Presented by : Don Leo M dela Pea BSN II- B

The infection rate following cesarean births is 3-5% with the highest rate occurring after emergency cesarean because there is more traumatization of the tissue (Gibbs et. al. 2004)

Predisposing Factors

Obesity Diabetes Mellitus Prolonged postpartal hospitalization PROM Metritis Prolonged labor Anemia Steroid therapy Immunosuppression

Signs of Abdominal Infection

Which may be not evident until after discharge includes: o Erythema o Warmth o Skin discoloration o Edema o Tenderness o Purulent discharge o Gaping of wound edges

Fever, pain, malodorous lochia, and other systemic signs are common.

abdominal distention and decrease bowel sounds may

be noted.
culture of the wound drainage commonly reveals

mixed pathogen.

Clinical Therapy
The infection site and causative organism are diagnosed by careful history and complete physical examination
Broad-spectrum antibiotic coverage treats

postpartal wound infection. Cephalosporins, penicillinase-resistant penicillin, and vancomycin are commonly used with anaerobic coverage by clindamycin or ampicillin ( Newton, 2003)

Antibiotic are generally continued until the woman is afebrile for 24-28 hours.
An abscess is frequently manifested by the development of a palpable mass and may be confirmed with ultrasound. It requires: 1. Incision 2. Drainage to prevent rupture

The woman with severe systemic infection is acutely ill and may require care in an intensive care unit. Support with adequate hydration with intravenous fluids, analgesic medications, ongoing assessment of the infection, and possible continuous nasogastric suctioning if paralytic ileus develops.

Nursing Management
inspect the womans perineum every 8-12 hours for

signs of early infection. The REEDA scale is reminder to consider R- Redness E- edema E- ecchymosis D- discharge A- approximation

Note and report fever, malaise, abdominal pain, foulsmelling lochia, tachycardia, and other kind of infection. Increased WBC level of more than 30% in 6hrs. Period, is indicative of infection.
WBC cannot be used reliably because of normal increased in WBCs during PP periods.

Nursing Diagnosis
Risk for Injury r/t the spread of infection
Pain r/t the presence of infection Risk for altered parenting r/t delayed parent infant

attachment secondary to womans pain and other symptoms of infection

Planning and Implementation ( Hospital-Based Nursing Care)

Teach the woman on self-care measure to prevent

infection. The woman should understand the importance of perineal care, good hygiene, practice to prevent contamination of the perineum including: 1. Wiping from front to back 2. Changing perineal pads 3. Handwashing

 Encourage to sitz baths once edema and perineal pain

is under control to cleanse and promote healing Adequate fluid intake, high protein diet, and vit. C for wound healing and prevention of infection Instructed on proper wound care and how to discard soiled dressing. Administered meds and IVF regulated properly Keep the woman comfortable by providing hygiene , positioning , oral care, and pain relief

Nursing care in the Community

Home care services should be contacted as puerperal

infection is diagnosed. Give instruction on proper NB care including feeding, bathing, cord care, immunization, and significant observation Mother who is receiving antibiotic should be instructed to check the infants mouth for signs of thrush.

 Tell the mother about

1. 2.

3.
4. 5. 6.

Activity Rest Medication Diet Sign and symptoms And schedule a return medical visit

The woman should know the importance of pelvic rest; that is not use tampons or douches or have intercourse until she has been examined by physician and told it is safe to resume activity.

Evaluation
Expected outcomes of nursing care include the following: 1. The infection is quickly identified and treated successfully, without further complications. 2. The woman understands the infection and the purpose of therapy; she cooperates with ongoing antibiotics therapy after discharge 3.Maternal-infant attachment is maintained