4500 Class 8 Postpartum Infection & Mood Disorders Flashcards
Who are at risk of infection (postpartum)
Immunocompromised, Diabetic, altered tissue integrity
Infection after 42 days of birth/induced abrtn/miscarriage
Postpartum infection
What are common symptoms of an infection
Fever 38 or higher, tachy, localized pain
What is the most common infection postpartum
Endometritis
What other infection would we suspect as a cause of fever postpartum period?
VTE or thrombophlebitis
Predisposing factors ANTEPARTUM/PRECONCEPTION for developing postpartum infection
Hx of venous thrombosis, UTI, mastitis, pneumonia
DM
Alcohol misuse
Immunosupression
Anemia
Malnutrition
Obesity; bmi of >55
Pre-eclampsia
Predisposing facyors for developing infection on INTRAPARTUM
Caesaream birth
Operative vaginal birth
Prolonged rupture of membranes ( >24 hours)
Chorioamnioitis
Prolonged labour
Bladder catheterization
Internal fetal or uterine pressure monitoring
MULTIPLE VAG EXAMS after ROM (>8)
Epidural anesthesia
Retained placental fragments
Postpartum hemorrhage
Episiotomy or lacerations
Hematomas
How does ENDOMETRITIS occur
commonly from bacteri of genital tract but can also be from surrounding skin / GI tract / introduced by hcp
What are risk factors of edimetritis
1 c section birth
Others: obesity, prolonged ROM, prolonged labour, multiple vag exams (>8), internal monitoring, chorioamnionitis
S/S of endometritis
Fever, tachycardia, chills, abd pain, anorexia, nausea, fatigue, uterine tenderness or fundal height, bogginess on fundal palpation, foul-smelling lochia
What are the nurses’ role in (endometritis)
Management?
1 BUBBLLEE assessments noting signs of endometritis
If noticed, inform provider asap
Management
1. Diagnostics may include: genital & blood cultures, CBC, urine culture
2. ANTIBIOTICS
3. HYDRATION, good nutirion and rest important
4. PAIN CONTROL
*may be outpatient or inoatient management
What are the top things to monitor/assess for improvement of Endometritis Treatment?
1 LOCHIA
- VS — febrile is the goal
- PAIN
**decrease in fever and uterine tenderness are signa of improvement
Why would c-section put a patient at risk of developing postpartum infection??
Obesity
Corticosteroid therapy
Immunosupression
Anemia
HTN
Hematoma
How do we prevent postpartum infection in c-section
1 IV ANTIBIOTIC PROPHYLAXIS (15-30 min prior to incision)
What signs do we look out for with c-section postpartum that they r developing/have infection
Fever, erythema, edema, warmth, purulent drainage, tenderness, wound dehiscence
S/Sx of infection in the Episiotomy site or Perineal tear/repair su\ite
Fever, edema, erythema, warmth, purulent drainage, tenderness, wound dehiscence
What are characteristics of MASTITIS
Usually localized to one are
Erythema, warmth, FIRM, te\exquisite tenderness/“worst bruise”
May be accompanied by: fever, chills, swelling of underarm lymph nodes (axillary adenopathy)
**comes suddenly
Mastitis Management
1 KEEP THE BREAT AS EMPTY AS POSSIBLE! Keep breats feed, best symptom relief!!
Cool compresses, analgesics
Abx: tylenol
Management… oral abx… keflec abx
Good nutrition, rest, hydration
Pain relief for breast feeding moms
NSAIDS, cool compress
WHAT ARE TOP 6 SIGNS OF SEPSIS
HYPOTENSION
TACHYCARDIA
TACHYPNEA
FEVER
DECREASED U/O
DECREASED LOC
Assessment tool we can use as a guide in POSTPARTUM
BUBBLLEE
What does bubbllee acronym cover
B = BREASTS (firmness) and nipples
U = UTERINE FUNDUS (location; consistency) ~normal positioning
B = BLADDER function (ampunt; frequency) ~minimum 30ml/hour; but mom will be voiding lots after giving birth— diuresis is normal in first first few days
B = BOWEL (passing gas or bowel movements)
L = LOCHIA (amount; colour) ~ bright red to darkbrown/serous to ???
L = legs (PERIPHERAL EDEMA)
E = Episiotomy/Laceration pr Caesarean birth incision (PERINEUM: discomfort; condition of repair — if done/needed)
E = emotional status (mood, fatigue)
Key characteristics of POSTPARTUM BLUES/ BABY BLUES
50-80% of birthers
Begins 3-4 days after childbirth, peaks on day 4-5 and RESOLVES WITHIN 2 WEEKS
It is mild, does not impair functiom, resolve on its own
It is anxiety or depression during pregnancy or within the 12 nonths after birth
Name a few
Perinatal Mood Disorders (PMD)
- Perinatal anxiety disorders: GAD, panic, OCD, PTSD (~20% of birthers)
- Perinatal depression/PP depression — (!10-15% of birthers)
- PP psychosis (0.1% of birthers) ~rare
What is perinatal anxiety
How to carr?
Pefvasice feeling of anxiety and cinstant worry
Trembling, n&, dizziness, dyspnea. INSOMNIA*
Generalize anxiety disorder, OCH, panic disorder and panic attacks, specific phoboas, social anxiety disorder, PTSD
Care: psychotherapy, CDT, ERP, meds, eduate that anxiety can worses postpartum, support
It is the intense and pervasive sadness with severe and labile mood swings that lasts more than 2 weeks postpartum
How to care?
Perinatal depression
Psychotherapy, antidepressants, peer support
Same signs as baby blues, but they last longer and more severe
Thoughts of harming yourself or your baby
Nit having interest in the baby
*can happen anytime in the first year after labour
Postpartum depression
Only last for a few days to a week
Sad anxious overwhelmed feeling
Crying spells
Loss of appetite
Difficulty sleeping
What is an assessment too. For screening perinatal mood disorders
EDINBURG POSTNATAL DEPRESSION SCALE
