Integrated Management of Childhood Illnesses - Additional Questions

• Severe pneumonia or very severe disease

• Pneumonia

• Cough or cold

What are the 3 classifications under cough or difficulty of breathing?

• Give 1st dose of antibiotic

• Refer urgently

What is the intervention if there is:

• Any general danger sign, OR

• Stridor in calm child

• Give oral amoxicillin for 5 days

• Soothe the throat and relieve the cough with a safe remedy

What is the intervention if there is:

• Chest indrawing, OR

• Fast breathing

1. Give an inhaled bronchodilator for 5 days

2. Give 1st dose of amoxicillin

3. Refer for possible TB or asthma

Under pneumonia, what is the intervention if there is:

1. Wheezing

2. Chest indrawing in an HIV exposed/infected child

3. Coughing for more than 14 days or recurrent wheeze

False

True or false? You will give oral amoxicillin to a child with cough or cold

Follow up

• 3 days

• 5 days

The interventions for pneumonia and cough or cold are the same, except for?

Salbutamol

In settings wherein inhaled bronchodilator is not available, oral _____ may be tried but not recommended for treatment of severe acute wheezes

3-4

Wait for _____ breaths, and then repeat

4-5

If the spacer is being used for the first time, it should be primed by _____ extra puffs from the inhaler

• Severe dehydration

• Some dehydration

• No dehydration

What are the 3 classifications under diarrhea? (young child)

• Severe persistent diarrhea

• Persistent diarrhea

What are the classifications if diarrhea persists for 14 days or more? (young child)

Dystentery

What are the classifications if there is diarrhea with blood in stool? (young child)

• If the child has no other severe classification

  • Plan C

• If the child also has another severe classification:

  • Refer with mother giving frequent sips of ORS on the way

  • Continue breastfeeding

• If the child is 2 years or older and there is cholera in your area:

  • Antibiotic

What are the interventions if there are 2 of the following signs?

• Lethargic or unconscious

• Sunken eyes

• Not able to drink or drinking poorly

• Skin pinch goes back very slowly (> 2s)

• Fluid, zinc supplement, and food (Plan B)

• Give 75 mL x kg for 4 hours in RHU

• If the child also has another severe classification:

  • Same as severe dehydration

What are the interventions if there are 2 of the following signs?

• Restless, irritable

• Sunken eyes

• Drinks eagerly, thirsty

• Skin pinch goes back slowly

Fluid, zinc supplement, and food (Plan A)

What are the interventions for no dehydration?

5 days; except for dysentery (3 days)

How many days is the follow-up for diarrhea?

• Ciprofloxacin for 3 days

What is the intervention if there is diarrhea with blood in the stool?

1. Give extra fluid (as much as the child will take)

2. Give zinc

3. Continue feeding

4. When to return

What are the 4 rules of home treatment for diarrhea?

ORS; clean water

No dehydration: If the child is exclusively breastfed, give _____ or _____ in addition to breast milk

• 50-100 mL after each loose stool

• 100-200 mL after each loose stool

How much fluid should be added to the usual fluid intake of children aged:

• Up to 2 years

• 2 years or more

10

If the child vomits, wait _____ minutes. Continue, but more slowly.

• Give 1 or more of: ORS solution, food-based fluids, or clean water

• Additional 100-200 mL of fluid after each loose stool

• Zinc 20 mg/1 tab daily for 14 days

• Tablet can be chewed or dissolved in a small amount of water

A 3-year-old child’s diarrhea is classified under no dehydration. His mother no longer breastfeeds him. What are the interventions?

4-hour

In the clinic, give recommended amount of ORS over a _____ period

IV therapy

What is the priority intervention for severe dehydration?

• 270 mL in 1 hour

• 630 mL in 5 hours

A 9-month-old infant has severe dehydration. Their weight is 9 kg. How many mL of IV fluids should be given?

• 420 mL in 30 minutes

• 980 mL in 2 ½ hours

A 4-year-old child has severe dehydration. Their weight is 14 kg. How many mL of IV fluids should be given?

1-2

Children on IV therapy for severe dehydration should be reassessed every _____ hours

• Very severe febrile disease

• Malaria

• Fever; no malaria

What are the classifications of fever if there is a malaria risk?

• Very severe febrile disease

• Fever; no malaria

What are the classifications of fever if there is NO malaria risk?

• Any general danger sign, OR

• Stiff neck

What are the signs under very severe febrile disease?

The 1st dose of artesunate or quinine is given for severe malaria

The interventions for very severe febrile disease with risk of malaria and no risk of malaria are the same, except for?

• 1st dose of antibiotic

• Prevent low blood sugar

• 1 dose of paracetamol (if > 38.5 deg C)

What are the similar interventions for very severe febrile disease with risk of malaria and very severe febrile disease with no risk of malaria?

3 days (except for fever na 2 days)

Follow-up in _____ days if fever persists

7

If fever is present everyday for more than _____ days, refer for assessment

True

True or false? If the child vomits the 1st dose of artesunate-amodiaquine (AS + AQ) within an hour, repeat the dose

OD for 3 days

For how many days is AS + AQ given?

• Severe complicated measles

• Measles with eye or mouth complications

• Measles

What are the classifications under fever with measles now or within the last 3 months?

Severe complicated measles

What is the classification of fever if there is:

• Any general danger sign

• Clouding of cornea

• Deep or extensive mouth ulcers

Measles with eye or mouth complications

What is the classification of fever if there is:

• Pus draining from the eye

• Mouth ulcers

Measles

What is the classification of fever if there is measles now or within the last 3 months?

Vitamin A treatment

What is the intervention for ALL classifications of fever with measles?

Tetracycline eye ointment

If there is clouding of the cornea or pus draining from the eye, treat eye infection with _____

Gentian violet

If there are mouth ulcers, treat with _____

3 days

When is the follow-up for measles with eye or mouth complications?

True

True or false? Follow-up is not included in the intervention for measles

• If the child has had a dose of vit A within the past month

• If the child has a RUTF (ready-to-use therapeutic food) treatment for severe acute malnutrition

When should you NOT give vitamin A?

False; continue using for another 48 hours after ulcers have been cured

True or false? Discontinue the use of gentian violet after mouth ulcers have been cured

4; 7

Treat thrush with nystatin _____ times daily for _____ days

1 mL

How many mL of nystatin should be instilled?

• Mastoiditis

• Acute ear infection

• Chronic ear infection

• No ear infection

What are the classifications under ear problem?

Mastoiditis

What is the classification if there is tender swelling behind the ear?

• Similarities: pus is seen draining from the ear

• Differences:

  • If acute, discharge has been reported for < 14 days

  • If chronic, discharge has been reported for > 14 days

  • If chronic, NO ear pain

What are the similarities and differences between the signs of acute ear infection and chronic ear infection?

False; wala naman kasing ear pain. For mastoiditis and acute ear infection lang ang paracetamol.

True or false? Paracetamol is given for chronic ear infection

5 days

When is the follow-up for acute ear infection and chronic ear infection?

3; 2

Instill quinolone ear drops after dry wicking _____ times daily for _____ weeks

• Severe anemia - severe palmar pallor

• Anemia - some pallor

• No anemia - no pallor

What are the signs and classifications of anemia?

• 14 days

• 5 days (if feeding problem)

When is the follow-up for:

• Anemia

• No anemia

Mebendazole

Anemia: give _____ if child is 1 year or older and has NOT had a dose in the previous 6 months

• 2-4 months (4-6 kg) and 4-12 months (6-10 kg)

• 1-3 years (10-14 kg) and 3-5 years (14-19 kg)

At what age and weight should you give:

• Iron syrup

• Iron/folate tablet

False

True or false? Children with severe acute malnutrition who are receiving ready-to-use therapeutic food (RUTF) need more iron

Malnutrition

After checking for anemia, check for _____

6 months

MUAC is measured using the MUAC tape in all children aged _____ and older

• < 115 mm

• 115-125 mm

• More than 125 mm

What is the MUAC measurement in:

• Severe acute malnutrition

• Moderate malnutrition

• No malnutrition

• Complicated severe acute malnutrition

• Uncomplicated severe acute malnutrition

• Moderate acute malnutrition

• No acute malnutrition

What are the classifications under malnutrition?

Uncomplicated severe acute malnutrition

Antibiotics are given for 5 days in what classification of malnutrition?

7 days

When is the follow-up for malnutrition?

Immunization status

After checking for malnutrition, check for _____

5-6

Give small, regular meals of RUTF and encourage the child to eat often _____ meals per day

2

Give only the RUTF for at least _____ weeks

• Very severe disease

• Local bacterial infection

• Severe disease or local infection unlikely

What are the classifications of local bacteria infection?

• Umbilicus red or draining pus

• Skin pustules

What are the signs of local bacterial infection?

• Severe jaundice

• Jaundice

• No jaundice

What are the classifications of jaundice?

• Jaundice if less than 24 hrs of age OR

• Yellow palms and soles at ANY age

What are the signs of severe jaundice?

• Jaundice after 24 hrs of age, AND

• Palms and soles NOT yellow

What are the signs of jaundice?

If palms and soles appear yellow

If an infant has jaundice, when should the mother return?

1 day

When is the follow-up for jaundice?

Severe dehydration (infants)

What is the classification if there is the presence of 2 of the following signs:

• Movement only when stimulated or no movement at all

• Sunken eyes

• Skin pinch goes back very slowly (> 2s)

Some dehydration (infants)

What is the classification if there is the presence of 2 of the following signs:

• Restless and irritable

• Sunken eyes

• Skin pinch goes back slowly

2 days

When is the follow-up for diarrhea in infants?

• Feeding problem or low weight

• No feeding problem

What are the classifications for feeding problems or low weight for age?

14 days

When is the follow-up for feeding problem or low weight?