Download Infections / Inflammations

Infections / Inflammations
Urinary Tract Infection
Most common infection complicating
Pregnancy


Etiology
 Pressure on ureters and bladder causing
Stasis with compression of ureters
 Reflux
 Hormonal effects cause decrease tone of
bladder
Assessment
 Dysuria, frequency, urgency
 lower abdominal pain; costal vertebral
pain
 fever

Interventions



Monthly cultures
Oral Sulfonamides; Amoxicillin, Ampicillin,
Cephalosporins,
NO tetracyclines
Increase fluid intake to 3 – 4 liters / day
 Knee
chest position
 Complication

Uterine Irritability, Premature labor
 T O R C H A Infections
T = Toxoplasmosis
 O = Other

Syphilis, Gonorrhea,
Chlamydial,Hepatitis A or B
R = Rubella
 C = Cytomegalovirus
 H = Herpes
 A = Aids

 Toxoplasmosis
 Etiology
 Protozoan infection. Raw meat and cat litter
 Maternal and Fetal Effects
 Mom - flu-like symptoms, lymphadenopathy
 Fetus – stillborn, premature birth, microcephaly;
mental retardation
Interventions / Nursing Care
Instruct to cook meat thoroughly
* Avoid changing cat litter
* Advise to wear gloves when working in
the garden
Treatment: Sulfa drugs
*
Syphilis
Etiology
• Spirochete – Treponema Pallium
Maternal and Fetal Effects
 May pass across the placenta to fetus
causing spontaneous abortion. Major
cause of late,second trimester abortions
 Infant born with congenital anomalies
Syphilis
Intervention:
• 1. Penicillin
• 2. Advise to return for prenatal visits
monthly to assess for reinfection.
• 3. Advise that if treated early, fetus may
not be infected
Gonorrhea


Etiology – Neisseria Gonorrhoeae
Maternal and Fetal Effects:



May get infected during vaginal delivery causing
Ophthalmia neonatorium (blindness) in the
infant
Mom will experience dysuria, frequency,
urgency
Major cause Pelvic Inflammatory Disease which
leads to infertility.
Treated with
Treat partner!!
Rocephin
Spectinomycin
Chlamydia
Three times more common than
gonorrhea.
 Etiology – Chlamydia trachomatis

 Maternal
and Fetal Effects
 Mom
– pelvic inflammatory disease,
dysuria, abortions, pre-term labor
 Fetus -- Stillbirth, Chylamydial
pneumonia

Interventions
Erythromycin, doxycycline, zithromax
 Advise treatment of both partners is very
important

Hepatitis A or B


Highly contagious when transmitted by direct
contact with blood or body fluids
Maternal and Fetal Effects:
•
•
•

All moms should be tested for Hep B during pregnancy
Fetus may be born with low birth weight and liver
changes\
May be infected through placenta, at time of birth, or
breast milk
Intervention:
•
Recommend Hepatitis B vaccination to both mother
and baby after delivery.
Rubella
 Etiology
Spread by droplet infection or through direct
contact with articles contaminated with
nasopharyngeal secretions.
Crosses placenta
 Maternal and Fetal Effects
Mom– fever, general malaise, rash
Most serious problem is to the fetus--causes
many congenital anomalies (cataracts, heart
defects)
 Intervention
 Determine immune status of mother. If titer
is low, vaccine given in early postpartum
period
 CYTOMEGALOVIRUS
Etiology -- Member of the Herpes virus
• Crosses the placenta to the fetus or
contracted during delivery. Cannot breast
feed because transmitted through breast milk
Effects on Mom and Fetus
• Mom – no symptoms, not know until after
birth of the baby
Fetus -- Severe brain damage; Eye damage
•
Intervention
No drug available at this time
Teach mom should not breast feed baby
Isolate baby after birth
Herpes Simplex Type 2
 Maternal and Fetal Effects
 Painful lesions, blisters that may rupture
and leave shallow lesions that crust over
and disappear in 2-6 weeks
 Culture lesions to detect if Herpes, No cure
 If mom has an outbreak close to delivery,
then cannot deliver vaginally. Must deliver
by Cesarean birth
*Virus is lethal to fetus if inoculated
at birth
 Intervention:
 Zivorax
AIDS
• Etiology: Human Immunodeficiency
Virus, HIV

Transmission of HIV to the fetus from
seropositive mom by:
 Perinatal transmission – through the placenta at birth

when the infant is exposed to maternal blood and
vaginal secretions.
Through breast milk
**The virus must enter the baby’s
bloodstream to produce infection.
Maternal and Fetal Effects:
Mom - brief febrile illness after exposure
to with symptoms of fatigue and
lymphadenopathy
Fetus has less than 2% chance of being
infected because of meds, cesarean
delivery, and bottlefeeding.
No symptoms until about 1 year of age
HIV
Diagnosis:
The mother can be diagnosed by the
ELISA test and confirmed using the
Western Blot.
 Assess immunodeficiency as determined
by CD4+ lymphocyte count

Evaluate risk of disease progression by
assessing plasma HIV-1 which provides
information about the viral load (amount
of virus present in the body).
Interventions

Provide Emotional Support

Teach measures to promote wellness

Give Antiretroviral drugs – zidovudine (ZDV) or
Retrovir (AZT)




Oral drug daily
IV drugs during labor and delivery
Oral liquid form of drugs to newborn starting 8 hours
after delivery for 6 weeks
Provide information about resources
The End
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