Nursing Care Plan & Management for Infections During Pregnancy

Infections during Pregnancy

• Maternal infections during pregnancy can lead to fetal morbidity and mortality.

• Common groups of infections:

  • Sexually transmitted infections (STIs)

  • TORCH infections (Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes)

Symptoms of Infections in Pregnancy

• General Symptoms:

  • Temperature elevation (>100.4°F)

  • Elevated white blood cell count

  • Chills and body aches

  • Malaise

Nursing Interventions for Infections

• Obtain cultures for discharge as needed.

• Report abnormal lab findings.

• Administer antibiotics as prescribed, considering breastfeeding safety.

• Monitor the patient's temperature.

• Educate the patient on signs and symptoms to report.

Specific Infections

Endometritis (Uterine Infection)

• Contributing Factors:

  • Operative birth

  • Long labor, frequent exams

  • Internal monitoring

  • Premature rupture of membranes

  • Manual placenta removal

• Clinical Findings:

  • Subinvolution of the uterus

  • Foul-smelling discharge

  • Abdominal cramping

Incisional Infection

• Contributing Factors:

  • Poor incision care

  • Operative delivery

  • Laceration

• Signs:

  • Poorly approximated incision

  • Redness with purulent drainage

Urinary Tract Infection (UTI)

• Indicators of UTI: >105 bacterial colonies/mL in two tests.

• Types of UTIs:

  • Cystitis: Inflammation of the urinary bladder.

  • Pyelonephritis: Inflammation of the renal pelvis.

• Common Symptoms:

  • Dysuria

  • Urinary frequency

  • Flank pain

Etiology of UTI

• Mostly due to ascending bacterial infections.

• Retention and residual urine promote bacterial growth.

Pathophysiology of UTI

• Common organisms: E. coli, Proteus, Pseudomonas, S. aureus, Streptococcus faecalis.

• Early detection is crucial to prevent kidney function loss.

Clinical Manifestations of UTI

• Symptoms vary by infection type:

  • General: Frequency, urgency, dysuria, hematuria, fever, suprapubic pain.

  • For pyelonephritis: High fever, chills, flank pain, vomiting.

Nursing Management for UTIs

• Recognize signs, obtain specimens, and administer appropriate treatments.

• Educate on bladder care and hygiene practices.

Puerperal Infection

• Definition: Infection in birthing structures post-delivery, major cause of maternal morbidity.

• Incidence: 14%-8% of deliveries, higher rates for cesarean.

• Common Sites: Pelvic cavity, breast, urinary tract, venous system.

Pathophysiology of Puerperal Infection

• May result from surgical intervention or local flora overgrowth.

• Infections can extend via lymphatics.

Assessment Findings for Puerperal Infection

• Temperature: >38°C (100.4°F) after 24 hours postpartum.

• Symptoms: Pain, elevated temperature, edema, abnormal lochia.

• Specific Signs: Severe endometritis symptoms, malaise, back pain.

Nursing Management for Puerperal Infection

• Inspect perineum; evaluate for symptoms.

• Offer balanced nutrition, hydration, promote ambulation.

• Administer antibiotics as needed.

Mastitis

• Inflammation of breast tissue, can result from poor breastfeeding.

• Common symptoms include fever and unilateral breast pain/swelling.

Nursing Interventions for Mastitis

• Teach effective breastfeeding techniques.

• Encourage increased fluid intake and hygiene practices.

Subinvolution of the Uterus

• Definition: Delayed return of uterus to normal size post-delivery.

• Caused by retained placental fragments, endometritis.

Nursing Management for Subinvolution

• Monitor for signs of infection and excessive blood loss.

• Massage uterus, facilitate voiding, and report complications.

Thrombophlebitis and Thrombosis in Postpartum

• Definition: Inflammation leading to clot formation.

• Incidence of postpartum thrombophlebitis ranges from 0.1% to 1%.

Risk Factors

• History of thrombophlebitis, obesity, cesarean delivery, age over 35.

Nursing Management for Thrombophlebitis

• Monitor vital signs, assess for clots, administer anticoagulants as prescribed.

Infections During Pregnancy: Overview of TORCHS

• TORCH Infections include: Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes

• Pregnant nurses should avoid caring for patients with specific infections.

Sexually Transmitted Infections Include:

• Chlamydia, Gonorrhea, Hepatitis B, HIV, Syphilis, etc.

Assessment for Infections

• Screen for STIs, consider maternal history, educate on hygiene and safe practices.

Postpartum Hemorrhage

• Defined as >500mL blood loss post-vaginal delivery.

• Causes: Uterine atony, trauma, placental disorders.

Nursing Interventions for Hemorrhage

• Administer oxygen, monitor vitals, perform fundal massage, administer medications.