Puerperal Fever

Question 1

etiology of peurperal fever?

Answer 1

self contamination from GI tact
iatrogenic
invasion of organism on it’s own to vulnerable area
droplet infxn

Question 2

5 sites of possible infxn?

Answer 2

uterine
breast
perineal
bladder 
pharynx

Question 3

9 predisposing factors to puerperal fever?

Answer 3

PROM
prolonged labor
trauma
intrauterine manipulation
hemorrhage
anemia
malnutrition
low SE status
retained parts

Question 4

ssxs of infxn?

Answer 4

temperature greater than 38 deg C
chills
pain
location of pain consistent w/locus of infxn
foul d/c
body aches
subinvolution

Question 5

lab findings suggestive of infxn? tx? tests to run?

Answer 5

culture (+)
consider drug sensitivity
blood culture - if (+) then systemic infxn
U/A + culture to determine if urinary in origin

Question 6

management of puerperal fever/infxn?

Answer 6

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

Question 7

broad spectrum antimicrobial activity
esp active against s. aureus, alpha and beta strep, e. coli
8-10 cloves/d

Answer 7

allium sativa

Question 8

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

Answer 8

hydrastis canadensis

Question 9

immunostimulating properties dt immune polysaccharides

sig: 300 mg qid, tincture: 120 gtt q 2-3 hrs

Answer 9

echinacea angustifolia

Question 10

effective against G (+) and G (=) bugs: s. aureus, s. pyogens, s. viridens, n. gonorrhea
sig: 5 gtt qid

Answer 10

lomatium dissectum

Question 11

very effective if administered early

sig: 10-100 gtt q 1/2 hr

Answer 11

serenoa repens

Question 12

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

Answer 12

veratrum viride

Question 13

uterine infxn and septic poisoning
relieves sxs of afterpains
sig: 60 gtt q 2 hrs

Answer 13

viburnum opulus

Question 14

3 synergists for an infxn?

Answer 14

gelsemium, aconite, phytolacca

Question 15

for sudden onset, fever but pt feels cold

5 gtt q 1 hr x 3 doses max

Answer 15

aconite

Question 16

nervous excitement, delirium

5-30 gtt q 2 hrs

Answer 16

gelsemium

Question 17

increases WBCs, indicated if marked LAD

10 gtt q 1 hr x 4 doses

Answer 17

phytolacca

Question 18

used preventatively
sore, bruised
bed feels too hard
don’t touch me I’m fine when seriously ill

Answer 18

arnica

Question 19

restless, anxious, fear of death
prostration, worse cold
chilly, burning pain
wants company
irritable, crabby
thirst
feeble pulse, no E
used to prevent septicemia

Answer 19

arsenicum

Question 20

great prostration
lochia acrid and fetid
distended abd: fullness, flatulence, rumbling, feels as if vomiting would relieve

Answer 20

baptisia

Question 21

sudden onset
fever w/delirium
lochia feels hot when being passed
no thirst
pain- worse w/slightest jar of bed, very sensitive to touch

Answer 21

belladonna

Question 22

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

Answer 22

bryonia

Question 23

stitches in vagina from abd causes her to start w/every pain

putrid, excoriating, blacking, lumpy lochia passed repeatedly, almost ceases then starts again

Answer 23

kreosotum

Question 24

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

Answer 24

mercurius

Question 25

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

Answer 25

pyrogenum

Question 26

wants window open
uterine pain extending to thighs
lochia offensive
promotes expulsion of retained parts

Answer 26

sabina

Question 27

putrid, dark lochia
mb no pain or cont bearing down pain
great prostration
burning fever interrupted by shaking chills, cold sweat over whole body

Answer 27

secale

Question 28

abx therapy for infxn?

Answer 28

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

Question 29

naturopathic tx of PP UTI? conventional?

Answer 29

botanical tincture: arctostaphylos, boldo, mahonia, althea
probiotics
pH lowering: ACV, vit C, cranberry
conventional: cephalexin 250 qid or 500 mg bid x 10 d

Question 30

cause of septic pelvic thrombophlebitis? ssxs? dx? tx?

Answer 30

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

Question 31

naturopathic tx of septic pelvic thrombophlebitis?

Answer 31

bromelain 1000 mg qid

homeopathics

Question 32

how to tx pelvic abscess?

Answer 32

botanicals
castor oil packs
abscess homeopathics
consider clindamycin which covers anaerobes
if do not respond to tx need to surgically drain then