产褥期感染PPT专业课件.ppt

产褥感染及护理 Maincontent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Clinicalmanifestationandpathology Maincontent 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Puerperalinfectionisgenitaltractinvasionbypathogenwhichleadstolocalorsystemicinfectionduringpuerperium Puerperalmorbidityisdefinedasatemperature dailyuseoralthermometertomeasurefourtimes eachtimewithanintervalof4hours greaterthan38 0 Conany2ofthefirst10daysfollowingdeliveryexclusiveofthefirst24hours Puerperalmorbidityismuchcausedbypuerperalinfectionwhichcanalsobecausedbyothersystems likerespiratorytract urinarytract etc 标题 Maincontent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Clinicalmanifestationandpathology Maincontent ClicktoaddText ClicktoaddText ClicktoaddText 机体免疫力 bodyimmunity 细菌数量 bacteriaquantity 细菌毒力 bacterialvirulence 诱发因素Contributor 平衡失调balancebrokendown 孕期贫血 营养不良 体质虚弱pregnancyanemia malnutrition physiqueweak 产科手术操作或慢性疾病obstetricoperationorchronicdisease 产前产后出血prenatalpostpartumhemorrhage 产程延长prolongedlabor 妊娠晚期性生活sexualintercourseduringthirdtrimester 胎膜早破prematureruptureofmembrane 羊膜腔感染amnioticcavityinfection 其他诱发因素 感染途径routeofinfection 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Endogenousinfection 外源性感染Exogenousinfection 感染途径routeofinfection Mostofthecausativeagentsthatnormallyresideinthegenitaltractorotherpartsarenotpathogenic Onlywhenthebodyresistancedropaccompanyinginfectionincentivecanbepathogenic conditionalpathogenicbacteria externalpathogensgetintogenitaltractoftenbyinfectedclothingequipmentvarioussurgicaldiagnosis treatmentequipmentandothercontactpatientsandcauseinfection 内源性感染Endogenousinfection 外源性感染Exogenousinfection 病原体Pathogens 需氧菌Aerobicbacteria 厌氧菌Anaerobicbacteria 链球菌streptococcus 杆菌bacteria 葡萄球菌staphylococcusaureus 球菌cocci 杆菌属bacterium 梭状芽胞杆菌clostridia 支原体与衣原体mycoplasmaandchlamydia Maincontent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Clinicalmanifestationandpathology Maincontent 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 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Clinicalmanifestationandpathology Acuteepisiotomyinfection infectionoftheperinealusuallydevelopingatthesiteofanmedianorlateralepisiotomyorlaceration localpain tenderness callosity warmth redorpurulentsecretion seriouswoundscanbesplit 01 Vaginalcervicitis cervicallacerationcauseinflammation butsymptomsisnotsoobvious ifthedepthreachesthebottomoffornixlatum thenfailstotimelysuture thepathogenscanbedirectlyascendingorthroughthelymphaticspreadingwhichleadtopelvicconnectivetissueinflammation simplevaginalcervicitis Theandtheclinicalmanifestationismucosalhyperemiaandedema ulcer increasingpurulentsecretions Mothersmayhavesomesystemicsymptomssuchasaslightfever chillsandpulsespeeding 02 临床表现及病理Clinicalmanifestationandpathology Uterineinfection includingendometritisandmyometritis Bacteriabyplacentalstrippingsurfaceinvasion thefirstspreadtouterinedecidualayertocauseacuteendometritis however inflammationmaycontinuetoinfringeuponshallowmusclelayerdeepmusclelayerandserousmembranelayer causingmyometritis duetothecongestion necrosisofendometrial therearemanypurulentsecretionandfrowzinessinvagina Whenitcomestomyometritis subinvolutionofuterus tendernessontheabdomen thepatientscanhaveinfectionsuchashighfever headache leukocytosis 03 1 4 1 急性盆腔结缔组织炎和急性附件炎Acuteinflammationofpelvicconnectivetissueandacuteappendagitis 2 血栓静脉炎Thrombophlebitis 3 脓毒血症和败血症Pyemiaandsepticemia 2 3 4 急性盆腔腹膜炎及弥漫性腹膜炎Acutepelvicperitonitisanddiffuseperitonitis 临床表现及病理Clinicalmanifestationandpathology Maincontent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Clinicalmanifestationandpathology Maincontent Generaltreatment strengtheningnutrition givingenoughvitamins halfdecubituswillbegoodformaternitytomakeiteasierforinflammationlochiatodrainageandmakeinflammationconfinedtothepelvicinside 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 Antibiotictreatment followthedoctor sadvice firstusingbroad spectrumantibiotics thenadjustmentafterbacteriacultureanddrugtest ifthetemperatureshowsnocontinuingdeclineafterusingantibiotics48to72hours itwillbenecessarytofindthereasons 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48 72h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 traditionalChinesemedicinetreatment accordingtopatientsconditiondialectical choosepromotingbloodcirculationtoremovebloodstasistreatmentoftraditionalChinesemedicine 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 Drainageunblocked getoutthewoundwireofperineuminfectiondogoodtodrainaging sitzbathstwiceaday onceitwassuspectedpelvicabscess drainagethroughabdominalorfornixvaginaincisioncouldbeavailable iftheperineumwoundorperitonealincisionsuffersinfection theincisiondrainagewillbeok 血栓静脉炎症治疗 1 肝素1mg kg d加入5 葡萄糖500ml中 静脉滴注Q6h 连续4 7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 thrombophlebitistreatment 1 heparin1mg kg dadd5 glucose500ml dripQ6h hepariniscontinuedfor4 7days 2 urokinase 400 000utojoin0 9sodiumchlorideor5 glucose500ml Intravenousdrip10days doremembertomonitoringduringthefunctionofbloodcoagulationduringthisperiod Alongsidewithoraldrugslikecoumarin aspirinanddipyridamole etc Maincontent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Clinicalmanifestationandpathology Maincontent 护理nursing 护理评估 护理诊断 预期目标 护理措施 护理评价 assessment diagnosis goals interventions evaluation 护理评估nursingassessment 2 1 3 检查诊断inspectiondiagnosis 身心状况及支持系统physicalandmentalconditionsandsupportsystem 病史history 1 评估诱因evaluationincentive 2 了解健康史Understandhealth3 了解本次妊娠情况understandthepregnancy 1 腹部检查Abdominalexamination2 妇科检查Gynecologialexamination3 实验室检查 白细胞 血沉 B超Laboratory whitebloodcells neutrophils Bultrasound 1 全身状况Generalsituation chilling2 局部状况Localstatus3 心里状况mentalcondition4 支持系统Supportsystem nursingdiagnosis 护理诊断 Thevitalsignsnormal anemiabasiccorrect Tomakesurethatpregnantwomenhavegottoknowhowtonurseforpuerperalinfection Anxiety Pain 预期目标 Infectionundercontrol normaltemperature increaseintimacy Painease Lackofknowledge Gettheunderstandingoffamily thecomfortofhusband Ahighbodytemperature Potentialcomplications uncontrolledhemorrhagicshockandinfection 护理措施nursinginterventions 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 wardenvironment quiet cleanandfreshair dailyventilationandkeepbedunitswarm bedunitandtheclothing dailythingsclean 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 highprotein highhea thighvitamin foodeasilytodigest morewaterencouraged ensureenoughliquidintake sleep enoughsleep 一般护理 Generalcare 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 Observationonpatient sillness generalsituation fever chill nauseaandvomiting muscleweakness abdominalpainsymptomssuchasabdominaldistension localsituation persistentpainforabdomen localvenouspressureandlowerlimbedema quantity character colorandsmelloflochia Uterineinvolution perineumwoundwithoutirritation 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 Activelycooperationwithtreatment followthedoctor sadvicetosupporttreatment correctionofanemia waterrecoveringofwaterandelectrolytedisorders increasingproteinvitaminintake followthedoctor sadvicetouseantibio