Community Health Nursing 1 Lecture Notes - BS Nursing Second Year PDF

Community Health Nursing 1 - Lecture STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR...

Community Health Nursing 1 - Lecture STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR Session # 18 Materials: LESSON TITLE: Integrated Management of Childhood Pen, paper, index card, book, and class List Illnesses (IMCI) Reference: LEARNING OUTCOMES: Famorca, Z. U., Nies, M. A., & McEwen, M. (2013). At the end of the lesson, the nursing student can: Nursing Care of the Community. Elsevier 1. Define IMCI; Gezondheidszorg. 2. Discuss the IMCI case management process; and, 3. Outline disease based on presenting signs and symptoms. LESSON PREVIEW/REVIEW (5 minutes) Instruction: Enumerate the six preventable diseases were initially included in the EPI. 1. _______________ 2. _______________ 3. _______________ 4. _______________ 5. _______________ 6. _______________ MAIN LESSON (30 minutes) Definition IMCI is an integrated approach to child health that focuses on the well-being of the whole child. IMCI strategy is the main intervention proposed to achieve a significant reduction in the number of deaths from communicable diseases in children under five Goal By 2010, to reduce the infant and under five mortality rates at least one third, in pursuit of the goal of reducing it by two thirds by 2015. Aim To reduce death, illness and disability, and to promote improved growth and development among children under 5 years of age. IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities. IMCI Objectives To reduce significantly global mortality and morbidity associated with the major causes of disease in children To contribute to the healthy growth & development of children This document and the information thereon is the property of PHINMA Education (Department of Nursing) 1 of 11 IMCI Components of Strategy Improving case management skills of health workers Improving the health systems to deliver IMCI Improving family and community practices **For many sick children a single diagnosis may not be apparent or appropriate Presenting complaint: Cough and/or fast breathing Lethargy/Unconsciousness Measles rash “Very sick” young infant Possible course/ associated condition: Pneumonia, Severe anemia, P. falciparum malaria Cerebral malaria, meningitis, severe dehydration Pneumonia, Diarrhea, Ear infection Pneumonia, Meningitis, Sepsis Five Disease Focus of IMCI: Acute Respiratory Infection Diarrhea Fever Malaria Measles Dengue Fever Ear Infection Malnutrition The IMCI Case Management Process Assess and classify Identify appropriate treatment Treat/refer Counsel Follow-up The Integrated Case Management Process 1. Check for General Danger Signs: A general danger sign is present if: The child is not able to drink or breastfeed The child vomits everything The child has had convulsions The child is lethargic or unconscious 2. Assess Main Symptoms Cough/DOB Diarrhea Fever Ear problems This document and the information thereon is the property of PHINMA Education (Department of Nursing) 2 of 11  3. Assess and Classify Cough of Difficulty of Breathing Respiratory infections can occur in any part of the respiratory tract such as the nose, throat, larynx, trachea, air passages or lungs. 4. Assess and classify PNEUMONIA Cough or difficult breathing An infection of the lungs Both bacteria and viruses can cause pneumonia Children with bacterial pneumonia may die from hypoxia (too little oxygen) or sepsis (generalized infection). ** A child with cough or difficult breathing is assessed for: How long the child has had cough or difficult breathing Fast breathing Chest indrawing Stridor in a calm child. Remember: ** If the child is 2 months up to 12 months the child has fast breathing if you count 50 breaths per minute or more ** If the child is 12 months up to 5 years the child has fast breathing if you count 40 breaths per minute or more. This document and the information thereon is the property of PHINMA Education (Department of Nursing) 3 of 11 Color Coding Assess and classify DIARRHEA A child with diarrhea is assessed for: How long the child has had diarrhea Blood in the stool to determine if the child has dysentery This document and the information thereon is the property of PHINMA Education (Department of Nursing) 4 of 11  Signs of dehydration. Classify DYSENTERY Child with diarrhea and blood in the stool Does the child have fever? Two of the following signs? **Decide:  Any general  Give first dose of quinine (under medical supervision danger VERY SEVERE FEBRILE or if a hospital is not accessible within 4hrs) sign or DISEASE / MALARIA  Give first dose of an appropriate antibiotic  Stiff neck  Treat the child to prevent low blood sugar  Give one dose of paracetamol in health center for high fever (38.5oC) or above  Send a blood smear with the patient  Abnormally sleepy or  Malaria Risk difficult to awaken  No Malaria Risk  Sunken eyes  Measles  Not able to drink or  Dengue drinking poorly  Skin pinch goes back Malaria Risk very slowly  If child has no other severe classification: Give fluid for severe dehydration (Plan C) SEVERE OR DEHYDRATION  If child has another severe classification: Two of the following signs: Refer URGENTLY to hospital with mother  Restless, irritable giving frequent sips of ORS on the way  Sunken eyes Advise the mother to continue breastfeeding  Drinks eagerly, thirsty  If child is 2 years or older and there is cholera in your  Skin pinch goes back area, give antibiotic for cholera slowly  Give fluid and food for some dehydration (Plan SOME DEHYDRATION B) Not enough signs to classify as  If child also has a severe classification: some or severe dehydration Refer URGENTLY to hospital with mother giving frequent sips of ORS on the way Advise mother when to return immediately Dehydration present  Follow up in 5 days if not improving  Home Care  Give fluid and food to treat diarrhea at home NO DEHYDRATION (Plan A) No dehydration  Advise mother when to return immediately  Follow up in 5 days if not improving  Treat dehydration before referral unless the child has another severe classification Blood in the stool This document and the information thereon is the property of PHINMA Education (Department of Nursing) 5 of 11 SEVERE  Advise the mother on feeding a child who has PERSISTE persistent diarrhea NT  Give PERSISTENT  Give Vitamin A Vitamin a DIARRHEA  Follow up in 5 days DIARRHE A  Treat for 5 days with an oral antibiotic  Refer recommended for Shigella in your area to hospital DYSENTERY  Follow up in 2 days  Give also referral treatment This document and the information thereon is the property of PHINMA Education (Department of Nursing) 6 of 11   Clouding of cornea  Give Vitamin A or SEVERE COMPLICATED  Give first dose of an appropriate antibiotic  Deep or extensive MEASLES  If clouding of the cornea or pus draining from the eye, mouth ulcers apply tetracycline eye ointment  Refer URGENTLY to hospital  Pus draining from  Give Vitamin A the eye or MEASLES WITH EYE OR  If pus draining from the eye, apply tetracycline eye  Mouth ulcers MOUTH COMPLICATIONS ointment  If mouth ulcers, teach the mother to treat with gentian violet  Measles now or within the  Give Vitamin A last 3 months MEASLES This document and the information thereon is the property of PHINMA Education (Department of Nursing) 7 of 11 This document and the information thereon is the property of PHINMA Education (Department of Nursing) 8 of 11 Give an Appropriate Antibiotic: TETRACYCLINE QID COTRIMOXAZOLE BID FOR 3 DAYS FOR 3 DAYS AGE OR WEIGHT Capsule 250mg Tablet Syrup 2 – 4 months (4 – < 6kg) ¼ 1/2 5ml This document and the information thereon is the property of PHINMA Education (Department of Nursing) 9 of 11  4 – 12 months (6 – < 10 kg) ½ 1/2 5 ml 1 – 5 years old (10 – 19 kg) 1 1 7.5ml Give an Oral Antimalarial Sulfadoxine + This document and the information thereon is the property of PHINMA Education (Department of Nursing) 10 of 15  Give Paracetamol for Fever Higher (38.5oC or more) or Ear Pain AGE OR WEIGHT TABLET (500MG) SYRUP (120MG / 5ML) 2 months – 3 years ¼ 5 ml (4 –