Chapter 16: Puerperal Infections Flashcards
Puerperal (Postpartum) Infections
bacterial infection, usually of endometrium (endometritis/metritis)
Types of Puerperal Infections
- Endometritis (Metritis)
- Mastitis
- Wound Infections
- UTI
- Septic Pelvic Thrombophlebitis
Endometritis (Metritits)
inflammation and infection of the inner lining of the uterus
>temperature elevation over 101 degrees F, often within first 24 to 48 hours after childbirth, followed by tachycardia, uterine tenderness, subinvolution, and malaise
-heavy, foul-smelling lochia (later sign; signals anaerobic organisms) or scant, odorless lochia (signals beta hemolytic Streptococcus)
-chills, poor appetite, cramping pain
-increased WBC count (above 20,000 -30,000 mm3)
Treatment for Endometritis (Metritis)
> antibiotics:
-broad spectrum cephalosporin or penicillin
treat symptoms:
-rest, antipyretics, increase fluid intake, encourage high protein, high vitamin C foods, promote urine drainage via ambulation and Fowler’s position, instruct in perineal care, or surgical intervention in severe cases
explain treatments
home antibiotic therapy may need to be arranged with follow-up
promote infant attachment
Wound Infections (Perineal): Signs + Symptoms
- pain, foul-smelling discharge
- edema
- low-grade fever
- sudden chills, high fever, abdominal tenderness, erythema, edema, warmth of incision, drainage from incision
Treatment for Wound Infections
> antibiotics per order
may require incision and drainage with placement of drain to facilitate healing by secondary intervention; if packing has been placed in the wound to keep it open and maintain drainage, alert patient to exercise caution when changing her perineal pads to avoid dislodging the packing
perineal: sitz baths
cesarean: wet to dry dressing changes 3+ times/day
pain medications per order (NSAIDS)
instruct on wound care
possible referral to home-health nurse
UTI: Signs and Symptoms
- may have none
- dysuria (painful urination)
- frequency
- burning on urination
- difficulty voiding and/or urinary retention
- costovertebral angle tenderness (CVA)
- back or suprapubic pain
- hematuria (blood in urine)
- fever, fatigue, nausea, vomiting
Treatment for UTI
> antibiotics per order (sulfonamides, aminopenicillins, anti-infectives, nitrofurantoin, or cephalosporins x 3-10 days)
measure voiding for the first 24 hours, assessing for complete emptying of the bladder (> 150 mL/hr)
change peripads every 3 to 4 hours
encourage voiding every 3 to 4 hours; increased fluid intake (3000 mL/day), and consumption of foods that increase acidity in the urine (e.g. cranberry juice, apricots, and plums)
rest
perineal care
monitor temperature, bladder function, normal appearance of urine
instruct in/ administer antipyretics, antispasmodics, analgesics, and antiemetics
educate to avoid recurrence; void following intercourse, clean from front to back
Mastitis
unilateral and develops after the flow of milk has been established
- involves the ductal system causing inflammatory edema, enlarged axillary lymph nodes, and breast engorgement with obstruction of milk flow
- S+S: warm, tender, hardened area on breast (usually one), a triangular flush underneath the affected breast is an early sign, enlarged axillary lymph nodes, fever, chills, generalized aching, headache, malaise
Treatment: Mastitis
> notify MD
initiate 10 day course of antibiotics
continue breastfeeding (offer affected breast first) or manual/electrical expression of milk to maintain lactation, promote complete emptying, and prevent clogged ducts; may be instructed to discard the milk
rest
increase fluid
pump breast after infant feeding to ensure breast is empty
warm compress or ice to breast for comfort
antipyretics
instruct in high-protein, high-vitamin C diet
educate regarding hygiene and future recurrence
assess infants mouth for signs of thrush (oral Candida), an overgrowth of fungal organisms related to the mother antibiotic therapy
isolate from other nursing mothers
Septic Pelvic Thrombophlebitis Signs and Symptoms
- fever > 102.2 with spikes after initiation of antibiotic therapy
- abdominal and/or back pain
- chills, increased pulse (resting tachycardia
- few or absent bowel sounds
Treatments for Septic Pelvic Thrombophlebitis
- antibiotics
- add heparin therapy to increase aPTT
- rest in Fowler’s position
- high-protein, high vitamin C diet
- increase fluids
- comfort measures; pain medication, antipyretics
- complementary therapies: heat, cold, relaxation, music, touch
- explain treatments
- promote infant attachment
Laboratory Analysis to help Identify a Postpartum Infection
- CBC with differential
- Blood Cultures if sepsis is suspected
- urinalysis with culture and sensitivity
- cervical, uterine, or wound culture as needed
