A pregnant woman presents with PROM with complaints of loose motions, fever and abdominal pain. What could be… - NHM MP Staff Nurse-2019

NHM MP Staff Nurse-2019

Obstetrics & Gynaecology

Hard

Appeared in: NHM MP Staff Nurse-2019

Explanation

The patient's symptoms of fever, abdominal pain, and loose motions are non-specific and can be caused by multiple conditions.
Infective diarrhea is a direct fit for the gastrointestinal symptoms and fever.
Typhoid fever is a systemic infection that can manifest with fever, abdominal pain, and diarrhea.
Premature Rupture of Membranes (PROM) is a major risk factor for chorioamnionitis, a form of intrauterine infection that presents with fever and abdominal pain and can rapidly progress to maternal sepsis.
Because all three conditions are plausible differential diagnoses in this clinical scenario, 'All of the above' is the most comprehensive and correct answer.

Option A: While 'Infective diarrhea' is a possible diagnosis that explains the symptoms, choosing it alone would be incomplete. It overlooks the immediate life-threatening risk of sepsis secondary to PROM, which presents with similar signs.
Option B: Choosing 'Typhoid' alone is too specific and ignores other common causes of the symptoms. While possible, especially in endemic regions, it is less common than infective diarrhea and does not directly account for the high risk of ascending infection from PROM.
Option C: Although 'Sepsis' is a critical and highly likely diagnosis given the PROM, fever, and pain, selecting it alone ignores the fact that the symptoms also perfectly match common gastrointestinal infections, which could be either coincidental or the actual source of the sepsis.

Clinical Relevance

Nursing practice connection: Use the key finding related to Differential diagnosis of fever and gastrointestinal symptoms in a pregnant patient with Premature Rupture of Membranes (PROM) to guide bedside assessment, documentation, and the next nursing action.
In any pregnant patient with PROM and signs of infection (fever, pain), sepsis must be the top consideration due to its high morbidity and mortality for both mother and fetus.
Immediate nursing actions include assessing vital signs, fetal heart rate, and signs of sepsis; obtaining blood cultures; and preparing for the administration of broad-spectrum IV antibiotics as per the 'Sepsis Six' or similar protocol.
This clinical picture represents an obstetric emergency requiring urgent escalation to the obstetric team for management, which often includes induction of labor or delivery to remove the source of infection.

How to Approach the Question

First, identify the key elements of the clinical scenario: a pregnant woman, Premature Rupture of Membranes (PROM), and a triad of symptoms (loose motions, fever, abdominal pain).
Recognize that PROM is a significant risk factor for infection.
Evaluate each option based on the patient's presentation.
Option A (Infective diarrhea): The symptoms of loose motions, fever, and pain are classic for this diagnosis.
Option B (Typhoid): This systemic infection also presents with fever, abdominal pain, and GI disturbances.
Option C (Sepsis): Given the PROM, fever, and abdominal pain, chorioamnionitis leading to sepsis is a highly probable and life-threatening diagnosis.

Concept Tested & Keywords

Concept Tested: Differential diagnosis of fever and gastrointestinal symptoms in a pregnant patient with Premature Rupture of Membranes (PROM).
Stem keywords: pregnant woman, PROM, loose motions, fever, abdominal pain
Lead-in keywords: What could be the diagnosis?
Clinical cues: The presence of PROM is a critical cue, as it significantly increases the risk of intrauterine infection and sepsis.

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E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 463-465

E6 Obstetrics Williams p. 1-8