A nurse is caring for a postpartum client. Which finding would make the nurse suspect endometritis in this cl… - DHS Staff Nurse - 2018 (Shift-2nd)

DHS Staff Nurse - 2018 (Shift-2nd)

Obstetrics & Gynaecology

Medium

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

Explanation

The primary indicator for postpartum infection (puerperal sepsis), including endometritis, is a fever of 38°C (100.4°F) or higher.
Crucially, this fever is considered significant for infection if it occurs on two separate occasions at least 24 hours apart, after the initial 24-hour postpartum period.
A fever beginning on the second day postpartum fits this clinical definition perfectly, making it the most suspicious finding for endometritis among the given options.
Other classic signs that often accompany the fever in endometritis include uterine tenderness, malaise, and foul-smelling lochia.

Option A: Breast engorgement is a normal physiological process related to lactation, not a uterine infection. While it can cause a transient, low-grade fever ('breast fever'), this typically occurs on days 3-5 and lasts less than 24 hours.
Option B: A significantly elevated WBC count (physiologic leukocytosis) is a normal and expected finding in the immediate postpartum period due to the stress of labor and delivery. It is not a specific indicator of infection by itself.
Option C: Lochia rubra (red discharge) is the normal type of lochia for the first 1-3 days postpartum. Its presence on day two is an expected finding.

Clinical Relevance

Nursing practice connection: Use the key finding related to Assessment of postpartum complications, specifically identifying the signs and symptoms of endometritis to guide bedside assessment, documentation, and the next nursing action.
Recognizing the signs of endometritis is critical for nurses to ensure prompt diagnosis and treatment, which is essential to prevent more severe complications like pelvic abscess, peritonitis, septic pelvic thrombophlebitis, and sepsis.
Patient education is key. The nurse should teach the client to report any fever, foul-smelling discharge, or increasing pelvic pain after discharge from the hospital.
What if? If the fever of 38°C occurred within the first 24 hours postpartum, it would be less specific for endometritis. It would more likely be attributed to dehydration or exertion from labor. However, it would still warrant close monitoring, encouragement of fluid intake, and reassessment, as a virulent infection (e.g., Group A Streptococcus) can present early and aggressively.

How to Approach the Question

First, identify the core of the question, which asks for a finding that suggests endometritis in a postpartum client.
Next, analyze each option by comparing it to the known normal physiological changes that occur during the puerperium (the postpartum period).
Evaluate Option A (Breast engorgement): Recall that this is a common lactation-related event, not a uterine infection.
Evaluate Option B (Elevated WBC): Remember that physiologic leukocytosis is a normal response to labor.
Evaluate Option C (Lochia rubra on day 2): Recall the normal stages and timeline of lochia (rubra, serosa, alba). Lochia rubra is expected on day 2.
Evaluate Option D (Fever >38°C after 24 hours): Recall the clinical definition of puerperal infection. A fever appearing after the first 24 hours is the hallmark sign.

Concept Tested & Keywords

Concept Tested: Assessment of postpartum complications, specifically identifying the signs and symptoms of endometritis.
Stem keywords: postpartum client, endometritis, suspect
Lead-in keywords: finding
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.

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E6 Obstetrics Williams p. 59-78

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 50-60