DE GUZMAN, DEODEL B.

BSN 2 D

SELF-ASSESSMENT EXERCISE A

Remember that all self-assessment exercise answers at in a key at the end of this module.

Let us practise what we have learned about cough or difficult breathing thus far.

1. What are two clinical signs that help you identify children with pneumonia?

 Fast breathing, chest indrawing.

2. Do the following children have fast breathing? Tick your answers

a. 3 years, 36 breaths per minute YES NO

 NO

b. 12 months, 50 breaths per minute YES NO

 YES

c. 6 months, 45 breaths per minute YES NO

 NO

d. 3 months, 57 breaths per minute YES NO

 YES

3. Julie arrives at your clinic with her mother. You begin by gathering important information about the
child. You check Julie for danger signs, and she has none. What do you do next?

a. ASK: does the child have cough or difficult breathing?

b. LOOK: do you notice any issues with breathing?

4. When you ask Julie’s mother, she says Julie has no cough or difficult breathing. You watch Julie, and
she seems to be breathing regularly. What do you do next?

 Continue to the next assessment, for diarrhoea.

SELF-ASSESSMENT EXERCISE B

Open your Chart Booklet. Review the classification table for cough or difficult breathing.

1. Match the boxes below. Each “signs” box should be matched with one classification.

2. Are these statements true or false? If false, write the statement as correct.

a. You should look for chest indrawing when the child

breathes OUT.

TRUE FALSE

 FALSE: You look for chest indrawing when the child breathes IN.

b. Fast breathing in a child 12 months and older is 40 or

more a minute.

TRUE FALSE

 TRUE

c. Chest indrawing is a sign of pneumonia.

TRUE FALSE

 TRUE

d. If a child has a cough but no other signs, they probably

have pneumonia.

TRUE FALSE

 FALSE: If a child shows no signs, they are classified as COUGH OR COLD.

e. A child with chest indrawing will always also have fast

breathing.

TRUE FALSE

 FALSE: A child with chest indrawing may not have fast breathing.

f. Chest indrawing is when the lower ribs move IN when

the child breathes IN

TRUE FALSE

 TRUE

g. A child 2 up to 12 months has fast breathing if more

than 45 breaths a minute.

TRUE FALSE

 FALSE: Fast breathing in this age group 50 or more breaths per minute.

h. A child with chest indrawing has a higher risk of death from pneumonia than a child with fast
breathing and

no chest indrawing.

TRUE FALSE

 TRUE

i. Difficult breathing can also be described as noisy,

interrupted, or fast.

TRUE FALSE

 TRUE

j. If a child has cough, fast breathing, and vomits everything, he is classified as PNEUMONIA (YELLOW)

TRUE FALSE

 FALSE: Classify as SEVERE PNEUMONIA OR VERY SERIOUS DISEASE. This child shows signs from
two classifications. Fast breathing is a sign of PNEUMONIA (yellow). He also has a general
danger sign (red classification). When a child presents with signs from different boxes, you
always classify with the more severe.
SELF-ASSESSMENT EXERCISE C

Read the following case study and answer the questions.

Gyatsu is 6 months old and weighs 5.5 kg. His temperature is 38 °C. His mother said he has had cough
for 2 days. The health worker checked for general danger signs. The mother said that Gyatsu is able to
breastfeed. He has not vomited during this illness. He has not had convulsions. Gyatsu is not lethargic or
unconscious.

The health worker said to the mother, “I want to check Gyatsu’s cough. You said he has had cough for 2
days now. I am going to count his breaths. He will need to remain calm while I do this.” The health
worker counted 58 breaths per minute. He did not see chest indrawing or hear stridor.

1. Record Gyatsu’s signs on the Recording Form below

2. To classify Gyatsu’s illness, look at the classification table for cough or difficult breathing in your chart
booklet. Look at the top row (is pink in the Chart Booklet).

a. Does Gyatsu have a general danger sign?

 NO

b. Does he have chest indrawing or stridor when calm? YES OR NO

 NO
c. Will you classify SEVERE PNEUMONIA OR VERY SEVERE DISEASE?

YES NO

 NO

3. If he does not have the severe classification, look at the middle row (yellow on Chart).

a. Does Gyatsu have fast breathing? YES NO

 NO

b. How would you classify Gyatsu’s illness? Write on the Recording Form.

 PNEUMONIA
SELF-ASSESSMENT EXERCISE D

Answer the following questions about the treatments you have read about.

1. Are these statements true or false? Circle your answer.

a. You should give a child the first-line antibiotic, unless

it is unavailable or the child has not responded to it.

TRUE
TRUE FALSE

b. If a child has more than one illness that requires antibiotics, if possible, give one antibiotic for more
than

one illness.

TRUE FALSE

c. If a child can drink, it is preferable to give syrup

antibiotics.

TRUE FALSE

d. If a child has two illnesses that require the same antibiotic, you should, just double the dosage or put

the child on the treatment for 10 days instead of 5.

TRUE FALSE
FALSE
2. How often should you give amoxicillin for pneumonia?

 5 days, 2 times a day

3. What is the correct dosage for the following oral treatments? Refer to your dosage chart for
pneumonia. Write out the medicine and concentration, and its dosage and schedule.

a. Child is 3 months old, weighs 5 kg, and can drink. You have amoxicillin syrup in your clinic.

 5 ml (250 mg/5 ml), two times a day, for five days

b. Child is 9 months old, and you have amoxicillin tablets.

 1 tablet (250 mg), two times a day, for five days

c. Child is 13 months old, and 8 kg. She can drink. You have amoxicillin syrup in your clinic.

 10 ml (250 mg/5 ml), two times a day, for four days

d. Child is 4 years. You have amoxicillin tablets in the clinic.

 3 tablets (250 mg) two times a day for five days

4. What is meant by a “safe” remedy? Give an example.

 Many safe remedies are locally specific and recorded in your chart booklet. Remedies can be
homemade, given at clinic, or bought at pharmacy. Breast milk is best remedy for exclusively
breastfed child – do not give other drinks or remedies

5. Give at least 2 examples of remedies that are not safe.

 Many unsafe remedies are locally specific and recorded in your chart booklet. Other harmful
remedies contain atropine, codeine or codeine derivatives, or alcohol. These items may sedate
the child. They may interfere with the child’s feeding. They may also interfere with the child’s
ability to cough up secretions from the lungs. Medicated nose drops (that is, nose drops that
contain anything other than salt) should also not be used.
SELF-ASSESSMENT EXERCISE E

Rewrite the following questions as good checking questions.

1. Do you remember when to give the amoxicillin?

 When will you give the amoxicillin?

2. Do you understand how much amoxicillin syrup to give your child?

 How much syrup will you give your child?

3. Did the nurse explain to you how to use an inhaler?

 How will you give the inhaler?

4. Do you know how to make a remedy for the throat?

 How will you make a remedy for the throat at home?

SELF-ASSESSMENT EXERCISE F

Review the case below on treating with antibiotics.

Nurse Aluka gives some oral antibiotics to a mother for her child, Maria Balana. Before he explains how
to give them, Aluka asks the mother if she knows how to give her child the medicine. The mother nods
her head yes. So Aluka gives her the antibiotics and says good-bye.

1. If a mother tells you that she already knows how to give a treatment, what should you do?

 Ask the mother to show you how to measure the dosage, and tell you the schedule for the
antibiotic. If she is incorrect, give her information, and demonstrate for her. If she does indeed
know the information and measures the dosage correctly, ask her to give the first dose so you
can observe.

2. How would you fill out this drug label? You have classified the child’s respiratory condition as
PNEUMONIA. Maria Balana is 4 months old. You have adult co- trimoxazole tablets (80/400 mg) in your
clinic.

3. When should a child classified as COUGH OR COLD return immediately to the clinic?

 They must return immediately if breathing becomes fast or difficult.

4. When should they follow-up on the cough or cold?

 They should return for a follow-up visit in 5 days, only if the cough is not improving.
SELF-ASSESSMENT EXERCISE G

Read the following case study. Answer the questions about how you would manage the case. Refer to
any of the case management charts as needed.

Pandit’s mother has brought him back for follow-up. He is one year old. Three days ago he was classified
as having PNEUMONIA and you gave him amoxicillin. You ask how he is doing and if he has developed
any new problems. His mother says that he is much better.

1. How would you reassess Pandit today? List all the signs you would look at and write the questions you
would ask his mother.

 Is he able to drink or breastfeed?

 Does he vomit everything?
 Has he had convulsions?
 See if he is lethargic or unconscious.
 Is he still coughing? How long has he been coughing?
 Count the breaths in one minute.
 Look for chest indrawing.
 Look and listen for stridor.
 Is he breathing slower?
 Is there less fever?
 Is he eating better?

When you assess Pandit, you find that he has no general danger signs. He is still coughing and he has
now been coughing for about 10 days. He is breathing 38 breaths per minute and has no chest indrawing
and no stridor. His mother said that he does not have fever. He is breastfeeding well and eating some
food. He was refusing all food before. He was playing with his brother this morning.

2. Based on Pandit’s signs today, what actions will you take?

 Tell his mother that he is improving nicely. She should continue giving him the pills as she has
been until they are all gone. You should ask her checking questions about how she has been
giving the treatment. If you notice any issues, or she has any concerns and questions, address
this.