History taking of the Sick Child According to IMCI Guidelines Flashcards
(30 cards)
What is the Process of Assessment? (12)
- Chief complaint
- Check the general danger signs
- Assess for cough
- Assess for diarrhoea
- Asses for fever
- Assess for measles
- Check the throat
- Assess the ear
- Check for anaemia and malnutrition
- Check for HIV infection or exposure
- Check for immunisation status
- Assess for feeding problems
What is done in the chief complaint?
- Ask the mother about the child’s chief complaint: what made them come to the clinic?
- Indicate if its an initial visit/follow up
What should you assess for?
- Check the general danger signs
- Not able to drink or breastfeed
- Vomits everything
- Hx of convulsions
- Lethargic or unconscious
- Convulsing now
How do you assess for cough?
> Ask
- Does the child have a cough or difficult breathing?
- For how long or how many days?
- Count the breaths in one minute
- Observe for fast breathing
- Look for chest indrawing
- Look and listen for stridor/wheezing
How do you assess for diarrhoea?
- Ask for how long/days
- Look at the child’s general condition
- Is the child lethargic or unconscious
- Is the child restless and irritable
- Does the child have sunken eyes
- Offer the child fluid or ask mother to breastfeed.
- Drinking poorly/eagerly, thirsty
- Pinch the skin of the abdomen; does it go back slowly?
How do you assess for fever?
- Does the child have a fever? (by history/feels hot/temperature 37.5°C or above)
- Fever is for how long?
- Has the child travelled to a malaria high risk area in the last 4 weeks
- Is Malaria risk high or low
- If fever is more than 7 days, has fever been present every day
- Look or feel for a stiff neck
How do you assess for measles?
- Look for signs of measles (generalised rash, cough, runny nose red eyes)
- Are mouth ulcers present?
- Check eyes is there pus draining
- Is the cornea cloudy?
How do you assess the ears?
- Does the child have an ear problem now or in the past?
- For smaller children examine the ear
- Is there a discharge present? If YES, for how long?
- Check if pus is draining ftrom the ear at present
- Check if there is tender swelling behind the ear
How do you check for malnutrition and anaemia?
- Is there visible severe wasting of body mass
- Ask if the child has lost weight
- (refer to the growth charts in the child’s health passport)
- Is there oedema of both feet?
- Is there growth faltering
How do you check for HIV infection or exposure
- Ask Mother if she has been tested for HIV
- Ask about the child as well
- Pneumonia, Parotid enlargement, Oral thrush
- Very low weight for age, ear discharge, persistent diarrhoea
- Generalised persistent lymphadenopathy
- If the mother is HIV infected and child is less than 24 months old, decide on infant feeding counselling needs.
How do you check the immunisation status?
- Check the child’s vitamin A supplementation and immunisation status (circle immunisations and vitamin A supplementation needed today and tick the ones already received)
- Remind mother/caregiver when the next immunisation is due
How do you assess for feeding problems?
- If the child has very low weight and is less than 2 years
- Ask if the mother is still breastfeeding. If YES, how many times per day?
- Do you breastfeed at night?
- Does the child take any other foods or fluids? If yes what food or fluids
- How many times per day
- What do you use to feed your child? How large are the servings/portions?
- Does the child receive his/her own serving?
- Who feeds the child now?
- During illness, have the child’s feeding habits changed? How?
What are the 6 elements of IMNCI, or Steps In Integrated Case Management?
- Assess
- Classify
- Identify treatment
- Treat
- Counsel
- Follow-up
What is step 1 in integrated case management (history taking according to IMNCI)
ASSESS
- Need good communication with mother of child
- Screen for general danger signs which would indicate any life-threatening condition
- Specific questions about the most common conditions affecting a child’s health
- If the answers are positive, focused physical examination should be done to identify the life threatening illness
- Evaluation of the child’s nutrition and immunization status assess and check for other problems
What is step 2 in integrated case management (history taking according to IMNCI)
CLASSIFY
- Based on the results of the assessment, a health care provider classifies child illnesses using a specially developed colour-coded triage system
- Because many children have more than one condition, each condition is classified according to what it requires.
What is step 3 in integrated case management (history taking according to IMNCI)
IDENTIFY TREATMENT
- After classifying all the condition present, a healthcare provider identifies specific treatment for the sick child or sick young infant
- If a child requires urgent referral (pink/red classification), essential treatment is to be given before referral is identified. Health education is also decided upon.
- If a child needs specific treatment (yellow), a treatment plan is developed and the drugs to be administered at the clinic are identified. Health education is also decided upon.
- If no serious condition has been found (green), the mother should be correctly advised on the appropriate actions to be taken for the care of the child at home.
What is step 4 in integrated case management (history taking according to IMNCI)
TREAT
- After identifying appropriate treatment, HCW carries out procedures relevant to child’s condition
- Give pre referral treatment
- Give first dose of relevant drugs and teach mother how to treat infection at home
- Proceed advice on home management
- Follow up date at specific time
What is step 5 in integrated case management (history taking according to IMNCI)
COUNSEL
- Give follow up care and indicate to the mother when to return to the clinic
- Teach the mother on the sign to look out for so as to come back immediately to the clinic
- Provide counselling on feeding and breastfeeding as well as counsel other about her own health
What is step 6 in integrated case management (history taking according to IMNCI)
FOLLOW-UP
- Since some conditions require you to see a child more than once, for a current episode of illness, give appropriate follow up care and re-assess the child for any new problems
When should the mother be advised to return immediately?
- Not able to drink or breastfeed
- Becomes sicker
- Develops a fever
- If the child has NO PNEUMONIA: COUGH
- Fast breathing
- OR COLD
- Difficulty breathing
- If the child has diarrhoea
- Blood in stool
- Drinking poorly
When is it not necessary for the mother to return to the clinic?
- If the child already has a fever, you do not need to tell the mother to return immediately for fever
- If the child already has blood in the stool, you do not need to tell the mother to return immediately for blood, just for drinking poorly
What illness requires a 2-day follow-up?
- Pneumonia
- Dysentery
- Malaria, if persists
- Fever- Malaria unlikely, if fever persists
- Measles with eye or mouth complications
What illnesses require a 5-day follow-up?
- Persistent diarrhoea
- Acute ear infection
- Chronic ear infection
- Feeding problem
- Any other illness, if not improving
What illnesses require a 14-day follow-up?
- Pallor
