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PROF . MERVAT A HESHAM

PROF . MERVAT A HESHAM. THE CASE MANAGEMENT PROCESS. The charts describe the following steps : Assess the child or young infant Classify the illness Identify treatment Treat the child Counsel the mother Give follow-up care. Case Management Process.

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PROF . MERVAT A HESHAM

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  1. PROF . MERVAT A HESHAM

  2. THE CASE MANAGEMENT PROCESS • The charts describe the following steps: • Assess the child or young infant • Classify the illness • Identify treatment • Treat the child • Counsel the mother • Give follow-up care

  3. Case Management Process • Assess the child or young infant • “Assess the child” means taking a history and doing physical examination.

  4. Case Management Process II. Classify the illness • “Classify the Illness” means taking a decision on the severity of the illness • Classifications are not specific disease diagnoses. Instead, they are categories that are used to determine treatment • For effectively manage childhood illness, a color-coded system has been utilized which represents: greenyellowpink

  5. Case Management Process II. Classify the illness

  6. ASSESS AND CLASSIFY THE SICK YOUNG INFANT AGE 1 week up to 2 months

  7. Introduction Young infants have special characteristics that must be considered when classifying their illness They can become sick and die very quickly from serious bacterial infections. They frequently have only general signs such as few movements, fever, or low body temperature

  8. Objectives • Assessing and classifying for possible bacterial infection • Assessing and classifying for diarrhea • Checking for feeding problem or low weight, assessing breastfeeding, and classifying feeding • Treating with oral or intramuscular antibiotics • Giving fluids for treatment of diarrhea • Teaching mother to treat local infections • Teaching correct positioning and attachment for breastfeeding • Advising how to give home care

  9. ASSESS AND CLASSIFY THE SICK YOUNG INFANTAGE UP TO 2 MONTH • GREETthe mother appropriately and • ask about her baby. • LOOK to see if the infant’s weight and temperature have been recorded • ASK the mother what the infant’sproblems are • DETERMINE if this is an INITIAL visit or FOLLOW UP visit for this problem

  10. NAME OF THE CHILD • AGE • WEIGHT • TEMPERATURE • CHILD’S PROBLEMS • INITIAL OR FOLLOW UP VISIT

  11. Check for POSSIBLE BACTERIAL INFECTION and classify the illness

  12. Check for POSSIBLE BACTERIAL INFECTION and classify the illness • This assessment step is done foreverysick young infant • The young infant must be calm and may be asleep while you assess thefirst seven signs,

  13. CHECK FOR POSSIBLE BACTERIAL INFECTION • ASK: 1.Has the infant had convulsions? 2.Is the infant NOT able to feed?

  14. CHECK FOR POSSIBLE BACTERIAL INFECTION • 3. LOOK:See if the infant is convulsing now? • 4. LOOK:Count the breaths in one minute. Repeat the count if elevated. 60 breaths per minute or more is the cutoff used to identify fast breathing in a young infant. • 5. LOOK:For severe chest indrawing. Mild chest indrawing is normal Severe chest indrawing is a sign of pneumonia

  15. CHECK FOR POSSIBLE BACTERIAL INFECTION • 6. LOOK: For nasal flaring. • 7. LOOK and LISTEN for grunting. Grunting is the soft, short sounds a young infant makes when breathing out.. • 8. LOOK and LISTEN for wheeze. Wheeze is a soft musical noise when the young infant breathes out. Wheeze is mainly due to bronchiolitis or severe pneumonia in a young infant.

  16. CHECK FOR POSSIBLE BACTERIAL INFECTION • 9. LOOK and FEEL for bulging fontanelle. The infant must not be crying. Then look at and feel the fontanelle. If the fontanelle is bulging rather than flat, this may mean the young infant has meningitis. • 10. LOOK: For pus draining from the ear. • 11. LOOK: to the eye, is it red, swollen and draining pus ?

  17. CHECK FOR POSSIBLE BACTERIAL INFECTION • 12. LOOK at the umbilicus - is it red or draining pus? Does the redness extend to the skin? If redness extends to the skin of the abdominal wall, it is a serious infection. • 13. FEEL: Measure temperature (or feel for fever or low body temperature). Fever may be the only sign of a serious bacterial infection. Young infants can also respond to infection by dropping their body temperature to below 35.5C (36C rectal temperature)..

  18. CHECK FOR POSSIBLE BACTERIAL INFECTION • 14. LOOK: For skin pustules. Are there many or severe pustules? Many or severe pustules indicate a serious infection • 15. LOOK: See if the young infant is lethargic or unconscious. A lethargic young infant is not awake and alert when he should be. He may be drowsy and may not stay awake after a disturbance. Look to see if the child wakens when the mother talks or gently shakes the child or when you clap your hands. An unconscious young infant cannot be wakened at all. He does not respond when he is touched or spoken to.

  19. CHECK FOR POSSIBLE BACTERIAL INFECTION • 16. LOOK: At the young infant's movements. Are they less than normal? An awake young infant will normally move his arms or legs or turn his head several times in a minute if you watch him closely.

  20. HOW TO CLASSIFY FOR BACTERIAL INFECTION

  21. Compare the infant's signs to signs listed and choose the appropriate classification. • If the infant has any sign in the top row, select • POSSIBLE SERIOUS BACTERIAL INFECTION.

  22. HOW TO CLASSIFY FOR BACTERIAL INFECTION • If the infant has any sign in the middle row, • LOCAL BACTERIAL INFECTION. • An infant who has none of the signs is classified as having • “BACTERIAL INFECTION UNLIKELY”. • Select only one classification in this table.

  23. CHECK FOR POSSIBLE BACTERIAL INFECTION SIGNS CLASSIFY AS TREATMENT • * Give first dose of an appropriate antibiotics. • * Give Vitamin A. • * Treat the child to prevent low blood sugar. • * Refer URGENTLY to hospital. • * Convulsion or • * Fast breathing (60 breaths per minute or more) or • * Severe chest indrawing or • * Nasal flaring or • * Grunting or • * Bulging fontanelle or • * Pus draining from ear of • * Umbilical redness extending to the skin or • * Fever (37.5ºC* or above or feels hot) or low body temperature (less than (35.5ºC* or feels cold) or • * Many or severe skin pustules or • * Abnormally sleepy or difficulty to awaken or • * Less than normal movement POSSIBLE SERIOUS BACTERIAL INFECTION * Red umbilicus or draining pus or * Skin pustulres LOCAL BACTERIAL INFECTION • * Give an appropriate oral antibiotic • * Treat local infection in the health center and teach the mother to treat local infections at home • * Advise mother to give home care for the young infant • * Follow up in 2 days

  24. An infant who has none of the signs is classified as having “BACTERIAL INFECTION UNLIKELY

  25. CHECK FOR SIGNIFICANT JAUNDICE

  26. ASK: Has the jaundice started in the first 24 hours after delivery? LOOK: For jaundice. Is it extending to the palms and soles ? Classify JAUNDICE

  27. Jaundice started in first 24 hours after delivery and still present, • OR • Jaundice extending from the body topalms and soles. • SIGNIFICANT JAUNDICE • and the infant should be URGENTLY referred to the hospital

  28. ASSESS DIARRHEA

  29. ASSESS DIARRHEA ASK: DOES THE YOUNG INFANT HAVE DIARRHEA IF YES, assess and classify the young infant’s diarrhea using the DIARRHEA classification

  30. Assessment ASK • Does the child have diarrhea? For how long? • Is there blood in the stool? LOOK & FEEL • Look at the child’s general condition • Is the child abnormally sleepy or difficult to awaken? • Restless or 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: • Very slowly (longer than 2 seconds)? • Slowly?

  31. Severe Dehydration

  32. DIARRHEA If DIARRHEA for14 days or more that there is only onepossible classification for persistent diarrhoea are classified as SEVERE, PERSISTENT DIARRHEA

  33. And if BLOOD in stool Young infants with blood in the stool are classified as severely ill and are referred urgently

  34. THEN ASK: Does the young infant have diarrhea * Dehydration lasting 14 days or more SEVERE PERSISTENT DIARRHEA • * If young infant is dehydrated, treat dehydration before referral unless the infant has also POSSIBLE SERIOUS BACTERIAL INFECTION • * Refer to hospital. * Blood in the stool DYSENTERY * Refer URGENTLY to hospital with mother giving frequent sips or ORS on the way. Advise mother to continue breastfeeding

  35. CHECK FOR FEEDING PROBLEM OR LOW WEIGHT

  36. 4. ASK: What do you use to feed the infant? a feeding bottle? or cup?. 5. LOOK: Determine weight for age. Use a weight for age chart to determine if the infant is low weight for age. Remember that the age of a young infant is usually stated in weeks, but the Weight for Age chart is labeled in months. In newborn: determine birth weight. 6.Lookfor ulcers or white patches in the mouth (thrush).

  37. Do not assess if • 1.Exclusively breastfed without difficulty and is not low weight for age • 2. Not breastfed at all • 3.With serious problem requiring urgent referral

  38. Assess breastfeeding if an infant • Has any difficulty feeding • Is breastfeeding less than eight times in 24 hours • Is taking any other foods or drinks • Is low weight for age • Has no indications for urgent referral • ASK: Has the infant breastfed in the previous hour? If not, ask to put infant to the breast and observe for 4 minutes • If infant was fed during the last hour, ask if mother can wait and tell you when the infant is willing to feed again

  39. Assess and Classify the Sick, Young Infant • Is the infant able to attach? • No attachment at all • Not well attached • Good attachment • To check attachment, LOOK for all of these signs • Chin touching breast • Mouth wide open • Lower lip turned outward • More areola visible above than below the mouth

  40. Is the infant hasGood Positioning : • *nfant's neck is straight or bent slightly back, • *Infant's body is turned towards the mother, • *Infant's body is close to the mother, and • *Infant's whole body is supported. • Is the infant suckingeffectively? • not sucking at all? • Not sucking effectively? • Satisfied infant releases the breast spontaneously

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