Puerperal Fever Flashcards
etiology of peurperal fever?
self contamination from GI tact
iatrogenic
invasion of organism on it’s own to vulnerable area
droplet infxn
5 sites of possible infxn?
uterine breast perineal bladder pharynx
9 predisposing factors to puerperal fever?
PROM prolonged labor trauma intrauterine manipulation hemorrhage anemia malnutrition low SE status retained parts
ssxs of infxn?
temperature greater than 38 deg C chills pain location of pain consistent w/locus of infxn foul d/c body aches subinvolution
lab findings suggestive of infxn? tx? tests to run?
culture (+)
consider drug sensitivity
blood culture - if (+) then systemic infxn
U/A + culture to determine if urinary in origin
management of puerperal fever/infxn?
REST!!
determine source of infxn
keep hydrated
hydrotherapy
nutrition (simple, easily digested foods)
monitor frequently esp if txing w/o abx
if repair site infected may need to remove suture and allow to heal by 1st intention or place drain
broad spectrum antimicrobial activity
esp active against s. aureus, alpha and beta strep, e. coli
8-10 cloves/d
allium sativa
broad spectrum antimicrobial activity
effective against s. aureus, a and b strep, e. coli along with GC/CT
also stimulates immune system via MO activation
tincture: 60-120 gtt qid
hydrastis canadensis
immunostimulating properties dt immune polysaccharides
sig: 300 mg qid, tincture: 120 gtt q 2-3 hrs
echinacea angustifolia
effective against G (+) and G (=) bugs: s. aureus, s. pyogens, s. viridens, n. gonorrhea
sig: 5 gtt qid
lomatium dissectum
very effective if administered early
sig: 10-100 gtt q 1/2 hr
serenoa repens
sudden onset w/strong fever, full bounding pulse
puerperal convulsions
sig: 5 gtt q 1/2 hr x 4 doses max
very toxic: vertigo, sweating, hypotension, bradycardia, slow respiration
veratrum viride
uterine infxn and septic poisoning
relieves sxs of afterpains
sig: 60 gtt q 2 hrs
viburnum opulus
3 synergists for an infxn?
gelsemium, aconite, phytolacca
for sudden onset, fever but pt feels cold
5 gtt q 1 hr x 3 doses max
aconite
nervous excitement, delirium
5-30 gtt q 2 hrs
gelsemium
increases WBCs, indicated if marked LAD
10 gtt q 1 hr x 4 doses
phytolacca
used preventatively
sore, bruised
bed feels too hard
don’t touch me I’m fine when seriously ill
arnica
restless, anxious, fear of death prostration, worse cold chilly, burning pain wants company irritable, crabby thirst feeble pulse, no E used to prevent septicemia
arsenicum
great prostration
lochia acrid and fetid
distended abd: fullness, flatulence, rumbling, feels as if vomiting would relieve
baptisia
sudden onset fever w/delirium lochia feels hot when being passed no thirst pain- worse w/slightest jar of bed, very sensitive to touch
belladonna
high fever w/great thirst lochia suppressed H/A constipation perspiration on single parts of body irritable, moody stitching, burning pains in abd worse pressure, motion and cough
bryonia
stitches in vagina from abd causes her to start w/every pain
putrid, excoriating, blacking, lumpy lochia passed repeatedly, almost ceases then starts again
kreosotum
lancing, boring or pressing pains in the uterine and genital regions
worse night
much perspiration that affords no relief
moist tongue showing imprints of the teeth
mercurius
great aching in bones as if they would break restlessness coldness, followed by high fever profuse sweat temperature not relieved by sweating d/c/lochia horribly offensive
pyrogenum
wants window open
uterine pain extending to thighs
lochia offensive
promotes expulsion of retained parts
sabina
putrid, dark lochia
mb no pain or cont bearing down pain
great prostration
burning fever interrupted by shaking chills, cold sweat over whole body
secale
abx therapy for infxn?
amoxicillin or ampicillin, diclaxacililn, augmentin
ampicillin: 500 mg qid x 10-14 d
if PNC allergic: erythromycin: broader spectrum, GI distress, 500 mg bid x 10 d
naturopathic tx of PP UTI? conventional?
botanical tincture: arctostaphylos, boldo, mahonia, althea
probiotics
pH lowering: ACV, vit C, cranberry
conventional: cephalexin 250 qid or 500 mg bid x 10 d
cause of septic pelvic thrombophlebitis? ssxs? dx? tx?
complication of endometritis
ssxs: pt may not appear very ill, multiple fever spikes, mild, vague abd pain, fever persists even after multiple abx courses
dx via U/S or CBC
tx: 5000 units IV heparin followed by 1000 units/hr until PTT is 1.5 fold level, then oral warfarin for 10-14 d
naturopathic tx of septic pelvic thrombophlebitis?
bromelain 1000 mg qid
homeopathics
how to tx pelvic abscess?
botanicals
castor oil packs
abscess homeopathics
consider clindamycin which covers anaerobes
if do not respond to tx need to surgically drain then
