5. 1. 3. 3. trachomatis (bacteroides).
         4. Staphylococc
      4. Predisposing conditions:
         1. Anemi
         2. PROM.
         3. Prolonged labor.
         4. Repeated vaginal examinations during labor.
         5. Intrauterine manipulation—, manual extraction of placent
         6. Retained placental fragments.
         7. Postpartum hemorrhag
      5. Assessment:
         1. Fever 38°C (100.4°F) or more on two or more occasions, after first 24 hr postpartum.
         2. Other signs of infection: pain, malaise, dysuria, subinvolution, foul lochial odor.
      6. Analysis/nursing diagnosis:
         1. Fluid volume deficit related to excessive blood loss, anemi
         2. Knowledge deficit related to danger signs of postpartum perio
         3. High risk for injury related to infection.
      7. Nursing care plan/implementation: prevention
         1. Goal: prevent anemi
            1. Minimize blood loss—accurate postpartal assessment and management of bleedin
            2. I#ll Diet: high protein, high vitamin.
            3. Vitamins, iron—suggest continuing prenatal pattern until postpartum checkup.
         2. Goal: prevent entrance/transport of microorganisms.
            Strict aseptic technique during labor, birth, and postpartum (standard precautions).
            1. Minimize vaginal examinations during labor.
            2. Perineal car
         3. Goal: health teachin
            1. Hand washing—before and after each pad change, after voiding or defecatin
            2. Perineal care—from front to back; use clear, warm water or mild antiseptic solution as a cascade; do not separate labi
            3. Maintain sterility of pads; apply from front to back.
            4. Avoid use of tampons until normal menstrual cycle resumes.
      8. Evaluation/outcome criteria:
         1. Woman has assessment findings within normal limits:
            1. Vital signs.
            2. Rate of involution (fundal height, consistency).
            3. Lochia: character, amount, odor.
         2. Woman avoids infection.
   2. Endometritis— infection of lining of uterus.
      1. Pathophysiology— see I General aspects, p. 15
      2. Etiology— most common: invasion by normal body flora (, anaerobic streptococci).
      3. Characteristics:
         1. Mild, localized—asymptomatic, or lowgrade fever.
         2. Severe—may lead to ascending infection, parametritis, pelvic abscess, pelvic thrombophlebitis.
         3. If remains localized, self-limiting; usually resolves within 10 days.
      4. Assessment:
         1. Signs of infection: fever, chills, malaise, anorexia, headache, backach
         2. Uterus: large, boggy, extremely tender.
            1. Subinvolution.
            2. Lochia: dark brown; foul odor.
      5. Analysis/nursing diagnosis:
         1. Anxiety/fear related to effects on self and newborn.
         2. Self-esteem disturbance and altered role performance related to inability to meet own expectations regarding parenting, secondary to unexpected hospitalization.
         3. Pain related to inflammation/infection.
         4. Ineffective individual coping related to physical discomfort and psychological stress associated with self-concept disturbance; worry, guilt, concern regarding newborn at hom
         5. Altered family processes— interruption of adjustment to altered life pattern related to postpartal infection/hospitalization.
      6. Nursing care plan/implementation:
         1. Goal: prevent cross-contamination. Contact-item isolation.
         2. B Goal: facilitate drainag Position: semiFowler’s.
         3. Goal: nutrition/hydration.
            1. (l) Diet: high-calorie, high-protein, highvitamin.
            2. Push fluids to 4000 mL/day (oral or IV, or both, as ordered).
            3. I&O.
         4. Goal: increase uterine tone/facilitate involution. Administer medications, as ordered (, oxytocics, antibiotics).
         5. Goal: minimize energy expenditure, as possibl
            1. Bed rest.
            2. Maximize rest, comfort.
         6. Goal: emotional support.
            1. Encourage verbalization of anxiety, concerns.
            2. Keep informed of progress.
      7. Evaluation/outcome criteria:
         1. Vital signs stable, within normal limits.