NLE Paediatric Nursing — Communicable & Infectious Diseases in Children (IMCI)Cheat Sheet
A printable cheat sheet for Communicable & Infectious Diseases in Children (IMCI), built for NLE reviewers who want one go-to reference in the final stretch. Covers formulas, key definitions, common question types, and the Professional Regulation Commission (PRC) — Board of Nursing-specific twists you will see on NLE day.
Exam context
For the Philippine Nurse Licensure Examination (PNLE), Professional Regulation Commission (PRC) — Board of Nursing tests Paediatric Nursing under a "Core" label, with Communicable & Infectious Diseases in Children (IMCI) in the 6th slot across 6 chapters. NLE candidates must clear the 75% weighted average with no sub-test below 60% cut on the 2026 paper, which draws about 50 Paediatric Nursing questions. Date to watch: Bi-annual.
Communicable & Infectious Diseases in Children (IMCI) - Cheat Sheet
Your last-minute revision companion for mastering common childhood infections, transmission routes, isolation precautions, complications, and IMCI classification. This sheet condenses every testable concept into rapid-fire reference format — perfect for final exam prep.
Sections
Section Title
Measles (Rubeola)
Important Facts
- Transmission: AIRBORNE — highly contagious; droplet precautions insufficient.
- Infectious period: 4 days before rash to 4 days after rash onset.
- Most common complication: PNEUMONIA — leading cause of measles death in children.
- Other complications: otitis media, encephalitis, subacute sclerosing panencephalitis (SSPE) if infected <1 year old.
- VITAMIN A SUPPLEMENTATION is mandatory for ALL measles cases — reduces mortality and severity.
- Vitamin A dosing: 100,000 IU once for infants 6–11 months; 200,000 IU for children ≥12 months.
- Management: supportive care (fluids, antipyretics, rest, dim lights for photophobia); airborne precautions.
- Prevention: MMR vaccine at 9 and 12 months (EPI schedule).
Key Definitions
Term
Koplik Spots
Example
Nurse recognizes these spots 3–4 days before maculopapular rash appears → confirms measles.
Definition
Tiny bluish-white spots on red base on buccal mucosa; appear BEFORE rash; pathognomonic for measles.
Term
The 3 C's
Example
Child presents with runny nose, cough, red eyes, and high fever for 3 days → assess for Koplik spots.
Definition
Cough, Coryza (runny nose), and Conjunctivitis — prodromal symptoms with high fever and photophobia before rash.
Term
Cephalocaudal Rash Spread
Example
Rash appears on forehead day 4, chest day 5, legs day 6 — this pattern distinguishes measles from rubella.
Definition
Maculopapular rash starts at hairline/face and spreads downward; fades in the same order, turning brownish.
Diagrams To Know
- Timeline of measles: prodrome (Koplik spots + 3 C's) → rash onset → rash progression (cephalocaudal).
- Koplik spots location and appearance (small bluish-white foci on red mucosa).
Section Title
Rubella (German Measles / 3-Day Measles)
Important Facts
- Transmission: DROPLET precautions.
- Milder illness than measles; low-grade fever, minimal cough.
- Lymphadenopathy: postauricular, occipital, posterior cervical (NOT anterior like mumps).
- Rash duration: ~3 days (hence 'German measles').
- GREATEST DANGER: NOT to the child but to the PREGNANT WOMAN — risk of congenital rubella syndrome.
- Critical rule: Keep infected children AWAY from pregnant women throughout contagious period.
- Prevention: MMR vaccine (congenital rubella syndrome is 100% preventable).
- Isolation: Droplet precautions; separate from pregnant women.
Key Definitions
Term
Congenital Rubella Syndrome
Example
Nurse must isolate rubella-infected child from all pregnant women — risk of permanent fetal damage.
Definition
TERATOGENIC infection of pregnant woman causes cataracts, congenital heart defects (PDA), deafness, and intellectual disability in fetus.
Term
Classic Rubella Rash Pattern
Example
Rash disappears by day 3 (unlike measles which lasts 6–7 days) — key distinguishing feature.
Definition
Pink maculopapular rash starting on face, spreading downward, lasting ~3 days; preceded by postauricular, occipital, and posterior cervical lymphadenopathy.
Diagrams To Know
- Rubella vs measles: rash onset location, duration, lymph node pattern, severity.
- Congenital rubella syndrome manifestations: cardiac, ocular, auditory, neurological.
Section Title
Mumps (Parotitis)
Important Facts
- Transmission: DROPLET precautions.
- Hallmark: painful swelling of parotid glands (not submandibular or sublingual).
- Fever and pain worse on chewing/swallowing; pain with acidic/sour foods (triggers saliva flow).
- Complications: orchitis (post-pubertal males, can cause infertility), oophoritis (females), meningitis, encephalitis, deafness.
- Management: supportive — analgesics/antipyretics, soft bland diet, warm or cool compresses to parotids, AVOID sour/acidic foods.
- Prevention: MMR vaccine (2 doses recommended).
- Isolation: Droplet precautions from 9 days before to 9 days after swelling onset.
Key Definitions
Term
Parotitis
Example
Child has fever, swollen cheeks, pain on eating sour candies → suspect mumps.
Definition
Bilateral (or unilateral) painful swelling of the parotid (salivary) glands with fever; pain on chewing/swallowing.
Term
Orchitis
Example
Adolescent boy with mumps develops testicular pain, swelling, and atrophy → may affect future fertility.
Definition
Testicular inflammation in post-pubertal males; occurs 1–2 weeks after parotitis; risk of subfertility/infertility.
Diagrams To Know
- Anatomy: parotid gland location and swelling pattern (bilateral, anterior to ear/below angle of mandible).
- Timeline: fever → parotitis → complications (orchitis in males, meningitis).
Section Title
Varicella (Chickenpox)
Important Facts
- Transmission: AIRBORNE and DIRECT CONTACT with vesicle fluid — very contagious.
- Contagious period: 1–2 days BEFORE rash onset until ALL lesions have crusted over (not just appeared, but fully crusted).
- Pruritic nature: intense itching; risk of secondary bacterial infection if child scratches.
- Prevention strategies: keep nails short, antihistamines, cool baths, calamine lotion.
- CRITICAL: NEVER give ASPIRIN — risk of Reye's syndrome (encephalitis + fatty liver degeneration).
- Treatment: supportive care + acyclovir (or valacyclovir) for HIGH-RISK groups (immunocompromised, pregnant, neonatal).
- Precautions: Airborne + Contact precautions; isolate from immunocompromised, pregnant women, neonates.
- Complication: post-herpetic neuralgia (more common in adults); viral pneumonia.
Key Definitions
Term
Vesicular Rash in Crops
Example
Child has macules, papules, vesicles, and scabs all at once on same body area — classic varicella pattern.
Definition
Pruritic vesicles appearing in successive crops over 3–4 days; lesions present simultaneously in ALL stages (macule → papule → vesicle → crust) — hallmark of varicella.
Term
Dewdrops on a Rose Petal
Example
Tiny clear blisters on red skin background — visual memory aid for varicella diagnosis.
Definition
Descriptive term for varicella vesicles: clear fluid-filled vesicles on an erythematous (red) base.
Diagrams To Know
- Rash progression: macule → papule → vesicle → crust timeline over 1–2 weeks.
- All-stages-at-once pattern: distinguish varicella from other vesicular rashes (which have synchronous lesions).
Section Title
Pertussis (Whooping Cough)
Important Facts
- Causative organism: Bordetella pertussis; Gram-negative coccobacillus.
- Transmission: DROPLET precautions.
- Three stages: (1) catarrhal (1–2 weeks: mild cough, runny nose, low fever); (2) paroxysmal (2–4+ weeks: severe paroxysmal cough with whoop); (3) convalescent (gradual improvement).
- Most dangerous in YOUNG INFANTS (<6 months): risk of apnea, hypoxia, seizures, death.
- Complications: pneumonia, apnea, seizures, encephalitis, secondary bacterial infection.
- Management: Macrolide antibiotics — erythromycin, azithromycin, or clarithromycin (especially if <6 weeks from cough onset); supportive care (oxygen, hydration, small frequent feeds); gentle suctioning; monitor for apnea (may need ICU).
- Prevention: DPT/pentavalent vaccine (3 primary doses + boosters per EPI).
- Isolation: Droplet precautions for first 5 days of antibiotic therapy (or 21 days if untreated).
Key Definitions
Term
Paroxysmal Cough with Inspiratory Whoop
Example
Infant has 10–15 rapid consecutive coughs, then gasps for air with characteristic 'whoop' sound — pathognomonic for pertussis.
Definition
Severe paroxysms of coughing followed by high-pitched inspiratory 'whoop' sound; often followed by post-tussive vomiting and cyanosis.
Term
Apnea (Pertussis in Young Infants)
Example
2-month-old with pertussis stops breathing during coughing fits → requires hospitalization and continuous monitoring.
Definition
Cessation of breathing lasting >20 seconds or with cyanosis/bradycardia; young infants may not cough/whoop but become apneic instead.
Diagrams To Know
- Three stages of pertussis: catarrhal → paroxysmal → convalescent with clinical features.
- Risk stratification: young infant (<6 months) vs older child — different severity/management.
Section Title
Diphtheria
Important Facts
- Causative organism: Corynebacterium diphtheriae; Gram-positive bacillus; toxin-mediated disease.
- Transmission: DROPLET precautions.
- Hallmark: thick greyish-white pseudomembrane over tonsils/pharynx; low-grade fever; sore throat.
- CRITICAL MANAGEMENT: (1) Diphtheria antitoxin IMMEDIATELY (horse serum — risk of serum sickness); (2) Antibiotics — penicillin or erythromycin.
- DO NOT attempt to remove pseudomembrane — risk of bleeding and airway obstruction.
- Complications: MYOCARDITIS (toxin damages heart — can cause arrhythmias, heart failure, death); neuritis (cranial nerve palsies, respiratory muscle paralysis).
- Nursing care: strict bed rest (cardiac risk), emergency airway equipment at bedside, continuous cardiac monitoring, keep patient warm.
- Prevention: DPT/pentavalent vaccine (highly effective; booster at school entry).
- Isolation: Droplet precautions until two consecutive throat cultures negative (or 7 days antibiotic therapy).
Key Definitions
Term
Pseudomembrane
Example
Nurse observes greyish membrane covering both tonsils → suspect diphtheria; do NOT attempt removal.
Definition
Thick greyish-white adherent membrane over tonsils, pharynx, or larynx; not easily stripped; can obstruct airway — hallmark of diphtheria.
Term
Bull Neck Appearance
Example
Child with diphtheria has marked neck edema and lymphadenopathy → increased risk of airway compromise.
Definition
Cervical swelling from lymphadenitis and edema; characteristic of severe diphtheria; increases airway obstruction risk.
Diagrams To Know
- Anatomical complications: pseudomembrane location → airway obstruction; myocardial involvement → cardiac complications.
- Timeline: sore throat → pseudomembrane → systemic toxin effects (myocarditis, neuritis).
Section Title
Dengue Fever
Important Facts
- Causative agent: dengue virus (4 serotypes: DENV-1, DENV-2, DENV-3, DENV-4); vector = Aedes aegypti (DAY-BITER).
- Transmission: mosquito-borne; breeds in CLEAN stagnant water (NOT in dirty water).
- Incubation: 3–14 days (average 4–7 days) after mosquito bite.
- Clinical signs: HIGH FEVER (sudden onset), severe headache, RETRO-ORBITAL PAIN (pain behind eyes), myalgia/arthralgia ('breakbone fever'), rash, positive tourniquet test.
- Two phases: (1) Febrile phase (3–7 days high fever); (2) Critical phase (when fever breaks = WARNING SIGNS appear — most dangerous time).
- WARNING SIGNS (report IMMEDIATELY): (1) Severe abdominal pain; (2) Persistent vomiting; (3) Mucosal/gum bleeding; (4) Restlessness or lethargy; (5) Rapid drop in temperature with cold clammy skin; (6) Weak pulse.
- NO SPECIFIC ANTIVIRAL — management is SUPPORTIVE: (1) FLUIDS/HYDRATION is the priority; (2) Monitor platelets and hematocrit; (3) Watch for bleeding and shock; (4) Use PARACETAMOL for fever (NOT aspirin or NSAIDs — bleeding risk).
- Avoid: Aspirin, NSAIDs, IM injections (bleeding risk).
- DOH '4-S' PREVENTION: (1) Search and destroy breeding sites; (2) Self-protection (repellent, long sleeves, screens); (3) Seek early consultation; (4) Support fogging during outbreaks.
- Recovery: immunity to that serotype (lifelong); but dengue x2 or more = higher risk of severe dengue/DSS.
Key Definitions
Term
Aedes aegypti Mosquito
Example
Dengue vector found in water in vases, gutters, roofs — NOT in cesspits or swamps like malaria vector.
Definition
DAY-BITING vector of dengue; breeds in CLEAN, stagnant water (flower pots, discarded containers, coconut shells); NOT in dirty water like Anopheles.
Term
Dengue Shock Syndrome (DSS)
Example
Child with dengue develops rapid drop in temperature, cold clammy skin, restlessness → warning signs of shock.
Definition
Severe dengue characterized by plasma leakage, hypovolemia, and shock (hypotension, cool extremities, restlessness/lethargy); mortality if untreated.
Term
Positive Tourniquet Test
Example
Nurse applies tourniquet test and observes >20 petechiae in 1 cm² circle → positive for dengue.
Definition
Petechiae (pinpoint bleeding spots) appearing below the antecubital fossa when BP cuff pressure held between systolic and diastolic for 5 minutes; indicates capillary fragility in dengue.
Diagrams To Know
- Dengue vs malaria: vector (Aedes vs Anopheles), breeding site (clean vs dirty water), time of bite (day vs night/dusk).
- Dengue warning signs timeline: febrile phase → fever drop → critical phase with warning signs.
Formulas
Formula
Zinc supplementation dosing (IMCI standard)
Meaning
Infants <6 months: 10 mg/day zinc gluconate or zinc acetate; Children ≥6 months: 20 mg/day; Duration: 10–14 days (continues even after diarrhoea resolves).
Watch Out
Many nurses forget zinc is CONTINUED even when child recovers — it prevents next diarrhoea episode. Compliance is critical.
When To Use
ALL children with acute diarrhoea — reduces duration, severity, and prevents future episodes for 2–3 months.
Formula
ORS rehydration volume (IMCI Plan B: Some Dehydration)
Meaning
75 mL/kg of low-osmolarity ORS given orally over 4 hours; then reassess hydration status and switch to Plan A or C accordingly.
Watch Out
Calculate TOTAL volume needed (kg × 75), divide into small frequent sips (every 2–3 minutes) — NOT in large boluses. Vomiting is common; persist with small amounts.
When To Use
Child with some signs of dehydration (lethargy, decreased skin turgor, dry mucous membranes) managed at health facility with close monitoring.
Common Values
Value
10 mg/day (<6 months) or 20 mg/day (≥6 months) for 10–14 days
Symbol
Zn
Quantity
Zinc dosing (acute diarrhoea)
Value
75 mL/kg over 4 hours
Symbol
Plan B
Quantity
ORS rehydration volume (some dehydration)
Value
100 mL/kg (shock) or 50 mL/kg (severe, no shock) Ringer's lactate or normal saline over 30 minutes
Symbol
Plan C
Quantity
IV fluid bolus (severe dehydration/shock)
Value
24–72 hours; peak in winter months
Symbol
RV
Quantity
Rotavirus incubation period
Section Title
Diarrhoeal Disease & Dehydration Management
Important Facts
- Leading cause of under-5 mortality in low-resource settings; dehydration is the key threat — NOT the diarrhoea itself.
- Most common cause: rotavirus (vaccine available in EPI); also bacterial (E. coli, Salmonella, Shigella) and parasitic.
- CORNERSTONE of treatment: ORS + ZINC.
- ORS composition (low-osmolarity): sodium 75 mEq/L, chloride 65 mEq/L, glucose 75 mmol/L, potassium 20 mEq/L.
- ZINC BENEFITS: (1) Reduces diarrhoea duration by 25%; (2) Reduces severity; (3) PREVENTS recurrence for 2–3 months; (4) Reduces respiratory infections.
- CONTINUE FEEDING throughout diarrhoea — do NOT withhold food; evidence shows no increase in stool output.
- Breastfeeding: continue — NO change needed.
- Supplementary feeds: return to usual diet after rehydration; avoid high-fat, high-fiber foods initially.
- Probiotics: NOT recommended as standard (insufficient evidence).
- AVOID: antidiarrhoeal drugs (loperamide), antibiotics unless dysentery present (bloody stools).
- Prevent recurrence: hand-washing, safe water access, food hygiene, sanitation, rotavirus vaccination.
Key Definitions
Term
Plan A (No Dehydration)
Example
Child has 3–4 loose stools but alert, drinks well, skin turgor normal → discharge with Plan A: ORS packets, zinc, continued breastfeeding.
Definition
Home-based management for child with no signs of dehydration: extra fluids + ORS after each loose stool; continue feeding/breastfeeding; zinc supplementation; and counseling on when to return.
Term
Plan B (Some Dehydration)
Example
Child has lethargy, decreased skin turgor, dry mucosa → admit for ORS 75 mL/kg over 4 hours with close monitoring.
Definition
Facility-based management using supervised ORS therapy: 75 mL/kg over 4 hours; continue feeding; zinc; reassess every 1–2 hours; transfer to Plan A or C if needed.
Term
Plan C (Severe Dehydration)
Example
Child with severe dehydration, weak pulse, cold extremities → start IV fluids immediately; monitor urine output and electrolytes.
Definition
Hospital-based management with IV fluids: use Ringer's lactate or normal saline bolus (100 mL/kg for shock, 50 mL/kg for severe dehydration); transition to ORS once able to drink.
Term
Low-Osmolarity ORS
Example
Current DOH-supplied ORS packets contain low-osmolarity formula; never use outdated hyperosmolar ORS.
Definition
DOH/WHO-recommended ORS with glucose:sodium ratio optimized to enhance absorption; reduces stool output by ~20% and vomiting by ~30% vs older hyperosmolar formulas.
Diagrams To Know
- Three-plan management algorithm: assess dehydration signs → classify (Plan A/B/C) → manage accordingly.
- Dehydration signs checklist: lethargy, drinks eagerly vs unable to drink, skin turgor, mucous membranes, tears, urine output.
Formulas
Formula
Fast-breathing respiratory rate thresholds (IMCI)
Meaning
<2 months: ≥60 breaths/min; 2–12 months: ≥50 breaths/min; 12 months–5 years: ≥40 breaths/min.
Watch Out
Use age-appropriate threshold; counting correctly (count for full 60 seconds, not 15 sec × 4); must be at REST, not crying. Common error: using same threshold for all ages.
When To Use
Assess ALL children with cough or difficult breathing to classify pneumonia severity and guide referral.
Common Values
Value
≥60 breaths/min
Symbol
RR1
Quantity
Fast-breathing threshold (<2 months)
Value
≥50 breaths/min
Symbol
RR2
Quantity
Fast-breathing threshold (2–12 months)
Value
≥40 breaths/min
Symbol
RR3
Quantity
Fast-breathing threshold (12 months–5 years)
Section Title
Integrated Management of Childhood Illness (IMCI)
Important Facts
- IMCI = Integrated Management of Childhood Illness; WHO/UNICEF/DOH strategy to reduce under-5 mortality at primary-care level.
- Two age-based charts: Young infant (1 week–2 months) and Child (2 months–5 years).
- Assessment pathway: ASSESS → CLASSIFY → TREAT or REFER → COUNSEL → FOLLOW-UP.
- Main symptoms assessed (2 months–5 years): (1) Cough/difficult breathing; (2) Diarrhoea; (3) Fever; (4) Ear problem; (5) Malnutrition/anemia.
- ALWAYS check for GENERAL DANGER SIGNS in every sick child — if any present → PINK (urgent referral).
- Fast-breathing WITHOUT chest indrawing/stridor → YELLOW (non-severe pneumonia) → oral antibiotic (e.g., amoxicillin) at facility.
- Fast-breathing WITH chest indrawing or stridor → PINK (severe pneumonia/croup) → urgent referral + oxygen.
- Dehydration assessment uses Plans A/B/C (see Diarrhoeal Disease section).
- Fever management: assess for malaria (in endemic areas), measles (ask about rash; check for Koplik spots), and dengue (tourniquet test, warning signs).
- Young infant (1 week–2 months) danger signs trigger urgent referral: not feeding well, convulsions, fast breathing (≥60/min), severe chest indrawing, fever (≥37.5°C) or low temperature (<35.5°C), movement only with stimulation or no movement.
- In young infant chart: always check for jaundice, assess breastfeeding/attachment, correct feeding problems, maintain warmth during transport.
Key Definitions
Term
IMCI Classification
Example
Child with no danger signs, fast breathing, no chest indrawing = YELLOW (pneumonia) → treat with oral amoxicillin at facility, then discharge.
Definition
Color-coded triage system: PINK (urgent referral/hospitalization); YELLOW (specific treatment at facility + home care); GREEN (home management with advice).
Term
General Danger Signs
Example
Child with diarrhoea and fever who cannot drink anything → PINK classification → urgent referral.
Definition
Signs indicating SEVERE ILLNESS requiring urgent referral: (1) unable to drink/breastfeed; (2) vomits everything; (3) convulsions/history of convulsions with this illness; (4) lethargic/unconscious.
Term
Chest Indrawing
Example
Child with fast breathing plus visible chest indrawing → PINK (severe pneumonia) → refer immediately.
Definition
Lower chest wall draws inward during inspiration (lower costal recession or subcostal indrawing); sign of SEVERE pneumonia; requires urgent referral and oxygen.
Term
Stridor
Example
Child with cough and audible stridor → assess for croup/diphtheria → urgent referral if severe.
Definition
High-pitched breathing sound heard without stethoscope, typically during inspiration; sign of upper airway obstruction (croup, diphtheria, epiglottitis); requires urgent evaluation.
Diagrams To Know
- IMCI assessment flowchart: Danger signs → Classify (PINK/YELLOW/GREEN) → Management pathway.
- Fast-breathing thresholds by age; chest indrawing assessment.
- Young infant (1 week–2 months) vs Child (2 months–5 years) chart differences.
- Dehydration signs for diarrhoea classification (Plan A/B/C).
- Fever assessment: malaria, measles, dengue key features.
Formulas
Formula
Garantisadong Pambata (GP) Vitamin A supplementation schedule
Meaning
Infants 6–11 months: 100,000 IU ONCE; Children 12–59 months: 200,000 IU TWICE yearly (May & November campaigns).
Watch Out
Dose differs by age; 6–11 months = single dose (100K); ≥12 months = double dose (200K twice yearly). Do NOT give 200K to infant <12 months.
When To Use
During GP outreach visits (May & November); also given routinely when child attends RHU/health facility for any reason.
Formula
EPI immunization schedule (key vaccines for infectious disease prevention)
Meaning
Birth: BCG, Hep B (0 dose); 6 weeks, 10 weeks, 14 weeks: Pentavalent (DPT+Hib+HepB), OPV, PCV; 9 months: Measles; 12 months: Measles-2 (or MMR); 18 months: Booster (DPT/Pentavalent, OPV); 4–5 years: DPT booster, OPV booster.
Watch Out
Schedule changes over time; use current DOH card. Pentavalent covers DPT+Hib+HepB in one injection (fewer needles, better compliance). Measles at 9 months + booster at 12 months for better coverage.
When To Use
All children per DOH EPI schedule; critical for preventing measles, pertussis, diphtheria, polio, TB, hepatitis B, Hib, pneumococcal disease.
Common Values
Value
100,000 IU ONCE
Symbol
VA1
Quantity
Vitamin A dose (GP, infants 6–11 months)
Value
200,000 IU TWICE yearly (May & November)
Symbol
VA2
Quantity
Vitamin A dose (GP, children 12–59 months)
Value
100,000 IU for 6–11 months; 200,000 IU for ≥12 months
Symbol
VAm
Quantity
Vitamin A dose (acute measles, all ages)
Value
At birth (or as soon as possible after birth)
Symbol
BCG
Quantity
BCG vaccination age
Section Title
Philippine Immunization & Child Health Programs
Important Facts
- EPI is UNIVERSAL and FREE; vaccination is COMPULSORY per RA 9173 (Philippine Nursing Practice Law).
- BCG and Hepatitis B dose 0 (HepB0) given AT BIRTH — earliest protection for TB and hepatitis B.
- Pentavalent given at 6, 10, 14 weeks (age-adjusted for catch-up); covers DPT+Hib+HepB.
- OPV (oral polio vaccine) given at same schedule as pentavalent.
- PCV (pneumococcal conjugate vaccine) given at 6, 10, 14 weeks; protects against pneumococcal disease.
- Measles vaccine at 9 months (primary dose); second dose at 12 months or later (booster); both essential for herd immunity.
- DPT boosters at 18 months, 4–5 years (school entry).
- Vitamin A is ALSO given during measles cases (100K for 6–11 mo, 200K for ≥12 mo) — reduces mortality.
- GP campaigns occur May & November; any child can attend (not just those in that month of age).
- Deworming (mebendazole) given during GP to children 1–5 years to reduce intestinal parasite burden.
- Nurses must educate parents on immunization importance, address vaccine hesitancy, maintain cold chain, and record all doses in child's health card.
Key Definitions
Term
Expanded Program on Immunization (EPI)
Example
At 6 weeks of age, infant receives pentavalent + OPV + PCV per EPI schedule at government health facility.
Definition
DOH national immunization program delivering free, compulsory vaccines to prevent TB, polio, diphtheria, pertussis, tetanus, hepatitis B, Haemophilus influenzae type b, pneumococcal disease, measles, and rubella.
Term
Garantisadong Pambata (GP)
Example
During May campaign, RHU nurse gives Vitamin A 200K IU and mebendazole to all children 12–59 months who attend.
Definition
DOH biannual (twice-yearly) child-health package delivering Vitamin A supplementation, deworming, immunization catch-up, and health education to all children aged 1–5 years.
Term
Pentavalent Vaccine
Example
Infant at 6, 10, 14 weeks receives pentavalent (instead of separate DPT, Hib, HepB injections) per EPI.
Definition
Combination vaccine protecting against FIVE diseases in one injection: DPT (diphtheria, pertussis, tetanus) + Hib (Haemophilus influenzae type b) + Hepatitis B; reduces needle injections and improves compliance.
Diagrams To Know
- EPI schedule timeline: age milestones and which vaccines given at each visit.
- Pentavalent vs separate injections: comparison of protection and convenience.
- Vitamin A dosing by age and context (routine GP vs acute measles).
Section Title
Isolation Precautions & Infection Control (Summary)
Important Facts
- Measles: AIRBORNE precautions — highly contagious; isolate from all non-immune persons.
- Rubella: DROPLET precautions — SEPARATE from pregnant women (teratogenic).
- Mumps: DROPLET precautions.
- Varicella: AIRBORNE + CONTACT precautions — isolate from immunocompromised, pregnant women, neonates.
- Pertussis: DROPLET precautions for first 5 days of antibiotic therapy.
- Diphtheria: DROPLET precautions; strict until two consecutive throat cultures negative.
- Dengue: NO person-to-person transmission; standard precautions; mosquito control.
- Diarrhoea (viral): STANDARD precautions + hand-washing; contact if bloody diarrhoea.
- Standard precautions apply to ALL patients: hand hygiene, PPE appropriate to task, safe injection practices, respiratory etiquette.
Key Definitions
Term
Airborne Precautions
Example
Measles and varicella require airborne precautions; nurses wear N95 masks; dedicated equipment; separate from non-immune persons.
Definition
Isolation measure for diseases transmitted by airborne particles (<5 microns); requires N95 respirator for healthcare workers; single private room with negative pressure ideal.
Term
Droplet Precautions
Example
Mumps, rubella, pertussis, diphtheria require droplet precautions; surgical mask on nurse and patient.
Definition
Isolation for diseases transmitted in respiratory droplets (>5 microns, travel ~3–6 feet); requires surgical mask for healthcare worker; patient mask if possible.
Term
Contact Precautions
Example
Varicella requires airborne + contact precautions (due to highly infectious vesicle fluid).
Definition
Isolation for diseases spread by direct contact with skin/secretions or contact with contaminated surfaces/equipment; requires gloves, gown, dedicated equipment.
Diagrams To Know
- Transmission routes and corresponding precautions: airborne vs droplet vs contact vs standard.
- When to use N95 vs surgical mask vs gloves/gown.
Must Remember
- MEASLES: Airborne transmission; KOPLIK SPOTS appear BEFORE rash (pathognomonic); '3 C's' + cephalocaudal rash; pneumonia is #1 cause of death; VITAMIN A mandatory for ALL cases (100K for 6–11 mo, 200K for ≥12 mo); airborne precautions essential.
- RUBELLA (GERMAN MEASLES): Droplet transmission; pink 3-day rash + postauricular/occipital lymphadenopathy; milder than measles; GREATEST DANGER is congenital rubella syndrome in pregnant women (cataracts, heart defects, deafness, disability) — KEEP AWAY FROM PREGNANT WOMEN; prevent with MMR.
- MUMPS: Droplet transmission; bilateral parotid gland swelling + pain on chewing/swallowing; AVOID SOUR FOODS (trigger saliva flow, worsen pain); complication: ORCHITIS (testicular inflammation, fertility risk in males); manage with analgesics + soft diet.
- VARICELLA (CHICKENPOX): Airborne + Contact transmission; pruritic vesicular rash in 'crops' with ALL STAGES AT ONCE (macule→papule→vesicle→crust); contagious until ALL lesions FULLY CRUST (not just appeared); NEVER aspirin (Reye's syndrome risk); use acyclovir for high-risk; airborne + contact precautions.
- PERTUSSIS (WHOOPING COUGH): Droplet transmission; inspiratory 'WHOOP' after paroxysmal cough; MOST DANGEROUS in young infants (<6 months) — risk of apnea, seizures, death; treat with macrolide antibiotics (erythromycin, azithromycin); requires hospitalization for infants; droplet precautions.
- DIPHTHERIA: Droplet transmission; thick greyish-white pseudomembrane over tonsils/pharynx; DO NOT ATTEMPT TO REMOVE (bleeding/obstruction risk); complication: MYOCARDITIS (cardiac toxin — can cause death); manage with diphtheria antitoxin + antibiotics + strict bed rest; cardiac monitoring essential.
- DENGUE: Aedes aegypti vector (DAY-BITER, clean stagnant water); high fever, retro-orbital pain, myalgia ('breakbone'), tourniquet-positive; NO antiviral — supportive care + FLUIDS (priority); AVOID aspirin/NSAIDs (bleeding risk) — use paracetamol; WARNING SIGNS (abdominal pain, vomiting, bleeding, restlessness, cold clammy skin) = immediate referral; DOH '4-S' prevention.
- DIARRHOEAL DISEASE & DEHYDRATION: ORS + ZINC is cornerstone; ZINC 10 mg/day (<6 mo) or 20 mg/day (≥6 mo) for 10–14 days (CONTINUE AFTER diarrhoea resolves — prevents recurrence); Plans A/B/C (home, supervised ORS, IV fluids); CONTINUE FEEDING/BREASTFEEDING — do NOT withhold food; low-osmolarity ORS is DOH standard.
- IMCI GENERAL DANGER SIGNS (urgent referral if ANY present): (1) Unable to drink or breastfeed; (2) Vomits everything; (3) Convulsions or history of convulsions; (4) Lethargic or unconscious; IMCI classification: PINK (urgent refer), YELLOW (facility treat + home care), GREEN (home manage).
- IMCI FAST-BREATHING & PNEUMONIA: Age-dependent thresholds (<2 mo ≥60; 2–12 mo ≥50; 12 mo–5 yr ≥40); fast breathing ALONE = YELLOW (oral antibiotic, home care); + chest indrawing/stridor = PINK (severe pneumonia, urgent referral + oxygen); VITAMIN A given in measles (mandatory); Garantisadong Pambata programs (GP) deliver Vitamin A + deworming biannually; EPI immunization prevents measles, pertussis, diphtheria, polio, TB, hepatitis B.
Last Minute Tips
- TRANSMISSION ROUTES — Memorize the top 3: (1) Measles = AIRBORNE (most contagious of all); (2) Rubella, Mumps, Pertussis, Diphtheria = DROPLET; (3) Varicella = AIRBORNE + CONTACT. On exam: if asked 'which disease requires airborne precautions?' → Measles and Varicella are the top answers. Rubella-infected child must be separated from pregnant women (teratogenic) — this is a high-yield concept.
- KOPLIK SPOTS = MEASLES GOLD STANDARD — These tiny bluish-white spots on red buccal mucosa appear 3–4 DAYS BEFORE the rash. This is pathognomonic and will appear in exam photos/case studies. The key is: Koplik spots = diagnosis CONFIRMED even before the full rash appears. Also remember: Koplik spots fade as the rash appears. This timing distinction is commonly tested.
- VITAMIN A IN MEASLES — This is non-negotiable on the NLE. EVERY child with measles gets Vitamin A: 100,000 IU once for 6–11 months; 200,000 IU for ≥12 months. The rationale: reduces mortality by ~23%, reduces severity, prevents corneal scarring/blindness. If exam asks 'what is given to all measles cases?' → answer is VITAMIN A supplementation. Do not confuse with Garantisadong Pambata Vitamin A (which is routine, biannual, preventive).
- DENGUE WARNING SIGNS = EMERGENCY — The 'critical phase' is when fever DROPS (not when high!). Warning signs that trigger immediate referral: (1) severe abdominal pain; (2) persistent vomiting; (3) mucosal bleeding/gum bleeding; (4) restlessness OR lethargy; (5) rapid fall in temperature with cold clammy skin. These are the moment DSS (dengue shock syndrome) can develop. On exam: a case showing fever drop + restlessness + bleeding = immediate recognize as danger → refer urgently.
- ORS + ZINC FORMULA — For exam calculations: If child weighs 10 kg with some dehydration → ORS = 10 kg × 75 mL/kg = 750 mL over 4 hours (approximately 3 mL/minute, give small sips). For zinc: if child is 18 months (>6 months) → 20 mg/day × 10 days = 200 mg total. These numeric problems appear on NLE; always show age-appropriate dosing and calculate total volume/duration correctly.
Comparison Tables
Rows
Values
- AIRBORNE (highly contagious)
- DROPLET
- DROPLET
Property
Transmission
Values
- Koplik spots (before rash) + 3 C's
- Postauricular/occipital lymphadenopathy + pink rash
- Bilateral parotid swelling + fever
Property
Hallmark sign
Values
- Red maculopapular; cephalocaudal spread; 6–7 days
- Pink maculopapular; face downward; ~3 days (milder)
- NO RASH (swelling only)
Property
Rash appearance
Values
- HIGH (39–40°C); photophobia
- LOW-GRADE (mild illness)
- MODERATE
Property
Fever grade
Values
- PNEUMONIA (leading cause of death in children)
- Congenital rubella syndrome (if pregnant woman infected)
- ORCHITIS (males) — can cause infertility
Property
Most dangerous complication
Values
- Supportive + Vitamin A (mandatory) + airborne precautions
- Supportive + separate from pregnant women
- Supportive + soft diet + avoid sour foods; analgesics
Property
Treatment
Values
- MMR vaccine (9 & 12 months)
- MMR vaccine (prevents CRS 100%)
- MMR vaccine (2 doses)
Property
Prevention
Values
- 3–4 days of 3 C's + Koplik spots (pathognomonic)
- Usually no prominent prodrome
- Prodrome rare; fever + malaise
Property
Prodrome
Columns
- Feature
- Measles (Rubeola)
- Rubella (German Measles)
- Mumps
Table Title
Measles vs Rubella vs Mumps: Quick Differentiation
Rows
Values
- Home-based
- Facility-based (RHU/health center)
- Hospital/facility with IV capability
Property
Setting
Values
- Alert, drinks well, normal skin turgor, normal mucosa, tears present, normal urine output
- Lethargy, drinks eagerly (increased thirst), decreased skin turgor, dry mucosa, few/no tears, decreased urine
- Lethargic/unconscious, unable to drink (or drinks poorly), very poor skin turgor, very dry mucosa, no tears, minimal/no urine
Property
Signs present
Values
- ORS 50 mL/kg over 4 hours PLUS 10 mL/kg after EACH loose stool
- ORS 75 mL/kg over 4 hours; reassess every 1–2 hours
- IV fluids FIRST: Ringer's lactate or normal saline 100 mL/kg (shock) or 50 mL/kg (severe, no shock) over 30 min; then ORS once drinking resumes
Property
Fluids given
Values
- CONTINUE breastfeeding + normal diet + extra fluids
- CONTINUE feeding (no withholding); reassess appetite as hydration improves
- Resume feeding once improved; start with small frequent sips then ORS
Property
Feeding
Values
- 10 mg/day (<6 mo) or 20 mg/day (≥6 mo) for 10–14 days
- 10 mg/day (<6 mo) or 20 mg/day (≥6 mo) for 10–14 days
- 10 mg/day (<6 mo) or 20 mg/day (≥6 mo) for 10–14 days
Property
Zinc supplementation
Values
- Teach mother signs to return (vomiting, unable to drink, blood in stool, signs of dehydration)
- Monitor urine output, reassess hydration status q1–2h; may move to Plan A or C
- Continuous monitoring: urine output, vital signs, capillary refill, weight (after rehydration)
Property
Monitoring
Values
- Return visit at 3 days or if worsening
- Follow-up after 2 hours; reassess and move to Plan A (if improved) or C (if worsening)
- Admit; monitor for electrolyte imbalance, shock; ICU care if needed
Property
Follow-up
Columns
- Feature
- Plan A (No Dehydration)
- Plan B (Some Dehydration)
- Plan C (Severe Dehydration)
Table Title
Diarrhoeal Dehydration: Plans A vs B vs C
Rows
Values
- ≥60 breaths/min
- Fast breathing (no indrawing/stridor) = refer; or severe pneumonia → refer urgently. Danger signs = urgent referral.
Property
<2 months
Values
- ≥50 breaths/min
- Fast breathing only = YELLOW; give oral amoxicillin; follow-up in 2 days. + Chest indrawing/stridor = PINK; refer urgently + oxygen.
Property
2–12 months
Values
- ≥40 breaths/min
- Fast breathing only = YELLOW; oral antibiotic (amoxicillin or cotrimoxazole); follow-up 2 days. + Chest indrawing/stridor = PINK; refer + oxygen.
Property
12 months–5 years
Values
- Use age-appropriate threshold; count for full 60 seconds at REST
- Chest indrawing or stridor = SEVERE pneumonia → PINK (urgent referral). Fast breathing alone (no indrawing) = non-severe → YELLOW (facility-based treatment).
Property
Key point
Columns
- Age Group
- Fast-breathing threshold
- Classification & Management
Table Title
IMCI Fast-Breathing Thresholds & Pneumonia Classification
Rows
Values
- Aedes aegypti (DAY-biter; clean stagnant water)
- High fever, retro-orbital pain, severe headache, myalgia/arthralgia, rash, positive tourniquet test, warning signs (abdominal pain, vomiting, bleeding, restlessness)
- Positive tourniquet test + retro-orbital pain + 'breakbone fever' complaint
Property
Dengue
Values
- Anopheles (NIGHT-biter; dirty stagnant water)
- Periodic fever (every 48–72 h depending on Plasmodium type), chills, sweating, hepatomegaly/splenomegaly, anemia
- History of living in/traveling to endemic area + fever spike pattern + thick/thin blood smear test
Property
Malaria (in endemic areas)
Values
- Fecal-oral (Salmonella typhi)
- SUSTAINED high fever (rose spots rash rare), headache, abdominal pain, rose-colored papules on trunk, hepatosplenomegaly, 'rose garden' appearance
- Prolonged sustained fever + abdominal symptoms + possible rose spots; blood/stool culture
Property
Typhoid
Values
- Ask: rash, tourniquet test, warning signs; use antimalarial if endemic area + fever; supportive care + fluids
- Ask: residence/travel; do blood film; antimalarial treatment
- Ask: sustained fever, abdominal pain; consider empiric typhoid treatment if high suspicion
Property
IMCI fever assessment
Columns
- Disease
- Vector
- Hallmark signs
- Diagnosis clue
Table Title
Dengue vs Malaria vs Typhoid: Fever Management in IMCI
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