• Show no significant bleeding from the gastrointestinal tract.
• Show no anxiety, a feeling of fullness in the epigastrium and other indicators that show hemorrhage and shock.
• Shows the results of the examination were negative for occult gastrointestinal bleeding.
• Free from areas that experienced ecchymosis or hematoma formation.
• Showed vital signs were normal.
• Maintaining a break in a state of calm when there is active bleeding.
• Recognizing the rationale for a blood transfusion and action to overcome the bleeding.
• Take action to prevent the trauma (eg, use a soft toothbrush, blow slowly, avoid knock and drop, avoid straining during defecation).
• Did not experience the side effects of drug delivery.
• Use all medications as prescribed.
• Recognizing rational to perform maintenance actions using all drugs.

Definition
Infection is associated with the proliferation of microorganisms in the human body, along with the body’s reaction to it.
Postpartum infections (puerperal sepsis or fever after childbirth) is a clinical infection in the genital tract that occurs within 28 days after abortion or childbirth (Bobak, 2004).

Etiology
This infection occurs after childbirth, the bacteria enter the body at the time of the birth process. Among them, when membranes rupture before, or during labor is to become a bridge entry of germs in the body through the uterus.
Infection can occur due to bacteria that are often found in the vagina (endogenous) or due to exposure to pathogenic agents from outside the vagina (exogenous) (Bobak, 2004). However, this infection usually does not cause disease in labor, birth or postpartum. Nearly 30 bacteria have been identified under the canals genital (vulva, vagina and cervix) at any time (Faro 1990). While some of it, including some of the fungus, are considered non pathogenic under most environments, and are at least 20, including E. coli, Staphylococcus aureus, Proteus mirabilis and Klebsiella pneumoniae, are pathogenic (Tietjen, L; Bossemeyer, D, & McIntosh, N , 2004).

Clinical Manifestations
Rubor (redness), calor (local fever) caused vasodilation and tumor (swelling) due to exudation. Nerve endings will feel stimulated by inflammation so that there are pain (dolor). Pain and swelling will lead to physiological disorders, and common reactions include headache, fever and increased heart rate (Sjamsuhidajat, R. 1997).

Pathophysiology
The reaction of the body can be a local reaction and may also be the general reaction. In infections with common reaction would involve neurological and metabolic reactions occur at that light-reticular limpo throughout the body, such as the proliferation of phagocytic cells and antibody producing cell (B lymphocyte). Then the local reaction is called an acute inflammatory reaction was continued during a process of tissue destruction by trauma. When the cause of destruction of tissue can be eradicated, then the rest of the damaged tissue called debris, will be in phagocytosis and removed by the body until there is a resolution and healing. When excessive trauma, corrections phagocytic cells sometimes excessively so excessive debris collects in a cavity or abscess formation gathered in other body tissues form flegman (extensive inflammation of connective tissue).

Prevention and Treatment
Reduce or prevent the predisposing factors such as anemia, malnutrition and weakness and treat the illnesses suffered by the mother.
Coitus in late pregnancy should be avoided or minimized and do be careful as it can cause rupture of the membranes. If this happens infection will easily fit in the birth canal. Avoid too long parturition and rupture length / take care that no protracted labor.
Resolving labor with little trauma as possible.
Injury to the vaginal birth for both action and periabdominal, cleaned, stitched as well as possible and maintain sterility.
Prevent bleeding a lot, if there is blood loss should be replaced by a blood transfusion.
All officers in the delivery room should cover the nose and mouth with a mask; suffering from respiratory infections are not allowed into the delivery room.
These tools and fabrics used in childbirth, should be disinfected.
Avoid repeated examination, do when there is a good indication to sterilization, especially if the membranes have ruptured.

Nursing Diagnosis for Postpartum Infections
1. Acute comfortable related to the inflammatory process.
2. Altered Body Temperature related to an increase in the metabolic rate.
3. Anxiety related to change in health status.

Nursing Diagnosis: Risk for self-mutilation, others and the environment related to delusions.
General purpose:
Clients do not injure themselves, others, and the environment.
Specific purpose:
1. Clients can build a trusting relationship with the nurse.
Rationale: The relationship of trust is fundamental to facilitate the interaction.
Nursing Interventions:

• Construct a trusting relationship: therapeutic greetings, introduce yourself, explain the purpose of the interaction, create a quiet environment, create a clear contract (subject, time, place).
• Do not argue and support the client’s delusions: tell the nurse receives client confidence “I accept your beliefs” with expressions received, say nurses do not support, accompanied by expressions of doubt and empathy, did not discuss the content of delusions clients.
• Ensure clients are safe and secure: tell the nurse will accompany the client and the client is in a safe place, use the openness and honesty do not leave the client alone.
• Observation is delusional disrupt daily activities and self-care.

2. Clients can identify capabilities.
Rationale: By knowing the capabilities of the client, it will allow nurses to direct the activities that are beneficial to the client rather than just thinking about it.
Nursing Interventions:

• Give compliments on the appearance and capabilities of clients are realistic.
• Discuss with clients the capabilities of past and present realistic.
• Ask the client, what is usually done, and encourage clients to do it now (linked with daily activities and self-care).
• If the client is always talking about delusions, listen to the needs of suspicion does not exist. Show the client that the client is essential.

3. Clients can identify unmet needs.
Rationale: By knowing the needs of clients who have not met the nurse, can plan to meet them and pay more attention to the needs of the client, so the client feels comfortable and safe.
Nursing Interventions:

• Observation of daily client needs.
• Discuss the client’s needs are not being met, either for at home or in the hospital (pain, anxiety, anger).
• Connect the unmet needs and the emergence of delusions.
• Increase activities that can meet the needs of clients and require time and effort (for the schedule if possible).
• Set the circumstances that the client does not have time to use the delusions.

4. Clients can relate to reality.
Rationale: In reality, the client can open his mind, that the reality is more true, than on what he thinks the client, so the client can eliminate the existing delusions.
Nursing Interventions:

• Speaking with clients in the context of reality (self, other people, places and times).
• Include the client in group activity therapy: reality orientation.
• Give praise to the positive activities undertaken by the client.

5. Clients can use the drug properly.
Rationale: The use of medications regularly and properly, will affect the healing process and the effects and side effects of drugs.
Nursing Interventions:

• Discuss with the client about drug name, dosage, frequency, effects and side effects of medication.
• Help clients use the drug with the principle of true 5 (patient name, drugs, dose, method and time).
• Encourage clients to talk about the effects and side effects of the drug are felt.
• Give reinforcement when the client is taking the correct medication.

6. Clients have the support of the family.
Rationale: Support and care of the family in caring for clients will be helping with the healing process of clients.
Nursing Interventions:

• Discuss with the client’s family, through family meetings about: symptoms of delusions, how to care for the client, the family and follow-up drug.
• Give reinforcement on family involvement.