A Nurse is monitoring a mother after a caesarean delivery. Which of the following would indicate a post partu… - RML Lucknow - 2021

RML Lucknow - 2021

Obstetrics & Gynaecology

Easy

Appeared in: RML Lucknow - 2021

Explanation

Foul-smelling (offensive or purulent) lochia is a cardinal sign of a postpartum uterine infection, such as endometritis.
The unpleasant odor is produced by anaerobic bacteria that have colonized the uterine lining, which is a rich medium for bacterial growth after delivery.
Normal lochia has a characteristic fleshy or musty smell, but it is not foul. It progresses through predictable stages of color change (rubra, serosa, alba) as the uterus heals.
Assessing the odor of lochia is a critical nursing intervention in the postpartum period to screen for infection.

Option A: An infection stimulates an immune response, which leads to an increase in the white blood cell count (leukocytosis), not a decrease. A fall in the Total Leukocyte Count (TLC) would suggest recovery, not an active infection.
Option B: Serum alkaline phosphatase (ALP) is not a primary or specific laboratory marker for postpartum uterine infection. ALP levels are normally elevated during pregnancy due to a placental isoenzyme and are expected to decrease after delivery.
Option D: A rapid rate of reduction in uterine size is a sign of normal, healthy uterine involution, where the uterus contracts and returns to its pre-pregnancy state. This is a desired finding.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Signs and Symptoms of Postpartum Infection in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Nurses must meticulously assess lochia for color, amount, and odor (the 'CAO' assessment) during every postpartum check. A foul smell is a key indicator of puerperal sepsis, a potentially life-threatening condition.
Early detection and reporting of foul-smelling lochia, especially when accompanied by fever, chills, and uterine tenderness, are critical for timely antibiotic administration and preventing complications like septicemia.
Patient education is vital. The nurse should teach the mother how to perform perineal care and to recognize and report signs of infection, such as a bad odor from her vaginal discharge or fever, after discharge.

How to Approach the Question

First, understand the question is asking for a sign of infection, which is an abnormal or pathological finding.
Evaluate each option by comparing it to the known normal physiological changes that occur in the postpartum period.
Analyze Option A: A 'fall in TLC count'. Recall that infection triggers an immune response, causing the white blood cell count to rise (leukocytosis). A fall is the opposite of what's expected in an infection.
Analyze Option B: 'Increasing serum alkaline phosphate'. Consider if this is a standard test for postpartum infection. It's primarily related to liver and bone, and while elevated in pregnancy, it's not a specific marker for uterine infection.
Analyze Option C: 'Foul smelling lochia'. Normal lochia has a fleshy, non-offensive odor. A foul or rotten smell is a classic textbook sign of bacterial overgrowth and infection.
Analyze Option D: 'Rapid rate of reduction in the size of the uterus'. This describes normal, effective involution, which is a healthy sign. Infection typically impairs this process, leading to subinvolution (a slow reduction).

Concept Tested & Keywords

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E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 51-62

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 129-131