INTRAUTERINE INFECTION

INTRAUTERINE INFECTIONBY: TIMOTHY METH S. CHUS

AssessmentAssess the FHR and maternal vital signs for evidence of infection:Fetal tachycardia (160> bpm for a term fetus); a rising baseline FHR often is the first sign of intrauterine infection.Maternal temperature; assess q 2-4 hrs in normal labor & q 2 hrs after membranes rupture; assess hourly if elevated (38C or ) or other signs of infection are present.Maternal PR, RR, and BP, assess at least q1 hr to identify tachycardia or tachypnea.Assess Amniotic fluid for normal clear color and mild odor. Small flecks of white vernix are normal in amniotic fluid. Yellow or cloudy fluid/fluid with a strong odor suggests infection. (The strong odor may be noted before birth or afterward on the infants skin.)

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Nursing DiagnosisFor the woman w/o signs of infection but with risk factors, the nursing diagnosis selected is Risk for Infection related to presence of favorable conditions for development. The nurse may specify the patient specific conditions that may cause infection when choosing this nursing diagnosis.PlanningExpected outcomes relate to detecting the onset of infection:Maternal temp. will remain 38C.The FHR will remain near the baseline with an average rate higher than 160 bpm.The amniotic fluid will remain clean and without a foul or strong odor.InterventionsS

Reducing the Risk for InfectionWash hands before and after each contact with all patients to reduce transmission of organisms. Limit vaginal examinations to reduce transmission of vaginal microorganisms -> uterine cavity, and maintain aseptic technique during essential vaginal examinations.Nurse is able to estimate a womans progress with few vaginal examinations. (e.g. bloody show and heightened anxiety may occur when the cervix is about 6 cm dilated. The woman may become irritable and lose control at about 8 cm dilation if she has chosen not to take epidural analgesia)Keep underpads as dry as possible to reduce the moist , warm environment that favors bacterial growth.Periodically clean excess secretions @ vaginal area in a front-to-back direction to limit fecal contamination and promote the mothers comfort.

Identifying the infectionIncrease frequency of assessments is labor is prolonged.If signs of infection are noted, report them to the birth attendant for further evaluation and treatment.Collection of specimen from the uterine cavity or placenta for culture to identify infectious organisms and determine antibiotic sensitivity.Transport specimens to the laboratory promptly.Antibiotic therapy is started promptly after collecting specimens.

EvaluationThe goals and expected outcomes are achieved if the following occur:The womans temperature remains 38C.Amniotic fluid has no normal characteristics that are typical of infection (cloudiness, yellow color, foul or strong odor).FHR remains within the expected range, no tachycardia