产褥期感染-PPT课件

1、产褥感染及护理Main content 主要内容概念 Concept护理 nursing 治疗 Treatment 诱发因素 Contributor 临床表现及病理 Clinical manifestation and pathology Main content概念 Concept产褥期感染是产褥期内生殖道受病原体侵袭而引起局部或全身的感染。产褥病率是指分娩结束后24小时以后的10日内，每日用口表测4次体温，每次间隔4小时，其中2次体温达到或超过38。产褥病率多由产褥期感染引起。也可以由其他系统感染而引起，例如呼吸道，泌尿道等Puerperal infection is genital tr

2、act invasion by pathogen which leads to local or systemic infection during puerperium . Puerperal morbidity is defined as a temperature , daily use oral thermometer to measure four times, each time with an interval of 4 hours, greater than 38.0C on any 2 of the first 10 days following delivery exclu

3、sive of the first 24 hours. Puerperal morbidity is much caused by puerperal infection which can also be caused by other systems ,like respiratory tract, urinary tract, etc.标题Main content 主要内容概念 Concept护理 nursing 治疗 Treatment 诱发因素 Contributor 临床表现及病理 Clinical manifestation and pathology Main contentC

4、lick to add TextClick to add TextClick to add Text机体免疫力body immunity 细菌数量bacteria quantity 细菌毒力bacterial virulence诱发因素Contributor 平衡失调balance broken down Contributor 孕期贫血、营养不良、体质虚弱pregnancy anemia 、malnutrition、 physique weak 产科手术操作或慢性疾病obstetric operation or chronic disease 产前产后出血prenatal postpartu

5、m hemorrhage 产程延长prolonged labor 妊娠晚期性生活sexual intercourse during third trimester 胎膜早破premature rupture of membrane 羊膜腔感染amniotic cavity infection 其他诱发因素. 感染途径route of infection 正常孕产妇生殖道或其他部位寄生的病原体，多数并不致病，当机体抵抗力下降出现感染诱因时则可致病（条件致病菌） 由外界的病原体侵入生殖道而引起的感染常由被感染的衣物、用具各种手术诊疗器械等接触患者造成感染 内源性感染 Endogenous infe

6、ction 外源性感染 Exogenous infection 感染途径route of infection Most of the causative agents that normally reside in the genital tract or other parts are not pathogenic. Only when the body resistance drop accompanying infection incentive can be pathogenic (conditional pathogenic bacteria) external pathogens

7、get into genital tract often by infected clothing equipment various surgical diagnosis ，treatment equipment and other contact patients andcause infection. 内源性感染 Endogenous infection 外源性感染 Exogenous infection 病原体 Pathogens 需氧菌 Aerobic bacteria 厌氧菌Anaerobic bacteria 链球菌streptococcus 杆菌bacteria 葡萄球菌sta

8、phylococcus aureus 球菌cocci 杆菌属 bacterium 梭状芽胞杆菌clostridia 支原体与衣原体 mycoplasma and chlamydia Main content 主要内容概念 Concept护理 nursing 治疗 Treatment 诱发因素 Contributor 临床表现及病理 Clinical manifestation and pathology Main content临床表现急性外阴切口感染：会阴裂伤和正中或侧切的部位是会阴感染常见部位，局部疼痛、压痛、硬结、灼热、红肿或脓性分泌物，严重者伤口可裂开 01阴道宫颈炎：宫颈裂伤引起炎症

9、，症状多不明显，若深度达穹窿阔韧带底部，又未及时缝合，则病原体可直接上行或通过淋巴播散引起盆腔结缔组织炎。单纯阴道、宫颈炎表现为粘膜充血、水肿、溃疡、分泌物增多并呈脓性，产妇可有轻微的发热，畏寒。脉速等全身症状 02子宫感染：包括子宫内膜炎和子宫肌炎。细菌经胎盘剥离面入侵，先扩散到子宫蜕膜层引起急性子宫内膜炎，炎症可继续侵犯浅肌层、深肌层乃至浆膜层，导致子宫肌炎，由于子宫内膜充血、坏死、阴道内有大量脓性分泌物且有臭味，若为子宫肌炎，则子宫复旧不良，腹部有压痛，患者可有高热、头痛、白细胞增多等感染。 03临床表现及病理 Clinical manifestation and pathologyAc

10、ute episiotomy 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 01Vaginal cervicitis: cervical laceration cause inflammation, but symp

11、toms 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 through the lymphatic spreading which lead to pelvic connective tissue inflammation 、simple vaginal cervicitis。The and the clinical manifestation is mucosa

12、l hyperemia and edema、 ulcer 、 increasing purulent secretions. Mothers may have some systemic symptoms such as a slight fever 、chills and pulse speeding .02临床表现及病理 Clinical manifestation and pathologyUterine infection: including endometritis and myometritis. Bacteria by placental stripping surface i

13、nvasion, 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, causing myometritis, due to the congestion 、necrosis of endometrial, there are many purulent secretion

14、 and frowziness in vagina. When it comes to myometritis, subinvolution of uterus, tenderness on the abdomen, the patients can have infection such as high fever , headache, leukocytosis 03141.急性盆腔结缔组织炎和急性附件炎 Acute inflammation of pelvic connective tissue and acute appendagitis 2.血栓静脉炎 Thrombophlebiti

15、s 3.脓毒血症和败血症 Pyemia and septicemia 234.急性盆腔腹膜炎及弥漫性腹膜炎 Acute pelvic peritonitis and diffuse peritonitis 临床表现及病理 Clinical manifestation and pathologyMain content 主要内容概念 Concept护理 nursing 治疗 Treatment 诱发因素 Contributor 临床表现及病理 Clinical manifestation and pathology Main content General treatment: strength

16、ening nutrition, giving enough vitamins, half decubitus will be good for maternity to make it easier for inflammation lochia to drainage and make inflammation confined to the pelvic inside.一般治疗：加强营养，给予足够的维生素，产妇宜取半卧位，有利于炎症恶露引流和使炎症局限于盆腔内 Antibiotic treatment: follow the doctors advice ,first using bro

17、ad-spectrum antibiotics, 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. 抗生素治疗：遵医嘱首先广谱抗生素后，待细菌培养和药试验后再作调整，应用抗生素后4872h小时，体温无持续下降，应寻找原因。 中医治疗：根据患者情况辩证，选择活血化瘀中医治疗 tradi

18、tional Chinese medicine treatment: according to patients condition dialectical, choose promoting blood circulation to remove blood stasis treatment of traditional Chinese medicine.引流通畅：会阴感染拆伤口线利于引流，坐浴每日2次，疑盆腔脓肿，可经腹或后穹窿切开引流，若会阴伤口或腹膜部切口感染，则行切开引流术。 Drainage unblocked: get out the wound wire of perineum

19、 infection do good to drainaging, sitz baths twice a day, once it was suspected 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. 血栓静脉炎症治疗：1、肝素1mg/kgd加入5葡萄糖500ml中

20、，静脉滴注Q6h，连续47天。2、尿激酶：40万u加入0.9氯化钠或5葡萄糖中500ml，静滴10天，注意使用该药物期间要监测凝血功能。同时口服，双香豆素，阿斯匹林或双嘧达莫等。 thrombophlebitis treatment: 1 )heparin 1 mg/kg d add 5% glucose 500 ml, drip Q6h, heparin is continued for 4-7 days .2） urokinase: 400,000 u to join 0.9 sodium chloride or 5% glucose 500 ml, Intravenous drip 10

21、 days, do remember to monitoring during the function of blood coagulation during this period .Alongside with oral drugs like coumarin, aspirin and dipyridamole, etc.Main content 主要内容概念 Concept护理 nursing 治疗 Treatment 诱发因素 Contributor 临床表现及病理 Clinical manifestation and pathology Main content护理 nursing

22、 护理评估 护理诊断预期目标 护理措施 护理评价 assessmentdiagnosisgoalsinterventionsevaluation 护理评估nursing assessment213检查诊断inspection diagnosis身心状况及支持系统 physical and mental conditions and support system病史 history1）评估诱因 evaluation incentive.2）了解健康史 Understand health3）了解本次妊娠情况 understand the pregnancy1）腹部检查 Abdominal exam

23、ination2）妇科检查 Gynecologial examination3）实验室检查：白细胞、血沉、B超Laboratory: white blood cells, neutrophils.B ultrasound, 1）全身状况 General situation: chilling2）局部状况 Local status3）心里状况mental condition4）支持系统 Support systemnursing diagnosis焦虑体温过高 潜在的并发症：失血性休克及感染疼痛知识缺乏护理诊断The vital signs normal, anemia basic correc

24、tTo make sure that pregnant women have got to know how to nurse for puerperal infectionAnxiety Pain 家人的理解，丈夫的安慰 感染得到控制，体温正常，舒适感增加 各项生命体征正常，贫血基本纠正测疼痛得到缓解 使孕妇具备产褥感染的护理知识 预期目标Infection under control, normal temperature, increase intimacyPain ease Lack of knowledge Get the understanding of family, the c

25、omfort of husband . A high body temperature Potential complications: uncontrolled hemorrhagic shock and infection护理措施nursing interventions环境：病室环境;病室安静、清洁、空气新鲜、每日通风并注意保暖。床单位:床单位及衣物，用物清洁。environment: ward environment; quiet, clean and fresh air ,daily ventilation and keep bed units warm: bed unit and

26、the clothing, daily things clean.高蛋白、高热量、高维生素，易消化饮食、鼓励多饮水，保证足够液体摄入。睡眠：保证足够的睡眠。high protein, high hea,t high vitamin, food easily to digest , more water encouraged, ensure enough liquid intake. sleep: enough sleep.一般护理General care饮食Diet病情的观察：全身情况：是否有发热、寒战、恶心、呕吐、全身乏力、腹痛、腹胀等症状。局部情况：下腹有无持续性疼痛，局部静脉压痛及下肢水

27、肿。恶露的量、性状、颜色及气味。子宫复旧情况，会阴伤口有无红肿，热，痛，硬结等。.Observation on patients 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 and lower limb edema ， quantity 、

28、character、 color and smell of lochia .Uterine involution, perineum wound without irritation, heat, pain, induration, etc积极配合治疗：遵医嘱进行支持治疗，纠正贫血，水，电解质紊乱，增加蛋白质维生素的摄入，遵医嘱使用抗生素，做好，脓肿引流术，清宫术。后穹窿穿刺术后，术前准备及术后护理。Actively cooperation with treatment: follow the doctors advice to support treatment, correction of anemia, water recovering of water and electrolyte disorders, increasing protein vitamin intake, follow the doctors advice t