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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