. If low weight for age, teach the mother how to keep the young infant with low weight warm at home. If breast or nipple problem, teach the mother to treat breast or nipple problems. Advise mother to give home can for the young infant. Advise mother when to return immediately Follow up any feeding problem or thrush in 2 days. Follow-up low weight for age in 14 days. Teacher: teaching Student: listening L C D
MRS.CHANDRALEKHA.E PROFESSOR ICON briefy explain the assess and classify the sick child age 2 months up to 5 years Not low weight for age and no other signs of inadequate feeding NO FEEDING PROBLEM Advice mother to give home care for the young infant Advice mother when to return immediately Praise the mother for feeding the infant well ASSESS AND CLASSIFY THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS THEN ASK ABOUT MAIN SYMPTOMS: DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? IF YES, ASK: • For how long? LOOK, LISTEN: • Count the breaths in the minute • Look for Chest indrawing • Look and listen for stridor Teacher: teaching Student: listening L C D How to assess and classify the sick child age 2 months up to 5 years FAST BREATHING If the child is 2months up to 12 months – 50 breaths per minute or more 12 months up to 5 years – 40 breaths per minute or more
MRS.CHANDRALEKHA.E PROFESSOR ICON DOES THE CHILD HAVE DIARRHOEA? IF YES, ASK: • For how long? • Is there blood in the stool? LOOK AND FEEL: • Look at the child’s general condition. Is the infant: - Lethargic or unconscious? - Restless and irritable? • Look for sunken eye. • Offer the child fluid. - not able to drink or drinking poorly? - drinking eagerly, thirsty? Teacher: teaching Student: listening L C D
MRS.CHANDRALEKHA.E PROFESSOR ICON • Pinch the skin of the abdomen. -Does it go back: very slowly (longer than seconds)? slowly? Two of the following signs: Lethargic or unconscious Sunken eyes Skin pinch goes back very slowly Not able to drink or drinking poorly SEVERE DEHYDRATION • If child has no other severe classification: - Give first dose of intramuscular ampicillin and gentamicin • If child also has another severe classification: - Refer URGENTLY to hospital with mother give frequent sips of ORS on the way - Advice mother to continue breastfeeding • If child is 2 years or older and there is cholera in your area, give doxycycline for cholera. Two of the following signs: Restless, irritable Sunken eyes Drinks eagerly, thirsty Skin pinch goes back very slowly SOME DEHYDRATION • Give fluid and food for some dehydration. • If child also has a severe classification: • Refer URGENTLY to hospital with mother give frequent sips of ORS on the way • Advice mother to continue breastfeeding • Advise mother when to return immediately. • Follow – up in 5 days if not improving Not enough signs to classify as some as severe dehydration NO DEHYDRATION • Give fluids and food to treat diarrhea at home • Advice mother when to return immediately • Follow - up in 5 days if not improving Teacher: teaching Student: listening L C D
MRS.CHANDRALEKHA.E PROFESSOR ICON Dehydration present SEVERE PERSISTENT DIARRHEA • Treat dehydration before referral unless the child has another severe classification. • Refer to hospital. No dehydration PERSISTENT DIARRHEA • Advice the mother on feeding a child who has PERSISTENT DIARRHOEA. • Give single dose of Vitamin A • Give Zinc sulphate 20 mg daily for 14 days. • Follow-up in 5 days. Blood in the stool DYSENTRY • Treat for 5 days with cotrimoxazole. • Follow-up in 2 day DOES THE CHILD HAVE FEVER IF YES: Decide Malaria Risk: High Low THEN ASK: • Fever for how long? • If more than 7 days, has fever been present every day? • Has the child had measles within the last 3 months? LOOK AND FEEL: • Look or feel for stiff neck. Teacher: teaching Student: listening L C D
MRS.CHANDRALEKHA.E PROFESSOR ICON • Look and feel for bulging fontanelle. • Look for runny nose LOOK FOR SIGNS OF MEASLES • Generalized rash and • One of these: cough, runny nose, or red eyes. 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 eyes. • Look for clouding of the cornea. HIGH MALARIA RISK Any general danger sign or Stiff neck or Bulging fontanelle. VERY SEVERE FEBRILE DISEASE Give first dose of IM quinine after making a blood smear. Give first dose of IV or IM chloramphenicol (if not possible, give oral amoxicillin). Treat the child to prevent low blood sugar. Give one dose of paracetamol in clinic for high fever (temp. 38.5C or above) Refer URGENTLY to hospital. Fever (by history or feels hot or temperature 37.5 MALARIAL Give oral antimalarial for HIGH malaria risk area after making a blood smear. Give one dose of Paracetamol in clinic for high fever Teacher: teaching Student: listening L C D
MRS.CHANDRALEKHA.E PROFESSOR ICON C or above) (temp. 38.5C or above) Advice mother when to return immediately. Follow-up in 2 days if fever persists. If fever is present every day for more than 7 days, refer for assessment. LOW MALARIA RISK Any general danger sign or Stiff neck or Bulging fontanelle. VERY SEVERE FEBRILE DISEASE Give first dose of IM quinine after making a blood smear. Give first dose of IV or IM chloramphenicol (if not possible, give oral amoxicillin). Treat the child to prevent low blood sugar. Give one dose of paracetamol in clinic for high fever (temp. 38.5C or above) Refer URGENTLY to hospital. Fever (by history or feels hot or temperature 37.5 C or above) MALARIAL Give oral antimalarial for LOW malaria risk area after making a blood smear. Give one dose of Paracetamol in clinic for high fever (temp. 38.5C or above) Advice mother when to return immediately. Follow-up in 2 days if fever persists. If fever is present every day for more than 7 days, refer for assessment. Runny nose PRESENT or Measles PRESENT or Other causes of FEVER MALARIA UNLIKELY Give one dose of Paracetamol in clinic for high fever (temp. 38.5C or above) Advice mother when to return immediately. Follow-up in 2 days if fever persists. If fever is present every day for more than 7 days, refer Teacher: teaching Student: listening L C D
MRS.CHANDRALEKHA.E PROFESSOR ICON fever PRESENT for assessment DOES THE CHILD HAVE AN EAR PROBLEM? IF YES, ASK: • If there ear pain? • Is there ear discharge? If yes, for how long? Teacher: teaching Student: listening L C D
MRS.CHANDRALEKHA.E PROFESSOR ICON LOOK AND FEEL: • Look for pus drainage from the ear. • Feel for tender swelling behind the ear. THEN CHECK FOR MALNUTRITION LOOK AND FEEL: • Look for visible severe wasting. • Look for edema of both feet. Visible severe wasting or Edema of both SEVERE MALNUTRITION Give single dose of vitamin A Teacher: teaching Student: listening V I D E O
MRS.CHANDRALEKHA.E PROFESSOR ICON feet Prevent low blood sugar. Refer URGENTLY to hospital. While referral is being organized, warm the child Keep the child warm on the way to hospital. Very low weight for age VERY LOW WEIGHT Assess and counsel for feeding ( if feeding problem, follow-up in 5 days) Advise mother when to return immediately. Follow up in 30 days Not very low weight for age and no other signs of malnutrition NOT VERY LOW WEIGHT If child is less than 2 years old, assess the child’s feeding and counsel the mother on feeding according to the FOOD box on the counsel If feeding problem, follow-up in 5 days Advise mother when to return immediately THEN CHECK FOR ANEMIA? LOOK: • Look for palmer pallor. Is it: Severe palmer pallor? Severe palmer pallor SEVERE ANEMIA Refer URGENTLY to hospital Some palmer pallor ANAEMIA Give Iron and folic acid therapy for 14 days. Assess the child’s feeding and counsel the mother on feeding according to the FOOD box on the counsel - If feeding problem, follow-up in 5 days Advise mother when to return immediately. Follow-up in days
MRS.CHANDRALEKHA.E PROFESSOR ICON No palmar pallor NO ANEMIA Give prophylactic Iron and folic acid if child 6 months or older. BIBLIOGRAPHY: TEXT BOOKS: o Park’s “The textbook of Preventive and social medicine” 21 edition, bhanot publisher o “Wong’s “Essentials of Pediatric nursing” Marilyn J Hokenberry, Wilson Winkelstein, 7th edition, Elseveir publications o “A text book of child health nursing with procedures” ManojYadav 1st edition, PeeVee publications,. o “ Pediatric Nursing” ParulDatta 2nd edition Elseveir publications. o Marlow’s “Text book of child health nursing” 7th edition, Elseveir publications.
MRS.CHANDRALEKHA.E PROFESSOR ICON NET REFERENCE:  WWW.pediatric.com  www.pediatremergcare.com PLACE : INDIRANI COLLEGE OF NURSING SUBJECT : CHILD HEALTH NURSING TOPIC : IMNCI GROUP OF STUDENT : B.SC IV YEAR NURSING STUDENTS DATE AND TIME : DURATION : METHOD OF TEACHING : LECTURER CUM DISCUSSION AV AIDS : BLACK BOARD, LCD, VIDEO NAME OF THE FACULTY : VAISHNAVI. L M.Sc. (N)., LECTURER IN CHN., ICON
MRS.CHANDRALEKHA.E PROFESSOR ICON GENERAL OBJECTIVE: At the end of the class the student will gain adequate knowledge regarding integrated management of neonatal and childhood illness and change their attitude and develop the skills on IMNCI. SPECIFIC OBJECTIVE: The students will be able to  explain about the IMCI  define the IMNCI  list out the high lights of IMNCI  enlist the objectives of IMNCI  enumerate the beneficiaries and care of children in IMNCI
MRS.CHANDRALEKHA.E PROFESSOR ICON  discuss the principles of IMNCI  find out the component of IMNCI  list out the classification of IMNCI  explain about elements and process of IMNCI  describes the assess and classify the sick infant age up to 2 months  briefy explain the assess and classify the sick child age 2 months up to 5 years SUMMARY: It helps to start the class with introduction of the IMCI and IMNCI a well planned manner and I try to maintain attention of the students and throughout of the class by maintaining discipline and have control over the students. It helps to close the class by summarizing the topic and monitoring to continue the teaching aboutIMNCI . CONCLUSION: After completed the class I hope you all well known about introduction, definition, objectives, components, principles, elements, classification of IMNCI.I sincerely thank my students for their cooperation throughout the class.
MRS.CHANDRALEKHA.E PROFESSOR ICON

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IMNCI-LESSON-PLAN. Disease conditions...

  • 1.
    MRS.CHANDRALEKHA.E PROFESSOR ICON S.N O TIME SPECIFIC OBJECTIVE CONTENT TEACHER`S &LEARNER`S ACTIVITY AV AIDS EVALUATION The students willbe able to explain about the IMCI INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS  Almost 19000 children under 5 years of age, died everyday across the world. 50% of its occurs in just five countries i.e. India, Nigeria, Congo, Pakistan and China.  World health organization (WHO), UNICEF & other international Partner came out with a new strategy known as INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI) in 1995.  IMCI mainly concentrate in 2 months to 5 years  An effort to bring health equity for child health.  The strategy emphasizes on integrated approach for treating the sick children.  Emphasizes on improving the family and community practices as well as care provided by the health system for better care of child. Integrated: different independent services and Teacher: teaching Student: listening B L A C K B O A R D What is the IMCI?
  • 2.
    MRS.CHANDRALEKHA.E PROFESSOR ICON administrative structure arecomplemented to achieve the common goal of Health (Multiple interventions are provided through one delivery channel eg. Vaccination) The objectives are to reduce deaths and frequency and severity of illness and disability and to contribute to improved growth and development. IMCI is the only child health strategy that aims for improvement  Children are not properly assessed and treated and their parents are poorly advised  Sick children present with sign and symptoms related to more than one condition (eg; bronchopneumonia, malnutrition, diarrhea)  Single diagnosis may not be possible or appropriate  So needs combined therapy for several condition. The core of the IMCI strategy is integrated case management of the most common childhood problems, with a focus on the most important causes of death i.e. diarrhoea, ARI,, Teacher: teaching Student: listening B L A C K B O A R D
  • 3.
    MRS.CHANDRALEKHA.E PROFESSOR ICON malaria, measles andmalnutrition. A guided process of adaptation ensures that guidelines, and the learning materials that go with them, reflect the epidemiology within a country and are tailored to fit the needs, resources and capacity of a country’s health system. When assessing a sick child, a combined of individual signs leads to one or more classifications, rather than to a diagnosis. IMCI classification are action oriented and allow a health care provider to determine if a child should be urgently referred to another health facility, if the child can be treated at the first-level facility (e.g. with oral antibiotic, antimalarial, ORS, etc.) or if the child can be safely managed at home. The complete IMCI case management process involves the following elements: 1. Assess 2. Classify 3. Identify 4. Treatment 5. Counsel Teacher: teaching Student: listening B L A C K B O A R D
  • 4.
    MRS.CHANDRALEKHA.E PROFESSOR ICON 6. Follow up INTEGRATEDMANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS The generic IMCI guidelines were adapted and the Indian version was named Integrated Management of Neonatal and childhood Illness (IMNCI). IMNCI strategy is one of the main interventions under RCH-II/ NRHM, that focuses on preventive, promotive and curative aspects of program. In India, common illnesses in children under 3 years of age include fever (27%), acute respiratory infections (17%), diarrhoea (13% ) and malnutrition (43%) – and often in combination (National Family Health Survey2. Infant Mortality Rate continues to be high at 68/1000 live births and Under Five Mortality Rate at 95/1000 live births per year. Neonatal mortality contributes to over 64% of infant deaths and most of these deaths occur during the first week of life. Mortality rate in the second month of life is also higher than at later ages. Any health program that aims at reducing Infant Teacher: teaching Student: listening L C D Tell about the what you about IMNCI?
  • 5.
    MRS.CHANDRALEKHA.E PROFESSOR ICON define the IMNCI Mortality Rateneeds to address mortality in the first two months of life, particularly in the first week of life. DEFINITION: IMNCI is an Integrated approach to child health that focuses on the well being of the whole child. It focused primarily on the most common causes of child mortality – diarrhea, pneumonia, measles, malaria, and malnutrition illness affecting children aged 1 week- 2months, 2 months – 5 year including both preventive and curative elements to be implemented by families and communities as well as by health facilities. IMNCI aims to reduce death, illness and disability and to Teacher: teaching Student: listening L C D What is meant by IMNCI?
  • 6.
    MRS.CHANDRALEKHA.E PROFESSOR ICON list out the highlights of IMNCI enlist the objectives of IMNCI promotes improved growth and development among children under five years of age. HIGHLIGHTS OF IMNCI:  0-7 days  Incorporating national guidelines on malaria, anemia, Vit-A supplementation & immunization schedule.  Training of the health personnel begins with sick young infants upto 2 months  Proportion of training time devoted to sick young infant and sick child is almost equal and  It is skill based. OBJECTIVES: 1. To determine baseline mortality among children under 5 years of age (NMR, IMR, USMR). 2. To determine prevalence of fever, loose stools, cough and any other illness (morbidity density) in two weeks prior to day of field survey among children under 5 years of age. Teacher: teaching Student: listening L C D Enlist the highlights of IMNCI? list the objectives of IMNCI?
  • 7.
    MRS.CHANDRALEKHA.E PROFESSOR ICON enumerate the beneficiaries and careof children in IMNCI 3. To assess effective programme coverage for specified disease condition (cough with fast breathing) occurring in two weeks prior to day of field survey. 4. contribute to improve the growth and development BENEFICIARIES OF IMNCI:  Care of young infants for newborns (under 2 months)  Young children (2 months - 5years) Care of Newborns and Young Infants (infants under 2 months) • Keeping the child warm • Initiation of breastfeeding • Counseling for exclusive breastfeeding • Cord, skin and eye care • Recognition of illness in newborn and management and/or referral • Immunization and Home visits in the postnatal period Care of Infants (2 months to 5 years)  Management of diarrhoea, ARI, malaria, measles, acute ear infection, malnutrition and anemia Teacher: teaching Student: listening Tell the beneficiaries of IMNCI and care of children?
  • 8.
    MRS.CHANDRALEKHA.E PROFESSOR ICON discuss the principles of IMNCI Recognition of illness and risk  Prevention and management of Iron and Vitamin A deficiency  Counseling on feeding for all children below 2 years  Counseling on feeding for malnourished  Immunization PRINCIPLES: Depending on a child’s age, various clinical signs and symptoms differ in their degrees of reliability and diagnostic value and importance. Therefore, the IMNCI guidelines recommend case management procedures based on two age categories:  Young infants age up to 2 months  Children age 2 months up to 5 years The IMNCI guidelines are based on the following principles:  All sick young infants up to 2 months of age must be assessed for “possible bacterial infection / jaundice”. Then they must be routinely assessed for the major symptom “diarrhoea”.  All sick children age 2months up to 5 years must be examined for “general danger signs” which indicate the Teacher: teaching Student: listening L C D discribe the principles of IMNCI?
  • 9.
    MRS.CHANDRALEKHA.E PROFESSOR ICON need for immediatereferral or admission to a hospital. They must then be routinely assessed for major symptoms: cough or difficult breathing, diarrhoea, fever and ear problems.  All sick young infants and children 2 months up to 5 years must also be routinely assessed for nutritional and immunization status, feeding problems, and other potential problems.  Only a limited number of carefully selected clinical signs are used, based on evidence of their sensitivity and specificity to detect disease. These signs were selected considering the conditions and realities of first-level health facilities.  A combination of individual signs leads to an infant’s or a child’s classification rather than a diagnosis. Clinical guidelines:  Prepared based on expert clinical opinion and research result (child health, researchers, academics, IAP and NNF)  To promote evidence based assessment and management using syndrome approach that support Teacher: teaching Student: listening L C D
  • 10.
    MRS.CHANDRALEKHA.E PROFESSOR ICON find out the componentof IMNCI list out the classification of IMNCI the rationale, effective and affordable use of drug.  Counselling the parents to solve feeding problems, advising parents about when to return to a health facility.  Showing them how to administer the first dose of the treatment eg: first give the medicine and tell how to give the medicine.  Checking parents understanding of the advice given COMPONENTS: IMNCI includes both preventive and curative interventions. The strategy has the following three components: 1. Health- worker component: Improvements in the case- management skills of health through the provision of locally adapted guidelines 2. Health-service component: improvements in the overall health system required for effective management of neonatal and childhood illness 3. Community component: improvement in family and community health care practices. IMNCI CLASSIFICATION: Teacher: teaching Student: listening L C D Tell the components of IMNCI ?
  • 11.
    MRS.CHANDRALEKHA.E PROFESSOR ICON explain about elements and processof IMNCI In IMNCI, only a limited number of carefully- selected clinical signs are considered, based on their sensitivity and specificity, to detect the disease. A combination of these signs helps in arriving at the child’s classification, rather than a diagnosis. 1. Pink : child needs urgent referral 2. Yellow: child needs specific medical treatment and advise 3. Green: child needs no medicine, advise home care. ELEMENTS: 1. Assess: - Danger signs, nutrition and immunization status - Other problems 2. Classify: -Using “Color coded” triage system Pink: urgent referral Yellow: specific medical treatment and advise Green: advise home care. 3. Identify: Teacher: teaching Student: listening L C D Discuss the elements and process of IMNCI?
  • 12.
    MRS.CHANDRALEKHA.E PROFESSOR ICON - Specific treatment 4.Treatment: - Pre referral - Medical treatment - Home management 5. Counsel: - Feeding problems - Mother’s health 6. Follow-up care Teacher: teaching Student: listening L C D
  • 13.
  • 14.
    MRS.CHANDRALEKHA.E PROFESSOR ICON describes the assess and classifythe sick infant age up to 2 months ASSESS AND CLASSIFY THE SICK INFANT AGE UPTO 2 MONTHS CHECK FOR POSSIBLE BACTERIAL INFECTION / JAUNDICE ASK • has the infant had convulsions? LOOK, LISTEN, FEEL: • Count the breaths in one minute. Repeat the count if elevated • Look for serve chest indrawing • Look for nasal flaring • Look and listen for grunting • Look and feel for bulging fontanelle. • Look for pus draining from the ear • Look at the umbilicus. Is it red or draining pus? • Look for skin pustules. Are there 10 or more skin pustules or big boil? Teacher: teaching Student: listening L C D How to assess and classify the sick infant age up to 2 months?
  • 15.
    MRS.CHANDRALEKHA.E PROFESSOR ICON • Measure axillarytemperature (if not possible, feel for fever or low body temperature) • See if the young infant’s movements. Are they less than normal? • Look for jaundice? • Are the palms and soles yellow? Teacher: teaching Student: listening L C D
  • 16.
    MRS.CHANDRALEKHA.E PROFESSOR ICON DOES THE YOUNGINFANT HAVE DIARRHOEA? Teacher: teaching Student: listening L C D
  • 17.
    MRS.CHANDRALEKHA.E PROFESSOR ICON IF YES, ASK: •For how long? • Is there blood in the stool? LOOK AND FEEL: • Look at the young infant’s general condition. Is the infant: - Lethargic or unconscious? - Restless and irritable? • Look for sunken eye. • Pinch the skin of the abdomen. -Does it go back: very slowly (longer than seconds)? slowly? Teacher: teaching Student: listening L C D
  • 18.
  • 19.
    MRS.CHANDRALEKHA.E PROFESSOR ICON CHECK FOR FEEDINGPROBLEM AND MALNUTRITION ASK: • If there any difficulty feeding? • Is the infant breastfeed? If yes, how many times in 24 hours? • Does the infant usually receive any other foods or drinks? - If yes, how often? • What do you use to feed the infant? LOOK, FEEL: • Determine weight for age Not able to feed or No attachment at all or Not sucking at all or Very low weight for age NOT ABLE TO FEED POSSIBLE SERIOUS BACTERIAL INFECTION OR SEVERE MALNUTRIT ION Give first dose of intramuscular ampicillin and gentamicin Treat to prevent low blood sugar Warm the young infant by skin to skin contact if temperature less than 36.5C (or feels cold to touch) while arranging referral Advice mother how to keep the young infant warm on the way to the hospital. Refer URGENTLY to hospital Teacher: teaching Student: listening L C D
  • 20.
    MRS.CHANDRALEKHA.E PROFESSOR ICON Not well attached to breastor Not sucking effectively or Less than 8 breastfeeds in 24 hours or Receive other foods or drinks or Thrush (ulcers or white patches in mouth) or Low weight for age FEEDING PROBLEM OR LOW WEIGHT If not well attached or not sucking effectively, teach correct positioning and attachment. If breastfeeding less than 8 times in 24 hours, advise to increase frequently of feeding. If receiving other foods or drinks counsel mother about breastfeeding more, reducing other foods or drinks, and using a cup and spoon. - if not breastfeeding at all, advise mother about giving locally appropriate animal milk and teach the mother to feed with a cup and spoon. If thrush, teach the mother to treat thrush at home. If low weight for age, teach the mother how to keep the young infant with low weight warm at home. If breast or nipple problem, teach the mother to treat breast or nipple problems. Advise mother to give home can for the young infant. Advise mother when to return immediately Follow up any feeding problem or thrush in 2 days. Follow-up low weight for age in 14 days. Teacher: teaching Student: listening L C D
  • 21.
    MRS.CHANDRALEKHA.E PROFESSOR ICON briefy explain the assessand classify the sick child age 2 months up to 5 years Not low weight for age and no other signs of inadequate feeding NO FEEDING PROBLEM Advice mother to give home care for the young infant Advice mother when to return immediately Praise the mother for feeding the infant well ASSESS AND CLASSIFY THE SICK CHILD AGE 2 MONTHS UP TO 5 YEARS THEN ASK ABOUT MAIN SYMPTOMS: DOES THE CHILD HAVE COUGH OR DIFFICULT BREATHING? IF YES, ASK: • For how long? LOOK, LISTEN: • Count the breaths in the minute • Look for Chest indrawing • Look and listen for stridor Teacher: teaching Student: listening L C D How to assess and classify the sick child age 2 months up to 5 years FAST BREATHING If the child is 2months up to 12 months – 50 breaths per minute or more 12 months up to 5 years – 40 breaths per minute or more
  • 22.
    MRS.CHANDRALEKHA.E PROFESSOR ICON DOES THE CHILDHAVE DIARRHOEA? IF YES, ASK: • For how long? • Is there blood in the stool? LOOK AND FEEL: • Look at the child’s general condition. Is the infant: - Lethargic or unconscious? - Restless and irritable? • Look for sunken eye. • Offer the child fluid. - not able to drink or drinking poorly? - drinking eagerly, thirsty? Teacher: teaching Student: listening L C D
  • 23.
    MRS.CHANDRALEKHA.E PROFESSOR ICON • Pinch theskin of the abdomen. -Does it go back: very slowly (longer than seconds)? slowly? Two of the following signs: Lethargic or unconscious Sunken eyes Skin pinch goes back very slowly Not able to drink or drinking poorly SEVERE DEHYDRATION • If child has no other severe classification: - Give first dose of intramuscular ampicillin and gentamicin • If child also has another severe classification: - Refer URGENTLY to hospital with mother give frequent sips of ORS on the way - Advice mother to continue breastfeeding • If child is 2 years or older and there is cholera in your area, give doxycycline for cholera. Two of the following signs: Restless, irritable Sunken eyes Drinks eagerly, thirsty Skin pinch goes back very slowly SOME DEHYDRATION • Give fluid and food for some dehydration. • If child also has a severe classification: • Refer URGENTLY to hospital with mother give frequent sips of ORS on the way • Advice mother to continue breastfeeding • Advise mother when to return immediately. • Follow – up in 5 days if not improving Not enough signs to classify as some as severe dehydration NO DEHYDRATION • Give fluids and food to treat diarrhea at home • Advice mother when to return immediately • Follow - up in 5 days if not improving Teacher: teaching Student: listening L C D
  • 24.
    MRS.CHANDRALEKHA.E PROFESSOR ICON Dehydration present SEVERE PERSISTENT DIARRHEA • Treat dehydrationbefore referral unless the child has another severe classification. • Refer to hospital. No dehydration PERSISTENT DIARRHEA • Advice the mother on feeding a child who has PERSISTENT DIARRHOEA. • Give single dose of Vitamin A • Give Zinc sulphate 20 mg daily for 14 days. • Follow-up in 5 days. Blood in the stool DYSENTRY • Treat for 5 days with cotrimoxazole. • Follow-up in 2 day DOES THE CHILD HAVE FEVER IF YES: Decide Malaria Risk: High Low THEN ASK: • Fever for how long? • If more than 7 days, has fever been present every day? • Has the child had measles within the last 3 months? LOOK AND FEEL: • Look or feel for stiff neck. Teacher: teaching Student: listening L C D
  • 25.
    MRS.CHANDRALEKHA.E PROFESSOR ICON • Look andfeel for bulging fontanelle. • Look for runny nose LOOK FOR SIGNS OF MEASLES • Generalized rash and • One of these: cough, runny nose, or red eyes. 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 eyes. • Look for clouding of the cornea. HIGH MALARIA RISK Any general danger sign or Stiff neck or Bulging fontanelle. VERY SEVERE FEBRILE DISEASE Give first dose of IM quinine after making a blood smear. Give first dose of IV or IM chloramphenicol (if not possible, give oral amoxicillin). Treat the child to prevent low blood sugar. Give one dose of paracetamol in clinic for high fever (temp. 38.5C or above) Refer URGENTLY to hospital. Fever (by history or feels hot or temperature 37.5 MALARIAL Give oral antimalarial for HIGH malaria risk area after making a blood smear. Give one dose of Paracetamol in clinic for high fever Teacher: teaching Student: listening L C D
  • 26.
    MRS.CHANDRALEKHA.E PROFESSOR ICON C or above)(temp. 38.5C or above) Advice mother when to return immediately. Follow-up in 2 days if fever persists. If fever is present every day for more than 7 days, refer for assessment. LOW MALARIA RISK Any general danger sign or Stiff neck or Bulging fontanelle. VERY SEVERE FEBRILE DISEASE Give first dose of IM quinine after making a blood smear. Give first dose of IV or IM chloramphenicol (if not possible, give oral amoxicillin). Treat the child to prevent low blood sugar. Give one dose of paracetamol in clinic for high fever (temp. 38.5C or above) Refer URGENTLY to hospital. Fever (by history or feels hot or temperature 37.5 C or above) MALARIAL Give oral antimalarial for LOW malaria risk area after making a blood smear. Give one dose of Paracetamol in clinic for high fever (temp. 38.5C or above) Advice mother when to return immediately. Follow-up in 2 days if fever persists. If fever is present every day for more than 7 days, refer for assessment. Runny nose PRESENT or Measles PRESENT or Other causes of FEVER MALARIA UNLIKELY Give one dose of Paracetamol in clinic for high fever (temp. 38.5C or above) Advice mother when to return immediately. Follow-up in 2 days if fever persists. If fever is present every day for more than 7 days, refer Teacher: teaching Student: listening L C D
  • 27.
    MRS.CHANDRALEKHA.E PROFESSOR ICON fever PRESENT forassessment DOES THE CHILD HAVE AN EAR PROBLEM? IF YES, ASK: • If there ear pain? • Is there ear discharge? If yes, for how long? Teacher: teaching Student: listening L C D
  • 28.
    MRS.CHANDRALEKHA.E PROFESSOR ICON LOOK AND FEEL: •Look for pus drainage from the ear. • Feel for tender swelling behind the ear. THEN CHECK FOR MALNUTRITION LOOK AND FEEL: • Look for visible severe wasting. • Look for edema of both feet. Visible severe wasting or Edema of both SEVERE MALNUTRITION Give single dose of vitamin A Teacher: teaching Student: listening V I D E O
  • 29.
    MRS.CHANDRALEKHA.E PROFESSOR ICON feet Prevent lowblood sugar. Refer URGENTLY to hospital. While referral is being organized, warm the child Keep the child warm on the way to hospital. Very low weight for age VERY LOW WEIGHT Assess and counsel for feeding ( if feeding problem, follow-up in 5 days) Advise mother when to return immediately. Follow up in 30 days Not very low weight for age and no other signs of malnutrition NOT VERY LOW WEIGHT If child is less than 2 years old, assess the child’s feeding and counsel the mother on feeding according to the FOOD box on the counsel If feeding problem, follow-up in 5 days Advise mother when to return immediately THEN CHECK FOR ANEMIA? LOOK: • Look for palmer pallor. Is it: Severe palmer pallor? Severe palmer pallor SEVERE ANEMIA Refer URGENTLY to hospital Some palmer pallor ANAEMIA Give Iron and folic acid therapy for 14 days. Assess the child’s feeding and counsel the mother on feeding according to the FOOD box on the counsel - If feeding problem, follow-up in 5 days Advise mother when to return immediately. Follow-up in days
  • 30.
    MRS.CHANDRALEKHA.E PROFESSOR ICON No palmar pallor NOANEMIA Give prophylactic Iron and folic acid if child 6 months or older. BIBLIOGRAPHY: TEXT BOOKS: o Park’s “The textbook of Preventive and social medicine” 21 edition, bhanot publisher o “Wong’s “Essentials of Pediatric nursing” Marilyn J Hokenberry, Wilson Winkelstein, 7th edition, Elseveir publications o “A text book of child health nursing with procedures” ManojYadav 1st edition, PeeVee publications,. o “ Pediatric Nursing” ParulDatta 2nd edition Elseveir publications. o Marlow’s “Text book of child health nursing” 7th edition, Elseveir publications.
  • 31.
    MRS.CHANDRALEKHA.E PROFESSOR ICON NET REFERENCE:  WWW.pediatric.com www.pediatremergcare.com PLACE : INDIRANI COLLEGE OF NURSING SUBJECT : CHILD HEALTH NURSING TOPIC : IMNCI GROUP OF STUDENT : B.SC IV YEAR NURSING STUDENTS DATE AND TIME : DURATION : METHOD OF TEACHING : LECTURER CUM DISCUSSION AV AIDS : BLACK BOARD, LCD, VIDEO NAME OF THE FACULTY : VAISHNAVI. L M.Sc. (N)., LECTURER IN CHN., ICON
  • 32.
    MRS.CHANDRALEKHA.E PROFESSOR ICON GENERAL OBJECTIVE: At theend of the class the student will gain adequate knowledge regarding integrated management of neonatal and childhood illness and change their attitude and develop the skills on IMNCI. SPECIFIC OBJECTIVE: The students will be able to  explain about the IMCI  define the IMNCI  list out the high lights of IMNCI  enlist the objectives of IMNCI  enumerate the beneficiaries and care of children in IMNCI
  • 33.
    MRS.CHANDRALEKHA.E PROFESSOR ICON  discuss theprinciples of IMNCI  find out the component of IMNCI  list out the classification of IMNCI  explain about elements and process of IMNCI  describes the assess and classify the sick infant age up to 2 months  briefy explain the assess and classify the sick child age 2 months up to 5 years SUMMARY: It helps to start the class with introduction of the IMCI and IMNCI a well planned manner and I try to maintain attention of the students and throughout of the class by maintaining discipline and have control over the students. It helps to close the class by summarizing the topic and monitoring to continue the teaching aboutIMNCI . CONCLUSION: After completed the class I hope you all well known about introduction, definition, objectives, components, principles, elements, classification of IMNCI.I sincerely thank my students for their cooperation throughout the class.
  • 34.