# Situation: A nurse trained in Integrated Management of Childhood Illness (IMCI) sees sick children at the under-five clinic of a Rural Health Unit (RHU). A 5-week-old infant is brought in because the umbilicus is red and draining pus. The redness does not extend to the skin around the umbilicus. The infant is feeding well, moves normally, has a temperature of 37.0 °C (98.6 °F), a respiratory rate of 48 breaths per minute, and no chest indrawing. Which action is CORRECT?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627157  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: A nurse trained in Integrated Management of Childhood Illness (IMCI) sees sick children at the under-five clinic of a Rural Health Unit (RHU).

A 5-week-old infant is brought in because the umbilicus is red and draining pus. The redness does not extend to the skin around the umbilicus. The infant is feeding well, moves normally, has a temperature of 37.0 °C (98.6 °F), a respiratory rate of 48 breaths per minute, and no chest indrawing. Which action is CORRECT?

## 보기

1. Give oral antibiotics, teach home cord care, and review in 2 days **✔ 정답**
2. Apply alcohol to the cord and review at the next vaccination visit
3. Give the first dose of IM antibiotics and refer urgently
4. Advise home cord care only and return if the infant gets sicker

**정답: 1**

## 해설

A red umbilicus or one draining pus, without any sign of very severe disease, is classified as local bacterial infection (yellow). The young infant receives an oral antibiotic, the mother is taught to treat the local infection at home, and the infant is followed up in 2 days. This infant has none of the very severe signs: feeding is good, movement is normal, temperature is between 35.5 °C and 37.5 °C, and the respiratory rate is below 60.

## 심화 해설

Classifying the young infant
For a young infant aged up to 2 months, IMCI first checks for signs of very severe disease: not feeding well, convulsions, movement only when stimulated or no movement, fast breathing (60 breaths per minute or more), severe chest indrawing, and temperature of 37.5 °C or above or below 35.5 °C. This 5-week-old infant has none of them: he feeds well, moves normally, has a temperature of 37.0 °C, a respiratory rate of 48, and no chest indrawing. His only finding is an umbilicus that is red or draining pus, with redness that has not spread to the surrounding skin. A red or pus-draining umbilicus without signs of very severe disease is classified as local bacterial infection (yellow).

Treatment for local bacterial infection
The yellow classification is treated at the health facility and at home. The infant receives an oral antibiotic, the mother is taught to treat the local infection at home, for example by cleaning the umbilicus and keeping it dry as instructed, and the infant returns for follow-up in 2 days to check that the infection is improving. The mother is also taught the signs that mean she must return immediately, such as poor feeding, fever, or spreading redness.

| Finding | IMCI classification | Action |
| --- | --- | --- |
| Any sign of very severe disease | Very severe disease (pink) | First IM antibiotics, urgent referral |
| Umbilicus red or draining pus, no severe sign | Local bacterial infection (yellow) | Oral antibiotic, home care, follow-up in 2 days |
| No infection signs | Infection unlikely (green) | Home care advice |

Why the other actions are wrong
Giving the first dose of intramuscular antibiotics and referring urgently is the treatment for very severe disease, which this infant does not have. Applying alcohol to the cord and waiting until the next vaccination visit leaves a bacterial infection without antibiotic treatment and delays review far beyond 2 days, which is unsafe in a young infant whose infections can spread quickly. Home cord care alone, with return only if sicker, fits an infant with no infection, not one with pus draining from the umbilicus. Watch out! If the redness extends to the skin around the umbilicus, the infant must be reassessed for a more severe classification.

Exam takeaway
First rule out very severe disease, then classify the local sign. In young infants, a local infection needs an antibiotic and a short follow-up interval because it can progress to sepsis. Counseling the mother on danger signs, exclusive breastfeeding, and keeping the infant warm completes the IMCI management.

## 임상 시나리오

Young Infant: Local Bacterial InfectionRed or pus-draining umbilicus
Check for very severe disease first: poor feeding, convulsions, reduced movement, breathing 60 or more, severe chest indrawing, temperature 37.5 °C or above or below 35.5 °C.

With none present, a red or pus-draining umbilicus is local bacterial infection (yellow).

Give an oral antibiotic, teach home treatment of the umbilicus, and follow up in 2 days.

CautionReassess at once if redness spreads to the skin around the umbilicus or any danger sign appears.

## 핵심 개념

- **Young infant** — In IMCI, an infant from birth up to 2 months of age, assessed with its own chart.
- **Local bacterial infection** — IMCI yellow classification for a red or pus-draining umbilicus or skin pustules without severe signs.
- **Very severe disease** — IMCI pink classification in young infants needing first-dose antibiotics and urgent referral.
- **Omphalitis** — Infection of the umbilical stump, shown by redness, swelling, or pus.

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