4500 Class 8 Postpartum Infection & Mood Disorders

Question 1

Who are at risk of infection (postpartum)

Answer 1

Immunocompromised, Diabetic, altered tissue integrity

Question 2

Infection after 42 days of birth/induced abrtn/miscarriage

Answer 2

Postpartum infection

Question 3

What are common symptoms of an infection

Answer 3

Fever 38 or higher, tachy, localized pain

Question 4

What is the most common infection postpartum

Answer 4

Endometritis

Question 5

What other infection would we suspect as a cause of fever postpartum period?

Answer 5

VTE or thrombophlebitis

Question 6

Predisposing factors ANTEPARTUM/PRECONCEPTION for developing postpartum infection

Answer 6

Hx of venous thrombosis, UTI, mastitis, pneumonia

DM

Alcohol misuse

Immunosupression

Anemia

Malnutrition

Obesity; bmi of >55

Pre-eclampsia

Question 7

Predisposing facyors for developing infection on INTRAPARTUM

Answer 7

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

Question 8

How does ENDOMETRITIS occur

Answer 8

commonly from bacteri of genital tract but can also be from surrounding skin / GI tract / introduced by hcp

Question 9

What are risk factors of edimetritis

Answer 9

1 c section birth

Others: obesity, prolonged ROM, prolonged labour, multiple vag exams (>8), internal monitoring, chorioamnionitis

Question 10

S/S of endometritis

Answer 10

Fever, tachycardia, chills, abd pain, anorexia, nausea, fatigue, uterine tenderness or fundal height, bogginess on fundal palpation, foul-smelling lochia

Question 11

What are the nurses’ role in (endometritis)

Management?

Answer 11

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

Question 12

What are the top things to monitor/assess for improvement of Endometritis Treatment?

Answer 12

1 LOCHIA

2. VS — febrile is the goal
3. PAIN

**decrease in fever and uterine tenderness are signa of improvement

Question 13

Why would c-section put a patient at risk of developing postpartum infection??

Answer 13

Obesity

Corticosteroid therapy

Immunosupression

Anemia

HTN

Hematoma

Question 14

How do we prevent postpartum infection in c-section

Answer 14

1 IV ANTIBIOTIC PROPHYLAXIS (15-30 min prior to incision)

Question 15

What signs do we look out for with c-section postpartum that they r developing/have infection

Answer 15

Fever, erythema, edema, warmth, purulent drainage, tenderness, wound dehiscence

Question 16

S/Sx of infection in the Episiotomy site or Perineal tear/repair su\ite

Answer 16

Fever, edema, erythema, warmth, purulent drainage, tenderness, wound dehiscence

Question 17

What are characteristics of MASTITIS

Answer 17

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

Question 18

Mastitis Management

Answer 18

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

Question 19

Pain relief for breast feeding moms

Answer 19

NSAIDS, cool compress

Question 20

WHAT ARE TOP 6 SIGNS OF SEPSIS

Answer 20

HYPOTENSION
TACHYCARDIA
TACHYPNEA
FEVER
DECREASED U/O
DECREASED LOC

Question 21

Assessment tool we can use as a guide in POSTPARTUM

Answer 21

BUBBLLEE

Question 22

What does bubbllee acronym cover

Answer 22

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)

Question 23

Key characteristics of POSTPARTUM BLUES/ BABY BLUES

Answer 23

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

Question 24

It is anxiety or depression during pregnancy or within the 12 nonths after birth

Name a few

Answer 24

Perinatal Mood Disorders (PMD)

1. Perinatal anxiety disorders: GAD, panic, OCD, PTSD (~20% of birthers)
2. Perinatal depression/PP depression — (!10-15% of birthers)
3. PP psychosis (0.1% of birthers) ~rare

Question 25

What is perinatal anxiety

How to carr?

Answer 25

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

Question 26

It is the intense and pervasive sadness with severe and labile mood swings that lasts more than 2 weeks postpartum

How to care?

Answer 26

Perinatal depression

Psychotherapy, antidepressants, peer support

Question 27

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

Answer 27

Postpartum depression

Question 28

Only last for a few days to a week

Sad anxious overwhelmed feeling
Crying spells
Loss of appetite
Difficulty sleeping

Question 29

What is an assessment too. For screening perinatal mood disorders

Answer 29

EDINBURG POSTNATAL DEPRESSION SCALE