Class 8: Postpartum Infection (Mastitis & Endometritis) Flashcards
what are risk factors for infection (3)
- immunocompromised
- diabetes
- surgery/wounds
define: postpartum infection
- any clinical infection of the genital canal that occurs within 28 days after miscarriage, induced abortion, or birth
- includes postpartum pyrexia
what are examples of postpartum infection (5)
- genital tract
- breasts (mastitis)
- wounds –> c-section site
- urinary tract
- pneumonia
what is included in postpartum genital tract infections (3)
- endometritis (more common)
- laceration sites
- episiotomy sites
define: postpartum pyrexia
- fever >38*C lasting 2 days in the period of 2-10 days postpartum, except the 1st day
in addition to infection, what can also be a cause of fever in the early PP period (2)
- DVTs
- thrombophlebitis
what are preconception/antepartum risks for developing a PP infection (5)
- DM
- alcoholism/substance use
- immunosuppression (chronic disease)
- anemia/malnutrition
- obesity
what are intrapartum risks for developing a PP infection (12)
- c-section
- prolonged rupture of membranes >24 h
- chorioamnionitis
- prolonged labor
- bladder catheter
- internal fetal or uterine pressure monitoring
- multiple vaginal exams (>8)
- epidural anesthesia
- retained placental fragments
- PPH
- episiomty/lacerations
- hematomas
endometritis is an infection from bacteria or viruses?
- bacteria
where does endometritis occur?
- in the endometrium of the uterus
what plays a huge role in endometritis?
- risk factors
what are risk factors for endometritis (8)
- obesity
- chronic conditions in birther
- c-section
- prolonged ROM
- prolonged labor
- multiple vaginal exams (>8)
- internal monitoring
- chorioamnionitis
what is the most common bacteria to cause endometritis in the 1st 24 h after birth
- group B strep
what other organisms can cause endometritis?
- polymicrobial from genital tract
what are S&S of endometritis (9)
- fever (after 1st 24h)
- tachycardia
- chills
- abdominal pain
- excessive uterine tenderness
- fundal height above expected location
- bogginess on palpation
- foul-smelling lochia
- anorexia, nausea
endometritis can proceed to?
- sepsis
what should be done if potential signs of endometritis are noticed on assessment?
- notify provider asap
what diagnostics may be used for endometritis (3)
- genital & blood cultures
- CBC
- urine culture
what is included in mngmt for endometritis (7)
- antibiotics (oral or IV)
- hydration (oral or IV)
- good nutrition
- rest
- pain control
- fever control
- monitor for improvement
what are signs of improvement of endometritis (2)
- afebrile for 24-48 h
- decreased uterine tenderness
mngmt for endometritis can be done..
- outpt or inpt
what is included in prevention for endometritis (5)
- be aware of those at higher risk for infection (review risk factors)
- hand hygeine/maintaining aseptic technique
- during L&D reduce internal vaginal exams for those who have ROM
- provide approp antibiotic prophylaxis
- thorough assessment and note abnormal findings
when are approp antibiotic prophylaxis provided? (2)
- if GBS positive
- if c-section
what is included in discharge teaching for endometritis (3)
- proper hand hygiene and aseptic technique
- pt & family education on S&S of infection
- when & where to seek care
within the 1st month PP, where should the pt be advised to seek care?
- return to hospital where gave birth, obstetrical triage
define: mastitis
- inflammation of the mammary glands/breast
mastitis is often caused by?
- bacteria that invades thru a break in the skin (ex. nipple trauma) or engorgement/blockage of the ducts
describe the onset of mastitis
- onset usually 2-3 weeks PP, after milk “comes in”
mastitis is characterized by: (7)
- localized to 1 breast usually
- triangle shaped erythema
- warmth
- firm
- exquisite tenderness to breast
- flu-like
- fever
what is included in mngmt of mastitis (6)
- oral abx
- good nutrition
- rest
- hydration
- symptom mngmt
- lactation support & resources
what is included in symptom mngmt of mastitis (3)
- cool compress after feeds
- NSAID
- keep breast as empty as possible
what is the nurses role in prevention of mastitis (8)
- teach hygiene
- assess latch and positioning
- avoid engorgement –> every couple hrs
- rest
- hydration
- nutrition –> increase caloric intake
- family support
- provide lactation resources
what education should be provided r/t mastitis (9)
- keep breast as empty as possible
- lactation resources
- complete prescription for abx
- pain relief –> NSAIDs, cold compress
- where to follow-up for care
- rest, hydration, good nutrition, hygiene
- educate & assess r/t latch and positioning & correct
- S&S of worsening or non-resolving infection
- potential for yeast infection (d/t abx)
what are signs of non-resolving infection w mastitis
- should be afebrile after 48 h = infection not covered by antibiotics
describe breastfeeding w mastitis
- not harmful to infant to breastfeed w mastitis
c-section incision site infection is often caused by…
- bacteria from the skin
what are risks for c-section incision (2)
- general preconception/antepartum risks for infection
- unplanned c-sections
what is included in prevention for c-section incision site infection
- IV antibiotic prophylaxis
what is included in S&S of c-section incision site infection (6)
- swelling
- redness
- purulent drainage
- tenderness
- wound dehiscence
- +/- fever
describe nurse’s role in mngmt of c-section incision site PP (7)
- freq wound assessments
- VS (including pain)
- wound care & proper hygiene measures
- encourage pain control
- nutrition
- rest & hydration
- notify provider if S&S of infection noted
what is included in discharge education for c-section incision (4)
- look for S&S of infection
- proper hygiene
- wound care
- where to access care if needed
what is included in mngmt of c-section incision site infection (3)
- antibiotics (IV or oral)
- possible wound debridement or drainage
- wound care
infection of the episiotomy site or perineal tear/repair site is often caused by?
- bacteria on the skin or nearby GI tract (now have portal of entry)
what do S&S of infection of the episiotomy site or perineal tear/repair site usually occur?
- after discharge from hospital
what are S&S of infection of the episiotomy site or perineal tear/repair site (7)
- swelling
- redness
- purulent drainage
- tenderness
- wound dehiscence
- +/- fever
- delayed healing
what is included in mngmt of the episiotomy site or perineal tear/repair site in hospital? (4)
- assess wound site
- VS
- assess pain
- if S&S of infection notify HCP
what is included in discharge teaching of the episiotomy site or perineal tear/repair site (8)
- S&S of infection
- perineal care
- hygiene (perineal bottle, wipe front to back)
- sitz baths
- avoid constipation
- pain mngmt
- when & where to seek care
- change peri-pad often
what is included in mngmt of infection of the episiotomy site or perineal tear/repair site (4)
- antibiotics (oral or IV)
- possible wound debridement or drainage
- wound care
- perineal hygiene
what is included in pain mngmt for episiotomy/perineal tear (2)
- cold compress
- analgesics
if the perineal tear is 4th degree, what may be done?
- IV abx prophylaxis
what is included in physical assessment in the PP in hospital (11)
- breasts
- uterine fundus
- bladder
- bowel
- lochia
- legs
- episiotomy/laceration or c-section incision
- emotional status
- VS
- pain
- IV site
