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

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) y Colonization of amniotic fluid ( Bowes, 1996)
y y

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

PATIENTS 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.

y

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. y Source of nutrition IVF.
y

ELIMINATION PATTERN
y

Urine output decrease and concentrated as observed for the past two days of confinement via catheter. Patient experience generalized malaise and inability to perform daily task since fever arise.

ACTIVITY/EXERCISE
y

SLEEP/REST PATTERN
y

During confinement, patient wasnt able to sleep. Patient is conscious and coherent. Patient wanted to be able to do things just like before as evidence to approving to different procedures done. Patient has good relationship with family and peers as evidenced by husbands support and frequent visitors. Patient reports of recent childbirth. She exhibits purulent vaginal discharge and perineal pruritus.

COGNITIVE/PERCEPTUAL PATTERN
y

SELF-PERCEPTION PATTERN
y

ROLE RELATIONSHIP PATTERN

y

SEXUALITY/REPRODUCTIVE PATTERN
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 patients belief and values has no conflicting ideas with regards to the patients care.

VALUES/ BELIEF
y

DIAGNOSTIC EXAMINATIONS
Date: Jan. 31, 2011 Test: Urinalysis Color Transparency Reaction Specific Gravity Sugar Albumin Pus Cells WBC Dark Yellow sL. Cloudy 6.0 1.020 (-) (-) 15-20/hpf 22,000 cells/mm3

PHYSICAL ASSESSMENT
Areas to Assess Skin Findings Dry and scaly, no presence of rash but flushing was observed in the cheeks

Head Hair

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

Skull and face

Eyes and vision

Ears and hearing

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, 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.

Thorax and Lungs

Musculoskeletal

Neurologic

Areas to Assess Genital/Inguinal

Findings Presences of purulent pus was seen in the vagina. Site of episiotomy was swelling and foul lochia was observed. Pain in the fundus. Patients anal area was normal.

Rectum/Anus

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

PATHOPHYSIOLOGY
LGA Prolonged labor Frequent I.Es 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 Subjective Cues: May nana na nalabas sa pwerta ko as verbalized by the patient.

Diagnosis

Planning

Intervention

Rationale

Evaluation

Fever related to infection possibly acquired during delivery

Address to patients 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.

Goal partially met. After 8 hours T37.7*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. It provides clue to portal of entry, type of primary infecting organisms. Fever is the result of endotoxins effects on the hypothalamus and pyrogenreleased endophins.

Continue interventions until patients health is gained.

presence of catheter.

Inspect wound/site of invaside daily

Pain in Fundic area with pain scale of 7. Chills Diagnostic results: WBC22,000mm3

Monitor temperature trends

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, particularly yeast. 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, irrigation, application of warm/moist soaks as indicated

Administer medication as indicated.

GENERIC NAME

BRAND NAME

CLASSIFICATION

INDICATION

CONTRAINDICA TION

Gentamicin Sulfate

Gentamicin

Antibiotics

Life Hypersensitivit threatening y, pregnancy infections due to susceptible organism

SIDE/ ADVERSE EFFECT Ototoxicity, 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, Uterine adnexitis, Meningitis, Intrauterine infection

Ampicillin Trihydrate

Ampicin

Antibiotics

Shock, hypersensitivi ty reactions, hematologic, reanal effect, Gi disturbances, alteration of bacterial flora, vitamin deficiencies, headache Respiratory Infectious Hypersensitivi tract, skin and Mononucleosis ty reactions, soft tissue, GI venereal, disturbances pelvic, severe systemic infections

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

500mg, 2g/day IV/IM inj. 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

END