IMCI Assignment
Reem Mahmoud Sayed, 1year 7 month old female patient, attended for the first time to the
primary health care facility. Her mother came complaining that she had diarrhea for the last 4 days.
Her temperature was 390 C. She weighed 11 kg and her height is 79 cm.
She had occasional vomiting, and she was conscious with no current or history of convulsions
before coming. No respiratory complaint. She had loose stools, not bloody of 4 days duration. On
examination, sunken eyes were noticed.
The attending physician asked about ear pain or discharge or sore throat; the mother replied: “no
sore throat, but ear ache of 4 days duration”. When examined, he did not have any cervical
swelling, congested throat or exudate on tonsils. The physician found pus coming from right ear
with no swelling behind any of them.
Fever was of 4 days duration, with no current or history of rash in the preceding 3 months, and her
neck was not stiff on examination. Her mid upper arm circumference was 119 mm. She did not
have any palmar or mucous membrane pallor. She received all obligatory vaccines as scheduled.
Record Reem's symptoms and signs, assess and classify her and outline treatment on the
provided form.
Management of sick child age 2 months up to 5 years
Name: gender: Age: weight:
Temperature: Initial visit:
What are the child's problems:
Assess Classify Identify treatment
Check the child have any general danger sign? Yes No
Not able to drink or breast feed Lethargic or unconscious
Vomits everything Convulsing now
history of convulsions
Does Does the child have cough or difficult breathing? Yes No
For how long? __ Days Count breaths in one minute
breaths per minute. Fast Breathing
Look for chest indrawing.
Look and listen for stridor
Look and listen for wheeze
Does the child have Yes No No
diarrhea? dehydration
For how long?4 Days Is the child:
Is there blood in stools? Lethargic or unconscious
Restless or irritable
*Look for sunken eyes
*Offer fluid. Is the child:
Not able to rink or drink poorly
Drinking eagerly, thirsty
*pinch the skin of abdomen. Does it go back:
Very slowly (longer than 2 seconds
Slowly )
Check for throat problems : *Feel enlarged tender lymph node on front of No throat
Does the child have fever? neck problem
Does the child have sore *Look for red ( congested throat)
throat? *Look for white or yellow exudates on throat or
tonsils
Does the child have an ear Yes No Acute ear Antibiotic for 10 days
problem? *look for pus draining from ear infection paracetamol for pain
Is there an agonizing ear pain? *feel for tender welling behind ear dry the ear by wicking
Is there ear discharge? Follow-up in5 days
If yes, for how long?_4__Days To come back immediately if Becomes
sicker:
Does the child have fever? (by Yes No FEVER- Give paracetamol for fever
history or feels hot or temperature Look or feel for stiff neck POSSIBLE Treat apparent causes of fever.
37.5°C * or above) Look for signs of MEASLES BACTERIAL Follow-up in 2 days if fever persists.
IF YES, ASK: Generalized rash and INFECTION
For how long? One of these: cough, runny nose, or red To come back immediately if:
If more than 5 days, has fever been eyes. Not able to drink or Becomes sicker
present every day? Look for mouth ulcers. Are they deep and
Has the child had measles within the extensive?
last 3 months Look for pus draining from the eye.
Look for clouding of the cornea.
Assess Classify Identify treatment
LOOK AND FEEL: Visible severe wasting OR Oedema of NO ACUTE Vit D 400 IU
both feet. OR W/A or W/L.H below –3 Z MALNUTRITION
Look for visible severe wasting. Look for score OR
edema of both feet Determine weight for W/A or W/L. H between –3 and – 2 Z score
height (W /L..H), Determine W/A ,length/ OR MUAC from 115 - 125 mm
height for age (L/HFA) Determine body mass W/A and W/L.. H –2 Z score or OR
index (BMI) Measure mid upper arm MUAC 125 mm or more and no other
circumference (MUAC), if no weight or height signs of malnutritionabove
measurement scale.
L/H/ A below -3 Z score NO STUNTING
L/H/A between –3or –2 Z score
L/H/A -2 Z score or more
BMI above 3 Z score NO OBESITY
BMI between 2 and 3 Z score
BMI below 2 Z score
Look for palmar pallor and mucous membrane Severe palmar and / or mucous NO ANAEMIA give iron
pallor Is it : membrane pallor weekly
Severe palmar pallor and / or mucous Some palmar and / or mucous membrane
membrane pallor? Some palmar pallor and / pallor
or mucous membrane pallor
No palmar or mucous membrane pallor