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NURS 4500: Final Material > Class 8: Postpartum Infection (Mastitis & Endometritis) > Flashcards

Class 8: Postpartum Infection (Mastitis & Endometritis) Flashcards

1
Q

what are risk factors for infection (3)

A
  • immunocompromised
  • diabetes
  • surgery/wounds
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2
Q

define: postpartum infection

A
  • any clinical infection of the genital canal that occurs within 28 days after miscarriage, induced abortion, or birth
  • includes postpartum pyrexia
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3
Q

what are examples of postpartum infection (5)

A
  • genital tract
  • breasts (mastitis)
  • wounds –> c-section site
  • urinary tract
  • pneumonia
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4
Q

what is included in postpartum genital tract infections (3)

A
  • endometritis (more common)
  • laceration sites
  • episiotomy sites
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5
Q

define: postpartum pyrexia

A
  • fever >38*C lasting 2 days in the period of 2-10 days postpartum, except the 1st day
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6
Q

in addition to infection, what can also be a cause of fever in the early PP period (2)

A
  • DVTs
  • thrombophlebitis
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7
Q

what are preconception/antepartum risks for developing a PP infection (5)

A
  • DM
  • alcoholism/substance use
  • immunosuppression (chronic disease)
  • anemia/malnutrition
  • obesity
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8
Q

what are intrapartum risks for developing a PP infection (12)

A
  • 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
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9
Q

endometritis is an infection from bacteria or viruses?

A
  • bacteria
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10
Q

where does endometritis occur?

A
  • in the endometrium of the uterus
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11
Q

what plays a huge role in endometritis?

A
  • risk factors
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12
Q

what are risk factors for endometritis (8)

A
  • obesity
  • chronic conditions in birther
  • c-section
  • prolonged ROM
  • prolonged labor
  • multiple vaginal exams (>8)
  • internal monitoring
  • chorioamnionitis
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13
Q

what is the most common bacteria to cause endometritis in the 1st 24 h after birth

A
  • group B strep
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14
Q

what other organisms can cause endometritis?

A
  • polymicrobial from genital tract
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15
Q

what are S&S of endometritis (9)

A
  • fever (after 1st 24h)
  • tachycardia
  • chills
  • abdominal pain
  • excessive uterine tenderness
  • fundal height above expected location
  • bogginess on palpation
  • foul-smelling lochia
  • anorexia, nausea
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16
Q

endometritis can proceed to?

A
  • sepsis
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17
Q

what should be done if potential signs of endometritis are noticed on assessment?

A
  • notify provider asap
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18
Q

what diagnostics may be used for endometritis (3)

A
  • genital & blood cultures
  • CBC
  • urine culture
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19
Q

what is included in mngmt for endometritis (7)

A
  • antibiotics (oral or IV)
  • hydration (oral or IV)
  • good nutrition
  • rest
  • pain control
  • fever control
  • monitor for improvement
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20
Q

what are signs of improvement of endometritis (2)

A
  • afebrile for 24-48 h
  • decreased uterine tenderness
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21
Q

mngmt for endometritis can be done..

A
  • outpt or inpt
22
Q

what is included in prevention for endometritis (5)

A
  • 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
23
Q

when are approp antibiotic prophylaxis provided? (2)

A
  • if GBS positive
  • if c-section
24
Q

what is included in discharge teaching for endometritis (3)

A
  • proper hand hygiene and aseptic technique
  • pt & family education on S&S of infection
  • when & where to seek care
25
Q

within the 1st month PP, where should the pt be advised to seek care?

A
  • return to hospital where gave birth, obstetrical triage
26
Q

define: mastitis

A
  • inflammation of the mammary glands/breast
27
Q

mastitis is often caused by?

A
  • bacteria that invades thru a break in the skin (ex. nipple trauma) or engorgement/blockage of the ducts
28
Q

describe the onset of mastitis

A
  • onset usually 2-3 weeks PP, after milk “comes in”
29
Q

mastitis is characterized by: (7)

A
  • localized to 1 breast usually
  • triangle shaped erythema
  • warmth
  • firm
  • exquisite tenderness to breast
  • flu-like
  • fever
30
Q

what is included in mngmt of mastitis (6)

A
  • oral abx
  • good nutrition
  • rest
  • hydration
  • symptom mngmt
  • lactation support & resources
31
Q

what is included in symptom mngmt of mastitis (3)

A
  • cool compress after feeds
  • NSAID
  • keep breast as empty as possible
32
Q

what is the nurses role in prevention of mastitis (8)

A
  • teach hygiene
  • assess latch and positioning
  • avoid engorgement –> every couple hrs
  • rest
  • hydration
  • nutrition –> increase caloric intake
  • family support
  • provide lactation resources
33
Q

what education should be provided r/t mastitis (9)

A
  • 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)
34
Q

what are signs of non-resolving infection w mastitis

A
  • should be afebrile after 48 h = infection not covered by antibiotics
35
Q

describe breastfeeding w mastitis

A
  • not harmful to infant to breastfeed w mastitis
36
Q

c-section incision site infection is often caused by…

A
  • bacteria from the skin
37
Q

what are risks for c-section incision (2)

A
  • general preconception/antepartum risks for infection
  • unplanned c-sections
38
Q

what is included in prevention for c-section incision site infection

A
  • IV antibiotic prophylaxis
39
Q

what is included in S&S of c-section incision site infection (6)

A
  • swelling
  • redness
  • purulent drainage
  • tenderness
  • wound dehiscence
  • +/- fever
40
Q

describe nurse’s role in mngmt of c-section incision site PP (7)

A
  • 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
41
Q

what is included in discharge education for c-section incision (4)

A
  • look for S&S of infection
  • proper hygiene
  • wound care
  • where to access care if needed
42
Q

what is included in mngmt of c-section incision site infection (3)

A
  • antibiotics (IV or oral)
  • possible wound debridement or drainage
  • wound care
43
Q

infection of the episiotomy site or perineal tear/repair site is often caused by?

A
  • bacteria on the skin or nearby GI tract (now have portal of entry)
44
Q

what do S&S of infection of the episiotomy site or perineal tear/repair site usually occur?

A
  • after discharge from hospital
45
Q

what are S&S of infection of the episiotomy site or perineal tear/repair site (7)

A
  • swelling
  • redness
  • purulent drainage
  • tenderness
  • wound dehiscence
  • +/- fever
  • delayed healing
46
Q

what is included in mngmt of the episiotomy site or perineal tear/repair site in hospital? (4)

A
  • assess wound site
  • VS
  • assess pain
  • if S&S of infection notify HCP
47
Q

what is included in discharge teaching of the episiotomy site or perineal tear/repair site (8)

A
  • 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
48
Q

what is included in mngmt of infection of the episiotomy site or perineal tear/repair site (4)

A
  • antibiotics (oral or IV)
  • possible wound debridement or drainage
  • wound care
  • perineal hygiene
49
Q

what is included in pain mngmt for episiotomy/perineal tear (2)

A
  • cold compress
  • analgesics
50
Q

if the perineal tear is 4th degree, what may be done?

A
  • IV abx prophylaxis
51
Q

what is included in physical assessment in the PP in hospital (11)

A
  • breasts
  • uterine fundus
  • bladder
  • bowel
  • lochia
  • legs
  • episiotomy/laceration or c-section incision
  • emotional status
  • VS
  • pain
  • IV site

NURS 4500: Final Material (16 decks)

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