Thursday, January 3, 2019

Nursing Care Plan for Puerperal Sepsis | Pathophysiology of Puerperal Sepsis

What is Puerperal Sepsis?
Puerperal infection is the infection of genital tract that occurs at any time between the onset of rupture of membrane or labor within 42nd days after abortion or delivery. 
Puerperal sepsis nursing care plan
Fig: Puerperal sepsis nursing care plan
Pathophysiology of Puerperal Sepsis:
The uterine infection may start before the onset of labor e.g. in cases of pre-labor rupture of membranes, during labor, or in the early postnatal period before healing of lacerations in the genital tract.

Following delivery, puerperal sepsis may be localized in the perineum, vagina or uterus. Some of the most common bacteria lead to infection such as streptococci, staphylococci, Escherichia coli, Clostridium tetani, Clostridium welchii, gonococci etc. bacteria of the uterus can rapidly spread due to virulent organisms, or mother’s immunity is impaired. When infection occurs in the uterine lining it’s called endometritis and infection in the uterine muscle called myometritis.

It can extend beyond the uterus to involve the fallopian tubes and ovaries, to the pelvic cellular tissue causing parametrizes to the pelvic peritoneum, causing peritonitis, and into the bloodstream causing septicemia. Thrombophlebitis of the uterine veins can transport infected clots to other organs that lead pulmonary embolism.

26 Nursing Interventions for Puerperal Sepsis:
All the nursing interventions for puerperal sepsis have listed in the below:

  1. Assess the woman’s condition.
  2. Monitor vital sing carefully and keep accurate records (Note the presence of chills or reports of anorexia or malaise).
  3. Give tepid sponge if high fever present.
  4. Observe perineum/incision for other signs of infection (e.g., redness, edema, ecchymosis, and discharge.
  5. Evaluate for abdominal pain, fever, malaise, tachycardia, and foul-smelling lochia.
  6. Provide proper fundal massage to enhance uterine contractility and passage of any retained placental fragments as subinvolution of uterus, extreme uterine tenderness.
  7. Check perineum/incision for other signs of infection (e.g., redness, edema, ecchymosis, and discharge)
  8. As soon as infection is suspected, isolate the woman.
  9. Obtain specimens for laboratory analysis to investigate the causative organisms and confirm the diagnosis.
  10. Wear gown and gloves when attending to the woman and remove the gown and gloves on completion of her care.
  11. Wash hands carefully before and after attending to the woman.
  12. Demonstrate and strictly maintain hand washing for patients, client, and medical staff.
  13. Keep one set of equipment, dishes, and utensil exclusively for the use of this woman and make sure they are not used by anyone else.
  14. Maintain high standards of hygiene, particularly during perineal and vulval care.
  15. Review the perineum twice daily for redness, ecchymosis, edema, and discharge.
  16. Ensure that soiled dressings and periods are disposed of carefully.
  17. Ensure that soiled linen is placed in a bag which specially marked for transport to the laundry, where it will be specially treated.
  18. Ensure adequate bed rest of affected woman.
  19. Administer prescribed antibiotics or medications and document the client’s response.
  20. Instruct in proper medication use (e.g., with or without meals, take the entire course of antibiotic, as prescribed).
  21. Instruct and demonstrate the correct perineal cleaning process after voiding and defecation.
  22. Suggest a balanced diet, frequent fluids, and early ambulation.
  23. Monitor intake output charts strictly and ensure at least 2000ml fluid per day.
  24. Promote early ambulation, balanced with adequate rest. Ambulation helps to increase circulation; promote clearing of respiratory secretions and lochia drainage; enhance healing and general well-being.
  25. Explain the significance of pelvic rest as appropriate (avoidance of douching, tampons, and intercourse). Promotes healing and reduces the risk of reinfection.
  26. Resuscitate the women if needed.