產(chǎn)褥期感染

1、產(chǎn)褥感染及護(hù)理,,Main content 主要內(nèi)容,,概念 Concept,護(hù)理 nursing,治療 Treatment,誘發(fā)因素 Contributor,臨床表現(xiàn)及病理 Clinical manifestation and pathology,Main content,概念 Concept,,產(chǎn)褥期感染是產(chǎn)褥期內(nèi)生殖道受病原體侵襲而引起局部或全身的感染。產(chǎn)褥病率是指分娩結(jié)束后24

2、小時(shí)以后的10日內(nèi)，每日用口表測(cè)4次體溫，每次間隔4小時(shí)，其中2次體溫達(dá)到或超過38℃。產(chǎn)褥病率多由產(chǎn)褥期感染引起。也可以由其他系統(tǒng)感染而引起，例如呼吸道，泌尿道等Puerperal infection is genital tract invasion by pathogen which leads to local or systemic infection during puerperium . Puerperal morbi

3、dity is defined as a temperature , daily use oral thermometer to measure four times, each time with an interval of 4 hours, greater than 38.0°C on any 2 of the first 10 days following delivery exclusive of the first

4、 24 hours. Puerperal morbidity is much caused by puerperal infection which can also be caused by other systems ,like respiratory tract, urinary tract, etc.,標(biāo)題,Main content 主要內(nèi)容,,概念 Concept,護(hù)理 nursing,治療 Tre

5、atment,誘發(fā)因素 Contributor,臨床表現(xiàn)及病理 Clinical manifestation and pathology,Main content,Click to add Text,Click to add Text,Click to add Text,機(jī)體免疫力,body immunity,細(xì)菌數(shù)量,bacteria quantity,細(xì)菌毒力,bacterial virulence,,,,誘發(fā)因素

6、Contributor,平衡失調(diào)balance broken down,孕期貧血、營(yíng)養(yǎng)不良、體質(zhì)虛弱pregnancy anemia 、malnutrition、 physique weak,產(chǎn)科手術(shù)操作或慢性疾病obstetric operation or chronic disease,產(chǎn)前產(chǎn)后出血prenatal postpartum hemorrhage,產(chǎn)程延長(zhǎng)prolonged labor,妊娠晚期性生活sexual

7、intercourse during third trimester,胎膜早破premature rupture of membrane,羊膜腔感染amniotic cavity infection,其他誘發(fā)因素.,,感染途徑route of infection,正常孕產(chǎn)婦生殖道或其他部位寄生的病原體，多數(shù)并不致病，當(dāng)機(jī)體抵抗力下降出現(xiàn)感染誘因時(shí)則可致?。l件致病菌）,由外界的病原體侵入生殖道而引起的感染常由被感染的衣物、用具各

8、種手術(shù)診療器械等接觸患者造成感染,,內(nèi)源性感染 Endogenous infection,,外源性感染 Exogenous infection,感染途徑route of infection,Most of the causative agents that normally reside in the genital tract or other parts are not pathogenic. Only when the bo

9、dy resistance drop accompanying infection incentive can be pathogenic (conditional pathogenic bacteria),external pathogens get into genital tract often by infected clothing equipment various surgical diagnosis ，treatment

10、 equipment and other contact patients andcause infection.,,內(nèi)源性感染 Endogenous infection,,外源性感染 Exogenous infection,,病原體 Pathogens,,,需氧菌 Aerobic bacteria,,厭氧菌Anaerobic bacteria,,,,鏈球菌streptococcus,桿菌bacteria,葡萄球菌staphy

11、lococcus aureus,,球菌cocci,,桿菌屬 bacterium,,梭狀芽胞桿菌clostridia,,支原體與衣原體 mycoplasma and chlamydia,Main content 主要內(nèi)容,,概念 Concept,護(hù)理 nursing,治療 Treatment,誘發(fā)因素 Contributor,臨床表現(xiàn)及病理 Clinical manifestation and p

12、athology,Main content,臨床表現(xiàn),,,急性外陰切口感染：會(huì)陰裂傷和正中或側(cè)切的部位是會(huì)陰感染常見部位，局部疼痛、壓痛、硬結(jié)、灼熱、紅腫或膿性分泌物，嚴(yán)重者傷口可裂開,,01,,陰道宮頸炎：宮頸裂傷引起炎癥，癥狀多不明顯，若深度達(dá)穹窿闊韌帶底部，又未及時(shí)縫合，則病原體可直接上行或通過淋巴播散引起盆腔結(jié)締組織炎。單純陰道、宮頸炎表現(xiàn)為粘膜充血、水腫、潰瘍、分泌物增多并呈膿性，產(chǎn)婦可有輕微的發(fā)熱，畏寒。脈速等全身癥狀,

13、,02,,子宮感染：包括子宮內(nèi)膜炎和子宮肌炎。細(xì)菌經(jīng)胎盤剝離面入侵，先擴(kuò)散到子宮蛻膜層引起急性子宮內(nèi)膜炎，炎癥可繼續(xù)侵犯淺肌層、深肌層乃至漿膜層，導(dǎo)致子宮肌炎，由于子宮內(nèi)膜充血、壞死、陰道內(nèi)有大量膿性分泌物且有臭味，若為子宮肌炎，則子宮復(fù)舊不良，腹部有壓痛，患者可有高熱、頭痛、白細(xì)胞增多等感染。,,,03,臨床表現(xiàn)及病理 Clinical manifestation and pathology,Acute episiotomy

14、 infection：infection of the perineal usually developing at the site of an median or lateral episiotomy or laceration , local pain 、tenderness 、callosity 、warmth、red or purulent secretion, serious wounds can be split,,01,

15、,Vaginal cervicitis: cervical laceration cause inflammation, but symptoms is not so obvious, if the depth reaches the bottom of fornix latum ,then fails to timely suture, the pathogens can be directly ascending or throug

16、h the lymphatic spreading which lead to pelvic connective tissue inflammation 、simple vaginal cervicitis。The and the clinical manifestation is mucosal hyperemia and edema、 ulcer 、 increasing purulent secretions. Mother

17、s may have some systemic symptoms such as a slight fever 、chills and pulse speeding .,,02,,,臨床表現(xiàn)及病理 Clinical manifestation and pathology,,Uterine infection: including endometritis and myometritis. Bacteria by placen

18、tal stripping surface invasion, the first spread to uterine decidua layer to cause acute endometritis, however, inflammation may continue to infringe upon shallow muscle layer deep muscle layer and serous membrane layer

19、, causing myometritis, due to the congestion 、necrosis of endometrial, there are many purulent secretion and frowziness in vagina. When it comes to myometritis, subinvolution of uterus, tenderness on the abdomen, the pat

20、ients can have infection such as high fever , headache, leukocytosis,,03,,,,1,4,1.急性盆腔結(jié)締組織炎和急性附件炎 Acute inflammation of pelvic connective tissue and acute appendagitis,2.血栓靜脈炎 Thrombophlebitis,3.膿毒血癥和敗血癥 Py

21、emia and septicemia,,,,2,3,,4.急性盆腔腹膜炎及彌漫性腹膜炎 Acute pelvic peritonitis and diffuse peritonitis,臨床表現(xiàn)及病理 Clinical manifestation and pathology,Main content 主要內(nèi)容,,概念 Concept,護(hù)理 nursing,治療 Treatment,誘發(fā)

22、因素 Contributor,臨床表現(xiàn)及病理 Clinical manifestation and pathology,Main content,General treatment: strengthening nutrition, giving enough vitamins, half decubitus will be good for maternity to make it easier for inflamm

23、ation lochia to drainage and make inflammation confined to the pelvic inside.,一般治療：加強(qiáng)營(yíng)養(yǎng)，給予足夠的維生素，產(chǎn)婦宜取半臥位，有利于炎癥惡露引流和使炎癥局限于盆腔內(nèi),Antibiotic treatment: follow the doctor's advice ,first using broad-spectrum antibiotics,

24、then adjustment after bacteria culture and drug test ,if the temperature shows no continuing decline after using antibiotics 48 to 72 hours, it will be necessary to find the reasons.,抗生素治療：遵醫(yī)囑首先廣譜抗生素后，待細(xì)菌培養(yǎng)和藥試驗(yàn)后再作調(diào)整，應(yīng)用抗

25、生素后48—72h小時(shí)，體溫?zé)o持續(xù)下降，應(yīng)尋找原因。,中醫(yī)治療：根據(jù)患者情況辯證，選擇活血化瘀中醫(yī)治療,traditional Chinese medicine treatment: according to patients condition dialectical, choose promoting blood circulation to remove blood stasis treatment of traditional

26、 Chinese medicine.,引流通暢：會(huì)陰感染拆傷口線利于引流，坐浴每日2次，疑盆腔膿腫，可經(jīng)腹或后穹窿切開引流，若會(huì)陰傷口或腹膜部切口感染，則行切開引流術(shù)。,Drainage unblocked: get out the wound wire of perineum infection do good to drainaging, sitz baths twice a day, once it was suspected

27、pelvic abscess, drainage through abdominal or fornix vagina incision could be available, if the perineum wound or peritoneal incision suffers infection , the incision drainage will be ok.,血栓靜脈炎癥治療：1、肝素1mg/kg·d加入

28、5％葡萄糖500ml中，靜脈滴注Q6h，連續(xù)4—7天。2、尿激酶：40萬u加入0.9氯化鈉或5％葡萄糖中500ml，靜滴10天，注意使用該藥物期間要監(jiān)測(cè)凝血功能。同時(shí)口服，雙香豆素，阿斯匹林或雙嘧達(dá)莫等。,thrombophlebitis treatment: 1 )heparin 1 mg/kg ·d add 5% glucose 500 ml, drip Q6h, heparin is continued for 4-7

29、 days .2） urokinase: 400,000 u to join 0.9 sodium chloride or 5% glucose 500 ml, Intravenous drip 10 days, do remember to monitoring during the function of blood coagulation during this period .Alongside with oral drugs

30、like coumarin, aspirin and dipyridamole, etc.,Main content 主要內(nèi)容,,概念 Concept,護(hù)理 nursing,治療 Treatment,誘發(fā)因素 Contributor,臨床表現(xiàn)及病理 Clinical manifestation and pathology,Main content,護(hù)理 nursing,,,,,,護(hù)理

31、評(píng)估,護(hù)理診斷,預(yù)期目標(biāo),護(hù)理措施,護(hù)理評(píng)價(jià),,,,,,,,,assessment,diagnosis,goals,interventions,evaluation,護(hù)理評(píng)估nursing assessment,,,,,,,2,1,3,檢查診斷inspection diagnosis,身心狀況及支持系統(tǒng) physical and mental conditions and support system,病史 history,1）評(píng)估誘

32、因 evaluation incentive.2）了解健康史 Understand health3）了解本次妊娠情況 understand the pregnancy,1）腹部檢查 Abdominal examination2）婦科檢查 Gynecologial examination3）實(shí)驗(yàn)室檢查：白細(xì)胞、血沉、B超Laboratory: white blood cells, neutrophil

33、s.B ultrasound,,1）全身狀況 General situation: chilling2）局部狀況 Local status3）心里狀況mental condition4）支持系統(tǒng) Support system,nursing diagnosis,護(hù)理診斷,,The vital signs normal, anemia basic correct,To make sure that pregnan

34、t women have got to know how to nurse for puerperal infection,Anxiety,Pain,預(yù)期目標(biāo),Infection under control, normal temperature, increase intimacy,Pain ease,Lack of knowledge,Get the understanding of family, the comfort of

35、 husband .,A high body temperature,Potential complications: uncontrolled hemorrhagic shock and infection,護(hù)理措施nursing interventions,環(huán)境：病室環(huán)境;病室安靜、清潔、空氣新鮮、每日通風(fēng)并注意保暖。床單位:床單位及衣物，用物清潔。,environment: ward environment; quiet, cl

36、ean and fresh air ,daily ventilation and keep bed units warm: bed unit and the clothing, daily things clean.,高蛋白、高熱量、高維生素，易消化飲食、鼓勵(lì)多飲水，保證足夠液體攝入。睡眠：保證足夠的睡眠。,high protein, high hea,t high vitamin, food easily to digest , mo

37、re water encouraged, ensure enough liquid intake. sleep: enough sleep.,一般護(hù)理,General care,飲食,Diet,,,,,,病情的觀察：全身情況：是否有發(fā)熱、寒戰(zhàn)、惡心、嘔吐、全身乏力、腹痛、腹脹等癥狀。局部情況：下腹有無持續(xù)性疼痛，局部靜脈壓痛及下肢水腫。惡露的量、性狀、顏色及氣味。子宮復(fù)舊情況，會(huì)陰傷口有無紅腫，熱，痛，硬結(jié)等。.,Observatio

38、n on patient's illness: general situation: fever 、chill、 nausea and vomiting 、muscle weakness、 abdominal pain symptoms such as abdominal distension 。local situation: persistent pain for abdomen, local venous pressure

39、 and lower limb edema ， quantity 、character、 color and smell of lochia .Uterine involution, perineum wound without irritation, heat, pain, induration, etc,積極配合治療：遵醫(yī)囑進(jìn)行支持治療，糾正貧血，水，電解質(zhì)紊亂，增加蛋白質(zhì)維生素的攝入，遵醫(yī)囑使用抗生素，做好，膿腫引流術(shù)，清宮術(shù)。

40、后穹窿穿刺術(shù)后，術(shù)前準(zhǔn)備及術(shù)后護(hù)理。,Actively cooperation with treatment: follow the doctor's advice to support treatment, correction of anemia, water recovering of water and electrolyte disorders, increasing protein vitamin intake,

41、follow the doctor's advice to use antibiotics, make it possible for abscess drainage, curettage，culdocentesis,get prepared for preoperative preparation and postoperative nursing.,護(hù)理措施nursing interventions,,,,健康教育,做好

42、會(huì)陰護(hù)理。體位：半臥位或抬高床頭，促惡露排出，炎癥局限，防止感染擴(kuò)散。,,,心理護(hù)理,鼓勵(lì)其丈夫及家屬參與護(hù)理，予以精神的支持。提供母嬰接觸等減輕產(chǎn)婦的焦慮。,,,health education,perineum nursing .Position: half decubitus or raising the head of a bed, promoting lochia discharge, inflammation limitat

43、ions, prevent infection .diffusion.,,,Psychological care,encourage her husband and family members to participate in nursing, offering spiritual support with maternal and child contact to reduce maternal anxiety.,護(hù)理措施nur

44、sing interventions,護(hù)理評(píng)價(jià)nursing evaluation,,產(chǎn)婦能自我護(hù)理，能采取，預(yù)防感染的措施,,出院時(shí)，體溫正常，舒適感增加,產(chǎn)褥感染癥狀消失，無并發(fā)癥發(fā)生,,,,Mothers can nurse by herself , and be able to take measures to prevent infections.,Puerperal infection symptoms disapp