產(chǎn)褥期感染-PPT課件

1、產(chǎn)褥感染及護理Main content 主要內(nèi)容概念 Concept護理 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)褥病率是指分娩結束后24小時以后的10日內(nèi)，每日用口表測4次體溫，每次間隔4小時，其中2次體溫達到或超過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 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.標題Main content 主要內(nèi)容概念 Concept護理 nursing 治療 Treatment 誘發(fā)因素 Contributor 臨床表現(xiàn)及病理 Clinical manifestation and pathology Main contentC

4、lick to add TextClick to add TextClick to add Text機體免疫力body immunity 細菌數(shù)量bacteria quantity 細菌毒力bacterial virulence誘發(fā)因素Contributor 平衡失調(diào)balance broken down Contributor 孕期貧血、營養(yǎng)不良、體質(zhì)虛弱pregnancy anemia 、malnutrition、 physique weak 產(chǎn)科手術操作或慢性疾病obstetric operation or chronic disease 產(chǎn)前產(chǎn)后出血prenatal postpartu

5、m hemorrhage 產(chǎn)程延長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，當機體抵抗力下降出現(xiàn)感染誘因時則可致?。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、用具各種手術診療器械等接觸患者造成感染 內(nèi)源性感染 Endogenous infe

6、ction 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 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. 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sta

8、phylococcus 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臨床表現(xiàn)急性外陰切口感染：會陰裂傷和正中或側切的部位是會陰感染常見部位，局部疼痛、壓痛、硬結、灼熱、紅腫或膿性分泌物，嚴重者傷口可裂開 01陰道宮頸炎：宮頸裂傷引起炎癥

9、，癥狀多不明顯，若深度達穹窿闊韌帶底部，又未及時縫合，則病原體可直接上行或通過淋巴播散引起盆腔結締組織炎。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 02子宮感染：包括子宮內(nèi)膜炎和子宮肌炎。細菌經(jīng)胎盤剝離面入侵，先擴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，則子宮復舊不良，腹部有壓痛，患者可有高熱、頭痛、白細胞增多等感染。 03臨床表現(xiàn)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臨床表現(xiàn)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.急性盆腔結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 Thrombophlebiti

15、s 3.膿毒血癥和敗血癥 Pyemia and septicemia 234.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 pathologyMain content 主要內(nèi)容概念 Concept護理 nursing 治療 Treatment 誘發(fā)因素 Contributor 臨床表現(xiàn)及病理 Clinical manifestation and pathology Main content 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.一般治療：加強營養(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 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. 抗生素治療：遵醫(yī)囑首先廣譜抗生素后，待細菌培養(yǎng)和藥試驗后再作調(diào)整，應用抗生素后4872h小時，體溫無持續(xù)下降，應尋找原因。 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 tradi

18、tional Chinese medicine treatment: according to patients condition dialectical, choose promoting blood circulation to remove blood stasis treatment of traditional Chinese medicine.引流通暢：會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，若會陰傷口或腹膜部切口感染，則行切開引流術。 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. 血栓靜脈炎癥治療：1、肝素1mg/kgd加入5葡萄糖500ml中

20、，靜脈滴注Q6h，連續(xù)47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)測凝血功能。同時口服，雙香豆素，阿斯匹林或雙嘧達莫等。 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 主要內(nèi)容概念 Concept護理 nursing 治療 Treatment 誘發(fā)因素 Contributor 臨床表現(xiàn)及病理 Clinical manifestation and pathology Main content護理 nursing

22、 護理評估 護理診斷預期目標 護理措施 護理評價 assessmentdiagnosisgoalsinterventionsevaluation 護理評估nursing assessment213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 history1）評估誘因 evaluation incentive.2）了解健康史 Understand health3）了解本次妊娠情況 understand the pregnancy1）腹部檢查 Abdominal exam

23、ination2）婦科檢查 Gynecologial examination3）實驗室檢查：白細胞、血沉、B超Laboratory: white blood cells, neutrophils.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 systemnursing diagnosis焦慮體溫過高 潛在的并發(fā)癥：失血性休克及感染疼痛知識缺乏護理診斷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，體溫正常，舒適感增加 各項生命體征正常，貧血基本糾正測疼痛得到緩解 使孕婦具備產(chǎn)褥感染的護理知識 預期目標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護理措施nursing interventions環(huán)境：病室環(huán)境;病室安靜、清潔、空氣新鮮、每日通風并注意保暖。床單位:床單位及衣物，用物清潔。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、高熱量、高維生素，易消化飲食、鼓勵多飲水，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 , more water encouraged, ensure enough liquid intake. sleep: enough sleep.一般護理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

27、腫。惡露的量、性狀、顏色及氣味。子宮復舊情況，會陰傷口有無紅腫，熱，痛，硬結等。.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積極配合治療：遵醫(yī)囑進行支持治療，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，清宮術。后穹窿穿刺術后，術前準備及術后護理。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