Postpartum Infection (PDF)
Document Details
Uploaded by ExultantBeech
Jordan University of Science and Technology
Tags
Summary
This document provides information on postnatal infections, specifically puerperal infections, including endometritis (or metritis) and mastitis. It covers the etiology (risk factors), pathophysiology, manifestations, laboratory data, therapeutic management, complications, and nursing considerations. The document also discusses mastitis, its symptoms, etiology, and management.
Full Transcript
Postnatal infection Puerperal Infection Endometritis (Metritis), Mastitis Chapter 28 1 Puerperal Infection Is a fever of 38°C or higher occurring at least 2 of the first 10 days after the first 24 hours following child birth...
Postnatal infection Puerperal Infection Endometritis (Metritis), Mastitis Chapter 28 1 Puerperal Infection Is a fever of 38°C or higher occurring at least 2 of the first 10 days after the first 24 hours following child birth 2 2 Puerperal Infection Etiology (Risk Factors) History of previous infection (UTI, Mastitis) Cesarean birth Trauma (from large baby, ventouse extraction (vacuum), laceration, episiotomy Catheterization Prolong rupture of membranes Prolong labor 3 3 Puerperal Infection Etiology (Risk Factors) Cont. Excessive number of vaginal Examination Retained placental fragments Hemorrhage Poor nutrition (Vit C, Anemia) Poor hygiene 4 4 Puerperal Infection Etiology (Risk Factors) Cont. Poor general health Medical condition (D.M) Low socioeconomic Status Colonization of lower genital tract with pathogenic organisms 5 5 Pathophysiology Every part of reproductive system is connected to each other Entire reproductive system is well supplied with blood vessels and blood vessels can carry infection to the rest of body Vaginal discharge acidity decrease during labor Necrosis of endometrial lining and presence of lochia Many small laceration occurs in endometrium, cervix and vagina 6 6 Endometritis (Metritis) Definition: Infection of the Uterus Also Called: Endometritis Endomyometritis Endoparametritis Etiology: Organism normal inhabitants of vagina such as group A and B streptococci and E. coli 7 7 Manifestation of Metritis Fever, chill, malaise, anorexia, abdominal pain and cramping. Uterine tenderness Foul purulent smelling lochia Additional signs: tachycardia and subinvolution 8 8 Laboratory data: Increased WBC Blood culture, endocervix culture uterine cavity culture Urine specimen 9 9 Therapeutic management of metritis I.V. administration of broad spectrum antibiotics such as Clindamycin and gentamicin Ampicillin, cephalsporin, metronidazole 10 10 Therapeutic management of metritis cont. Oral antibiotics is unnecessary after IV completion Prophylactic antibiotics IV after CS Antipyretic for fever Oxytocics (e.g. methargine) to increase lochia drainage 11 11 Complications of Metritis Salpingitis Oophoritis (may lead to sterility) Peritonitis (may lead to pelvic abcess) Pelvic thrombophlebitis 12 12 Nursing consideration (Metritis) Fowler's position to promote drainage of lochia Medication as needed for pain Observe woman for signs of improvement Observe woman for signs of complications. Assess vital signs every two hours if there is fever and then every 4 hours 13 13 Provide comfort measures Warm blanket Cool compress Cold or warm drink Heating pad Food high in vitamin C and protein 14 14 Teaching S/S of complication Side effect of therapy Adhering to therapy If woman will breast feed her baby, pump breast to maintain lactation 15 15 Mastitis An infection of breast occurs most often during 2nd and 4th week after birth Usually affect one breast 16 16 Etiology Staphylococcus aureous from: Crack or soreness nipple Incomplete emptying of breast Engorgement and stasis of milk Constriction of breast by bra Stress (decrease immunity) 17 17 Manifestation of Mastitis Flue –like symptoms initially Fatigue, muscle aches Fever 38.4°C or higher Chills, maliase, headache Localized wedge – shaped area ()وﺗﺪ that is red, edematous, hot and painful 18 18 19 19 Therapeutic management of mastitis Antibiotics Emptying of breast by feeding or pump. (Breast feeding should be continued unless an abscess is ruptured into breast duct) Surgical drainage and antibiotics if abscess develop 20 20 Supportive measures – Heat or ice packs – Breast support – Analgesics – Continuous emptying of the breast 21 21 Change nursing pads when they are wet Avoid continuous pressure on breast from tight bra or carrying infant 22 22 What about Breast Feeding? Breast feeding should be continued unless an abscess is ruptured into breast duct , in this case breast feeding should be discontinued from that side and emptying of this side should be by pump temporarily. But breast feeding should be continued from other side 23 23 Nursing consideration (Mastitis) Preventive Measure: Correct positioning of infant Avoid nipple trauma and milk stasis Breast feeding every 2 to 3 hours Avoid formula supplements and breast shields 24 24 25 If mastitis occurs Comfort measure and enhance lactation Moist heat application Shower or hot packs before feeding or pumping Cold packs to reduce edema between feeding Complete emptying of breast 26 26 Massage over affected area before and during feeding to empty it completely Fluid intake at least 2500 -3000ml /day Analgesics 27 27 Encourage mother not to stop breast feeding Engorgement during weaning may lead to abscess formation Mother should stay in bed during acute phase of illness Pumping or breast feeding every hour and half or 2 hours 28 28