KIMS COLLEGE OF NURSING, THIRUVANANTHAPURAM

LESSON PLAN ON

ACUTE RESPIRATORY INFECTION CONTROL

PROGRAMME

SUBMITTED TO SUBMITTED BY
PROF. SONI P S MS. RESHMA A
PROFESSOR LECTURER
KIMS COLLEGE OF NURSING KIMS COLLEGE OF NURSING
THIRUVANANTHAPURAM THIRUVANANTHAPURAM
Name of the teacher : Ms. Reshma A

Subject : Community Health Nursing

Unit :VII- National Health Programmes

Topic : ARI Control Programme

Group : 4th year B.Sc nursing.

Venue : 4th year B.Sc nursing classroom.

Number of students :66

Duration :1 hr

Date :

Time :

Method of teaching : lecture cum discussion.

Av aids : LCD, whiteboard.

Previous knowledge of students: students will have some knowledge regarding the ARI Control Programme.

Central objectives : At the end of the class, the group will be able to develop a positive attitude and knowledge regarding
ARI Control Programme and use the same in clinical practice as well as in the community.
Specific objectives : At the end of the class, the group is able to;

 Explain Swajaldhara programme

 Elaborate Bharat Nirman
 Enumerate the Rural Sanitation Programmes
 Elaborate Swatchh Bharath Mission- Gramin
 Specific Time Content Teaching and AV aids Evaluation
objectives learning
activity
introduce the 3 min INTRODUCTION The teacher
topic  Infections of the respiratory tract are perhaps the most common introduces the
human ailment. While they are source of discomfort, disability & loss of time topic and the
for more adults, they are a substantial cause of morbidity & mortality in group eagerly
young and in the elderly children & the elderly. However, young Infants, listening
small children and in the elderly, or in persons with impaired respiratory tract
reserves, it increases the morbidity & mortality rates.
 In India, The ARI control programme was taken up as a pilot project
in 14 district of the country in the Year 1990. Since 1992-93 the programme
is implemented as a part of CSSM programme & later with RCH.
 The aim of programme is to reduce the mortality rate in children due to acute
Respiratory infections 20% by 1995 & 40% by the year 2000.
DEFINITION OF ARI
ARI may cause inflammation of the respiratory tract anywhere from
nose to alveoli, with a wide range of combination of symptoms & signs.
ARI is classified as:
1) AURI [Acute Upper Respiratory Infection]
2) ALRI [Acute Lower Respiratory Infection]
 Specific Time Content Teaching and AV aids Evaluation
objectives learning
activity
Some of the AURI:
• Common cold.
• Pharyngitis
Some of the ALRI:
• Laryngitis
• Bronchitis
Lecture cum
• Pneumonia.
discussion

Factors influencing the incidence of respiratory tract infections

• Poor nutritional status
• Poor socio-economic status.
• Parental smoking
• Parasitic infection.
• Breastfeeding & Early wearing.
• HN incidence.
• Immunization.
 Specific Time Content Teaching and AV aids Evaluation
objectives learning
activity
Explain 5 min INCIDENCE Lecture cum What is
Swajaldhara discussion Swajaldhara
ARI responsible for 20% of childhood (< 5 years) Deaths ,90% from
programme programme?
pneumonia.
Six to eight respiratory tract infections per year (2-3years)
70% of which are upper respiratory infection, 30% are lower respiratory
infections.

NATIONAL ARI CONTROL PROGRAMME

 The ARI control programme was taken up as a pilot project in 14
district of the country in the Year 1990. Since 1992-93 the programme is
implemented as a part of CSSM programme & later with RCH.

AIMS OF THE PROGRAMME

 The aim of programme is to reduce the mortality rate in children due
to acute Respiratory infections 20% by 1995 & 40% by the year
2000.
 Rationalize the use of antibiotics and other drugs in ARI
 Specific Time Content Teaching and AV aids Evaluation
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activity
STRATEGIES Lecture cum
discussion
1. To ensure standard Care management of pneumonia in children
under 5 years by training medical and other health personal.
2. To train peripheral health staff to recognize & treat cases of
pneumonia.
3. To promote timely referral of sever pneumonia by the peripheral
health staff & community.
4. To improve maternal knowledge about home management of cough,
cold & recognition of early danger signs for seeking appropriate care.
5. To promote immunization, exclusive breast feeding in the first 4-6
months, proper weaning & vitamin A administration.

Prevention
 Improving the primary medical care Services & developing better
methods for early detection, treatment and prevention of ARI is the
best way to control ARI
 Mortality rate due to pneumonia is Reduced if treated correctly.
 Specific Time Content Teaching and AV aids Evaluation
objectives learning
activity
Elaborate 3 min  Feeding children with adequate amounts of varied & nutritious to Lecture cum What do you
Bharat Nirman discussion mean by Bharat
keep their immune system strong.
Nirman?
 Immunization:
 Measles Vaccine
 HIB Vaccine [Haemophilus influenza type B]
 Pneumococcal Pneumonia vaccine

WHO recommendation for management of ARI

Clinical assesment
History taking and management are very important
1)age
2)feeding habits
3)fever
4)convulsions
5)irregular breathing
6)history of treatment during the illness
7)Activity
 Specific Time Content Teaching and AV aids Evaluation
objectives learning
activity
Enumerate the 3 min Physical examination Lecture cum Which all are
Rural 1:count the breaths in one minute discussion the Rural
Sanitation  Breathing count depends on the age of the child Sanitation
Programmes  Count respiratory rate for a minute Programmes?
 Fast breathing is present when RR is
-60 breaths /min or more in a child less than two months of age
-50/min or more in child aged monthsupto 12 months
-40 breaths/min or more in a child aged 12 months upto 5 years
2:Chest indrawing
 Look for chest indrawing when child breaths in
 Child has indrawing if the lower chest wall when the child breaths in
 Occurs when the effort required to breath in , is much greater than
normal
3:Stridor
 Harsh noise while breathing IN is stridor
Elaborate  Occurs due to narrowing of trachea , larynx or epiglottis What are the
Swatchh 10 min  These conditions often called croup objectives of
Bharath Swatchh
Mission- Bharath
Gramin Mission-
Gramin?
 Specific Time Content Teaching and AV aids Evaluation
objectives learning
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4:Wheeze Lecture cum
discussion
 A child with wheeze makes a soft whistling noise or shows signs that
breathing out is difficult
 This is due to the narrowing of the air passages
5:Fever
 Check for body temperature
6:Cyanosis
 Signs of hypoxia
7: Danger signs
 Persistant vomitting
 Reluctance to feed
 Convulsions

Ask about risk factors:

 Exposure to cold weather
 History of birth problems
 Poor nutritional status
 Early weaning
 Immunization
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 Poor socio-economic status
Lecture cum
 Parental smoking discussion
 Chronic use of drugs (affect immunity)
 Family history

Look and listen

 Respiratory rate
Tachypnea 3 months > 60
 3 months - 1 year > 50
 1year -4 years > 40
 >5y >20

 Chest indrawing
 Listen for stridor
 Listen for wheeze. Is it recurrent?
 Look for cyanosis
 See if the child is abnormally sleepy, difficult to wake, or restless
 Body temperature
 Signs of malnutrition (Marasmus. Kwashiorkor)
 Specific Time Content Teaching and AV aids Evaluation
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Describe 8:Malnutrition Lecture cum What are the
Swachh Bharat 10 min components of
If malnutrition is present its high risk and case fatality rates are higher discussion
Mission-Urban Swachh Bharat
In severely malnourished: Mission-
Urban?
1)children with pneumonia, fast breathing and cest indrawing may not be
evident
2) impaired or absent response to hypoxia and a weak or absent cough reflex
3) careful Evaluation and management
ARI control programmes
ARI control in children
ARI is an episode of acute symptoms & signs resulting from
infection of any part of respiratory tract and related structures
Constitutes 22-66% of outpatients & 12-4% of inpatients.
In India 10-50 children die per 10,000 episodes of ARI

WHO protocol comprises 3 steps

1. Case finding and assessment
2. Case classification
3. Institution of appropriate therapy
 Specific Time Content Teaching and AV aids Evaluation
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Step 1: Case finding and assessment
Cough and difficult breathing in children <5 years age
Fever is not an efficient criteria

Step 2: Case classification

Children grouped into 2: infants < 2 months & older children
Lecture cum
Specific signs to be looked : in younger children like feeding difficulty,
discussion
lethargy, hypothermia, convulsions.

Step3: Institution of appropriate therapy

Antibiotics
Ampicillin 25-50 mg/kg/day
Gentamycin 5.0 mg/kg/day for a period of 7-10 days.

Prevention of ARI
Exclusive breast feeding
Avoid irritants such as smoke,etc.
Immunization
 Specific Time Content Teaching and AV aids Evaluation
objectives learning
activity
 Specific Time Content Teaching and AV aids Evaluation
objectives learning
activity
 Specific Time Content Teaching and AV aids Evaluation
objectives learning
activity
SUMMARY
Infections of the respiratory tract are perhaps the most common human
ailment. While they are source of discomfort, disability & loss of time for
more adults, they are a substantial cause of morbidity & mortality in young
and in the elderly children & the elderly.
RECAPITULATION
What is Swajaldhara programme?
Summarize the 1 min
Which all are the Rural Sanitation Programmes?
topic
What are the objectives of Swatchh Bharath Mission- Gramin?
What are the components of Swachh Bharat Mission-Urban?

BIBLIOGRAPHY
 Park K; Text book for preventive and social medicine, 26th
edition, Bhanot Publications; Page no: 536-538
 Kadri AM; IAPSM’s Textbook of Community Medicine; 1st
edition; 2019; Jaypee Publishers; Page no: 995

National health portal government of India.