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 postpartum 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 Care Plans
The nursing management of clients with puerperal infection includes preventing the control spread of infection, promoting healing, and improving the attachment/bonding of parent and infant.
Here are four (4) nursing care plans for Puerperal Infection or postpartum infections:
- Risk For Infection
- Acute Pain
- Risk For Altered Parent-Infant Attachment
- Imbalanced Nutrition: Less Than Body Requirements
Risk for Infection: At increased risk for being invaded by pathogenic organisms.
- 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)
Possibly evidenced by
- [Not applicable]
- Patient will verbalize understanding of individual causative risk factors.
- Patient will initiate behaviors to limit the spread of infection, as appropriate, and reduce the risk of complications.
- Patient will achieve timely healing, free of additional complications.
|Review prenatal, intrapartal, and postpartal record.||Identifies factors that place client in high-risk|
category for development/spread of postpartal infection.
|Demonstrate and maintain a strict hand-washing policy for staff, client, and visitors.||Helps prevent cross-contamination.|
|Instruct the proper disposal of contaminated linens, dressings, and peripads. Maintain isolation, if indicated.||Prevents spread of infection.|
|Demonstrate correct perineal cleaning after voiding and defecation, and frequent changing of peripads.||Cleaning removes urinary/fecal contaminants. Changing pad removes moist medium that favors bacterial growth.|
|Demonstrate proper fundal massage. Review importance and timing of the procedure.||Enhances uterine contractility; promotes involution and passage of any retained placental fragments.|
|Monitor temperature, pulse, and respirations. Note presence of chills or reports of anorexia or malaise.||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.|
|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.||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.|
|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.||Increased intake replaces losses and enhances circulating volume, preventing dehydration and aiding in fever reduction.|
|Encourage semi-Fowler’s position.||Enhances flow of lochia and uterine/pelvic drainage.|
|Promote early ambulation, balanced with adequate rest. Advance activity as appropriate.||Increases circulation; promotes clearing of respiratory secretions and lochial drainage; enhances healing and general well-being. Note: Presence of pelvic/femoral thrombophlebitis may require strict bed rest.|
|Investigate reports of leg or chest pain. Note pallor, swelling, or stiffness of lower extremity.||These signs and symptoms are suggestive of septic thrombus formation. Note: Embolic sequelae, especially pulmonary embolism, may be initial indicator of thrombophlebitis.|
|Recommend that breastfeeding mother periodically check infant’s mouth for presence of white patches.||Oral thrush in the newborn is a common side effect of maternal antibiotic therapy.|
|Encourage client/couple to prioritize postdischarge responsibilities (e.g., homemaking tasks, child care)||Client will require additional rest to facilitate recuperation/healing. Household duties need to be reassigned or delayed as appropriate.|
|Instruct in proper medication use (e.g., with or without meals,take entire course of antibiotic, as prescribed).||Oral antibiotics may be continued after discharge. Failure to complete medication may lead to relapse.|
|Discuss the importance of pelvic rest as appropriate (avoidance of douching, tampons, and intercourse).||Promotes healing and reduces the risk of reinfection.|
|Monitor laboratory studies, as indicated:||Identifies infectious process/causative organism and appropriate antimicrobial agents.|
|Aids in tracking resolution of infectious or inflammatory process. Identifies degree of blood loss and determines presence of anemia.|
|Helps in identifying alterations in clotting associated with development of emboli. Aids in determining effectiveness of anticoagulation therapy.|
|Hepatic insufficiency and decreased renal function may develop, altering drug half-life and increasing risks of toxicity|
|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.||Water promotes cleansing. Heat dilates perineal blood vessels, increasing localized blood flow and promotes healing.|
|Provide supplemental oxygen when necessary.||Promotes healing and tissue regeneration, especially in presence of anemia; may enhance oxygenation when pulmonary emboli are present.|
|Demonstrate perineal application of antibiotic creams, as appropriate.||Eradicates local infectious organisms, reducing risk of spreading infection.|
|Administer medications as indicated:|
|Combats pathogenic organisms, helping prevent infection from spreading to surrounding tissues and bloodstream. Note: Parenteral route is preferred for parametritis, peritonitis, and, on occasion, endometritis.|
|Promotes myometrial contractility to retard the spread of bacteria through the uterine walls, and aids in the expulsion of clots and retained placental fragments.|
|In presence of pelvic thrombophlebitis, anticoagulants prevent or reduce additional thrombi formation and limit spread of septic emboli.|
|Administer whole blood/packed RBCs, if needed.||Replaces blood losses and increases oxygen-carrying capacity in presence of severe anemia and/or hemorrhage.|
|Arrange for transfer to intensive care setting as appropriate.||May be necessary for client with severe infection (e.g., peritonitis, sepsis) or pulmonary emboli to provide appropriate care leading to optimal recovery.|
|Assist with procedures, such as incision and drainage (I&D) or D & C, as necessary.||Draining the infected area, and possible insertion of iodoform gauze packing, promotes healing and reduces risk of rupture into peritoneal cavity. D & C may be needed to remove retained products of conception and/or placental fragments.|
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Maternal and Newborn Care Plans
Nursing care plans related to the care of the pregnant mother and her infant. See care plans for maternity and obstetric nursing:
- Abruptio Placenta| 3 Care Plan
- Cesarean Birth | 10 Care Plans
- Cleft Palate and Cleft Lip | 6 Care Plans
- Dysfunctional Labor (Dystocia) | 4 Care Plans
- Elective Termination | 6 Care Plans
- Gestational Diabetes Mellitus | 4 Care Plans
- Hyperbilirubinemia | 4 Care Plans
- Labor Stages, Induced and Augmented Labor | 36 Care Plans
- Neonatal Sepsis | 5 Care Plans
- Perinatal Loss | 5 Care Plans
- Placenta Previa | 3 Care Plans
- Postpartum Hemorrhage | 8 Care Plans
- Postpartum Thrombophlebitis | 4 Care Plans
- Prenatal Hemorrhage | 7 Care Plans
- Prenatal Substance Dependence/Abuse | 6 Care Plans
- Precipitous Labor | 3 Care Plans
- Pregnancy Induced Hypertension | 6 Care Plans
- Premature Dilation of the Cervix | 3 Care Plans
- Prenatal Infection | 3 Care Plans
- Preterm Labor | 6 Care Plans
- Puerperal Infection | 4 Care Plans
Recommended books and resources:
- Nursing Care Plans: Diagnoses, Interventions, and Outcomes
- Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
- Nursing Diagnoses 2015-17: Definitions and Classification
- Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)
- Manual of Psychiatric Nursing Care Planning
- Maternal Newborn Nursing Care Plans
- Delmar's Maternal-Infant Nursing Care Plans, 2nd Edition
- Maternal Newborn Nursing Care Plans