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Table 4-13

Condition/Etiology	Assessment: Signs/Symptoms	Nursing Interventions
Postpartum Infection
Traumatic labor and birth and postpartum hemorrhage make woman more vulnerable to infection by such bacteria as nonhemolytic streptococci, Escherichia coli, and Staphylococcus species	Depends on location and severity of infection; usually include fever, pain, swelling, and tenderness Temperature of 100.4°F (38°C) or more after first 24 hours after birth on two or more occasions indicates puerperal infection (“childbed fever”)	Monitor: Signs and symptoms, drainage (e.g., uterine) Obtain culture and sensitivity Administer antimicrobial agents and analgesic agents Ensure comfort; encourage rest Use standard precautions Force fluids and provide high-calorie diet Keep family informed of mother’s and newborn’s progress Promote maternal-infant contact as soon as possible Plan and implement discharge and follow-up care
Endometritis
Microorganisms invade placental site and may spread to entire endometrium	Temperature, chills, anorexia, malaise, boggy uterus, foul-smelling lochia, and cramps	Administer antimicrobial agents and analgesic agents Encourage Fowler’s position to promote drainage Force fluids Take standard precautions
Pelvic Cellulitis or Parametritis
Microorganisms spread through lymphatics and invade tissues surrounding uterus	Fever, chills, lower abdominal pain, and tenderness	Administer antimicrobial agents and analgesic agents Encourage bedrest Force fluids
Perineal Infection
Trauma to perineum makes woman more vulnerable to infection	Localized pain, fever, swelling, redness, and seropurulent drainage	Administer antimicrobial agents and analgesic agents Provide sitz baths or heat/cold applications Take standard precautions
Mastitis
Lesions or fissure on nipples allow entry of microorganisms (e.g., Staphylococcus aureus ) from infant’s nose/mouth or mother’s unwashed hands (Breastmilk is a good medium for growth of organism)	Marked engorgement, pain, chills, fever, tachycardia If untreated, single or multiple breast abscesses may form	Order culture and sensitivity studies of mother’s milk Administer antimicrobial agents and analgesic agents Apply heat or cold therapy Assist with incising and draining abscesses Use standard precautions and perform meticulous hand washing
Thrombophlebitis
Infected pelvic or femoral thrombi Increased tendency to clot formation during pregnancy, trauma to tissues, and hemorrhage decrease new mother’s resistance to infection	Pain, chills, and fever
	Femoral: stiffness of affected area or part and positive Homans’ sign	Femoral: Rest and elevate leg Administer antimicrobial agents, analgesic agents, and anticoagulants
	Pelvic: severe chills and wide fluctuations in temperature	Pelvic: Encourage bedrest Force fluids Administer antimicrobial agents and anticoagulants