6. 2. 5. 2. All assessment findings within normal limits.
         3. Unable to recover organism from discharg
   3. Urinary tract infections
      1. Pathophysiology—normal   physiological changes associated with pregnancy (, ureteral dilation) and the postpartal period (, diuresis, increased bladder capacity with diminished sensitivity of stretch receptors) —> increased susceptibility to bacterial invasion and growth —-» ascending infections (cystitis, pyelonephritis).
      2. Etiology: usually bacterial.
      3. Predisposing factors:
         1. Birth trauma to bladder, urethra, or meatus.
         2. Bladder hypotonia with retention (due to intrapartal anesthesia or trauma).
         3. Repeated or prolonged catheterization, or poor technique
         4. Weakening of immune response secondary to anemia, hemorrhage
      4. Assessment:
         1. Maternal vital signs (fever, tachycardia).
         2. Dysuria, frequency (flank pain—with pyelonephritis).
         3. Feeling of “not emptying” bladder.
         4. Cloudy urine; frank pus.
      5. Analysis/nursing diagnosis:
         1. Altered urinary elimination related to diuresis, dysuria, inflammation/infection.
         2. Pain related to dysuria secondary to cystitis, Knowledge deficit related to self-care (perineal care).
      6. Nursing care plan/implementation:
         1. Goal: minimize perineal edem Perineal ice pack in fourth stage—to limit swelling secondary to trauma, facilitate voidin
         2. Goal: prevent overdistention of bladder.
            1. Monitor level of fundus, lochia, bladder distention. (Note: Distended bladder displaces uterus, limits its ability to contract —> boggy fundus, increases its vaginal bleedin)
            2. Encourage fluids and voiding; I&O.
            3. Aseptic technique for catheterization.
            4. Slow emptying of bladder on catheterization—to maintain ton
         3. Goal: identification of causative organism— to facilitate appropriate medication (antibiotics). Obtain clean-catch (or catheterized) specimen for culture and sensitivity.
         4. Goal: health teachin See previous discussion of fluids, general hygiene, diet, and medications.
      7. Evaluation/outcome criteria:
         1. Voiding: quantity sufficient (although Urine character: clear, amber, or straw colore
         2. Vital signs: within normal limits.
         3. No complaints of frequency, urgency, burning on urination, flank pain.
   4. Mastitis—inflammation of breast tissue:
      1. Pathophysiology—local inflammatory response to bacterial invasion; suppuration may occur; organism can be recovered from breast milk.
      2. Etiology—most common: Staphylococcus aureus; source—most common: infant’s nose, throat.
      3. Assessment:
         1. Signs of infection (may occur several weeks: postpartum).
            1. Fever.
            2. Chills.
            3. Tachycardi
            4. Malais
            5. Abdominal pain.
         2. Breast
            1. Reddened area(s).
            2. Localized/generalized swellin
            3. Heat, tenderness, palpable mass.
      4. Analysis/nursing diagnosis:
         1. Impaired skin integrity related to nipple fissures, cracks.
         2. Pain related to tender, inflamed tissue secondary to infection.
         3. Disturbance in body image, self-esteem related to association of breastfeeding with female identity and rol
         4. Anxiety/fear related to sexuality; impact on breastfeeding, if any.
      5. Nursing care plan/implementation:
         1. Goal: prevent infection. Health teaching in early postpartum:
            1. Hand washin
            2. Breast care—wash with warm water only (no soap) —to prevent removing protective body oils.
            3. Let breast milk dry on nipples to prevent drying of tissu
            4. Clean bra (with no plastic pads or liners) to support breasts, reduce friction, minimize exposure to microorganisms.
            5. Good breastfeeding techniques (see p. 157).
            6. Alternate position of infant for nursing to change pressure areas.
         2. Goal: comfort measures.
            1. Encourage bra or binder—to support breasts, reduce pain from motion.
            2. Local heat or ice packs as ordered— to reduce engorgement, pain.
            3. Administer analgesics, as necessary.
         3. Goal: emotional support.
            1. Encourage verbalization of feelings, concerns.