PUERPERAL SEPSIS

Group II Aubrey Sarmiento Anne Moralizon Calvin Cordova Alex Salango Claudine Maghirang Cessna Mercado Windelyn Gamaro Riz Aquino Elsa Arceo Joseph Ronquilo

PUERPERAL SEPSIS

usually localized in the endometrium. . 6 hours apart on any 2 of the first 10 days postpartum. 1995). 1996). Postpartum infections are the leading causes of nosomial infection and maternal morbidity and mortality ( Clark. Criteria/Definition: of postpartum infection: an oral temperature greater than 38*C taken twice. excluding the first 24 hours after delivery (Bowes.PUERPERAL SEPSIS Description: any infection of the reproductive organs that occurs within the first 6 weeks after childbirth or 4 weeks after abortion.

ETIOLOGY Bacterial causative agents. both aerobic and anaerobic ( the most common being anaerobic streptococci Escherichia coli .

anemia. and malnutrition . 1996) y y Invasive procedures in prolonged labor with frequent vaginal examinations.20 times greater than in the vaginal birth is cesarean section (Littleton and Engebretson. commonly obtained from cultures of amniotic fluid History of UTI. 2006) y Colonization of amniotic fluid ( Bowes. Coli and Klehsiella. Prolonged delivery after rupture of membranes (>24 hours) Internal fetal monitoring Positive amniotic fluid culture: E. STDs Prenatal: Obesity.HIGH-RISK FACTORS Strongest predictions of developing a puerperal infection: Duration of labor> 18 hours Route of delivery: The single most significant risk for postpartum infections.

delayed uterine involution Body malaise. and tachycardia Change in the color. amount. headache Dysuria. odor (foul) and consistency of lochia Painful/tender uterine fundus. burning sensation on urination. costovertebral tenderness . chills.SIGNS AND SYMPTOMS Fever. anorexia.

COMPLICATIONS PID.pelvic inflammatory disease Pelvic cellulites Generalized peritonitis Puerperal sepsis is one of the leading cause of maternal mortality .

PROGNOSIS Improved with early detection and appropriate medical and nursing management .

28. Santiago .PATIENT·S PROFILE Name: Mrs. San Pablo City Age: 28 y/o Birth date: Jan. 2011 Admitting Diagnosis: Fever Admitting Physician: Dra. 31. X Address: City Subdivision. 1983 Civil Status: Married Religion: Roman Catholic Date Admitted: Jan.

.History of present illness: Prior to admission patient experienced fever. chills and foul vaginal discharges.

y ELIMINATION PATTERN y Urine output decrease and concentrated as observed for the past two days of confinement via catheter. ACTIVITY/EXERCISE y .FUNCTIONAL ASSESSMENT HEALTH PERCEPTION/HEALTH MGT. y Source of nutrition IVF. negative to nausea and vomiting. NUTRITIONAL AND METABOLIC PATTERN Reports loss of appetite. Patient experience generalized malaise and inability to perform daily task since fever arise. y Patient verbalizes anxiety with regards to procedures to be done but understands them thoroughly.

COGNITIVE/PERCEPTUAL PATTERN y SELF-PERCEPTION PATTERN y ROLE RELATIONSHIP PATTERN y SEXUALITY/REPRODUCTIVE PATTERN y . Patient has good relationship with family and peers as evidenced by husband·s support and frequent visitors. patient wasn·t able to sleep. Patient wanted to be able to do things just like before as evidence to approving to different procedures done. SLEEP/REST PATTERN y During confinement. She exhibits purulent vaginal discharge and perineal pruritus. Patient is conscious and coherent. Patient reports of recent childbirth.

VALUES/ BELIEF y . COPING/STRESS TOLERANCE PATTERN y Upon knowing the diagnosis the patient was anxious and angered when she found out the possible cause of her disease. But she was ready for any procedures and treatments to be done. The patient·s belief and values has no conflicting ideas with regards to the patient·s care.

31.020 (-) (-) 15-20/hpf 22.000 cells/mm3 .DIAGNOSTIC EXAMINATIONS Date: Jan. 2011 Test: Urinalysis Color Transparency Reaction Specific Gravity Sugar Albumin Pus Cells WBC Dark Yellow sL. Cloudy 6.0 1.

PHYSICAL ASSESSMENT Areas to Assess ‡ Skin Findings Dry and scaly. Vision is normal. no presence of rash but flushing was observed in the cheeks ‡Head Hair Evenly distributed and no infestations Nomocephalic. sclera slightly red Symmetrical. uniform color all over the face. presence of flushing in the cheeks. hearing is normal Skull and face Eyes and vision Ears and hearing .

and well oriented. Patient is conscious and coherent.Areas to assess Nose and sinuses Findings Symmetrical Absence of lesions on outer lip Mouth Absence of stiffness or pain ‡NECK ‡Lymph nodes Lymph nodes palpable in the neck area Chest is symmetrical. Weakness was observed in the extremities. breath sounds normal but increased respiratory rate No deformities or contractures. ‡Thorax and Lungs ‡Musculoskeletal ‡Neurologic .

Areas to Assess ‡Genital/Inguinal Findings Presences of purulent pus was seen in the vagina. Pain in the fundus. Site of episiotomy was swelling and foul lochia was observed. Patient·s anal area was normal. ‡Rectum/Anus .

RR-25 bpm. PR. Upon assessment data gathered are as follows: Pain in the fundic area v/s taken: BP.Mrs.85 bpm . X delivered a healthy baby boy six (6) days prior to admission. According to her she delivered via forceps delivery due to prolonged labor (duration 18 hours approximately). Upon admission she complained of foul discharges from her vagina and she had a temperature of 38*C per axillary.110/90.

NURSING CARE PLAN .

general peritonitis ultimately. death. .E·s w/c might have introduced microorganisms Forcep delivery that causes unintentional lacerations and open wounds on the uterus Infection delelops after a few days post partum Manifestation of fever. dysuria and elevated WBC If let untreated infection will spread: the woman may develop PID. foul vaginal discharges. lower abdominal pain.PATHOPHYSIOLOGY LGA Prolonged labor Frequent I.

After 8 hours T37. type of primary infecting organisms.000mm3 Monitor temperature trends . Fever is the result of endotoxins effects on the hypothalamus and pyrogenreleased endophins. Diagnosis Planning Intervention Rationale Evaluation Fever related to infection possibly acquired during delivery Address to patient·s fever and provide comfort to the client Maintain aseptique technique by washing hands before/after care activity Provide Tepid sponge bath to client To reduce risk of cross contamination. Inspect wound/site of invaside daily ‡ Pain in Fundic area with pain scale of 7.7*C Objective Cues: ‡v/s: BP.110/90 RR-25 bpm PR85 bpm T-38*C TSB promotes evaporation thus reducing the heat in the body. Goal partially met. ‡ Chills ‡Diagnostic results: WBC22. It provides clue to portal of entry. ‡ presence of catheter. Continue interventions until patient·s health is gained.Assessment Subjective Cues: ´May nana na nalabas sa pwerta koµ as verbalized by the patient.

application of warm/moist soaks as indicated Administer medication as indicated.Assessment Diagnosis Planning Intervention Observe for shaking chills and profuse diaphoresis Rationale Chills often precede temperature spikes and presence of generalized infection. . Depression of immune system and use of antibiotics increase risk of secondary infections. irrigation. Facilitates removal of purulent materials/necrot ic tissues and promotes healing Evaluation Investigate reports of vaginal/perineal itching or burning Assist w/prepare for I&D of wound. particularly yeast.

nephrotoxicity PREPARATION / PACKAGING Amp 80mg/ 2ml x 10 s NURSING RESPONSIBILI TIES ‡Ask for history of allergies ‡Skin test ‡Monitor V/S Ceftizoxime Tergen Cephalosporins Peritonitis. Gi disturbances. disturbances pelvic. Intrauterine infection Ampicillin Trihydrate Ampicin Antibiotics Shock. hypersensitivi ty reactions. vitamin deficiencies. 2-4 equal doses ‡Monitor V/S ‡Assess for sign of shock ‡Eat before taking ‡Ask for history of allergies 75mg/kg QID ‡Monitor hypersensitivit y to the drug ‡Maintain adequate fluid intake . 2g/day IV/IM inj. pregnancy infections due to susceptible organism SIDE/ ADVERSE EFFECT Ototoxicity. skin and Mononucleosis ty reactions. GI venereal. Uterine adnexitis. hematologic. Meningitis. soft tissue.GENERIC NAME BRAND NAME CLASSIFICATION INDICATION CONTRAINDICA TION Gentamicin Sulfate Gentamicin Antibiotics Life Hypersensitivit threatening y. reanal effect. severe systemic infections History of shock. headache Respiratory Infectious Hypersensitivi tract. hypersensitivit y to lidocaine or anilide-type local anesthesia 500mg. alteration of bacterial flora.

END .

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