A patient is on postpartum period of 72 hours, A purpura developed fever with decreased skin integrity due to fluid loss and excessive vaginal secretions may indicate development of sepsis. In above scenario, the body temperature support sepsis is:

1. A

   36°C

2. B

   37°C

3. C

   38°C

4. D

   40°C

Appeared in: AIIMS Delhi NO- 2019

Explanation

• A temperature of 40°C (104°F) represents a high-grade fever, which is a critical sign of a severe systemic infection.
• The scenario describes a patient with multiple signs of infection, progressing towards sepsis. Sepsis is a systemic inflammatory response, and a high fever is a hallmark of this severe condition.
• While postpartum fever is defined as a temperature of 38°C or higher, a temperature of 40°C provides much stronger evidence to support a diagnosis of sepsis compared to the threshold value.
• Medical literature indicates that spiking fevers of 39°C or higher in the postpartum period can be associated with virulent pelvic infections, a common cause of puerperal sepsis.

Why Other Options Were Wrong

• Option A: A temperature of 36°C is at the lower end of the normal range or may indicate hypothermia. While severe sepsis can sometimes present with hypothermia (less than 36°C), it is not the typical presentation of fever and does not support the diagnosis in this context.
• Option B: A temperature of 37°C is considered a normal body temperature (afebrile) and does not indicate an infectious process.
• Option C: A temperature of 38°C meets the minimum definition for puerperal fever. While it correctly identifies the presence of a fever, it is a less forceful indicator of the severity of sepsis compared to a high-grade fever of 40°C. The question asks what supports sepsis, and 40°C is stronger support.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Puerperal Sepsis and Temperature Criteria helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• Recognizing the significance of high-grade fever is a critical nursing skill. A temperature of 40°C in a postpartum patient with other signs of infection is a red flag for sepsis and requires immediate escalation and intervention to prevent septic shock and maternal mortality.
• Nurses must be vigilant in monitoring vital signs, especially temperature, in the postpartum period. Any fever of 38°C or higher warrants a thorough assessment for the source of infection, including endometritis, UTI, wound infection, or mastitis.
• What if? If the patient's temperature was 38.1°C with no other signs of systemic illness (e.g., normal heart rate, blood pressure, and feeling well), the nurse would still report it as postpartum fever and continue close monitoring, but the urgency would be less than with a 40°C fever, as it is less suggestive of sepsis without other SIRS criteria being met.

How to Approach the Question

• First, analyze the clinical scenario: a postpartum patient (72 hours) with signs of infection (fever, fluid loss, secretions) and suspected sepsis.
• Identify the core question: Which temperature value provides the strongest support for a diagnosis of sepsis?
• Recall the definition of postpartum fever. The threshold is 38°C (100.4°F). This eliminates the normal temperature options (36°C and 37°C).
• Differentiate between the threshold for fever (38°C) and a strong indicator of a severe systemic process like sepsis.
• Recognize that sepsis is a severe condition. A higher temperature (40°C) is a more significant and alarming sign than the minimum threshold temperature.
• Conclude that the high-grade fever of 40°C is the most compelling piece of evidence among the choices to support the development of sepsis.

Concept Tested & Keywords

• Concept Tested: Puerperal Sepsis and Temperature Criteria
• Stem keywords: postpartum period, 72 hours, fever, sepsis, body temperature
• Lead-in keywords: support
• Clinical cues: Patient is 72 hours postpartum, which is outside the initial 24-hour period where temperature elevation can be common and non-pathological.
• Clinical cues: Presence of decreased skin integrity and excessive vaginal secretions points towards a source of infection.

Question ID

QhleKhR0jJVfpQ5mjFpIeO

Copy ID

Reference Book

E6 Obstetrics Williams p. 59-78

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