PUERPERAL SEPSIS

Group II

Aubrey Sarmiento Cessna Mercado

Anne Moralizon Windelyn Gamaro

Calvin Cordova Riz Aquino

Alex Salango Elsa Arceo

Claudine Maghirang Joseph Ronquilo

PUERPERAL SEPSIS

PUERPERAL SEPSIS

Description: any infection of the reproductive organs that occurs within the first 6 weeks after childbirth or 4 weeks after abortion; usually localized in the endometrium. Postpartum infections are the leading causes of nosomial infection and maternal morbidity and mortality ( Clark, 1995).

Criteria/Definition: of postpartum infection: an oral temperature greater than 38*C taken twice, 6 hours apart on any 2 of the first 10 days postpartum, excluding the first 24 hours after delivery (Bowes, 1996).

ETIOLOGY

Bacterial causative agents, both aerobic and anaerobic ( the most common being anaerobic streptococci

Escherichia coli

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- 20 times greater than in the vaginal birth is cesarean section (Littleton and Engebretson, 2006)

Colonization of amniotic fluid ( Bowes, 1996) Invasive procedures in prolonged labor with frequent

vaginal examinations. Prolonged delivery after rupture of membranes (>24

hours) Internal fetal monitoring Positive amniotic fluid culture: E. Coli and Klehsiella,

commonly obtained from cultures of amniotic fluid History of UTI, STDs Prenatal: Obesity, anemia, and malnutrition

SIGNS AND SYMPTOMS

Fever, chills, and tachycardia Change in the color, amount, odor (foul) and

consistency of lochia Painful/tender uterine fundus; delayed

uterine involution Body malaise, anorexia, headache Dysuria, burning sensation on urination,

costovertebral tenderness

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

PATIENT’S PROFILE

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

History of present illness: Prior to admission patient experienced fever, chills

and foul vaginal discharges.

FUNCTIONAL ASSESSMENT

HEALTH PERCEPTION/HEALTH MGT. Patient verbalizes anxiety with regards to procedures

to be done but understands them thoroughly. NUTRITIONAL AND METABOLIC PATTERN

Reports loss of appetite; negative to nausea and vomiting.

Source of nutrition IVF. ELIMINATION PATTERN

Urine output decrease and concentrated as observed for the past two days of confinement via catheter.

ACTIVITY/EXERCISE Patient experience generalized malaise and inability

to perform daily task since fever arise.

SLEEP/REST PATTERN During confinement, patient wasn’t able to sleep.

COGNITIVE/PERCEPTUAL PATTERN Patient is conscious and coherent.

SELF-PERCEPTION PATTERN Patient wanted to be able to do things just like before

as evidence to approving to different procedures done. ROLE RELATIONSHIP PATTERN

Patient has good relationship with family and peers as evidenced by husband’s support and frequent visitors.

SEXUALITY/REPRODUCTIVE PATTERN Patient reports of recent childbirth. She exhibits

purulent vaginal discharge and perineal pruritus.

COPING/STRESS TOLERANCE PATTERN 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.

VALUES/ BELIEF The patient’s belief and values has no conflicting ideas

with regards to the patient’s care.

DIAGNOSTIC EXAMINATIONS

Color Dark Yellow

Transparency sL. Cloudy

Reaction 6.0

Specific Gravity 1.020

Sugar (-)

Albumin (-)

Pus Cells 15-20/hpf

WBC 22,000 cells/mm3

Date: Jan. 31, 2011Test: Urinalysis

PHYSICAL ASSESSMENT

Areas to Assess Findings

• Skin

•HeadHair

Skull and face

Eyes and vision

Ears and hearing

Dry and scaly, no presence of rash but flushing was observed in the cheeks

Evenly distributed and no infestations

Nomocephalic, uniform color all over the face, presence of flushing in the cheeks.Vision is normal, sclera slightly red

Symmetrical, hearing is normal

Areas to assess FindingsNose and sinuses

Mouth

•NECK

•Lymph nodes

•Thorax and Lungs

•Musculoskeletal

•Neurologic

Symmetrical

Absence of lesions on outer lip

Absence of stiffness or pain

Lymph nodes palpable in the neck area

Chest is symmetrical, breath sounds normal but increased respiratory rate

No deformities or contractures. Weakness was observed in the extremities.

Patient is conscious and coherent, and well oriented.

Areas to Assess Findings

•Genital/Inguinal

•Rectum/Anus

Presences of purulent pus was seen in the vagina. Site of episiotomy was swelling and foul lochia was observed. Pain in the fundus.

Patient’s anal area was normal.

Mrs. 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. Upon assessment data gathered are as follows:

Pain in the fundic area v/s taken: BP- 110/90, RR-25 bpm, PR- 85 bpm

NURSING CARE PLAN

PATHOPHYSIOLOGYLGA

Prolonged labor

Frequent I.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, foul vaginal discharges, lower abdominal pain, dysuria and elevated WBC

If let untreated infection will spread: the woman may develop PID, general peritonitis ultimately, death.

Assessment Diagnosis Planning Intervention Rationale Evaluation

Subjective Cues:

“May nana na nalabas sa pwerta ko” as verbalized by the patient.

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

To reduce risk of cross contamination.

Goal partially met.After 8 hours T-37.7*C

Objective Cues:•v/s: BP- 110/90 RR-25 bpm PR- 85 bpm T-38*C

Provide Tepid sponge bath to client

TSB promotes evaporation thus reducing the heat in the body.

Continue interventions until patient’s health is gained.

• presence of catheter.

Inspect wound/site of invaside daily

It provides clue to portal of entry, type of primary infecting organisms.

• Pain in Fundic area with pain scale of 7.• Chills

•Diagnostic results: WBC- 22,000mm3

Monitor temperature trends

Fever is the result of endotoxins effects on the hypothalamus and pyrogen-released endophins.

Assessment Diagnosis Planning Intervention Rationale Evaluation

Observe for shaking chills and profuse diaphoresis

Investigate reports of vaginal/perineal itching or burning

Assist w/prepare for I&D of wound, irrigation, application of warm/moist soaks as indicated

Administer medication as indicated.

Chills often precede temperature spikes and presence of generalized infection.

Depression of immune system and use of antibiotics increase risk of secondary infections, particularly yeast.

Facilitates removal of purulent materials/necrotic tissues and promotes healing

GENERIC NAME BRAND NAME CLASSIFICATION INDICATION CONTRAINDICATION

SIDE/ ADVERSE EFFECT

PREPARATION/ PACKAGING

NURSING RESPONSIBILITIES

Gentamicin Sulfate

Gentamicin Antibiotics Life threatening infections due to susceptible organism

Hypersensitivity, pregnancy

Ototoxicity, nephrotoxicity

Amp 80mg/ 2ml x 10’s

•Ask for history of allergies•Skin test•Monitor V/S

Ceftizoxime Tergen Cephalosporins Peritonitis, Uterine adnexitis, Meningitis, Intrauterine infection

History of shock, hypersensitivity to lidocaine or anilide-type local anesthesia

Shock, hypersensitivity reactions, hematologic, reanal effect, Gi disturbances, alteration of bacterial flora, vitamin deficiencies, headache

500mg, 2g/dayIV/IM inj.2-4 equal doses

•Monitor V/S•Assess for sign of shock•Eat before taking•Ask for history of allergies

Ampicillin Trihydrate

Ampicin Antibiotics Respiratory tract, skin and soft tissue, venereal, pelvic, severe systemic infections

Infectious Mononucleosis

Hypersensitivity reactions, GI disturbances

75mg/kg QID•Monitor hypersensitivity to the drug•Maintain adequate fluid intake

END