PUERPERAL INFECTION - PUERPERALINFECTION

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PUERPERAL INFECTION Puerperal infection is an infection of the reproductive tract occurring within 28 days following childbirth or  abortion. It is one of the major causes of maternal death (ranking second behind postpartal hemorrhage) and includes  localized   infectious   processes   as   well   as   more   progressive   processes   that   may   result   in   endometritis/metritis  (inflammation of endometrium), peritonitis, or parametritis/pelvic cellulitis (infection of connective tissue of broad  ligament and possibly connective tissue of all pelvic structures).  (This plan of care is an adjunct to the regular postpartal plans of care.) CLIENT ASSESSMENT DATA BASE Activity/Rest Malaise, lethargy Exhaustion and/or ongoing fatigue (prolonged labor, multiple postpartal stressors) Circulation Tachycardia of varying severity Elimination Diarrhea may be present. Bowel sounds may be absent if paralytic ileus occurs. Ego Integrity Marked anxiety (peritonitis) Food/Fluid Anorexia, nausea/vomiting Thirst, dry mucous membranes Abdominal distension, rigidity, rebound tenderness (peritonitis) Hygiene Lack of or inadequate perineal care Neurosensory Headache Pain/Discomfort Localized pain, dysuria, abdominal discomfort Severe or prolonged afterpains, lower abdominal or uterine pain and tenderness with guarding (endometritis) Unilateral/bilateral abdominal pain/rigidity (salpingitis/oophoritis, parametritis) Respiration Rapid/shallow respirations (severe/systemic process)
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Safety Temperature: 100.4°F (38.0°C) or higher, occurring on any 2 successive days but excluding the first 24 hr postpartum,  is indicative of infection; however, temperature higher than 101°F (38.3°C) in the first 24 hr is highly indicative  of ensuing infection (although persistent low-grade fever during this time may also reflect infectious process). Low-grade fever of less than 101°F (38.3°C) suggests incisional infection; fever greater than 102°F (38.8°C) is  indicative of more extensive infection (e.g., salpingitis, parametritis, peritonitis). Chills may occur; severe/recurrent chills (often lasting 30–40 min), with temperature spikes to 104°F (40.0°C), suggest  pelvic infections, thrombophlebitis, or peritonitis. Reports of internal monitoring, frequent intrapartal vaginal examinations, lapses in aseptic technique, traumatic  delivery and/or lacerations of reproductive tract, operative procedures/incisions. Preexisting infections, including human immunodeficiency virus (HIV). Environmental exposure.
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PUERPERAL INFECTION - PUERPERALINFECTION

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