puerperal fever Flashcards
etiology of puerperal fever
Self contamination from GI tract
Iatrogenic via practitioner dilation checks or instrumentation
Invasion of organism on own to vulnerable site
Droplet infection - usu from nasopharnyx of birth attendant
sites of infxn
Uterine Breast Perineal Bladder Pharynx
predisposing factors
PROM Prolonged labor Trauma Intrauterine manipulation Hemorrhage - pt weakened, manipulations to control hemorrhage Anemia Malnutrition Low socioeconomic status Retained parts
ssx infx
Temperature >38° C (100.4°F) p.o.
Chills
Pain - if uterine infection strong or persistent afterpains or abdominal tenderness
Location of pain consistent with locus of infection.
Foul discharge
Body aches
Subinvolution
laboratory findings
Culture: Positive for pathogen(s); consider doing drug sensitivity
Elevated WBC - count >15,000 usu accompanied by left shift
Blood culture - Positive if infection is systemic.
Temp >102°F
U/A, culture - Positive if infection is urinary in origin
management
Rest, rest, rest
Determine source of infection
Keep pt hydrated
Hydrotherapy - fever tx i.e. hot foot bath, hot fomentation etc
Nutrition - simple, easily digestible i.e. broth - do not divert energy to metabolism
Monitor frequently esp if managing without antibiotics. Set limits and then reevaluate.
If repair site is infected may need to remove sutures and allow to heal by first intention or place drain
allium sativa
Broad spectrum antimicrobial activity
Effective against Staph aureus, alpha and ß-hemolytic strep, E.coli.
Sig: 10-30 g fresh garlic (~8-10 cloves) for a 60 kg pt
hydrastis canadensis
Broad spectrum antimicrobial activity
Effective against Staph aureus, alpha and ß-hemolytic strep, E.coli, Chlamydia and N. gonorrhea (in vitro tests)
Also stimulates immune system via macrophage activation
Sig: Tincture: 60 - 120 gtt qid
Also true for Mahonia – indigenous to Oregon
echinacea angustifolia
All spp likely to be similar in Immunostimulating properties dt immune polysaccharides
Sig: 300mg qid Tincture: 120gtt q 2-3 hrs
lomatium dissectum
Effective against gram positive and negative bacteria including: Staph aureus Strep pyogens and viridens
Partially effective against N.gonorrhea.
Sig: 5gtt lomatium isolate qid
serenoa repens
Very effective if administered early (Ellingwood)
Sig: 10-100gtt q 1/2 hr
veratrum viride
Indicated for sudden onset with strong fever, full bounding pulse, puerperal convulsions Sig: 5gtt q 1/2 hr x 4 doses maximum **Very toxic** Vertigo Sweating Hypotension Bradycardia Slow respiration
viburnum opulus
Uterine infection and septic poisoning (Parvati); Relieves sx of afterpains
Sig: 60gtt q 2 hrs
synergists
Aconite - for sudden onset, fever
but pt feels cold; Sig: 5 gtt q 1 hr x 3 doses maximum
Gelsemium - nervous excitement,delirium; Sig: 5-30 gtt q 2hrs
Phytolacca - increases WBC, indicated if marked lymphadenopathy; Sig: 10 gtt q 1hr x 4 doses
diaphoretic tea for fever
Achillea millefolium 1 oz
Mentha piperita 1 oz
Make infusion in 1/2 gallon of water. Begin drinking while tea still hot
Caution: Do not use in very weak patient AND do not use yarrow alone in fevers >102°F
arnica
Used preventatively
Sore, bruised
Bed feels too hard
“don’t touch me , I’m fine” when seriously ill
arsenicum
Restless, anxious, fear of death
Prostration,
baptisia
Great prostration Lochia acrid and fetid. Distended abdomen Fullness Flatulence Rumbling Feels as if vomiting would relieve She feels that if only she could vomit she would have great relief
belladonna
Sudden onset Fever with delirium Lochia feels hot while being passed No thirst Pain
bryonia
High fever with great thirst Lochia supressed H/A Constipation Perspiration on single parts of body Irritable, moody Stitching, burning pains in abdomen < pressure,
kreosotum
Stitches in vagina from the abdomen
Causing her to start with every pain
Putrid, excoriating, blackish, lumpy lochia passed repeatedly
Almost ceases then starts again
mercurius
Lancing, boring or pressing pains in the uterine and genital regions
pyrogenum
Great aching in bones as if they would break Restlessness Coldness, followed by high fever Profuse sweat Temperature not relieved by sweating Discharge/Lochia horribly offensive
sabina
Wants window open
Uterine pain extending to thighs
Lochia offensive
Promotes expulsion of retained parts
