Puerperal Infection Nursing Care Plan & Management

 Description

  1. Puerperal infection is an infection developing in the birth structures after delivery.
  2. Puerperal infection is a major cause of maternal morbidity and morality.
  3. The incidence ranges from 14% and to 8% of all deliveries; there is a higher incidence in cesarean deliveries.
  4. The major site of postpartum infections is the pelvic cavity; other common sites include the breast, urinary tract, and venous system.
  5. Localized infections may affect the vagina, vulva, and perineum.
  6. Endometritis, localized infection of the uterine lining, occurs 48 to 72 hours after delivery.
Etiology
  • Puerperal infections can be caused by poor sterile technique, delivery with significant manipulation, cesarean birth, or overgrowth of local flora.
Pathophysiology

1. Causative organisms

  • Aerobic organisms include beta-hemolytic streptococci, Escherichia coli, Klebsiella, Proteus mirabilis, Pseudomonas, Staphylococcus aureus, and Neisseria.
  • Anaerobic organisms include Bacteroides, Peptostreptococcus, Peptococcus, and Clostridium perfringens.

2. In parametritis (pelvic cellulitis), infection spreads by way of the lymphatics of the connective tissue          surrounding the uterus.

3. Puerperal infection may extend to the peritoneum by way of the lymph nodes and uterine wall.

Assessment Findings

1. Clinical manifestations

  • Puerperal morbidity is marked by a temperature of 38°C (100.4°F) or higher after the first 24 hours postpartum on any two of the first 10 postpartum days.
  • Localized vaginal, vulval, and perineal infections are marked by pain, elevated temperature, edema, redness, firmness, and tenderness at the sit of the wound; sensations of heat; burning on urination; and discharge from the wound.
  • Manifestations of endometritis include a rise in temperature for several days. In severe endometritis, symptoms include malaise, headache, backache, general discomfort, loss of appetite, large tender uterus, severe postpartum cramping, and brownish red, foul-smelling lochia.
  • Parametritis (pelvic cellulitis) commonly produces elevated temperature of more than 38.6°C (102° to 104°F), chills, abdominal pain, subinvolution of uterus, tachycardia, and lethargy.
  • Signs and symptoms of peritonitis include high fever, rapid pulse, abdominal pains, nausea, vomiting, and restlessness.
Nursing Management

1. Promote resolution of the infectious process.

  • Inspect the perineum twice daily for redness, edema, ecchymosis, and discharge.
  • Evaluate for abdominal pain, fever, malaise, tachycardia, and foul-smelling lochia.
  • Obtain specimens for laboratory analysis; report the findings.
  • Offer a balanced diet, frequent fluids, and early ambulation.
  • Administer prescribed antibiotics or medications; document the client’s response.

2. Provide client and family teaching. Describe and demonstrate self-care, stressing careful perineal hygiene and handwashing.