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IMCI 1.

Know the general danger signs c convulsion - malaria u unable to feed/drink BF - diarrhea v vomits everything - diarrhea a abnormally sleepy or difficult to awaken one general danger sign is classified as severe Know the color coding pink -severe classification -urgent referral -needs immediate attention -give first dose/one dosse of antibiotic -treat to prevent low blood sugar -0-2mo. keep the infant warm -monitoring and follow-up -plan c yellow -give an antibiotic -give an appropriate antibiotic -give oral drugs -treat local infection -dry the ear by wicking -soothe the throat with safe remedy (calamansi) -follow-up within 2 or 5 days -instruct or advise mother when to return immediately -plan b green -follow-up within 2 or 5 days -home management -home treatment -give home care -no urgent measures needed -feeding and fluids -praise the mother for feeding the child -plan a 3. Know the assessment process 2mo-5yo -cough/difficulty of breathing - pneumonia -diarrhea a. Within 5 days b. More than 14 days - Persistent Diarrhea - give multivitamins and minerals for 14 days c. Blood in stool - ciprofloxacin -fever a. Malaria b. Measles c. DHF -Ear problem a. Mastoiditis b. More than 14 days - chronic c. Less than 14 days - acute -malnutrition -anemia -immunization -vitamin A -deworming - done twice a year a. First line - abendazole b. Second line - mebendazole 0-2mo -very severe disease -jaundice -diarrhea -feeding problem

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COUGH/DOB - PNEUMONIA g GDS c chest indrawing - severe pneumonia s stridor - for wheezing - give trial of rapid acting inhaled bronchodilator o give 3x dose for 15-20min apart o if -W + -S = asthma o if -W + +S = severe pneumonia fast breathing pneumonia - yellow o 2mo-12mo = 50bpm o less than 2mo. = 60bpm o more than 12mo. = 40bpm no s and sx - no pneumonia; no, not, unlikely - green Diarrhea within 5 days a. GDS (1) + s/sx (1) = severe dehydration b. No GDS + s/sx (2) = some dehydration c. No GDS + s/sx (1/no) = no dehydration more than 14 days + s/sx = severe persistent diarrhea a. s sunken eye b. i irritable c. r restless d. s slow skin turgor more than 14 days w/o s/sx = persistent diarrhea blood in the stool - dysenterY - yellow - ciprofloxacin Malaria

Measles

with malaria risk (BT) a. G GDS (convulsion) b. S Stiff neck - very severe febrile disease/very severe malaria c. (+) blood smear - malaria d. (-) blood smear - fever: malaria unlikely e. 1st line - artemether lumefanthrine f. 2nd line - chloroquine, primaquine, quinine, sulfadoxine no malaria risk (Hx of malaria) a. G GDS b. S Stiff neck - VSFD no s/sx of malaria - fever: no malaria

DHF

E extensive mouth ulcer C clouding of cornea G GDS (optional) s/sx (1) - severe complicated measles a. P pus draining in the eyes - tetracycline ointment b. M mouth ulcer - paint with 1/2 strength gentian violet measles with eye/mouth complications measles now/within 3months - measles (green)

with s/sx - severe DHF - pink - plan C if bleeding only; avoid aspirin, dolan (ibuprofen) no s/sx - fever DHF unlikely - green

Ear Problem T Tender swelling behind the ear - mastoiditis (pink) G GDS (optional) more than 14 days - chronic - instill otic solution (quinolones) for 14 days - yellow less than 14 days - acute - yellow 1st line - (amoxicillin) mastoiditis, pnemonia, acute ear problem, VSD 2nd line - cotrimoxazole - hepatotoxic no s/sx of ear problem - no ear problem - green Malnutrition v visible severe muscle wasting e edema on both feet m mid upper arm circumference - tape measure - 115mm or below (started 6mo-5yo) (CBQ) only 1 s/sx = severe malnutrition (pink) very low weight for age (yellow)

Anemia

not very low weight for age (green) follow up 30 days

2.

severe palmar pallor - severe anemia some palmar pallor - anemia no s/sx of anemia - no anemia follow up is 14 days meds (Iron supplementation for 14 days, vitamin A

Alternative Treatment IMCI cough - tamarind, calamansi, ginger (before); calamansi juice (give only if child more than is 6mo. hypoglycemia - glucose water oral thrush - wash mouth with clean soft cloth with salt and water 0-2 months Very severe disease - 8 assessment (at least 1) a. C convulsions b. S severe chest indrawing c. F fast breathing d. T temperature (37.5) hyperthermia; (35.5) hypothermia e. MOS/NMA - move only if stimulated; no movement at all f. N not feeling well Local bacterial infection - 3 assessment a. D draining Pus b. Re red umbilicus c. S skin pustules Very severe disease/Local bacterial infection unlikely - no s/sx

Early skin to skin contact of NB and mother -prevents: H hypothermia I infection H hypoglycemia 3. Properly timed cord clamping and cutting -1-3 min after cord pulsations stops -prevents: a anemia b brain hemorrhage 4. Non separation of mother and newborn to initiate BF colustrum - first immunization

3 Categories of Unang Yakap Time Bound - routinely performed 1. Withing 30 sec 2. After thorough drying 3. 1-3 min 4. Within 90 min Non time bound 1. v vitamin K administration 2. i immunization BCG and Hepa B 3. e eye prophylaxis - erythromycin 4. w weighing of newborn - 2500grams Unnecessary - optional 1. f foot printing 2. a administration of prelacteal - glucose water 3. r routine suctioning 4. r routine separation kwashiorkor vs marasmus cause: poverty treatment: food onset: toddler - 0-2yo main problem: CHON - CHO s/sx: (kwashiorkor) m moon face e edema on both extremities s stunted growth a apathy s/sx (marasmus) w wasted muscles o old man face w wrinkled skin skin: desquamation - wrinkle treatment: increase CHON, variety of foods - increase CHO UFC - Under Five Care Program mother (pregnant) - HBMR (Home Based Mothers Record) UFC GMC - Growth Monitoring Chart; assess height and weight; assess MALNUTRITION ORT - Oral Rehydration Therapy

Jaundice less 24 hours with jaundice with yellow palm/sole - severe jaundice more 24 hours with jaundice no yellow palm/sole - jaundice no s/sx of jaundice - no jaundice pneumonia + dysentery = cipro only Diarrhea within 5 days - MOS/NMA + s/sx (sunken eyes or skin pinch goes back slow) = severe DHN 2 of the following = some DHN no s/sx of DHN = no DHN more than 14 days + s/sx or no s/sx - severe persistent diarrhea pink blood in the stool - dysentery - pink Feeding Problem Feeding Problem/low weight for age - yellow o s/sx: not sucking effectively, not well attached, receive other food/fluids, BF less 8 for 24 hours, oral thrush No feeding problem - No s/sx less 4mo = 200-450ml 4-12mo = 450-800ml 12mo-2yo = 800-960ml 2-5yo = 960-1600ml UNANG YAKAP launched December 7, 2009 legal basis - AO 2009-0025 goal/aim: reduce child mortality 3 Hospital 1. Quirino Memorial Medical Center 2. Fabella Memorial MC 3. PGH protocol for new life according to ENC 4 new steps in NBC 1. Immediate and thorough drying of the skin -stimulates breathing -prevents hypothermia (do not wash, bath, nor remove vernix caseosa - prevent infection) and can only be done after 16 hours -done 30 sec

Elements of Diarrhea 1. Frequency - 5-10 unformed stool w/in 24 hours is called MILD DHN; 10-15 MODERATE DHN; more than 15 SEVERE DHN 2. Consistency - rice watery stool (cholera) - give tetracycline; dysentery, amoebiasis (mucoid like stool) - avoid Vit C since unabsorbed instead give metronidazole (anti-protozoan) 3. Intervention/Management b breastfeeding - most effective and affordable treatment for less than 6mo a am h home made oresol 1L H20 + 8tsp sugar + 1tsp salt; 1glass + 2tsp sugar + 1 pinch salt o oresol commercial: 1sachet + 1lit of h20

DOH vision l leader a advocate (staunched) m models in promoting health mission q quality health care e excellence and equitable s sustainable for all Filipinos

Environmental Sanitation Code of Philippines -PD 856 1. Approved toilet facilities Level 1 p pit latrines - hole with cover r reed odorless earth closet - requires small amount of water a aqua privies p pour flush Level 2 s septic tank w water sealed f flush type Level 3 s septic tank with vault w water carriage type s sewage system Approved water supply facilities Pollution

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6 No No No Words 1. Rich 2. Money 3. Politics - referrals, networking and linkages 4. Funding 5. Dependency, Discourage 6. Nurse focused 10 Magic Words 1. Health promotion 2. Self reliance 3. People empowerment 4. Partnership with people 5. Health education 6. Availability, affordability, accessibility 7. Active community participation 8. Community integration 9. IMCI - assess 10. Healthy lifestyle