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RATIONALE _ CHN _PREBOARDS
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Prioritizing Family Nursing Problems
Nature of theproblem
Wellness, HD HT, FC
Modifiabilityof the Problem
the probability of success in minimizing, alleviating or totally eradicatingthe problem
PreventivePotential
the nature and magnitude of future problems that can be minimized ortotally preventedif intervention is done on the problem under consideration
Salience
the familys perception and evaluation of the problem in terms ofseriousness and urgency of attention needed
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#1 Factors Affecting MODIFIABILITY
OF THE PROBLEM
Current knowledge,technology andinterventions to
manage the problem
Resources of thefamily
Resources of thenurse
Resources of thecommunity
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# 2 Factors in Considering the
Preventive Potential
Progress and extentGravity and
severity
Length of timeDuration
Presence and appropriatenessCurrent
management
Increases the PPExposure to anyhigh risk group
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# 3 Nature of the Problem
1. WELLNESS
2. HEALTH DEFICIT
3.
HEALTH THREAT4. FORESEEABLE CRISIS / STRESS POINT
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# 5 HOME VISIT Guidelines
1) Greet and introduceself.
2) Explain the purpose.
3) Ask about healthstatus.
4) Inquire about healthand welfare of the ct
and other familymembers.
5) Place PHN bag in aconvenient place.
7. Perform PA well toinfectious member.
8. Provide health
teachings / counselling.9. Make appropriate
referral.
10. Do cleansing of
equipment.11. Make an appointment.
12. Record.
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#7 TOILET FACILITIES
LEVEL 1 LEVEL 2 LEVEL 3
A. Non water carriage
toilet facility
-NO WATER IS USED
TO FLUSH!!!
-EX: PIT LATRINES
B. Small amount ofwater required to flush
the waste
-EX: POOR FLUSH
TOILET, AQUA PRIVIES
On site toilet facilities
of the water carriage
type
With water sealed and
flush type
With septic tank
disposal system
Water carriage types of
toilets
Connected to sewerage
system to plant for tx
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#8 WATER FACILITIES (from PD 856)
LEVEL 1 (Point Source) LEVEL 2 (CommunalFaucet System /
Standpost)
LEVEL 3 (WaterworksSystem or Individual
House Connection)
Protected well or a
developed spring with an
outlet but without adistribution system
Rural areas
15 25 households,
outreach must not be
more than 250m from
farthest user
40 140 L/min
Composed of a
source/reservoir, piped
distribution network andcommunal faucets,
located not more than 25
m from the farthest
house
Rural area
40 80 L/ head / day :
1faucet: 4-6household
With source, reservoir,
piped distribution
network and householdtaps
Quality water
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RA 9275
CLEAN WATER ACT 2004
Unapproved type of water facilities: Open dug wells
Unimproved springs and wells
Examination of drinking H2O: performed only by LABS acc. ByDOH
Certification of Potability of wells as source: granted/issuedby Sec. of DOH/representative
Construction of WELLS: comply with standards of DOH
No booster pump shall be allowed to boost water fromdistribution pipe
LEVEL 3: preferred
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#9 Solid Waste Management RA
9003
Sec. 21.
Mandatory Segregation of Solid Wastes. - The LGUsshall evaluate alternative roles for the public and
private sectors in providing collection services, type ofcollection system, or combination of systems, that bestmeet their needs: Provided, That segregation of wastesshall primarily be conducted at the source, to includehousehold, institutional, industrial, commercial and
agricultural sources: Provided, further; That wastes shallbe segregated into the categories provided in Sec. 22of this Act.
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(a) provide for the residents a designated area and
containers in which to accumulate source separated
recyclable materials to be collected by the
municipality or private center; and
(b) notify the occupants of each buildings of the
requirements of this Act and the regulations
promulgated pursuant thereto.
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Sec. 22. Requirements for the Segregation andStorage of Solid Waste. - The following shall bethe minimum standards and requirements forsegregation and storage of solid waste pendingcollection:
(a) There shall be a separate container for eachtype of waste from all sources: Provided, That in
the case of bulky waste, it will suffice that thesame be collected and placed in a separatedesignated area; and
(b) The solid waste container depending on its
use shall be properly marked or identified for on-site collection as compostable, non-recyclable, recyclable or special waste, orany other classification as may be determined bythe Commission.
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GREEN BLACK YELLOW ORANGE
WET NON PATHOLOGIC
WASTES
DRY NON -PATHOLOGIC
WASTES
INFECTIOUS /PATHOLOGIC
WASTES
TOXIC /HAZARDOUS!
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#10 SENTRONG SIGLA
MOVEMENT
a certification recognition program which develops
and promotes standards for health facilities
CENTER FOR HEALTH VITALITY
- Joint effort bet.:
1.DOH provides technical and financial assistancepackages for health care
2. LGUs direct implementers of health programs &prime developers of health centers and hospitalsmaking services accessible to every Filipino
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Pillars of SSM
1. Quality Assurance
2. Grant and Technical Assistance
3.
Health Promotion4. Awards
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Expected Outcome: SSM
Empowered individuals adopting healthy lifestyle,
improved health-seeking behavior and well-being
& increased demand for quality health services
Institutions will develop policies, provide quality
services , institute system for surveillance/ merits
and advocate for laws
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Programs: SSM
EPI
Disease Surveillance
CARI
CDD
Nutrition/ Micronutrient Supplementation-
*Food Fortification :
Rice iron; Oil and sugar Vit. A;Flour-Vit. A & iron; Salt- iodine
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#13 Botika ng Barangay
A.O # 23-a, July 5, 1996
Outlines the guidelines in establishing the BnB
BnB drug outlet managed by legitimate community
organization, NGO and the LGU with a trained
operator and a supervising pharmacist.
Licensed by BFAD to sell, distribute OTC or generics
2000 = pharma 50 = cutting the prices into 50%
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Goal of BnB
Promote equity in health by ensuring the
availability and accessibility of AHSE
medicines with priority for marginalized,underserved, critical and hard to reach
areas.
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CBQ tips CRITERIA
1) Managed by: CO or Cooperative duly recognized bya judicial body
2) Coverage: 1-more adjacent brgys, far-flung, no
licensed drug stores3) Source of funds: 1/3 = community funded
4) LGU = 1/3
5) Master list of indigents
6) Commitment from a licensed pharmacist7) 2 accredited BHWs
8) Available space
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#14 Bag Technique
a tool making use of public health bag throughwhich the nurse, during his/her home visit, canperform nursing procedures with ease and deftness,
saving time and effort with the end in view ofrendering effective nursing care.
Public health bag
is an essential and indispensable equipment of the
public health nurse which he/she has to carry alongwhen he/she goes out home visiting. It contains basicmedications and articles which are necessary for givingcare.
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Rationale
To render effective nursing care to clients and /or
members of the family during home visit.
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Principles
1. The use of the bag technique should minimize if nottotally prevent the spread of infection from individuals tofamilies, hence, to the community.
2. Bag technique should save time and effort on the part ofthe nurse in the performance of nursing procedures.
3. Bag technique should not overshadow concern for thepatient rather should show the effectiveness of totalcare given to an individual or family.
4. Bag technique can be performed in a variety of waysdepending upon agency policies, actual home situation,etc., as long as principles of avoiding transfer of infectionis carried out.
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STEPS IN BAGTECHNIQUECBQs
Place bag lined with cleanpaper clean side out (foldedpart touching the table). Putthe bags handles or strapbeneath the bag.
Ask for basin of water Open bag, take out soap
and towel. Wash hands.Leave the plastic wrappersof the towel in a soap dish inthe bag.
Put on apron right side out andwrong side with crease touchingthe body, sliding the head into theneck strap. Neatly tie the strapsat the back.Put out allnecessary articles
Close the bag, place it inone corner of the workingarea
Perform NSG Care/tx Clean all things after usage Open bag, return all things Remove apron folding
away from the body, withsoiled sidefolded inwards,andthe clean side out. Placeit in the bag.
Fold lining, place inside thebag
Record Set appointment
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#15 OHN
Based in commercial and industrial establishments
Concerned with the promotion of health and
prevention of disease among adult workers and
their families in the commercial and industrial
establishments
CONCENTRATION:
Health and wellbeing of the employees
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ACTIVITIES OF OHN
1) Observation / assessment of worker and workingenvt
2) Interpretation and evaluation of the workers medicaland occupational hx, PE, industrial hygiene and
personal exposure3) Interpretation of medical dx
4) Appraisal of working envt for potential exposures
5) Identification of abnormalities
6) Description of workers response to exposures7) Occupational and non occupational injuries
8) Documentation
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# 17 10 ELEMENTS OF RH
1) MCH nutrition
2) FP
3) Abortion
complication mgt
4) RTI mgt
5) Sexual HE
6) Breast Ca & gyne
7) Mens RH
8) VAWC
9) Infertility & sexual
dse tx
10) Adolescent Health
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#19 IV
RA 9173
ARTICLE VI Nursing Practice
Section 28. cope of Nursing. - A person shall be deemed to be practicingnursing within the meaning of this Act when he/she singly or incollaboration with another, initiates and performs nursing services to
individuals, families and communities in any health care setting. Itincludes, but not limited to, nursing care during conception, labor,delivery, infancy, childhood, toddler, preschool, school age, adolescence,adulthood, and old age. As independent practitioners, nurses areprimarily responsible for the promotion of health and prevention ofillness. A members of the health team, nurses shall collaborate with otherhealth care providers for the curative, preventive, and rehabilitative
aspects of care, restoration of health, alleviation of suffering, and whenrecovery is not possible, towards a peaceful death. It shall be the dutyof the nurse to:
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(a) Provide nursing care through the utilization of thenursing process. Nursing care includes, but not limited to,traditional and innovative approaches, therapeutic useof self, executing health care techniques and
procedures, essential primary health care, comfortmeasures, health teachings, and administration ofwritten prescription for treatment, therapies, oraltopical and parenteral medications, internalexamination during labor in the absence of antenatal
bleeding and delivery. In case of suturing of perineallaceration, special training shall be provided accordingto protocol established;
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(b) establish linkages with community resources andcoordination with the health team;
(c) Provide health education to individuals, families andcommunities;
(d) Teach, guide and supervise students in nursing educationprograms including the administration of nursing services invaried settings such as hospitals and clinics; undertakeconsultation services; engage in such activities that requirethe utilization of knowledge and decision-making skills of a
registered nurse; and (e) Undertake nursing and health human resource
development training and research, which shall include, butnot limited to, the development of advance nursing practice;
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# 20 LEPROSY Treatment
EtiologyEtiology MOTMOT IPIP DxcDxc S/SxS/Sx
M. lepraeM. leprae
//
HANSENSHANSENSBACILLUSBACILLUS
RespiRespi
dropletdroplet
SkinSkin--toto--skinskin
MonthsMonths --
yearsyears
TissueTissue
biopsybiopsy
BloodBlood
worksworks
EARLYEARLY
Skin colorSkin color
Loss of hairLoss of hair
Skin lesionSkin lesion
ParesthesiaParesthesia
Ulcers thatUlcers that
does not healdoes not heal
LATELATE
LagopthalmosLagopthalmosMadarosisMadarosis
Clawing ofClawing of
fingersfingers
Saddle NoseSaddle Nose
ContracturesContractures
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10/18/2010 32
WHO CLASSIFICATION OF LEPROSY
PAUCIBACILLARY
Non infectious
Tuberculoid
6 9 mos
MULTIBACILLARY /
BORDERLINE
Infectious
Lepromatous
24 30 mos
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10/18/2010 33
PAUCIBACILLARY 6 9 mos.
MEDSMEDS ADULTADULT 1010 14 Y/O14 Y/O < 10 Y/O< 10 Y/O
Monthly TxMonthly Tx
DAY 1 (SD)DAY 1 (SD)
RifampicinRifampicin 600 mg600 mg 450 mg450 mg 300 mg300 mg
DapsoneDapsone 100 mg100 mg 50 mg50 mg 25 mg25 mg
Daily TxDaily Tx
DAY 2DAY 2 2828
(SAD)(SAD)
DapsoneDapsone 100 mg100 mg 20 mg20 mg 25 mg25 mg
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10/18/2010
34
MEDSMEDS ADULTADULT 1010 14 Y/O14 Y/O
RifampicinRifampicin 600 mg600 mg 300 mg300 mg
OfloxacinOfloxacin 400 mg400 mg 200 mg200 mg
MinocyclineMinocycline 100 mg100 mg 50 mg50 mg
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10/18/2010 35
MULTIBACILLARY 24 30 mosMEDSMEDS ADULTADULT 1010 14 Y/O14 Y/O < 10 Y/O< 10 Y/O
Monthly TxMonthly Tx
DAY 1 (SD)DAY 1 (SD)
RifampicinRifampicin 600 mg600 mg 450 mg450 mg 300 mg300 mg
ClofazimineClofazimine 300 mg300 mg 150150 100 (1x/mo)100 (1x/mo)
DapsoneDapsone 100 mg100 mg 50 mg50 mg 25 mg25 mg
Daily TxDaily Tx
DAY 2DAY 2 28 (SAD)28 (SAD)
ClofazimineClofazimine 50 mg50 mg 50 mg qod50 mg qod 50 mg (2x/mo)50 mg (2x/mo)
DapsoneDapsone 100 mg100 mg 50 mg50 mg 25 mg25 mg
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# 21-23 MINORITY FAMILY
Transcultural Nursing - A humanistic and scientific
area of formal study and practice in nursing which
is focused upon differences and similarities among
cultures with respect to human care, health, andillness based upon the people's cultural values,
beliefs, and practices, and to use this knowledge to
provide cultural specific or culturally congruent
nursing care to people ... Leininger
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Culture
Culture is made up of the values, beliefs,
underlying assumptions, attitudes, and behaviors
shared by a group of people. Culture is the
behavior that results when a group arrives at a setof - generally unspoken and unwritten - rules for
working together.
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Seven (7) characteristics of culture
Ken Thompson & Fred Luthans
1. Culture = Behavior.
2. Culture is Learned.
3. Culture is Learned Through Interaction.
4.Sub-cultures Form
Through
Rewards - People Shapethe Culture, Culture is Negotiated, Culture is Difficult to
Change.
5. Your work culture is often interpreted differently bydiverse people.
6. Your culture may be strong or weak.7. Ideally, organizational culture supports a positive,
productive, environment.
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Boyle and Andrews proposed measures in
assessing cultural variations
1. History of the origins of the patients' culture.
2. Value orientations, including view of the world, ethics, and normsand standards of behavior as well as attitudes about time, work,money, education, beauty, strength, and change.
3. Interpersonal relationships, including family patterns, demeanor,and roles and relationships.
4. Communication patterns and forms.
5. Religion and magic.
6. Social systems, including economic values, political systems, andeducational patterns.
7. Diet and food habits.
8. Health and illness belief systems, including behaviors, decisionmaking, and use of healthcare providers.
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Consider the ff in working with
MINORITIES
Familiarize your self with the customs, values, laws and health of thecountry you will work in.
Try the food, listen to the music and if possible talk with people ofthat culture before leaving home.
Learn the language, you can't provide adequate care if you can notcommunicate with your patients.
Learn about the organization under who you will work - purpose,goals, philosophy, policies
Remember you will be under other's rules, laws, value system,customs.
Can you cope with lack of structure, boredom, change and danger ? The right experience may enrich your life immeasurably.
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Most important factor to consider in
working with minorities
Communication
Space
Social organizations
Time
Environmental control
Biological variation
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# 28 COMPLEMENTARY FEEDING
Readiness to feed
good rule of thumb is to "Watch the Baby - Not theCalendar
beginning to awaken more often at night or eat moreoften than "usual"
Loss of extrusion reflex 32 oz of formula a day or 960 ml and does not seem
satisfied
nursing q 3-4 hrs and does not seem satisfied
always consult your babys pediatrician beforeintroducing new foods
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WHO recommends that infants start receiving
complementary foods at 6 months of age in
addition to breastmilk, initially 2-3 times a day
between 6-8 months, increasing to 3-4 times dailybetween 9-11 months and 12-24 months with
additional nutritious snacks offered 1-2 times per
day, as desired
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Guidelines
Start out slowly - tablespoon sized portion, one
food at a time 5-7 days b/w items
using their (clean and washed) finger as a spoon
eat 1/2 of the tablespoon sized portion the very
first times you begin solids
Introduce when hungry
Salt and sugar?
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FOODS TO INTRODUCE
1ST CEREALS (5-6MOS), Fe-fortifiedcereal mixed with
breast milk, orangejuice, or formula
2nd VEGETABLES(7MOS), FRUITS
(8MOS) 3RD MEAT (9MOS)
4TH EGGS (10MOS)
Prevents IDA, lessallergenic, easilydigested
VIT.A
VIT. C, A
CHON, Fe and B
Fe
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CEREALS
Rice and Oatmeal cereals are the least of the
allergenic grains and thus most babies are started
out with those cereals.
FRUITS
May be served raw after 8 months old bananasand avocados do NOT need to be cooked ever
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VEGGIES
Always serve cooked until after 12 months old or
when baby can chew well enough so that no
choking hazard is present
PROTEIN
Always serve cooked with no pink areas NEVERgive a small baby/child raw meat or fish
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DAIRY
NEVER replace breast milk or formula until after 12
months of age serious health risks are possible.
Never give a child under the age of 2yrs
old low fat or skim milk products; whole milk is
necessary.
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Suggested Daily "Milk" Intakes
0-3 Months of age:Breastfeed every 1-3 hours or Formula 18-40 ounces
4-5 Months of age:
Breastfeed every 2-4 hours or Formula 24-45 ounces 6-8 Months of age:
Breastfeed every 3-4 hours or Formula 24-37 ounces
9-12 Months of age:Breastfeed every 4-5 hours or Formula 24-31 ounces
Whole Cow Milk, as a drink, should not be introduceduntil 12 months of age!
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# 29: IMCI General Danger Signs
1. Not able to drink orbreastfeed
2. Vomits everything3. Convulsions (during this illness)4. Abnormally sleepy or difficult
to awaken
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MAIN SYMPTOMS
Cough / DOB Diarrhea
Fever
Ear Problems
10/18/2010
51
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Ask the childs name and
age
Decide which age group the
child is in
Child is 2 mos - 5 yrs:
ASSESS AND CLASSIFY THE
SICK CHILD AGE 2 MONTHS
UP TO 5 YEARS
Child is not yet 2 mos,ASSESS, CLASSIFY AND
TREAT THE SICK YOUNG
INFANT
Ask the mother aboutthe childs problem
Check GENERALDANGER SIGNS
Ask for FOUR MAINSYMPTOMS
When the main symptomis present
Assess the child further(main sx)
Classify according to theillness
10/18/2010
52
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10/18/2010
53
Check for the signs of malnutrition and anemia and
classifying
Check for childs immunization status and decide
Check for the childs Vit. A status
Assess any other problems
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# 34 IMCI FEVER
Fever is a very common condition and is often the
main reason for bringing children to the health
center
Minor infections, life threatening disease
Children are considered to have fever if their body
temperature is above 37.5C axillary (38C rectal).
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Assess for:
Stiffed neck
Risk of malaria and other endemic diseases
Runny nose
Duration of fever
Measles
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Classifications of fever
Any danger sign or
Stiff neck
very severe febriledisease
REFER
In a high malaria risk area or season, children
with fever and no general danger sign or stiffneck should be classified as having MALARIA.
All children with fever and any general danger
sign or stiff neck are classified as having VERYSEVERE FEBRILE DISEASE and should be urgently
referred to a hospital after pre-referral
treatment with antibiotics (the same choice as
for severe pneumonia or very severe disease).
Fever (by history or feels hotor temperature 37.5C or
above)malaria
In a low malarial risk area or season, children
with fever (or history of fever) and no generaldanger sign or stiff neck are classified as
having MALARIA and given an antimalarial only
if they have no runny nose (a sign of ARI), no
measles, and no other obvious cause of fever(pneumonia, sore throat, etc.).
NO runny nose and NO measles
and NO other causes of fevermalaria
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.In a low malaria risk area or season,
children with runny nose, measles or
clinical signs of other possible infectionare classified as having FEVER
MALARIA UNLIKELY. These children need
follow-up. If their fever lasts more than
five days, they should be referred for
further assessment to determine causesof prolonged pyrexia. If possible, in
low malaria risk settings, a simplemalaria laboratory test is highly
advisable.
Runny nose PRESENT or
Measles PRESENT or
Other causes of feverPRESENT
fever malaria
unlikely
In a no malaria risk area or season an attempt
should be made to distinguish cases of possiblebacterial infection, which require antibiotic
treatment, from cases of non-complicated viralinfection. Presence of a runny nose in such
situations has no or very little diagnostic value.
Obvious causes of feverpossible bacterial
infection
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In a no malaria risk area or season, if no
clinical signs of obvious infection are found, the
working classification becomes UNCOMPLICATEDFEVER.
NO obvious causes of fever uncomplicated fever
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# 44 Does not have ear problem
Communicating- History Taking
General Danger Signs
Main Symptoms
Cough or Difficult Breathing
Diarrhoea
Fever
Ear Problems
Nutritional Status
Immunization Status
Other Problems