A nurse in the postpartum unit is reviewing the records of the clients on the unit. During the review, the nurse determines that which client is most at risk for developing endometritis following delivery?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

The client who underwent an emergency caesarean delivery for fetal distress presents the highest cumulative risk for endometritis.
Cesarean delivery is the single most significant risk factor for postpartum uterine infection, as it involves a surgical incision into the uterus.
The emergency nature of the surgery implies that the client likely experienced labor, rupture of membranes, and multiple vaginal examinations, all of which introduce bacteria into the genital tract.
Adolescent (young maternal) age is an independent risk factor that further increases the likelihood of developing a postpartum infection.

Option A: A normal spontaneous vaginal delivery is the least invasive method and carries the lowest risk for developing endometritis.
Option B: While prolonged labor (18 hours) is a risk factor for endometritis, the risk associated with a vaginal delivery is substantially lower than that of a caesarean section.
Option C: An elective caesarean delivery carries a high risk of infection due to the surgical procedure. However, it is generally less risky than an emergency caesarean because it is typically performed before the onset of labor and rupture of membranes, limiting bacterial exposure to the uterus.

Clinical Relevance

Nursing practice connection: Use the key finding related to Risk factors for postpartum endometritis to guide bedside assessment, documentation, and the next nursing action.
Nurses must be vigilant in assessing all postpartum clients for risk factors of endometritis. This allows for targeted monitoring and early intervention.
Key signs and symptoms of endometritis to monitor for include fever (38.0°C or higher), uterine tenderness, abdominal pain, and foul-smelling lochia.
Prophylactic antibiotics administered before a caesarean section are a crucial intervention that significantly reduces the incidence of postpartum metritis by 65 to 75 percent.

How to Approach the Question

First, identify the core of the question: it asks to find the client with the highest risk for a specific complication, endometritis.
Next, recall or look up the major risk factors for postpartum endometritis. Key factors include mode of delivery, duration of labor, duration of ruptured membranes, number of vaginal exams, and maternal factors like age.
Analyze each option systematically. For each client, list the risk factors present.
Compare the cumulative risk profiles. Option A has the lowest risk. Option B has one risk factor (prolonged labor). Option C has a major risk factor (C-section). Option D has multiple, compounding risk factors: the most significant one (C-section), its emergency nature (implying labor/ruptured membranes), and an independent demographic risk (adolescent age).
Conclude that the client with the greatest number and severity of risk factors is the correct answer.

Concept Tested & Keywords

Concept Tested: Risk factors for postpartum endometritis
Stem keywords: postpartum unit, endometritis, risk, delivery
Lead-in keywords: most at risk
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

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E6 Obstetrics Williams p. 60-80

Practise the full DHS Staff Nurse - 2018 (Shift-2nd)

Attempt every question from this paper in a timed mock, then review the full solution for each one.