The document discusses puerperal sepsis and urinary tract infections. Puerperal sepsis is defined as an infection of the genital tract occurring after childbirth. Common causes include bacteria like Doderlein bacillus. Risk factors include prolonged rupture of membranes, operative deliveries, and retained placental tissues. Signs include fever, foul-smelling discharge, and pelvic pain. Treatment involves isolation, intravenous antibiotics like cefotaxime and metronidazole, and possible drainage of abscesses. Urinary tract infections in the postpartum period are also discussed, with E. coli being a common cause. Symptoms include fever and painful urination. Diagnosis is by urine culture and
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UTIs in pregnancy is common and a serious cause of maternal and perinatal morbidity and mortality.
Clinical presentations include asymptomatic bacteriuria , acute cystitis and pyelonephritis
How many patients does case series should have In comparison to case reports.pdfpubrica101
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Damage to the spinal cord above the sacral region causes reflex incontinence. This condition causes loss of voluntary control of urination; but the micturition reflex pathway often remains intact, allowing urination to occur without sensation of the need to void
Overflow incontinence occurs when a bladder is overly full and bladder pressure exceeds sphincter pressure, resulting in involuntary leakage of urine. Causes often include head injury; spinal injury; multiple sclerosis; diabetes; trauma to the urinary system; and postanesthesia sedatives/hypnotics, tricyclics, and analgesia
Hyperreflexia, a life-threatening problem affecting heart rate and blood pressure, is caused by an overly full bladder. It is usually neurogenic in nature; however, it can be caused functionally by blockage
Diseases that cause irreversible damage to kidney tissue result in end-stage renal disease (ESRD).
uremic syndrome- An increase in nitrogenous wastes in the blood, marked fluid and electrolyte abnormalities, nausea, vomiting, headache, coma, and convulsions characterize this syndrome. As the uremic symptoms worsen, aggressive treatment is indicated for survival
Nocturia - awakening to void one or more times at night
An excessive output of urine is polyuria.
. A urine output that is decreased despite normal intake is called oliguria.
increased urine formation (diuresis)
a stoma (artificial opening)
Urinary Retention. Urinary retention is an accumulation of urine resulting from an inability of the bladder to empty properly.
URINE OVERFLOW- The sphincter temporarily opens to allow a small volume of urine (25 to 60 mL) to escape. With retention a patient may void small amounts of urine 2 or 3 times an hour with no real relief of discomfort or may continually dribble urine.
pain or burning during urination (dysuria) as urine flows over inflamed tissues
blood-tinged urine (hematuria)
Urinary incontinence is the involuntary leakage of urine that is sufficient to be a problem. It can be either temporary or permanent, continuous or intermittentUrinary elimination depends on the function of the kidneys, ureters, bladder, and urethra. Kidneys remove wastes from the blood to form urine. Ureters transport urine from the kidneys to the bladder. The bladder holds urine until the urge to urinate develops. Urine leaves the body through the urethra. All organs of the urinary system must be intact and functional for successful removal of urinary wastes. Intact efferent and afferent nerves from the bladder to the spinal cord and brain must be present
INTAKE AND OUTPUT OF URINE
Assess the patient’s average daily fluid intake.
at home, ask him or her to estimate his or her intake by showing a measurement on a commonly used glass or cup
Special receptacles (urimeters) that attach between indwelling catheters and drainage bags are a convenient means of accurately measuring urine volume. A urimeter holds 100 to 200 mL of urine. After measuring urine from a urimeter, drain the cylinder
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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ASSISTING WITH THE USE OF BED PAN BY ANUSHRI SRIVASTAVA.pptxAnushriSrivastav
When a patient uses a bedpan, promote comfort and normalcy and respect the patient’s privacy as much as possible. Be sure to maintain a professional manner. In addition, provide skin care and perineal hygiene after bedpan use
Regular bedpans have a rounded, smooth upper end and a tapered, open lower end. The upper end fits under the patient’s buttocks toward the sacrum, with the open end toward the foot of the bed
. A special bedpan called a fracture bedpan is frequently used for patients with fractures of the femur or lower spine
Fracture bedpan - used for patients with fractures of the femur or lower spine. The fracture pan has a shallow, narrow upper end with a flat wide rim, and a deeper, open lower end. The upper end fits under the patient’s buttocks toward the sacrum, with the deeper, open lower end toward the foot of the bed.
Ordinary Bedpan
EQUIPMENTS
Bedpan (regular or fracture)
Toilet tissue
Disposable clean gloves
Additional PPE, as indicated
Cover for bedpan or urinal (disposable waterproof pad or cover)
ASSESSMENT
Assess the patient’s normal elimination habits.
Determine why the patient needs to use a bedpan (e.g., a medical order for strict bed rest or immobilization).
Assess the patient’s degree of limitation and ability to help with activity.
Assess for activity limitations, such as hip surgery or spinal injury, which would contraindicate certain actions by the patient.
Check for the presence of drains, dressings, intravenous fluid infusion sites/equipment, traction, or any other devices that could interfere with the patient’s ability to help with the procedure or that could become dislodged.
Assess the characteristics of the urine and the patient’s skin
Assisting With Use of a Bedpan When the Patient Has Limited Movement
Patients who are unable to lift themselves onto the bedpan or who have activity limitations that prohibit the required actions can be assisted onto the bedpan in an alternate manner using these actions
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
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Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
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Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...
PUERPERAL SEPSIS & UTI.ppt
1. PUERPERAL SEPSIS AND
URINARY TRACT INFECTION
BY:
MS. LAMNUNNEM HAOKIP
SENIOR TUTOR/LECTURER
OBG NURSING
SSNSR, SU
2. PUERPERIUM
Puerperium is the period following childbirth during
which the body tissues, specially the pelvic organs revert
back approximately to the pre-pregnant state both
anatomically and physiologically with in 6 wks.
The key to management of sepsis is early recognition,
aggressive resuscitation, antibiotic administration and
source control.
6. CAUSATIVE ORGANISM
Doderlein bacillus (60-70%)
Yeast like fungus –candida albicans (25%)
Staphylococcus albus or aureus
Streptococcus –anerobic common
Beta hemolyticus streptococcus rare
E.coli
7. PREDISPOSING FACTORS
Antepartum factors :
• Malnutrition and anaemia
• Preterm labor
• Premature rupture of the membrane
• Chronic deliberating illness
• Prolonged rupture of the membrane
8. • Repeated vaginal examination
• Prolonged rupture of the membranes
• Dehydration and keto-acidosis during labor
• Traumatic operative delivery
• Haemorrhage - antepartum or postpartum
• Retained bits of the placental tissue or membranes
• Placental praevia – placental site lying close to the vagina
• Caesarean delivery
Intrapartum factors
9. PATHOGENESIS
• Transmitted by another person
• Source - midwife, doctor and other
patients or visitors
EXOGENOUS
• Causative organisms - Streptococcus
fecalis
• Anaerobic streptococci and
clostridium welchi found in the
vagina
ENDOGENOUS
10. SIGN AND SYMPTOMS
Local infection-
Slight raise in temperature, generalized malaise and
headache.
Redness and the swelling of the local wound
Pus formation and disruption of wound
Uterine infection- mild infection
Pyrexia of variable degree and tachycardia.
Red, copious, offensive lochia & tender and soft
uterus.
11. CONT…
Fever which occurs within 24 hours or more is the
first sign.
Increased Pulse rate .
The uterus is sub-involuted,.
Foul smelling vaginal discharge.
Local pain and swelling of the infected suture line.
Headache, insomnia and anorexia
12. In severe sepsis:
Constant pelvic pain.
Rise in temperature with increased pulse rate.
Lower abdominal pain.
Intense pain which worsens the condition of the
patients.
Severe infection of the fallopian tubules.
Collection of pus in the pouch of Douglas.
17. ANTENATAL
Improvement of general condition
Treatment of septic cocci
Abstinence from sexual intercourse in the last two
months
Care about personal hygiene – bathing in dirty water to
be avoided
Avoiding contact with people having infection, such as
cold, boils.
Avoiding unnecessary vaginal examinations and douches
in the later months.
18. INTRAPARTUM
Staff attending on labor client should be free of
infections.
Full surgical asepsis to be taken while conducting
delivery
Prophylactic antibiotic must be administered in cases
of caesarean section to reduced the incidence of
wound infection, endometritis UTI.
Ceftriaxone 1g IV immediately after cord clamping
and a second dose after 8 hours is recommended.
19. POSTPARTUM
Take aseptic precautions while dressing the perineal
wound
Restriction of the visitor in the postpartum ward
Mothers to be instructed to use sterile sanitary pads
and to change them frequently
Vulva and perineum to be cleaned with mild
antiseptic solution following urination and defecation
Infected mothers and babies are to be isolated
20. TREATMENT
1. ISOLATION OF PATIENT: specially when
haemolytic streptococcus is obtained on culture.
2. MAINTAIN INTAKE & OUTPUT
3. INDWELLING CATHETER: to relieve any urine
retention due to pelvic abscess.
4. ANTIBIOTIC: intravenous administration of
cefotaxim 1g, 8hrly & metronidazole 0.5g, every 8
hrly. The treatment is continued for at least 7-10
days.
21. SURGICAL INTERVENTION
PERINEAL WOUND:
• The stitches of the perineal wound may have to be
removed to facilitate drainage of pus and relieve pain
After the infection is controlled, secondary sutures
may be given later.
RETAINED UTERINE PRODUCTS
PELVIC ABSCESS :should be drained by
colpotomy under ultrasound guidance.
HYSTRECTOMY
23. DEFINITION
It is an infection of the urinary organs
such as kidney, ureter, urinary bladder
and urethra.
The causative organisms are:
⚫ E. coli
⚫ Klebsiella
⚫ Proteus
⚫ Staphylococcus aureus
24. Others:
⚫Recurrence of previous cystitis and pyelitis
⚫Infection contracted for the first time during
pregnancy is due to :-
Effect of frequent catheterization either during labor
or in early puerperium to relative retention of urine.
Stasis of urine during early puerperium due to lack of
bladder tone and less desire to pass urine.
25. CLINICAL FEATURES
Raised temperature ( pyrexia)
Costovertebral angle pain
Supra pubic discomfort
Frequent and often painful micturition
Nausea and vomiting
26. DIAGNOSIS
UTI is confirmed by examination of an
uncontaminated midstream clean catch
sample for urinalysis and culture and
antibiotic sensitivity test.
27. MANAGEMENT
Adequate intake of fluids
Adequate drainage of urine
Keeping the perineal area clean and hygienic
Frequent changing of inner wears
Used of clean warm water
Proper Antimicrobial therapy: Ceftriaxone 250 mg 6 hours apart or
500 mg 8 hours apart IV.
28. BIBLIOGRAPHY/REFERENCES
• Annamma Jabob. A comprehensive textbook of Midwifery and Gynaecological
Nursing, Fourth edition.
• Lily Podder. Fundamentals of Midwifery and Obstetrical Nursing. ELSEVIER.
• DC Dutta’s textbook of Obstetrics. Hiralal Konar 8th Edition.Jaypee The Health
Sciences Publisher.
• https://www.nhp.gov.in/disease/gynaecology-and-obstetrics/puerperal-sepsis
• https://pubmed.ncbi.nlm.nih.gov/23993724/