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I. INTRODUCTION
Every year almost million of children under the age of five in developing
countries die from readily preventable and treatable illness such as diarrheal
dehydration, acute respiratory infection, measles and malaria. Parents seek help
care for their sick children, taking them to the hospitals, health centers, pharmacist,
doctors or even traditional healers. Survey reveals that many sick children are not
properly assessed and treated by these health care providers, and that their parents
are poorly advised.
Primarily health care staffs are trained to identify children who have these
illnesses. Sick children are assessed according to their signs and symptoms. The
treatment is given if necessary and the caregiver and parents is counselled and is
advised on the follow-up of the patient. Severely ill patients are urgently referred to
the hospital, while moderately ill children get specific treatment at primary health
care level and at home and those are mildly are given supportive measures, therapy
and counselling.
Integrated Management of Childhood Illnesses or IMCI is currently regarded
as the most efficient strategy for the burden of disease and disability among the
population in this age group. This main goal is to contribute to healthy growth and
development during the first years of life.
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IMCI has important objectives; one is to reduce infant mortality, second for
reducing the incidence and seriousness of illnesses and health problems that affect
boys and girls.
With regards to improve the performance of health workers, IMCI offers a
number of practical tools, including modules foe the evaluation, classification and
treatment of children; Guides for health care workers to provide support in effective
IMCI application, training materials on how to improve communications with the
parents during their child’s evaluation, diagnosis, treatment, and telling them how to
deal with problems and promoting practices for healthy growth and development.
This will also benefit us to further expand our knowledge and practices
regarding Integrated Management of Childhood Illnesses. IMCI helps to improve the
overall functioning of health services by giving guidelines for evaluating the care
provided to children under five in primary health care services and in hospitals,
training materials on how to develop local plans for the IMCI implementation, training
courses to improve the availability of attention and medications needed for the IMCI
application, and guidelines to evaluation of the applying IMCI.
What does IMCI means? IMCI is an integrated approach to child health that
focuses on the well being of the whole child. IMCI aims reduce death, illness and
disability among children, and to promote and improved growth and development.
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II. SEMINAR OBJECTIVES
General:
A five-hour seminar that aims to discuss the pediatric case management
process and apply the integrated management of childhood illnesses concept
given a specific situation.
Specific:
Specifically, the learners will be able to;
Identify the important elements in IMCI case management such as;
Out-patient Health Facility
Referral Health Facility
Appropriate Home Management
Know the Out-patient management of;
Young infants age 1 week up to 2 months.
Children age 2 months up to 5 years.
Determine nursing responsibilities on counselling mothers and/or primary
health care providers.
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III. INVOCATION
LEAD ME LORD
Lead me Lord, lead me by the hand
And make me face the rising sun
Comfort me through all the pain
That life may bring
There's no other hope
That I can lean upon
Lead me Lord Lead me all my life
Walk by me, walk by me across
The lonely road that I may face
Take my arms and let your hadn
Show me the way
Show the way to live inside your heart
All my days, all my life
Refrain: You are my light
You're the lamb upon my feet
All the time my Lord
I need You there
You are my light I (just) cannot live
alone
Let me stay
By Your guiding love
All through my life
Lead me Lord
Lead me Lord Even though at times
I'd rather go alone my way
Help me take the right direction
Take Your road Lead me Lord
And never leave my side
All my days
All my life
You are my light
You're the lamb upon my feet
All the time my Lord
I need You there
You are my light I (just) cannot live
alone
Let me stay By Your guiding love
All through my life
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All through my days Lead me, O Lord Lead me Lord
IV.OPENING REMARKS
To our guest speaker, Mr. Tim C. Concepcion, our Dean, Prof. Neil G.
Cabbo, Ms. Lualhati H. Angel, fourth year coordinator, Ms. Naihla O. Balleta,
fourth year section B adviser and to you my fellow nursing students, good
morning.
Every year, more than 10 million children all over the world die before they
reach their fifth birthday. Studies show that 7 out of 10 of these deaths are due to
acute respiratory infections, diarrhea, measles, malaria or malnutrition and often
to a combination of these conditions. However, the annual number of deaths
among children less than five years old has decreased by almost 20% since the
1970’s still; this reduction has not been evenly distributed throughout the world.
Today, many well known prevention and treatment strategies have already
proven effective for saving young lives and different interventions have shown
great success. These form part on proper management of childhood illnesses
which is the topic of our today’s seminar. We strongly believe that integrated
approach to managing sick children is needed to achieve better outcome. Our
main goal is to educate and enlighten each one of us on managing of childhood
illnesses in order for us to contribute to improved growth and development.
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I, Gersie Rose Toribio, the president of fourth year section B together with
the whole class welcome all of you to this day’s seminar entitled “ INTEGRATED
MANAGEMENT OF CHILHOOD ILLNESSES; Help to save thousand lives.”
So sit down and relax while listening, once again, a pleasant morning to each
and everyone.
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V. PRESENTATION OF PARTICIPANTS
Honored resource speaker, Mr. Tim C. Concepcion, energetic Dean of the
College of Nursing, Prof. Neil G. Cabbo, Level IV coordinator, Ms. Lualhati H.
Angel, Ms. Naihla O. Balleta, fourth year section B – adviser, our clinical
instructors, to our guests and fellow students, a pleasant morning to each and
everyone.
This seminar, INTEGRATED MANAGEMENT OF CHILDHOOD
ILLNESSES: Help to Save Thousand Lives, is very much grateful to present to
you our participants today. May we request each delegate to please stand once
your section is called, to be recognized.
Fourth year section A headed by their president, Ms. Jhona Maria
Bautista.
Fourth year section C headed by their president, Mr. Edver Galecia.
Fourth year section D headed by their president, Ms. Raquel Villanueva.
Fourth year section E headed by their president, Ms. Jomalyn Lobo.
Fourth year section F headed by their president, Mr. Joel dela Cruz.
Fourth year section G headed by their president, Ms. Lovely Grace
Valdez.
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Fourth year section H headed by their president, Ms. Geralyn Francisco.
VI. INTRODUCTION OF THE GUEST SPEAKER
A man of honour and achievement need not to have an idiomatic and
sophisticated description for a simple word of success describes it all.
Introducing a high calibre figure is indeed of great pride for committing an
speaking engagement is an difficult as putting a thread into a needle’s eye.
A consistent dean’s lister with the degree of BSN at the royal and
pontifical University of Santo Thomas graduated 2000. Purely academically
inclined he then pursued his Masters of Arts in Nursing Major in Adult Health
Nursing at the renowned University of the Philippines, Manila, where his basic
course degree in Education and Certificate in Test Making and Test Taking
Strategy was also earned.
Currently, a university scholar of the same prestigious university, the
University of the Philippines, Manila, with his doctorate degree.
Because of this strong educational foundation and back bone he then
founded on June 2007 The Saint Thomas Review Centre where he is at the
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same time the president and C.O.O. a highly conceptualized institution then
awarded as the “Most Innovative Reviewer” by the Marketing Excellence Award.
Gloriously as it seemed, he was hailed as the Most Outstanding member
of the academe of La Consolacion College, Mendiola.
Presently, another feather is added to his lap. He gained a continues
education program in Diabetic Nursing from the California Board of Nursing,
United State of America.
To add it up he is a CGFNS, IELTS and NCLEX, California, United State
of America score.
Ladies and gentlemen, an author, an educator, an inspiration….. A
young and vibrant achiever a national figure…
MR. PRIMITIVO “TIM” C. CONCEPCION.
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INTEGRATED MANAGEMENT OF
CHILDHOOD ILLNESSES:
“HELP TO SAVE THOUSAND LIVES.”
MR. TIM C. CONCEPCION, PRN, CCN, USRN
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Integrated Management of Childhood Illnesses
“Help To Save Thousand Lives.”
Elements of IMCI Case Management Process
I - Immediately ask
M - Mother (assessment)
C - Classify (used color coded triage system)
Green
Yellow
Pink
I - Identify appropriate treatment
Immediately ask the mother
Remember: Gloria Macapagal Did not First Enter Malacanang In Victory
1. G eneral danger sign
2. M ain symptoms (ask)
3. D iarrhea (ask)
4. F ever (ask)
5. E ar infection (ask)
6. M alnutrition/anemia
7. I mmunization
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8. V itamin A status
1. GENERAL DANGER SIGNS
ASK:
Is the child able to drink or breast feed?
Has history of convulsion
Vomits everything
LOOK:
see if abnormal sleepy or difficult to awaken
4S’s (danger signs)
SSeizure
Sunken eyeballs
Sleepiness
Suka (vomit)
2. MAIN SYMPTOMS
ASSESS:
cough and cold
COUNT:
fast breathing = abnormal
Less than 2 months = 60bpm
2 - 11 months = 50bpm
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1 - 5 years old = 40bpm
LOOK:
Chest indrawing - always check if child is CALM
STEP: Lift the shirts
Breaths IN
Chest goes IN
Remember: 4C’s (main signs)
C Cough and cold
Count breathing
Stridor
Chest indrawing
LOOK and LISTEN:
Stridor - inspiration
oCalm the patient
oPut your ear to the mouth of the client
oHarsh noise upon inspiration
3. Classify
Green - simple advice on home management
Yellow - specific medical treatment advice health care management
Pink - seek urgent and referral to hospital
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4. Identify
soothe the throat – breast milk (for less than 2 months old)
* Tamarind (for less than 2 months old)
follow up - advice mother when to return
antibiotic therapy
1st line: Co-trimoxazole
Dose:
2 months to 11 months – 5ml
1 year old to 5 years old – 10ml
2nd line: Amoxicillin (same dose)
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P N E U M O N I A
ASK ABOUT THE MAIN SYMPTOMS:
Does the child have cough or difficulty in breathing?
IF YES,ASK: LOOK,LISTEN: For how long has the child had
it? Count the child’s breaths in 1 minute. Look for indrowning. Look and listen for stridor.
>the child must be calm
Classify cough or difficulty in breathing:
SIGNS CLASSIFY AS TREATMENT Any general
danger sign or Chest indrawing
or Stridor in a calm
child
SEVERE PNEUMONIA OR VERY SEVERE
DISEASE
> Give the first dose of an appropriate antibiotic.
> Give Vitamin A.> Treat a child to prevent the
lowering of his or her blood sugar level.
> Refer the child URGENTLY to the hospital.
Fast breathingPNEUMONIA
> Give the child an appropriate antibiotic for 5 days.
> Soothe the throat and relieve the cough with a safe remedy.
> Advise the mother regarding when to return immediately to the health center.
> Follow-up in 2 days.
No signs of pneumonia or a very severe disease
NO PNEUMONIA: COUGH OR COLD
> If coughing has been present for more than 30 days, refer the child to a hospital for assessment.
> Soothe the throat and relieve the cough with a safe remedy.
> Advise the mother regarding
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when to return immediately to the health center.
> Follow-up in 5 days if the child’s condition is not improving.
PATHOPHYSIOLOGY
For children ages less than 2 months old
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PNEUMONIA
>2months old
Cough/ cold(+) Fast breathing
“4S’s” danger sign
No Pneumonia
Severe Pneumonia Very Severe
Pneumonia
Pink:Hospital(SAFE)
S- Send to hospitalA- Vit. A givenF- First dose antibioticE- Eliminate hypoglycemia> Give breast milk
Green:Home Management
(SAFE)S- Soothe the throatA- Advice the mother
when to returnF- Follow up for 5 daysE- Excessive coughing
more than 3 days referral again
PATHOPHYSIOLOGY
For children ages more than 2 months old
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< 2monthsold
(+) Fast breathing
(+) Chest indrawing
(+) Fast breathing
Cough/ cold
Danger sign
PNEUMONIA
Green:Home
Management(SAFE)
S- Soothe the throat
A- Advice the mother when to return
F- Follow up for 5 days
E- Excessive coughing more than 3 days referral again
No Pneumonia
Pneumonia
Yellow:(SAFE)
S- Soothe the throat
A- Advice the mother when to return
F- Follow up for 2 days
E- Engage antibiotic therapy
Severe Pneumonia
Pink:(SAFE)
S- Soothe the throat
A- Advice the mother when to return
F- First doseE- Eliminate
hypoglycemia
Very Severe Pneumonia
Pink:(SAFE)
S- Soothe the throat
A- Advice the mother when to return
F- First doseE- Eliminate
hypoglycemia
E A R I N F E C T I O N
ASK: Does the child have an ear infection
If yes, ASK: Look and Feel: Is there ear infection? Is there ear discharge? If yes, for how long has it
been present?
Look for pus draining from the ear. Feel if there is tender swelling behind the ear.
Classify the EAR PROBLEM
SIGNS CLASSIFY AS TREATMENT
Tender swelling behind the ear MASTOIDITIS
> Give the first dose of an appropriate antibiotic.> Give the first of Paracetamol for pain.> Refer the child URGENTLY to a hospital.
Pus is seen draining from the ear, and there has been discharge for less than 14 days or
Ear pain
Pus in seen draining from the ear, and there has been discharge for 14 days or more.
ACUTE EAR INFECTION
CHRONIC EAR INFECTION
> Give an antibiotic for 5 day> Give paracetamol for pain.> Dry the ear by wicking.> Follow up 5 ays.
> Dry the ear by wicking.> Follow up in 5 days.
No ear pain and
No pus is seen draining from the ear
NO EAR INFECTION
> No additional treatment needed.
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PATHOPHYSIOLOGY
EAR INFECTION
EarPain/ Drainage/ How long
> No ear pain> No drainage> No infection
(+) Ear pain(+) Drainage
(+) swelling of the back(Mastoiditis)
Green< 14 daysAcute Ear Infection
> 14 days Chronic Ear Infection
Pink
Yellow:
> give anti - biotic
>
Paracetamol
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D I A R R H E A
ASK: Does the child have diarrhea?
If yes, ASK: Look and Feel: For how long has
the child had it? Is there blood in
the stool?
Look at the child’s general condition.Is the child:- Abnormally sleepy or difficult to awaken?- Restless and irritable?
Look for sunken eyes. Offer the child fluid. Is the child:
- Not able to drink or drinking poorly?- Drinking eagerly, thirsty?
Pinch the skin of the abdomen. Does it go back to its original state:- Very slow (longer than 2 seconds)?- Slowly?
Signs and Symptoms
D rink poorly (Pink)
E levated cardiac rate
H and pinch goes back slowly (Yellow), very slowly (Pink)
Y
D rink eagerly (Yellow)
R estless
A bnormally sleepy
T hirsty
I rritable
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O liguria
N ote for sunken eyeballs
Classify DIARRHEA
for DEHYDRATION
SIGNS CLASSIFY AS TREATMENTTwo or more of the following signs: Abnormally sleepy
or difficult to awaken
Sunken eyes Not able to drink or
drinking poorly Pinched skin goes
back to its original state very slowly
SEVERE DEHYDRATION
> (PlanC)If the child has no other severe classification: Give fluid for severe
dehydration If the child has another severe classification: Refer him/her URGENTLY to
a hospital with the mother giving the child frequent sips of ORS on the way.
Advise the mother to continue breastfeeding the child.
> If the child is aged 2 years or older and there is cholera in your area give an antibiotic for cholera.
Two of the following signs: Restless, irritable Sunken eyes Pinched skin goes
back to its original state, very slow
SOME DEHYDRATION
> (PlanB)Give fluid and food for some dehydration > If the child also has a severe classification: Refer him/her URGENTLY to a
hospital with the mother giving the child frequent sips of ORS on the way.
Advise the mother to continue breastfeeding the child.
> Advise the mother regarding when to return immediately to the health center.> Follow up in 5 days if the child’s condition is not improving.
Not enough signs to allow classification as some or severe dehydration.
NO DEHYDRATION
> (PlanA)Give fluid and food to treat diarrhea at home.> Advise the mother regarding when to return immediately to the health center.> Follow up in 5 days if the child’s
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condition is not improving.
And if there has been diarrhea for 14 days or moreSIGNS CLASSIFY AS TREATMENT
Dehydration present
SEVERE PERSISTENT DIARRHEA
> Treat dehydration before referral to a hospital unless the child has another severe classification.> Give Vitamin A> Refer the child to a hospital
No Dehydration
PERSISTENT DIARRHEA
> Advise the mother regarding the feeding of a child who has persistent diarrhea.> Give Vitamin A> Follow up in 5 days
And if there is blood in the stoolSIGNS CLASSIFY AS TREATMENT
Blood in the stool DYSENTERY
> Treat the child for 5 days with an oral antibiotic recommended for shigella in your area> Follow up in 2 days
MANAGEMENT:
Plan A : Treat diarrhea at home (Green)
Plan B : Treat some dehydration with ORS (Yellow)
Plan C : Treat severe dehydration quickly (Pink)
Plan A (Green)
1. Fluids
2 years old = 50 to 100 ml*
More than 2 years old = 100 to 200 ml*
*For each watery stool
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2. Feeding
Lugaw (rice porridge) with pulverized Dilis or Bananas
3. Follow up check up
Plan B (Yellow)
1. Oral Rehydration Salt (ORS)
Remember: 4411225 2447799 loc.14
Age ORS
0-4 months
4 months - 1 year old
1 - 2 years old
2 - 5 years old
200 - 400 ml
400 - 700 ml
700 - 900 ml
900 - 1400 ml
Plan C (Pink)
1. Start Intravenous Fluid
100 ml per kg
Lactated Ringer’s Solution (fluid of choice)
Normal Saline Solution
2. Oral Rehydration Salt (ORS)
3. Nasogastric T ube (NGT)
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PATHOPHYSIOLOGY
(+) bloody stool = dysentery
DIARRHEA
“duration”
< 14 days “Dehydration” > 14 days Diarrhea”
No signs of Dehydration
T hirstyH and pinch
goes back slowly
I rritabilityRestlessnessS unken
eyeballsT akes water
eagerly
Skin pinch goes back slowly,Sunken eyeballs,Abnormally sleepy, andDrink poorly
No dehydration (+) dehydration
Persistent diarrhea
Severe persistent diarrhea
Yellow/ plan B
Pink/ Plan C
NoDehydration
Green/Plan C
Some dehydration
Severe dehydration
Yellow/ Plan B
Pink/ Plan C
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VII.CLOSING REMARKS
To our honourable and lively resource speaker, Mr. Tim C. Concepcion,
Our ever compassionate and respected Dean of the college, Dean Neil Gaddi
Cabbo, Our ever most beloved and supportive Clinical Instructors. My fellow
Nursing students and participants, a pleasant morning to each and every one.
We are very grateful and privilege to gain an understanding on how to
facilitate a seminar like this. At first, it seems that this festivity is a difficult event
to organize, especially for a Novice Nursing Students like us. But we believe
that with enough courage, patience and hard work, nothing is impossible, we
work hand in and to achieve our goal, and that is, to make this seminar a
success. With the proper guidance of course of our supportive and devoted
seminar adviser, Ms. Naihla O. Balleta.
May this seminar “INTEGRATED MANAGEMENT OF CHILDHOOD
ILLNESESS” served as an instrument for us skills for better quality and effective
Nursing care that will contribute to the preservation of life.
In behalf of the BSN Level IV section B, We would like to extend our
heartfelt gratitude and appreciation to the learning Endeavour that is undeniably
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worth keeping and remembering.
Thank you and God Bless!
IX.SUMMARY
In view with Nursing Care Management 105 basic requirements, we the
Bachelor of Science in Nursing batch 2009 sponsored a seminar entitled:
“INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES: Help to Save
Thousand Lives.” Held at Martinez Memorial Colleges Auditorium last February
12, 2009.
The seminar was envisioned to convey new information on childhood
illnesses, vital for each and every partaker that will served as their anchor for
future nursing practice.
Organization and the whole event, was subject headed by Mr. P-Jay D.
Fortes, the over-all-chairman, different working committees under the direction
and supervision of our humble seminar adviser, Ms. Naihla O. Balleta and the
persistent support of our honoured Level IV coordinator Ms. Lualhati H. Angel
and erudite dean Mr. Neil G. Cabbo, whom we give our recognition for the
triumph of this occurrence.
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Achievement of this affair is equated with the numerous partaker whom
themselves grace the event with fervent interest to gain knowledge on childhood
illnesses, these are Bachelor of Science in Nursing Level III and Level IV
students, Bachelor on Science in Midwifery students, clinical instructors and
members of the faculty of Martinez Memorial Colleges
The successful-organized-envisioned colloquium on “INTEGRATED
MANAGEMENT OF CHILDHOOD ILLNESSES: Help to Save Thousand Lives.”,
was made uniformly evocative by our seminar Resource Speaker Mr. Tim C.
Concepcion an alumni of Bachelor of Science in Nursing at the University of
Santo Tomas and currently working as head reviewer of Saint Thomas Review
Center.
Last of all, the preferred theme: “INTEGRATED MANAGEMENT OF
CHILDHOOD ILLNESSES: Help to Save Thousand Lives.” Have truly lifted a
mark to everyone to be more vigilant and watchful on matters pertaining to
childhood illnesses and their welfare.
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