Anticipatory guidance provided by the nurse is beneficial for the patient. Provide information about antibiotic therapy, procedures that occur during labor and delivery, and possible outcomes for the infant. Since the patient's anxiety level is elevated, you may need to repeat information several times. Allow the patient to express her fears. Answer the questions of the significant others and take time to listen to their concerns, as well.

Monitor the patient for signs of infection after delivery, including the mother's lochia, fundal height, vital signs, and incisional healing. The patient with an intrauterine infection is at a higher

230 Chronic Fatigue Immune Dysfunction Syndrome risk for a postpartum hemorrhage than are her noninfected counterparts. Careful and frequent assessments for vaginal bleeding and firmness of the fundus are critical. If the fundus is "boggy," massage the fundus until firm.

DOCUMENTATION GUIDELINES If the Patient Is Undelivered

• Maternal vital signs; fetal heart rate pattern; uterine activity; maternal response to antibiotics; color, odor, and consistency of vaginal discharge

If the Patient Is Delivered

• Maternal and infant vital signs; amount and odor of lochia; involution of uterus; assessment of episiotomy or abdominal incision

• Amount of the infant's fluid intake and output, infant's response to antibiotics, daily weight of the baby

POSTPARTUM COMPLICATIONS. Instruct the patient to inform the physician if her temperature rises above 100.4°F. Increased vaginal bleeding, foul odor of the vaginal discharge, increased uterine tenderness, difficulty urinating, the appearance of hardened red areas in the breasts, pain in the calves of the legs, incisional pain, and redness or drainage from the incision are also reasons to notify the physician.

INFANT COMPLICATIONS. Instruct the patient to inform the pediatrician if the baby's rectal temperature is above 101°F. Decreased interest in feeding, increased jaundice, a red or draining umbilical cord or circumcision site, increased irritability, difficulty breathing, lack of a bowel movement in 2 days, and fewer than six wet diapers a day are also reasons to notify the pediatrician.

MEDICATIONS. Instruct the patient to take the entire prescription of antibiotics, even if symptoms subside. Encourage the patient to notify the physician if symptoms persist when the prescription has ended.

RESTRICTIONS. Instruct the patient to abstain from sexual intercourse until the 6-week follow-up visit. Teach the patient to resume activity gradually and to limit use of stairs for the first week. Explain that patients should not lift anything heavier than their infant for the first 2 weeks after delivery. Teach vaginally delivered patients to avoid driving for 1 week and cesarean patients to avoid driving until the pain ceases.

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