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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

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Infections / Inflammations

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  1. Infections / Inflammations

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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 Rocephin Spectinomycin Treat partner!!

  9. 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

  10. 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.

  11. 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

  12. 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

  13. 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

  14. 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.

  15. 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

  16. HIV Diagnosis: The mother can be diagnosed by theELISA test and confirmed using theWestern 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).

  17. 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

  18. The End RETURN

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