WHO Clinical Care in Crisis Implementation Guide for Children
0.1.0 - ci-build

WHO Clinical Care in Crisis Implementation Guide for Children - Local Development build (v0.1.0). See the Directory of published versions

Questionnaire: Signs

Branch:
Structure
LinkIdTextCardinalityTypeFlagsDescription & Constraintsdoco
.. CHE.B18-2.Signs.2.m.mQuestionnairehttps://fhir.dk.swisstph-mis.ch/matchbox/fhir/Questionnaire/che.b18-2.signs.2.m.m#0.1.0
... Agenull0..1quantityiconExpressions:
... Weight (kilograms)null0..1quantityiconExpressions:
... YI severe classification other than severe dehydrationnull0..1booleaniconiconExpressions:
  • Initial Value: YI severe classification other than severe dehydration
... Diarrhoeanull0..1booleaniconiconExpressions:
... Breastfednull0..1booleaniconiconExpressions:
... zwfanull0..1decimalExpressions:
... CHE.B24.DE01.Respiratory.RateRespiratory rate0..1group
.... CHE.B24.DE01.Respiratory.Rate-helpThis element is referencing the Respiratory rate test from Group questions0..1display
... CHE.B18S2.DE07Severe Chest Indrawing0..1booleanicon
.... CHE.B18S2.DE07-help<p>The young infant must be calm while you assess for severe chest indrawing.  Lift the young infant’s shirt. </p> <p>Look for chest indrawing when the young infant breathes in. Lower chest wall indrawing is the inward movement of the bony structure of the chest wall <br /> when the child breathes in. Look at the lower chest wall (lower ribs). The child has chest indrawing if the lower chest wall goes IN when the child breathes IN.<br /> In normal breathing, the whole chest wall (upper and lower) and the abdomen move <span class="caps">OUT</span> when the child breathes IN. </p> <p>Mild chest indrawing is normal in a young infant because the chest wall is soft. Severe chest indrawing is very deep and easy to see.</p>0..1display
... CHE.B18S2.DE08Infant&#8217;s Movements0..1choiceOptions: 3 options
.... CHE.B18S2.DE08-help&#8220;Look at the young infant’s movements. Does the young infant move on his/her own? Does the infant move only when stimulated but then stops? Does the infant not move at all?<br /> Young infants often sleep most of the time, and this is not a sign of illness. It is not necessary for the infant to be awake if he/she is moving spontaneously. <br /> If a young infant is not moving spontaneously and does not wake up during the assessment, ask the caregiver to wake him. An awake young infant will normally move his arms or legs or turn his head several times in a  minute if you watch him closely. If the infant is awake but has no spontaneous movements, gently stimulate the young infant. Stimulation  is a gentle, painless touching of the baby with enough pressure that would evoke movements, sound making and eye opening. The presence of any movement such as a grimace of the face, eye-opening or movement of a limb will qualify &#8220;Movement only when stimulated but then stops&#8221;.  An infant who cannot be woken up even after stimulation is considered to have the sign &#8220;Does not move even with stimulation. &#8220;&#8221; 0..1display
... CHE.B18S2.DE12Umbilicus Red or Pus Draining0..1booleanicon
.... CHE.B18S2.DE12-helpThe umbilical cord usually separates one week after birth and the wound heals within 15 days. <br /> Redness of the end of the umbilicus or pus draining from the umbilicus are signs of umbilical <br /> infection.0..1display
... CHE.B18S2.DE13Skin Pustules0..1booleanicon
.... CHE.B18S2.DE13-helpExamine the skin on the entire body. Skin pustules are red spots or blisters which contain pus.0..1display
... CHE.B19S2.DE01Yellow Skin0..1booleanicon
.... CHE.B19S2.DE01-helpJaundice is a yellow discoloration of skin and mucus membranes. It is important to look for jaundice in natural light. To look for jaundice, press the <br /> infant’s skin over the forehead with your fingers to blanch, remove your fingers and look for yellow discolouration. If there is yellow discoloration, the infant has jaundice0..1display
... CHE.B19S2.DE02Yellow Palms or Yellow Soles0..1booleanicon
.... CHE.B19S2.DE02-helpJaundice is a yellow discoloration of skin and mucus membranes. Jaundice in the palms of hands or soles of feet is a sign of Severe Jaundice.  It is important to look for jaundice in natural light. To assess for severe jaundice, press the infant&#8217;s skin in the palm of there hand and then in the sole of their feet with your fingers to blanch, remove your finders and look for yellow dicoulouration in the palm or the sole. If there is yellow discoloration of the palm or sole, the infant has severe jaundice.0..1display
... CHE.B19S2.DE04When did the Jaundice first appear?0..1choiceOptions: 3 options
Expressions:
  • Enable When: %resource.repeat(item).where(linkId='CHE.B19S2.DE01').answer.first().value = true and %resource.repeat(item).where(linkId='CHE.B19S2.DE02').answer.first().value = false and %resource.repeat(item).where(linkId='Age').answer.first().value >=24 'hours' and %resource.repeat(item).where(linkId='Age').answer.first().value <21 'days'
.... CHE.B19S2.DE04-helpAsk the caregiver when the baby&#8217;s skin first turned yellowish. If the caregiver didn&#8217;t notice the yellow discolouration or can&#8217;t remember when it started, select &#8220;don&#8217;t know&#8221;. <br /> Jaundice that appears in less than 24 hours after birth is always due to an underlying disease. These babies should be referred urgently. <br /> Many normal babies, particularly small babies, may have jaundice during the first week of life. This jaundice usually appears on the third or fourth day of life and is mild and disappears before the age of two to  three weeks. It does not need any treatment.0..1display
... dhreanull0..1groupExpressions:
  • Enable When: %resource.repeat(item).where(linkId='Diarrhoea').answer.first().value = true
.... CHE.B20S2.DE01Sunken Eyes0..1booleanicon
..... CHE.B20S2.DE01-help<p>The eyes of a dehydrated infant may look sunken. In a low-weight infant, the eyes may always look sunken, even if the young infant is not dehydrated. Even though the sign “sunken eyes” is less reliable in a low-weight infant, it can still be used to classify the young infant‘s dehydration. </p> <p>Decide if you think the eyes are sunken. Then ask the mother if she thinks her child’s eyes look unusual. Her opinion can help you confirm.</p>0..1display
.... CHE.B20S2.DE02Skin pinch of Abdomen0..1choiceOptions: 3 options
..... CHE.B20S2.DE02-helpLocate the area on the infant’s abdomen halfway between the umbilicus and the side of the abdomen. To do the skin pinch, use your thumb and first finger. Do not use your fingertips because this will cause pain. Place <br /> your hand so that when you pinch the skin, the fold of skin will be in a line up and down the child’s body and not across the child’s <br /> body. Firmly pick up all of the layers of skin and the tissue under them. Pinch the skin for <br /> one second and then release it. When you release the skin, look to see if the skin pinch <br /> goes back:<br /> • immediately<br /> • slowly (2 seconds or fewer, but not immediately)<br /> • very slowly (longer than 2 seconds)<br /> If the skin stays up for even a brief time after you release it, decide that the skin pinch goes back slowly0..1display
.... CHE.B20S2.DE06Restless and Irritable0..1booleaniconExpressions:
  • Enable When: %resource.repeat(item).where(linkId='CHE.B18S2.DE08').answer.first().value.code= 'CHE.B18S2.DE09'
..... CHE.B20S2.DE06-helpLook at the young infant&#8217;s general condition Is the infant restles and irritable? <br /> An infant has teh sign &#8220;restless and irritable&#8221; if the infant is restless and irritable all the time or every time he is touched and handled. If an infant is calm when breastfeeding but again <br /> restless and irritable when he stops breastfeeding, he has the sign “restless and irritable”. A healthy infant will be consoled when put on the breast.0..1display
... CHE.B21S2.DE01Weight Status0..1choiceOptions: 3 options
Expressions:
  • Enable When: %resource.repeat(item).where(linkId='Weight (kilograms)').answer.first().exists()
  • Calculated Value: iif(%resource.repeat(item).where(linkId='zwfa').answer.first().exists(),iif(%resource.repeat(item).where(linkId='zwfa').answer.first().value <= (-3) and %resource.repeat(item).where(linkId='Age').answer.first().value < 7 'days' , 'CHE.B21S2.DE02',iif(%resource.repeat(item).where(linkId='zwfa').answer.first().value < (-2) , 'CHE.B21S2.DE03', 'CHE.B21S2.DE04')),{})
.... CHE.B21S2.DE01-helpWeight status is auto-calculated based on the young infant&#8217;s weight for age Z-score, which is determined from a standardized chart for weight -for-age for the infant&#8217;s sex. <br /> A young infant is low weight for age if the z-score is below -2. <br /> A young infant who is less than 7 days old and weighs less than 2 kg is considered very low weight.<br /> Some young infants who are low weight for age were born with low birth weight. Some did not gain weight well after birth.0..1display
... no-yi-sever-wo-dehydranull0..1groupExpressions:
  • Enable When: ( %resource.repeat(item).where(linkId='YI severe classification other than severe dehydration').answer.empty() or %resource.repeat(item).where(linkId='YI severe classification other than severe dehydration').answer.first().value=false )
.... bf-assesnull0..1groupExpressions:
  • Enable When: %resource.repeat(item).where(linkId='Breastfed').answer.first().value = true
..... CHE.B21S2.DE05Breastfed how many times in 24 hours?0..1integer
...... CHE.B21S2.DE05-helpAsk the caregiver how many times in 24 hours (one day and one night) they usually breastfeed the young infant. The recommendation is that the young infant be breastfed as often and for as long as the infant wants, day and night. This should be 8 or more times in 24 hours.0..1display
..... CHE.B21S2.DE06Sufficient feeds0..1booleaniconiconExpressions:
  • Calculated Value: ((%resource.repeat(item).where(linkId='Age').answer.first().value < 29 'days' and %resource.repeat(item).where(linkId='no-yi-sever-wo-dehydra').repeat(item).where(linkId='bf-asses').repeat(item).where(linkId='CHE.B21S2.DE05').answer.first().value >=8) or (%resource.repeat(item).where(linkId='Age').answer.first().value >=30 'days' and %resource.repeat(item).where(linkId='no-yi-sever-wo-dehydra').repeat(item).where(linkId='bf-asses').repeat(item).where(linkId='CHE.B21S2.DE05').answer.first().value >=7))
...... CHE.B21S2.DE06-helpThe young infant is breastfed 8 or more times in 24 hours (autocalculated)0..1display
..... CHE.B21S2.DE07Insufficient feeds0..1displayExpressions:
  • Enable When: %resource.repeat(item).where(linkId='no-yi-sever-wo-dehydra').repeat(item).where(linkId='bf-asses').repeat(item).where(linkId='CHE.B21S2.DE06').answer.first().value = false
...... CHE.B21S2.DE07-helpThe young infant is breastfed fewer than 8 times in 24 hours (autocalculated)0..1display
..... CHE.B21S2.DE08Young Infant receives food or fluids other than breast milk0..1booleanicon
...... CHE.B21S2.DE08-helpFind out if the young infant is receiving any other foods or drinks such as other milk, juice, tea, thin porridge, dilute cereal, or even water. Ask how often he receives it and the amount. You need to know if the infant is mostly breastfed, or mostly fed on other foods0..1display
.... ubf-assesnull0..1groupExpressions:
  • Enable When: %resource.repeat(item).where(linkId='Breastfed').answer.first().value = false
..... CHE.B21S2.DE09What milk is being given as a replacement feed?0..1choiceOptions: 2 options
...... CHE.B21S2.DE09-helpAsk the mother questions to determine what replacement milk or milks are used. It may be a breastmilk replacement, animal milk or some other fluid or some combination. Determine if this type of replacement feed is appropriate or not appropriate in your setting.0..1display
..... CHE.B21S2.DE12How many replacement feeds during the day and night (24 hours)?0..1booleanicon
...... CHE.B21S2.DE12-helpA young infant up to one month of age should be fed 8 times and a young infant between 1 and 2 months of age should be fed 7 times in 24 hours.0..1display
..... CHE.B21S2.DE13Sufficient replacement feeds (in 24 hours)0..1booleanicon
...... CHE.B21S2.DE13-helpThe young infant is given a sufficient number of replacement feeds (8 or more times in 24 hours for a young infant under 1 month of age; 7 or more times for a young infant between 1 and 2 months of age) (autocalculated)0..1display
..... CHE.B21S2.DE14Insufficient replacement feeds (in 24 hours)0..1booleanicon
...... CHE.B21S2.DE14-helpThe young infant is not given a sufficient number of replacement feeds (fewer than 8 times in 24 hours for a young infant under 1 month of age; fewer than 7 times for a young infant between 1 and 2 months of age) (autocalculated)0..1display
..... CHE.B21S2.DE15How much milk is given at each feed?0..1choiceOptions: 2 options
...... CHE.B21S2.DE15-helpA young infant up to one month of age should be given approximately 60 ml per feed, 8 times per day, and a young infant between 1 and 2 months of age approximately 90 ml at each feed, 7 times per day. It is helpful to have common bottles or cups available so that a mother can show you the amount that she gives.0..1display
..... CHE.B21S2.DE18How is the milk prepared?0..1choiceOptions: 2 options
...... CHE.B21S2.DE18-helpAsk the mother to demonstrate or explain how a feed is prepared and how she gives it to the infant. Determine if the breastmilk substitute is being prepared correctly and hygienically.0..1display
..... CHE.B21S2.DE21How is the milk given?0..1choiceOptions: 2 options
...... CHE.B21S2.DE21-helpAsk the caregiver how they give milk to the young infant0..1display
..... CHE.B21S2.DE24How are the feeding utensils cleaned?0..1choiceOptions: 2 options
...... CHE.B21S2.DE24-helpAsk the caregiver how they clear the feeding utensils. Determine if this is a safe and hygienic cleaning method.0..1display
..... CHE.B21S2.DE27Is infant given any breast milk at all?0..1choiceOptions: 2 options
...... CHE.B21S2.DE27-helpDoes the caregiver give the young infant any breastmilk at all?0..1display
.... CHE.B21S2.DE30Ulcers or White Patches in Mouth0..1booleaniconExpressions:
  • Enable When: %resource.repeat(item).where(linkId='no-yi-sever-wo-dehydra').repeat(item).where(linkId='CHE.B21S2.DE31').answer.first().empty()
..... CHE.B21S2.DE30-helpLook inside the mouth at the tongue and inside of the cheek. Thrush looks like milk curds on the inside of the cheek, or a thick white coating of the tongue. Try to wipe the white off. The white patches of thrush will remain.0..1display
.... CHE.B21S2.DE31Unable to check if Ulcers or White Patches in Mouth0..1booleaniconExpressions:
  • Enable When: %resource.repeat(item).where(linkId='no-yi-sever-wo-dehydra').repeat(item).where(linkId='CHE.B21S2.DE30').answer.first().empty()
..... CHE.B21S2.DE31-helpThe healthcare worker is unable to check if the young infant has ulcers or white patches in the mouth0..1display
... CHE.B21S2.DE06.1Sufficient feeds0..1displayExpressions:
  • Enable When: %resource.repeat(item).where(linkId='no-yi-sever-wo-dehydra').repeat(item).where(linkId='bf-asses').repeat(item).where(linkId='CHE.B21S2.DE06').answer.first().value = true
.... CHE.B21S2.DE06.1-helpThe young infant is breastfed 8 or more times in 24 hours (autocalculated)0..1display
... timestampnull0..1dateTimeiconExpressions:

doco Documentation for this format

Option Sets

Answer options for CHE.B18S2.DE08

  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B18S2.DE09 ("Moves on his or her own or moves spontaneously or without stimulation")
  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B18S2.DE10 ("Movement only when stimulated but then stops")
  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B18S2.DE11 ("No movement at all")

Answer options for CHE.B19S2.DE04

  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B19S2.DE05 ("Within less than 24 hours of birth")
  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B19S2.DE06 ("24 hours or more after birth")
  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B19S2.DE07 ("Unknown when Jaundice first appeared")

Answer options for CHE.B20S2.DE02

  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B20S2.DE05 ("Goes back Normally (immediately)")
  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B20S2.DE04 ("Goes back slowly (2 seconds or fewer, but not immediately)")
  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B20S2.DE03 ("Goes back very slowly (More than 2 seconds)")

Answer options for CHE.B21S2.DE01

  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B21S2.DE02 ("Very Low Weight for Age")
  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B21S2.DE03 ("Low Weight for Age")
  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B21S2.DE04 ("Normal Weight for Age")

Answer options for CHE.B21S2.DE09

  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B21S2.DE10 ("Appropriate replacement milk")
  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B21S2.DE11 ("Inappropriate replacement milk")

Answer options for CHE.B21S2.DE15

  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B21S2.DE16 ("Sufficient replacement feeds")
  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B21S2.DE17 ("Insufficient replacement feeds")

Answer options for CHE.B21S2.DE18

  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B21S2.DE19 ("Correct or hygienic feed preparation")
  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B21S2.DE20 ("Incorrect or unhygienic feed preparation")

Answer options for CHE.B21S2.DE21

  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B21S2.DE22 ("Cup")
  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B21S2.DE23 ("Bottle")

Answer options for CHE.B21S2.DE24

  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B21S2.DE25 ("Feeding utensils cleaned hygienically")
  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B21S2.DE26 ("Feeding utensils not cleaned hygienically")

Answer options for CHE.B21S2.DE27

  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B21S2.DE28 ("Breastmilk also given")
  • https://fhir.dk.swisstph-mis.ch/matchbox/fhir/CodeSystem/che-custom-codes#CHE.B21S2.DE29 ("No Breastmilk at all")