Nurses Revision

Nurses Revision
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Kebera obubonero obwobulabe okusooka
Omwana omuto 0-2 emyezi Omwana 2 emyezi-5 emyaka
Ebisinga: Malaria Pneumonia Diarrhoea Fever HIV

Results for "Fever" (Age: 2 months - 5 years)

Fever - No Malaria 2 months - 5 years

Routine Management / Treat underlying cause if identified High match
Byo ogamba omukuumi
  • If bacterial cause identified: Explain diagnosis and need for antibiotic. Teach how to give antibiotic correctly.
  • If no bacterial cause identified: Explain likely viral cause, reassure that antibiotics are not needed. Explain that fever may last a few days.
  • Teach how to give Paracetamol for high fever at home (correct dose, frequency max every 6 hours).
  • Advise on increasing fluids and continuing feeding.
  • Advise WHEN TO RETURN IMMEDIATELY: Develops danger signs, develops stiff neck, becomes sicker, fever persists > 3 days without improving at all, or develops localizing signs.
  • Advise to return in 3 days if fever persists.

Classification for a child presenting with fever (or history/hot/temp ≥37.5°C) who has a negative malaria test OR malaria test was not done but no obvious cause of fever identified, AND no signs of Very Severe Febrile Disease. Requires management of fever and identification/treatment of any other bacterial cause.

Key Features
  • Fever (current or recent history).
  • Malaria test is negative (or not done but malaria unlikely/ruled out clinically where appropriate).
  • Absence of any general danger sign or stiff neck.
  • Need to search for and treat other potential causes of fever.
  • If no cause found, likely viral, manage symptomatically.
Red Flags (Warning Signs)
  • Development of any danger sign or stiff neck.
  • Fever persisting > 3 days without improvement.
  • Fever present every day for more than 7 days.
  • Fever present for 14 days or more (check for TB).
Okukebera
Buuza
  • Does the child have fever (by history, feels hot, or temperature ≥37.5°C)?
  • Confirm absence of General Danger Signs.
  • Confirm absence of Stiff Neck.
  • Perform Malaria Test (RDT or Microscopy) - Result is NEGATIVE OR test not done.
  • Look for other causes of fever (e.g., signs of pneumonia, ear infection, UTI symptoms, skin infection, throat infection).
Classification
  • Fever present AND Malaria test NEGATIVE (or not done/available) AND Other cause of fever PRESENT -> FEVER - NO MALARIA (Treat the identified cause)
  • Fever present AND Malaria test NEGATIVE (or not done/available) AND No other cause of fever identified -> FEVER - NO MALARIA (Likely Viral)
Urgency / Refer urgently

Routine Management / Treat underlying cause if identified

Enfuga
Non-Pharmacological Management
  • Advise adequate fluid intake.
  • Continue feeding.
  • Advise tepid sponging for comfort if high fever (optional).
Pharmacological Treatment
  • Give one dose of Paracetamol (10-15 mg/kg) in the clinic if high fever (≥38.5°C axillary) - see dosage on page 15.
  • If an identified bacterial cause of fever is present (e.g., Pneumonia, Acute Ear Infection, Dysentery): Give appropriate antibiotic treatment for that condition (refer to relevant sections/pages for drug, dose, duration - e.g., Amoxicillin for Pneumonia/AOM, Ciprofloxacin for Dysentery).
  • If fever is present every day for > 7 days, refer for further assessment.
  • If fever is present for > 14 days, check for TB (assess symptoms, contact history - see page 9).
Monitoring & Follow-Up
  • Follow-up in 3 days IF fever persists.
  • At follow-up: Reassess child fully (check danger signs, stiff neck, source of fever). If danger signs/stiff neck, treat as Very Severe Febrile Disease and refer. If fever persists without source, reassess carefully, consider referral if >7 days total or child unwell. If another cause identified, treat. If improving, reassure.
  • Advise mother when to return immediately.
Counselling Points
  • If bacterial cause identified: Explain diagnosis and need for antibiotic. Teach how to give antibiotic correctly.
  • If no bacterial cause identified: Explain likely viral cause, reassure that antibiotics are not needed. Explain that fever may last a few days.
  • Teach how to give Paracetamol for high fever at home (correct dose, frequency max every 6 hours).
  • Advise on increasing fluids and continuing feeding.
  • Advise WHEN TO RETURN IMMEDIATELY: Develops danger signs, develops stiff neck, becomes sicker, fever persists > 3 days without improving at all, or develops localizing signs.
  • Advise to return in 3 days if fever persists.
Differential Diagnosis
  • Viral URTI / LRTI (Flu, adenovirus etc.)
  • Pneumonia
  • Acute Otitis Media
  • Urinary Tract Infection (UTI)
  • Tonsillitis/Pharyngitis (Bacterial or Viral)
  • Skin and soft tissue infection (abscess, cellulitis)
  • Gastroenteritis (may have fever)
  • Typhoid fever
  • Tuberculosis (if prolonged fever)
  • Other less common infections (e.g., Brucellosis, Rickettsial)
  • Non-infectious causes (rare in this context - e.g., Kawasaki disease)
Potential Complications
  • Febrile convulsions
  • Dehydration
  • Complications related to the underlying cause of fever (e.g., mastoiditis from ear infection, pyelonephritis from UTI).
Prevention
  • Immunizations.
  • Handwashing, hygiene.
  • Good nutrition.
  • Malaria prevention (reduces malaria as cause, helps focus on other causes).
  • Prompt care seeking.

Reference: IMCI Chart Booklet - Page 4, Page 9 (TB), Page 15 (Paracetamol), Page 23 (Follow-up), Page 30 (Return signs)

Very Severe Febrile Disease 2 months - 5 years

Refer URGENTLY High match
Byo ogamba omukuumi
  • Explain the extreme seriousness of the child's condition and the urgent need for hospital care.
  • Explain treatments given (antimalarial, antibiotic, sugar, paracetamol if given).
  • Advise on keeping the child warm during transport.
  • Advise on continuing breastfeeding if possible.
  • Write a detailed referral note listing findings, classifications, and all treatments given (drug, dose, time).
Dosage Helper

Enter child weight (kg). Verify against local protocol before prescribing.

  • Rectal Artesunate: --
  • IM Ampicillin: --
  • IM Gentamicin: --

Classification for a child presenting with fever (or history of fever/feels hot/temp ≥37.5°C) who has any general danger sign OR a stiff neck. This indicates a potentially life-threatening infection (like severe malaria, meningitis, sepsis) requiring immediate pre-referral treatment and urgent referral.

Key Features
  • Presence of Fever (current or recent history).
  • Presence of ANY General Danger Sign OR a Stiff Neck.
  • Stiff neck strongly suggests meningitis.
  • Requires immediate pre-referral antimalarial, antibiotic, and hypoglycemia prevention, followed by urgent referral.
Red Flags (Warning Signs)
  • Any general danger sign
  • Stiff neck
  • Impaired consciousness / lethargy
  • Convulsions
  • Signs of shock
Okukebera
Buuza
  • Does the child have fever (by history, feels hot, or temperature ≥37.5°C)?
Tunuulira, wulira, kwata
  • Look or feel for stiff neck (difficulty or pain when gently flexing the neck forward).
  • Check for General Danger Signs (Any ONE: Unable to drink/breastfeed, Vomits everything, Had convulsions, Lethargic/unconscious, Convulsing now).
Classification
  • Fever present AND (Any general danger sign OR Stiff neck) -> VERY SEVERE FEBRILE DISEASE
Urgency / Refer urgently

Refer URGENTLY

Obujjanjabi nga tonasindika
  • Give 1st dose of pre-referral antimalarial: Rectal Artesunate (10 mg/kg) OR IM/IV Artesunate (3 mg/kg if =20kg) OR IM Quinine (see page 11 for specific dosing based on formulation).
  • Give 1st dose of appropriate IM antibiotic: Ampicillin (50 mg/kg) AND Gentamicin (7.5mg/kg) OR alternative based on local guidelines (e.g., Ceftriaxone). See page 12 for Ampicillin/Gentamicin dosing.
  • Treat child to prevent low blood sugar: If child can breastfeed, ask mother. If cannot breastfeed but can swallow, give 30-50ml EBM/substitute/sugar water (4 tsp sugar in 200ml water). If cannot swallow, give 50ml via NG tube.
  • Give one dose of Paracetamol (10-15 mg/kg) if high fever (≥38.5°C axillary). Dosage (500mg tablet): 2-3m (<6kg): 1/4 tab. 4m-3y (6-<14kg): 1/2 tab. 4-5y (14-19kg): 3/4 tab (or 1/2 of 500mg tab from p15). Note: page 15 suggests 10mg/kg for paracetamol, use local guideline preference.
  • If convulsing now, give rectal Diazepam (see page 11 for dose).
Enfuga
Non-Pharmacological Management
  • Quickly complete assessment.
  • Ensure airway is clear, position appropriately.
  • Keep child warm.
Monitoring & Follow-Up
  • To be managed at referral hospital facility.
Counselling Points
  • Explain the extreme seriousness of the child's condition and the urgent need for hospital care.
  • Explain treatments given (antimalarial, antibiotic, sugar, paracetamol if given).
  • Advise on keeping the child warm during transport.
  • Advise on continuing breastfeeding if possible.
  • Write a detailed referral note listing findings, classifications, and all treatments given (drug, dose, time).
Differential Diagnosis
  • Severe Malaria (Cerebral malaria)
  • Bacterial Meningitis
  • Sepsis
  • Severe Pneumonia (may present with fever and danger signs)
  • Typhoid fever (severe)
  • Encephalitis
  • Other severe systemic infections
Potential Complications
  • Coma
  • Permanent neurological damage (from meningitis, cerebral malaria, hypoglycemia)
  • Shock
  • Severe anaemia (malaria)
  • Kidney failure
  • Respiratory failure
  • Death
Prevention
  • Use of Insecticide Treated Nets (ITNs).
  • Prompt diagnosis and treatment of uncomplicated malaria.
  • Immunizations (Hib, Pneumococcal, Meningococcal if available/indicated).
  • Good nutrition.
  • Prompt care seeking for any fever.

Reference: IMCI Chart Booklet - Page 4, Pages 1, 11, 12, 15

Malaria 2 months - 5 years

Routine Management / Treat with ACT High match
Byo ogamba omukuumi
  • Explain the diagnosis (malaria) and the need for antimalarial tablets.
  • Teach how to give the full course of ACT correctly: dose, timing (especially for AL's 8-hour second dose), duration (3 days), importance of giving with food for AL.
  • Teach how to give Paracetamol for high fever.
  • Advise on increasing fluids and continuing feeding.
  • Advise WHEN TO RETURN IMMEDIATELY: Develops danger signs (cannot drink, vomits everything, convulsions, lethargy), develops stiff neck, becomes sicker.
  • Advise to return in 3 days if fever persists, or sooner if condition worsens.

Classification for a child presenting with fever (or history/hot/temp ≥37.5°C) who has a positive malaria test (RDT or microscopy) and NO signs of Very Severe Febrile Disease. Requires treatment with a recommended first-line antimalarial.

Key Features
  • Fever (current or recent history).
  • Positive malaria diagnostic test.
  • Absence of any general danger sign or stiff neck.
  • Requires treatment with oral Artemisinin-based Combination Therapy (ACT).
Red Flags (Warning Signs)
  • Development of any danger sign or stiff neck (indicates progression to severe malaria/disease).
  • Persistent vomiting preventing oral medication.
  • Fever persisting after 3 days of treatment.
Okukebera
Buuza
  • Does the child have fever (by history, feels hot, or temperature ≥37.5°C)?
  • Confirm absence of General Danger Signs.
  • Confirm absence of Stiff Neck.
  • Perform Malaria Test (RDT or Microscopy) - Result is POSITIVE.
Classification
  • Fever present AND Malaria test POSITIVE AND No signs of Very Severe Febrile Disease -> MALARIA
Urgency / Refer urgently

Routine Management / Treat with ACT

Enfuga
Non-Pharmacological Management
  • Advise adequate fluid intake.
  • Advise tepid sponging for comfort if high fever (optional, do not use cold water).
  • Continue feeding.
Pharmacological Treatment
  • Give first-line oral Artemisinin-based Combination Therapy (ACT): Artemether-Lumefantrine (AL) OR Artesunate-Amodiaquine (AS+AQ).
  • AL Dosing (Coartem® 20/120mg tablets, give dose twice daily for 3 days at 0, 8, 24, 36, 48, 60 hours): Weight 5-<15kg (Age 4m-<3y): 1 tablet per dose. Weight 15-<25kg (Age 3-<9y): 2 tablets per dose. Weight 25-<35kg (Age 9-=35kg (Age >14y): 4 tablets per dose. Give with food/fatty drink.
  • AS+AQ Dosing (Fixed dose combination, give once daily for 3 days): Refer to specific product dosing based on age/weight bands.
  • Give Paracetamol (10-15 mg/kg) if high fever (≥38.5°C axillary) - see dosage on page 15.
  • If fever persists every day for more than 7 days, refer for further assessment.
Monitoring & Follow-Up
  • Follow-up in 3 days IF fever persists.
  • At follow-up: Reassess child fully. If danger signs or stiff neck, treat as Very Severe Febrile Disease and refer. If malaria is only cause of persistent fever, treat with second-line antimalarial (e.g., Quinine) or refer. If other cause identified, treat accordingly.
  • If fever has been present > 7 days total, refer for assessment.
Counselling Points
  • Explain the diagnosis (malaria) and the need for antimalarial tablets.
  • Teach how to give the full course of ACT correctly: dose, timing (especially for AL's 8-hour second dose), duration (3 days), importance of giving with food for AL.
  • Teach how to give Paracetamol for high fever.
  • Advise on increasing fluids and continuing feeding.
  • Advise WHEN TO RETURN IMMEDIATELY: Develops danger signs (cannot drink, vomits everything, convulsions, lethargy), develops stiff neck, becomes sicker.
  • Advise to return in 3 days if fever persists, or sooner if condition worsens.
Differential Diagnosis
  • Very Severe Febrile Disease (especially Severe Malaria)
  • Fever - No Malaria (viral illness, other bacterial infection)
  • Pneumonia
  • Urinary Tract Infection
  • Typhoid fever
  • Other febrile illnesses
Potential Complications
  • Progression to severe malaria
  • Anaemia
  • Febrile convulsions
  • Dehydration
Prevention
  • Sleeping under an Insecticide Treated Net (ITN) every night.
  • Indoor residual spraying (IRS) where implemented.
  • Prompt diagnosis and effective treatment of malaria episodes.
  • Intermittent Preventive Treatment in pregnancy (IPTp) and infancy (IPTi)/Seasonal Malaria Chemoprevention (SMC) where applicable.

Reference: IMCI Chart Booklet - Page 4, Page 15 (AL/AS+AQ, Paracetamol), Page 23 (Follow-up)

TB (Tuberculosis) 2 months - 5 years

Initiate Treatment / Link to TB Clinic High match
Byo ogamba omukuumi
  • Explain the diagnosis (TB) and the need for long-term treatment (usually 6 months).
  • Explain the importance of taking medications every day exactly as prescribed.
  • Teach how to give the TB medicines (crushing/dispersing tablets if needed).
  • Explain potential side effects and when to return if they occur (e.g., yellow eyes, skin rash).
  • Counsel on good nutrition to support recovery.
  • Explain importance of follow-up visits at TB clinic.
  • Discuss infection control measures within the household (e.g., cough hygiene, ventilation) if relevant.
  • Ask about the caregiver's health (possible source case) and advise screening if needed.
  • Counsel on contact tracing for other household members, especially young children.

Classification for a child suspected of having Tuberculosis disease based on symptoms, contact history, and possibly physical signs or diagnostic tests. Requires initiation of TB treatment and linkage to TB clinic.

Key Features
  • Diagnosis often based on a combination of symptoms, contact history, and signs, especially in young children where bacteriological confirmation is difficult.
  • Criteria differ slightly based on HIV status: >=2 symptoms/signs if HIV Neg, >=1 symptom/sign if HIV Pos.
  • Positive contact history is significant.
  • Positive GeneXpert or smear microscopy confirms TB.
  • Requires multi-drug anti-TB treatment regimen.
Red Flags (Warning Signs)
  • Signs of TB meningitis (stiff neck, altered consciousness, convulsions).
  • Signs of respiratory distress (severe pneumonia).
  • Signs of miliary TB (severe illness, hepatosplenomegaly).
  • Signs of spinal TB (back swelling, neurological deficit).
  • Any general danger sign.
Okukebera
  • Ask (Symptoms suggestive of TB):
  • Has the child been coughing for 14 days or more?
  • Has the child had persistent fever (≥14 days)?
  • Has the child had poor weight gain in the last month? (Defined as: Weight loss >5% since last visit OR Weight-for-age < -3 Z-score OR Weight-for-age < -2 Z-score OR Growth curve flattening OR Red/Yellow MUAC colour code).
  • Ask (History of contact):
  • Has the child had contact with a person with Pulmonary TB or chronic cough?
  • Look/Feel (Physical signs suggestive of TB):
  • Look/Feel for swellings in the neck or armpit (lymphadenopathy).
  • Look/Feel for swelling on the back (e.g., gibbus).
  • Look/Feel for stiff neck.
  • Listen for persistent wheeze not responding to bronchodilators.
  • Check HIV status (HIV positive status increases suspicion/risk).
  • Review available diagnostic tests: Collect sample for GeneXpert or smear microscopy if available. Chest X-Ray results if available.
Classification
  • Criteria for TB Classification:
  • (HIV Negative Child): Two or more of the following: (Cough ≥14d) OR (Fever ≥14d) OR (Poor weight gain*) OR (Positive contact history) OR (Suggestive physical sign: neck/axilla/back swelling, stiff neck, persistent wheeze).
  • (HIV Positive Child): One or more of the following: (Cough ≥14d) OR (Fever ≥14d) OR (Poor weight gain*) OR (Positive contact history) OR (Suggestive physical sign).
  • OR A positive GeneXpert or smear microscopy test.
  • -> Classify as TB
Urgency / Refer urgently

Initiate Treatment / Link to TB Clinic

Obujjanjabi nga tonasindika
  • If signs of severe TB (meningitis, respiratory distress) or other severe classification present, provide appropriate pre-referral treatments (antibiotics, manage danger signs) before urgent referral to hospital (TB treatment may be initiated at hospital).
Enfuga
Non-Pharmacological Management
  • Provide nutritional support counselling.
  • Counsel on adherence to long-term treatment.
  • Trace contacts of the child (especially the source case) for screening.
Pharmacological Treatment
  • Initiate TB treatment using appropriate regimen based on national guidelines (typically involves Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), +/- Ethambutol (E) in intensive phase, followed by HR in continuation phase).
  • Use weight-band dosing for fixed-dose combinations (FDCs) if available (See Page 19 for RHZ 75/50/150 and E100 weight bands: 4-7kg: 1 tab RHZ, 1 tab E; 8-11kg: 2 tabs RHZ, 2 tabs E; 12-15kg: 3 tabs RHZ, 3 tabs E; 16-24kg: 4 tabs RHZ, 4 tabs E).
  • Intensive Phase (First 2 months): Typically 2RHZE or 2RHZ.
  • Continuation Phase (Next 4 or 10 months): Typically 4RH or 10RH (longer for TB meningitis/bone TB). See Page 19: 4RH for most forms, 10RH for TB meningitis/osteoarticular TB.
  • Link the child to the nearest TB clinic for registration, ongoing treatment, monitoring, and follow-up.
  • If GeneXpert or smear microscopy test is not available or negative, but clinical suspicion is high based on criteria, initiate treatment and refer for further assessment/confirmation.
  • Treat, counsel, and follow up any co-infections (e.g., HIV, malnutrition).
  • If available, give Pyridoxine (Vitamin B6) 12.5mg/day for children <5 years on Isoniazid to prevent neuropathy (absence should not delay starting TB meds).
Monitoring & Follow-Up
  • Requires regular follow-up at the TB clinic (e.g., monthly) for monitoring treatment response, side effects, adherence, and weight gain.
  • Contact tracing follow-up.
Counselling Points
  • Explain the diagnosis (TB) and the need for long-term treatment (usually 6 months).
  • Explain the importance of taking medications every day exactly as prescribed.
  • Teach how to give the TB medicines (crushing/dispersing tablets if needed).
  • Explain potential side effects and when to return if they occur (e.g., yellow eyes, skin rash).
  • Counsel on good nutrition to support recovery.
  • Explain importance of follow-up visits at TB clinic.
  • Discuss infection control measures within the household (e.g., cough hygiene, ventilation) if relevant.
  • Ask about the caregiver's health (possible source case) and advise screening if needed.
  • Counsel on contact tracing for other household members, especially young children.
Differential Diagnosis
  • Persistent bacterial pneumonia
  • Asthma (persistent wheeze)
  • Chronic lung disease
  • Lymphoma or other malignancy (lymphadenopathy)
  • HIV-related complications (poor weight gain, fever)
  • Malnutrition (poor weight gain)
  • Other chronic infections
Potential Complications
  • TB Meningitis
  • Miliary TB
  • Spinal TB (Pott's disease)
  • Pleural effusion
  • Bronchiectasis
  • Treatment failure / Drug resistance
  • Drug toxicity (e.g., hepatitis, neuropathy)
  • Malnutrition
  • Death
Prevention
  • BCG vaccination at birth (protects mainly against severe forms like meningitis).
  • Isoniazid Preventive Therapy (IPT) for eligible contacts (especially HIV+ children and children <5y who are close contacts) - see TB Exposure classification.
  • Early diagnosis and treatment of infectious TB cases (source control).
  • Infection control measures (ventilation, cough hygiene).
  • HIV prevention and treatment (reduces TB risk).

Reference: IMCI Chart Booklet - Page 9, Page 19 (TB Regimens, Dosing), Page 20 (IPT)

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IMCI Guidelines

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Common Conditions Quick Access

Respiratory

Cough / Pneumonia

Guidance for assessing cough, difficult breathing, and classifying pneumonia severity.

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Gastrointestinal

Diarrhoea / Dehydration

Protocols for diarrhoea assessment, dehydration levels, and fluid management.

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Systemic

Fever / Malaria

Steps for managing fever, malaria testing, and treating febrile illness.

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Severe Illness

Danger Signs

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