Nursing Care Plan for 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).


NURSING PRIORITIES
1. Control spread of infection.
2. Promote healing.
3. Support ongoing process of family acquaintance.

DISCHARGE GOALS
1. Infection resolving
2. Involution progressing, sense of well-being expressed
3. Attachment/bonding demonstrated and care of infant resumed

Nursing diagnosis for Puerperal Infection: Infection may be related to presence of infection, broken skin and/or traumatized tissues, high vascularity of involved area, invasive procedures and/or increased environmental exposure, chronic disease (e.g., diabetes), anemia, malnutrition, immunosuppression and/or untoward effect of medication (e.g., opportunistic/secondary infections)

Desired Outcomes
1. Verbalize understanding of individual causative risk factors.
2. Initiate behaviors to limit spread of infection, as appropriate, and reduce risk of complications.
3. Achieve timely healing, free of additional complications.

Nursing intervention with rationale
1. Review prenatal, intrapartal, and postpartal record.
Rationale: Identifies factors that place client in high-risk category for development/spread of postpartal infection.

2. Demonstrate and maintain strict hand-washing policy for staff, client, and visitors.
Rationale: Helps prevent cross-contamination.

3. Provide for, and instruct client in, proper disposal of contaminated linens, dressings, chux, and peripads. Initiate/maintain isolation, if indicated.
Rationale: Prevents spread of infection.

4. Demonstrate/encourage correct perineal cleaning after voiding and defecation, and frequent changing of peripads.
Rationale: Cleaning removes urinary/fecal contaminants. Changing pad removes moist medium that favors bacterial growth.

5. Demonstrate proper fundal massage. Review importance and timing of procedure.
Rationale: Enhances uterine contractility; promotes involution and passage of any retained placental fragments.

6. Monitor temperature, pulse, and respirations. Note presence of chills or reports of anorexia or malaise.
Rationale: Elevations in vital signs accompany infection; fluctuations, or changes in symptoms, suggest alterations in client status. Note: Persistent fever unresponsive to antibiotic therapy may indicate pelvic thrombophlebitis.

7. Observe perineum/incision for other signs of infection (e.g., redness, edema, ecchymosis, discharge and approximation [REEDA scale]). Note subinvolution of uterus, extreme uterine tenderness.
Rationale: Allows early identification and treatment; promotes resolution of infection. Note: Although localized infections are usually not severe, occasional progression to necrotizing fasculitis can be life-threatening.

8. Monitor oral/parenteral intake, stressing the need for at least 2000 ml fluid per day. Note urine output, degree of hydration, and presence of nausea, vomiting, or diarrhea.
Rationale: Increased intake replaces losses and enhances circulating volume, preventing dehydration and aiding in fever reduction.

9. Encourage application of moist heat in the form of sitz baths and of dry heat in the form of perineal lights for 15 min 2–4 times daily.
Rationale: Water promotes cleansing. Heat dilates perineal blood vessels, increasing localized blood flow and promotes healing.

10. Arrange for transfer to intensive care setting as appropriate.
Rationale: May be necessary for client with severe infection (e.g., peritonitis, sepsis) or pulmonary emboli to provide appropriate care leading to optimal recovery.