IMCI-NURSES

IMCI / Oman
 IMCI -NURSES
 INTRODUCTION
 TRIAGE
 GENERAL DANGER SIGNS
 NUTRITION & PALLOR
 FEEDING & PSCHO SOCIAL
DEVELPOMENT
 IMCI FORMS A & B
 COUNSELLING
 DEFINITION

IMCI is a global strategy

recommended by WHO & UNICEF.
It encompasses interventions at
the health facility, the family &
the community. It has been
adopted & adapted by Oman to
suit the current health status of
the country.
 OBJECTIVES
 To reduce childhood morbidity & mortality & contribute to
the improved growth & wellbeing of the children of Oman.

 To improve practices in health facilities, the health system

& in the community.

 To ensure rationale use of drugs, medical supplies & other

resources.

 To strengthen utilization of evidence-based medicine &

syndromic case management approach in the management
of childhood illnesses.

 To strengthen community role as partner in health

achievement.
 TRIAGE
 FRENCH VERB-TRIER- MEANS TO
PICK OR SORTING OUT.
 TRIAGE IS THE PROCESS THAT
PLACES THE EMERGENCY PATIENT
IN THE RIGHT PLACE , AT THE RIGHT
TIME TO RECEIVE THE RIGHT LEVEL
OF CARE.
 WHY TRIAGE ?
 TO RAPIDLY IDENTIFY PTS WITH
URGENT LIFE THREATENING
CONDITIONS
 ENSURE PTS ARE SEEN IN ORDER
OF CLINICAL URGENCY
 TO DETERMINE THE MOST
APPROPRIATE TREATMENT AREA
FOR PTS
 WHY TRIAGE?
 TO DECREASE CONGESTION IN THE
EMERGENCY TREATMENT AREA
 TO PROVIDES ON GOING ASSESSMENT
OF PATIENTS.
 TO IMPROVE PUBLIC RELATIONS BY
PROVIDING INFORMATION TO PTS AND
FAMILIES REGARDING SERVICES AND
EXPECTED CARE & WAITING TIMES.
 WHY TRIAGE?
 TO CONTRIBUTE INFORMATION THAT
HELPS DEFINE DEPARTMENTAL
ACUITY AND CASE MIX.
WHO SHOULD DO
TRIAGE?
A SPECIFICALLY
TRAINED AND
EXPERIENCED
NURSE
 TRIAGE NURSE
 QUALITIES- TRIAGE NURSE

 TRIAGE NURSE MUST DEMONSTRATE

HIGH LEVEL OF CLINICAL COMPETENCY IN
EMERGENCY SITUATION.

 COMMUNICATION SKILLS,
ORGANISATIONAL SKILLS .

 ABLE TO PERFORM IN CHAOTIC &

DIFFICULT SITUATION.
 TRIAGE LOCATION
 FIRST AREA VIEWED BY PTS –MAKES
LASTING IMPRESSIONS
 COMFORTABLE,PROVIDE PRIVACY
AND PLEASING ATMOSPHERE
 TRIAGE
 HISTORY TAKING
 ANTHROPOMETRY-WT, HT, HC
 VITALS-HR,RR,BP,TEMP
 GENERAL DANGER SIGNS
 HISTORY TAKING

 CHIEF COMPLAINTS-(parents impression)

 IMMUNISATION
 ALLERGIES
 MEDICATIONS
 PAST MEDICAL HISTORY
 EVENTS SURROUNDING ILLNESS
 DIET-CHANGES IN EATING PATTERN
 SYMPTOMS ASSOCIATED WITH ILLNESS
OR INJURY.
 IMCI CLINIC
The clinic is to be
equipped with the
following items:

EPI room -vaccine and

equipment (ARI timers)
measuring equipments –
HC,WT,HT
examination room
equipment
(Stethoscope ,
otoscope….)
ORT corner
Counseling area
 INFANT WEIGHT
ASSESSMENT

The scale -durable, accurate, and safe

. No sharp edges and large enough tray to
adequately support an infant or young child
who weighs up to 20 kg or 40 lb.
 WEIGHT-INFANT
 Quality beam balance or electronic
 Weighs to 20 kg or 40 lb
 Weighs in 0.01 kg (10 gm) or 1/2 oz
increments
 Tray large enough to support the infant
 Can be easily ‘zeroed’
 Can be calibrated
 WEIGHING CHILDREN

No bathroom scales to weigh children, or

adolescents
be a quality beam balance or electronic scale
WEIGHING CHILDREN
 Quality beam balance or electronic
 Weighs in 0.1 kg (100 gm)
or 1/4 lb increments
 Stable weighing platform
 Can be easily ‘zeroed’
 Can be calibrated
 No stature device attached
LENGTHBOARD-LENGTH

No devices attached to scales, rulers or tapes

Lengthboards for infants must be sturdy, easily
cleaned and specific to the purpose
STADIOMETERS-HT
HEIGHT MEASUREMENT
 A stadiometer for stature measurements
requires:
 a vertical board with an attached
metric rule
 a horizontal headpiece that can
be brought into contact with the
most superior part of the head
HEAD CIRCUMFERENCE

Non-stretchable, plasticized
1/4 - 1/2 inch wide
Insertion tape
. ASSURING ACCURATE &
RELIABLE EQUIPMENT
 Maintenance is a regular, daily event.
 scales be checked and ‘zeroed’ before each daily clinic.
 length boards and stadiometers be checked and zeroed
before each daily clinic.

 Calibration is a monthly event.

 scales be ‘tested’ with standard weights on at least a
monthly movable scales be calibrated after each time the
scale is moved.
 length boards and stadiometers be checked with standard
length rods on at least a monthly basis
 moveable length boards and stadiometers be checked with
standard rods after each time the equipment is moved.
 GROWTH CURVES
 RECORD THE WT,HT,HC
 PLOT IN THE GRAPH
 VITAL SIGNS
 OBSERVATIONS / VITALS
 Critical physiological changes

 PULSE RATE
 BLOOD PRESSURE
 RESPIRATORY RATE
 TEMPERATRE
 PULSE RATE

 Heart rate – volume ,rhythm, regular,

 Radial, brachial, carotid ,dorsalis pedis
 Varies with crying ,sleep, age and anxiety
 RESPIRATORY RATE

 Identifies respiratory dysfunction

 By counting-ARI timer, stethoscope
 Influenced by crying, sleep, age, agitation
BLOOD PRESSURE

 Sphygmomanometer & stethoscope/

Doppler / electronic device / palpation
 Cuff size-12 cm /15 cm / 18 cm
 Position of arm and body
 Technique of the health care provider
 KROTKOFFS SOUNDS
Measurement of blood pressure by auscultation is based on
the sounds produced as a result of changes in blood flow,
termed Korotkoff's sounds, and are:

1. Phase I The pressure level at which the first faint, clear

tapping sounds are heard, which increase as the cuff is
deflated (reference point for systolic BP).
2. Phase II During cuff deflation when a murmur or swishing
sounds are heard.
3. Phase III The period during which sounds are crisper and
increase in intensity.
4. Phase IV When a distinct, abrupt, muffling of sound is
heard
5. Phase V The pressure level when the last sound is heard
(reference point for diastolic BP).
 How record BP
 Pt should be seated –arm at hearts level
 Cuff appropriate size- completely
encircle the arm (80%) or 2/3rd.
 Well calibrated BP apparatus
 Record both systolic and diastolic BP
 Disappearance of Korotkoff's sound –
diastolic
 Repeat after 2 min another recording
TEMPERATURE
 Normal temperature range
 Rectal 36.6°C to 38°C (97.9°F to
100.4°F)
 Ear 35.8°C to 38°C (96.4°F to 100.4°F)
 Oral 35.5°C to 37.5°C (95.9°F to 99.5°F)
 Axilla 34.7° C to 37.3° C(94.5 to 99.1 F)
 TEMPERATURE
 Area measurement of wide range of instruments,
body temperature · glass mercury
 .mouth thermometer
· electronic thermometer
· axilla · pulmonary artery catheter
· tympanic membrane · endotracheal tube with
· rectum temperature probe
· skin surface · urinary catheter with
· pulmonary artery temperature probe
· nose · liquid crystal
· groin thermometer strip
· oesophagus · disposable thermometers
· trachea · infrared (tympanic)
thermometers
· urinary bladder
· urine·
GENERAL DANGER SIGNS

 CONVULSIONS
 PERSISITENT VOMITING
 INABILTY TO FEED
 LETHARGY / UNCONSIOUSNESS
NUTRITION-2 SPECTRUM
 PEM -NUTRITON DEFECIENCY
 OBESE-NUTRITION EXCESS
 NUTRITIONAL
ASSESSMENT
 GROWTH OF CHILDREN
 PALLOR
 TYPES OF ANAEMIA :-
 NUTRITIONAL-IRON DEFN
 SICKLE CELL ANAEMIA
 G6PD DEFN
 THALASSAEMIA
 FEEDING
 BREAST FEEDING

Breast feeding
assessment:
Attachment.
Positioning.
Effectiveness of suckling.
 SAY NO TO BOTTLE
 Bottle feeding breast feeding
FEEDING ASSESMENT

Complimentary
feeding
Healthy diet
 FEEDING ASSESMENT

Complimentary feeding
Healthy diet
New food pyramid
 FEEDING ASSESMENT

 Types of food
 Consistency of food
 Frequency of food
 3 meals and 2 snacks -by 1 yr
DEVELOPMENT ASSESSMENT
danger signs of a global delay
in development are:
 • parental concern
• no social smile at 2 months
• not achieved good eye contact at 3 mt
• not reaching for objects at 5 months
• failed distraction test at 8 months
• not sitting with support at 9 months
• not walking unaided at 18 months
• not saying single words with meaning at
18 months
• regression of acquired skills
• discordance in developmental areas.
IMMUNIZATION IN OMAN

WHEN TO IMMUNIZE WHAT IS GIVEN

Birth BCG , OPV , HBV – 1
OPV, PENTA – 1
6 weeks
OPV – 1 , PENTA – 2
3 months OPV – 2 , PENTA – 3
5 months OPV – 3 , VITAMIN – A
7 months MMR – 1 , VITAMIN – A
12 months OPV & DTP BOOSTER ,
MMR - 2
18 months
 IMMUNISATION

VACCINE TYPE ROUTE DOSE SIDE

EFFECT

BCG Live Intra 0.5ML Local

dermal abscess

OPV Live Oral 2 Drops

HIB Conjuga IM 0.5ML Local
ted redness
 IMMUNISATION
VACCINE TYPE ROUTE DOSE SIDE
EFFECT

HBV Inactivat IM 0.5ml Local

ed viral reactions
Ag
Diphtheri Toxoid IM 0.5ml Local
a reactions

Tetanus Toxoid IM 0.5ml Local

reactions
 IMMUNISATION
VACCIN TYPE ROUTE DOSE SIDE
E EFFECT

PERTUS Toxoid IM 0.5ML Local

SIS reaction

MEASLE Live IM 0.5ML Local

S reaction

RUBELL Live IM 0.5ML Local

A reaction

MUMPS Live IM 0.5ML Local

reaction
IMMUNISATION
IMMUNISATION
TECHNIQUE
 IMMUNISATION
 There are only three situations at present that are
contraindications to immunization:
 ■ Do not give BCG to a child known to have AIDS.
 ■ Do not give DPT 2 or DPT 3 to a child who has had
convulsions or shock within 3 days of the most recent
dose.
 ■ Do not give DPT to a child with recurrent convulsions
or another active neurological disease of the central
nervous system.
 good rule to follow: There are no contraindications
 to immunization of a sick child if the child is well
enough to go home.
 IMMUNISATION
 CONTRAINDICATIONS TO IMMUNIZATION
 DPT ■ Do not give DPT2 or DPT 3 to a child who had
convulsions, shock or any other
 adverse reaction after the most recent dose. Instead,
give DT.
 ■ Do not give to a child with recurrent convulsions or
another active neurological
 disease of the central nervous system.
 OPV ■ If the child has diarrhoea, give a dose of OPV,
but do not count the dose. Ask the
 mother to return in 4 weeks for the missing dose of
OPV.
 IMCI FORMS A &B
Form-A(0-2/12) Form-B(2/12 -5 Y)
SEVERE INFECTION COUGH
MINOR INFECTIONS EAR PROBLEM
JAUNDICE CHECK THROAT
DIARRHOEA DIARRHOEA
FEVER
 COUNSELING
 HOME CARE
 WHEN TO RETURN
 CAUSE OF ILLNESS
 PREVENTION
 OTHERS
 FOLLOW UP
 FOLLOW UP CARE

 REASSESS & FURTHER

MANAGEMENT
 HEALTHY CHILDREN TO HAPPY
PARENTS