Postpartum period of 72 hours a purpura developed fever, with decrease skin integrity due to fluid loss and excessive vaginal secretions may indicative to develop sepsis. In this condition which body temperature supports sepsis?

1. A

   36°C

2. B

   37°C

3. C

   38°C

4. D

   39°C

Appeared in: NIMHANS Nursing Officer - 2019

Explanation

• Puerperal fever, a primary indicator of postpartum infection, is clinically defined as a body temperature of 38.0°C (100.4°F) or higher, occurring after the first 24 hours postpartum.
• The patient is 72 hours postpartum and presenting with signs of infection, making a temperature of 38°C a significant finding that supports a diagnosis of sepsis.
• This temperature also meets the criteria for Systemic Inflammatory Response Syndrome (SIRS), where a temperature greater than 38°C or less than 36°C is one of the key indicators.

Why Other Options Were Wrong

• Option A: This is a low-normal temperature. It does not meet the criterion for fever.
• Option B: This is considered a normal body temperature (normothermia) and does not indicate an infection or a septic process.
• Option D: While a high fever of 39°C is a strong indicator of sepsis, the question asks which temperature supports the diagnosis. 38°C is the established clinical threshold that first defines the presence of a significant fever in the postpartum context.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Diagnostic criteria for postpartum fever and sepsis as background academic context rather than a clinical decision trigger.
• A temperature of 38°C or higher in a postpartum woman after the first 24 hours is a critical red flag for puerperal infection and requires prompt assessment and intervention to prevent progression to sepsis, a life-threatening condition.
• Nurses must be prepared to initiate sepsis protocols, which may include obtaining blood cultures, administering broad-spectrum antibiotics as ordered, and starting fluid resuscitation for any postpartum patient with fever and other signs of infection.
• What if? If the patient's temperature was 35.8°C (hypothermia) along with other signs like confusion, tachycardia, and hypotension, this would also be highly indicative of severe sepsis or septic shock, requiring immediate emergency intervention.

How to Approach the Question

• First, identify the key elements of the clinical scenario: a postpartum patient (72 hours) with signs of infection (fever, fluid loss, secretions) and suspected sepsis.
• Next, recall the clinical definition of postpartum fever and the temperature criteria for Systemic Inflammatory Response Syndrome (SIRS).
• The definition of puerperal fever is a temperature of 38.0°C or higher after the first 24 hours postpartum. The SIRS temperature criterion is greater than 38°C or less than 36°C.
• Evaluate the options against these criteria. 37°C is normal. 36°C is on the borderline of the lower limit but doesn't meet the 'less than 36°C' threshold. Both 38°C and 39°C indicate fever.
• Select 38°C as the best answer because it represents the specific diagnostic threshold that defines the presence of fever in this clinical context.

Concept Tested & Keywords

• Concept Tested: Diagnostic criteria for postpartum fever and sepsis
• Stem keywords: Postpartum period, 72 hours, fever, sepsis, body temperature
• Lead-in keywords: which body temperature supports
• Clinical cues: Patient is 72 hours postpartum, which is beyond the initial 24-hour period where transient fever can occur.
• Clinical cues: Symptoms like decreased skin integrity, fluid loss, and excessive vaginal secretions point towards an infectious process.

Question ID

QGND4mH7z3jFPXUKzsV8GM

Copy ID

Reference Book

E6 Obstetrics Williams p. 59-78

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 18-26