Postpartum Fever Clinical Assessment
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Questions and Answers

What temperature indicates postpartum fever?

  • 38ºC on at least two occasions (correct)
  • Over 37.0ºC on one occasion
  • 38.5ºC once
  • 37.5ºC on at least two occasions

What is the expected change in the uterus's position after delivery?

  • Moves to the right side of the pelvis
  • Swells and stays at the same level
  • Descends rapidly to the pelvic floor
  • Firm at umbilicus, reducing by 1 cm daily (correct)

Which factor increases the risk of metritis after vaginal delivery?

  • Low maternal age
  • Short length of labor
  • Minimal cervical examinations
  • Prolonged labor (correct)

What is a normal finding in the healing of the perineum postpartum?

<p>Mild edema and redness, well approximated (D)</p> Signup and view all the answers

Which symptom suggests the possibility of an infection postpartum?

<p>Malodorous discharge (C)</p> Signup and view all the answers

What is expected regarding white blood cell levels immediately after birth?

<p>Increase (C)</p> Signup and view all the answers

Which condition is NOT a differential diagnosis for postpartum fever?

<p>Chest pneumonia (A)</p> Signup and view all the answers

Why might a mild temperature increase occur on days 2-3 postpartum?

<p>Start of milk production (A)</p> Signup and view all the answers

What is a common assessment tool for identifying infections in a hospital setting postpartum?

<p>CBC (Complete Blood Count) (B)</p> Signup and view all the answers

Which of the following conditions may elevate the risk for chorioamnionitis?

<p>Multiple cervical examinations (C)</p> Signup and view all the answers

Which of the following symptoms is most indicative of mastitis?

<p>Localized breast tenderness with erythema (C)</p> Signup and view all the answers

What is commonly associated with a pelvic infection in the postpartum period?

<p>Fevers ≥39°C within the first 24 hours (A)</p> Signup and view all the answers

What treatment is first-line for mastitis?

<p>Cephalexin 500 mg QID x7-10 days (B)</p> Signup and view all the answers

What symptom differentiates acute pyelonephritis from a regular urinary tract infection?

<p>Chills and fever (A)</p> Signup and view all the answers

What is the primary management strategy for dehydration postpartum?

<p>Intravenous hydration and rest (A)</p> Signup and view all the answers

Which bacteria is commonly associated with mastitis?

<p>Staphylococcus aureus (A)</p> Signup and view all the answers

A post cesarean patient experiencing respiratory complications may be at risk for which of the following?

<p>Pelvic infection (B)</p> Signup and view all the answers

What is NOT a symptom of endometritis?

<p>Severe headache (B)</p> Signup and view all the answers

What is a common result of incorrect attachment of the baby to the breast?

<p>Mastitis due to nipple trauma (A)</p> Signup and view all the answers

Which of the following is NOT typically included in the treatment plan for an acute urinary tract infection?

<p>Warm compresses (B)</p> Signup and view all the answers

What is the recommended frequency for breastfeeding a term and healthy baby?

<p>At least 8 times a day (A)</p> Signup and view all the answers

What should a mother do if her baby cannot fully empty her breasts?

<p>Pump every 3 hours (A)</p> Signup and view all the answers

Which of the following is a sign that a baby is getting enough food?

<p>Gaining weight (C)</p> Signup and view all the answers

To build and maintain milk supply, what is the target amount of breastmilk by the end of the first week?

<p>500 ml (B)</p> Signup and view all the answers

What is an appropriate way to wake a sleeping baby for breastfeeding?

<p>Changing the baby's diaper while talking (C)</p> Signup and view all the answers

What happens to stool frequency in a baby after the first month of life?

<p>Stools may not be as frequent (B)</p> Signup and view all the answers

What is the optimal daily total of breastmilk by weeks 2 or 3?

<p>800 ml (C)</p> Signup and view all the answers

How can mothers gradually reduce pumping during breastfeeding?

<p>By monitoring baby's weight and output (D)</p> Signup and view all the answers

What is a breastfeeding crisis or growth spurt primarily characterized by?

<p>An increase in the baby's physical development and milk demand. (B)</p> Signup and view all the answers

What is a late sign of hunger in a baby?

<p>Crying (C)</p> Signup and view all the answers

What should mothers do during the early days postpartum to support breastfeeding?

<p>Seek help for household tasks (B)</p> Signup and view all the answers

At what ages are growth spurts most commonly expected in infants?

<p>10 days, 3 weeks, 6 weeks, 3 months, and 6 months. (D)</p> Signup and view all the answers

What should reassure a mother that breastfeeding is going well during growth spurts?

<p>Breastfeeding is comfortable, and the baby has a good latch. (D)</p> Signup and view all the answers

What misconception may arise during a breastfeeding crisis?

<p>The mother may think her milk supply is low, leading to perceived insufficient milk supply (PMIS). (B)</p> Signup and view all the answers

How do growth spurts benefit milk production?

<p>They stimulate the mother's body to produce more milk through increased demand. (C)</p> Signup and view all the answers

What is an effect of introducing supplementary fluids or foods during perceived insufficient milk supply?

<p>It may create negative feedback on milk production and lower actual supply. (A)</p> Signup and view all the answers

Which sign indicates that a breastfeeding baby is likely content during growth spurts?

<p>The baby continues to nurse frequently and appears satisfied. (A)</p> Signup and view all the answers

Why might mothers mistakenly think they have a low milk supply during growth spurts?

<p>The feeding schedule appears to change unexpectedly. (C)</p> Signup and view all the answers

What behavior should mothers avoid when they suspect a breastfeeding crisis?

<p>Introducing formula or other supplements unnecessarily. (D)</p> Signup and view all the answers

What is the primary way to increase milk production in breastfeeding mothers?

<p>Removing milk frequently from the breast (D)</p> Signup and view all the answers

What should mothers consider if they notice sore, cracked nipples while breastfeeding?

<p>Consult a healthcare provider for help (D)</p> Signup and view all the answers

How can skin-to-skin contact benefit a breastfeeding mother and her baby?

<p>It calms a fussy baby and stimulates feeding interest (D)</p> Signup and view all the answers

What is a good indicator that an infant is receiving enough milk?

<p>The number of diapers the baby uses daily (A)</p> Signup and view all the answers

Why is it important for breastfeeding mothers to ensure an effective latch?

<p>To allow the baby to swallow frequently and signal milk transfer (A)</p> Signup and view all the answers

Which foods are commonly considered galactagogues to promote milk production?

<p>Oatmeal, dark leafy greens, and nuts (A)</p> Signup and view all the answers

What might be a side effect of taking domperidone for milk production?

<p>Dry mouth, headaches, and dizziness (D)</p> Signup and view all the answers

What is the recommended frequency of breastfeeding during the early weeks for optimal milk production?

<p>8-12 times a day, including nights (C)</p> Signup and view all the answers

What is the effect of supplementation with formula on a mother's milk supply?

<p>It may further decline her milk supply (D)</p> Signup and view all the answers

What is the recommended action if there is no increase in milk production by day five postpartum?

<p>Consult a healthcare provider (C)</p> Signup and view all the answers

Flashcards

Mastitis

Breast infection, red, tender, accompanied by flu-like symptoms and fever.

Mastitis treatment

Continue nursing on affected side. Use warm compress, pain relievers and possibly antibiotics if symptoms persist.

Postpartum UTI

Urinary Tract Infection in the mother after giving birth.

Postpartum UTI symptoms

Pelvic pressure, pain, fever, chills, general discomfort.

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Postpartum wound infection

Infection of surgical or delivery wounds (e.g., episiotomy, C-section).

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Endometritis

Uterine infection after childbirth.

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Endometritis symptoms

Tender, soft uterus, chills, discomfort, foul-smelling lochia.

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Dehydration symptoms

Headache, fatigue, lack of fluids.

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Dehydration treatment

Oral and/or intravenous fluids, pain relievers, rest.

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Postpartum infection

A general term for infection in the mother after birth.

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Postpartum Fever

Fever greater than 38°C on at least two occasions after childbirth.

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Postpartum Fever Symptoms

Includes chills, dysuria, flank pain, erythema, wound drainage, respiratory symptoms, perineal/abdominal pain, or malodorous discharge.

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Postpartum Infection Risk Factors

Factors increasing likelihood of postpartum infection include vaginal delivery, c-section, prolonged labor, prolonged rupture of membranes, frequent cervical exams, internal fetal monitoring, lower socioeconomic status, and young maternal age.

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Increased WBCs

White blood cell count expected to rise after childbirth.

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Milk Production Fever (Engorgement)

A mild temperature increase around days 2-3 postpartum, when milk production starts.

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Postpartum Uterine Involution

Uterus returning to normal size after childbirth; shrinking 1cm daily, firm at the umbilicus.

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Diagnosis Tools (Postpartum Fever)

Complete blood count (CBC) in hospital settings can assess possible infections; swabs and urinalysis may also be done.

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Differential Diagnosis (Postpartum Fever)

Considerations include intrauterine infection, endometritis (uterine lining infection), or other complications like breast infections.

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Breastfeeding Crisis

A period when a baby suddenly increases feeding frequency, usually due to a growth spurt.

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Frequent-Feeding Days

Days when a baby feeds more often than usual, often associated with growth spurts.

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Growth Spurts

Normal periods of rapid growth in a baby, leading to increased milk demand.

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Milk Supply Increase

The frequent feeding during growth spurts triggers an increase in milk production to meet the baby's demand.

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Perceived Insufficient Milk Supply (PMIS)

A mother's belief that she is not producing enough milk for her baby.

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Supplementation Impact

Introducing supplements during breastfeeding can negatively impact milk production.

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Supplementation during Growth Spurt

Supplementation during growth spurts can be unnecessary and harm milk production.

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Wet Diapers

The number of wet diapers should remain consistent even during growth spurts.

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Comfortable Nursing

Nursing should feel comfortable for both mother and baby.

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Content Baby

Even with increased feeding frequency, the baby should appear content and satisfied.

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Milk Supply Decline

When an infant receives a low volume of intake from breastfeeding and is supplemented, the mother's milk supply will decrease further.

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Cluster Feeds

A normal breastfeeding pattern in newborns where they feed frequently in short bursts, especially during evenings.

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Early and Frequent Feedings

The primary way to increase milk production is to feed the baby frequently, starting within the first hour after birth.

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Skin-to-Skin Care

Holding the baby skin-to-skin after birth and often throughout the day encourages frequent feeding and increases milk production.

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Effective Latch

A good latch is comfortable for the mother and allows the baby to get more milk at each feeding, signaling the breasts to produce more.

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Signs of Hunger

If a baby shows signs of hunger, like rooting, sucking on hands, or making noises, feed her, even if she just fed recently.

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Breast Compressions

Gently squeezing the breast during feeding when the baby is sucking but not swallowing can help milk flow.

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Milk Expression

If a baby is not latching well, express milk using a breast pump or hand expression to stimulate production.

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Domperidone

A prescription drug used to treat gastrointestinal issues which can increase milk production as a side effect.

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Exclusive breastfeeding

Feeding your baby only breast milk, no formula or other foods.

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Breastfeeding cues

Signs your baby is hungry, like waking up, rooting, licking their lips, or moving their mouth.

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Late breastfeeding cue

Crying is a late breastfeeding cue, meaning your baby is already quite hungry.

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How to wake a baby for feeding

Ways to gently wake a baby for feeding, like changing their diaper while talking to them, or taking their temperature.

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Building milk supply

Producing enough breast milk to feed your baby.

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Full milk supply sign

Pumping at least 60 ml from both breasts, 8 times a day, by the end of the first week.

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Gradually reduce pumping

As your baby breastfeeds well, you can slowly pump less often, while still monitoring weight and output.

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Signs baby is getting enough milk

Gaining weight, passing adequate urine, and having soft, yellow, seedy stools.

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Frequency of stools (after first month)

Baby may have fewer bowel movements (1 every 2 to 7 days), but they should still be soft and yellow.

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Rest and support in breastfeeding

Limit visits, rest between feeds, and seek help for household tasks to make breastfeeding easier.

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Study Notes

Postpartum Fever

  • Definition: Body temperature above 38°C (100.4°F) on at least two occasions.

History Taking and Clinical Assessment

  • Vital Signs: Temperature range 36.5-37.5°C, heart rate 60-100 bpm, blood pressure 100/60-140/90 mmHg.
  • Pain and Comfort: Mild afterpains, pain at perineal trauma site, abdominal pain.
  • Uterus: Firm at umbilicus, reducing by 1 cm daily, non-tender. Retained placenta is a possibility.
  • Bleeding/Discharge: Non-malodorous, reducing lochia (from rubra to serosa).
  • Wound Healing: Perineum: mild edema and redness, well-approximated; incision: dry, intact, no discharge;
  • Bladder and Bowel function, genitourinary tract: Mild urinary incontinence, delayed bowel.
  • Breasts and Nipples: Minor temperature elevation possible during milk production (day 2-3 postpartum), but rarely exceeding 38°C.
  • Specific Questions for Client: Chills, dysuria, flank pain, erythema, wound drainage, respiratory issues, perineal/abdominal pain, foul-smelling discharge, breast engorgement.

Potential Infections Timeline and Risk Factors

  • Infection Risk Increases: Varies depending on the infection; some more likely in the first 24 hours (potentially serious pelvic infection).
  • White Blood Cells: Expected increase at birth.
  • Diagnostic Testing: Complete blood count (CBC) useful in hospital setting, but not always necessary outside.
  • Delivery Route: Vaginal delivery increases risk for metritis and perineal infection; Cesarean section also carries risks.
  • Labor Duration: Prolonged labor increases metritis risk.
  • ROM Duration: >24hrs increases risk.
  • Cervical Examinations: Increased frequency of examinations increases risk of infection.
  • Fetal Monitoring: Internal fetal monitoring increases risk.
  • Socioeconomic Factors may contribute.
  • Maternal Age: Young maternal age is a risk factor.
  • Nulliparity: First-time mothers are at higher risk.
  • Labor Induction: Prolonged labor induction increases risk.
  • Chorionamnionitis (Chorioamnionitis): Potential risk.
  • Obesity: Increased risk.
  • Group B Streptococcus (GBS) status: Important factor.
  • Meconium Stained Amniotic Fluid: Indicative of potential fetal distress.
  • Placental conditions: Assess properly.

Differential Diagnoses

  • Intrauterine Infections: Endometritis, endomyometritis, and parametrite are possible.

  • Breast Infections: Breast engorgement is common postpartum (particularly with non-breastfeeding); mastitis.

  • Mastitis: Inflammation of the breast caused by milk stasis. Redness, tenderness, flu-like symptoms (fatigue, headache, muscle aches), fever, chills likely.

  • Urinary Infection/Acute Pyelonephritis: Associated with normal postpartum diuresis.

  • Perineal/Wound Infections: Episiotomies, lacerations, incision sites are common sites for infection (especially MRSA).

  • Pelvic Infection: Vagina, uterus, fallopian tubes infections are possible, especially with high fever (>39°C) in first 24 hours, potentially severe (Streptococcus group A).

  • Dehydration: Fever with headaches, fatigue; treated with oral/IV hydration, analgesics, and rest.

Treatment and Management

  • Mastitis (S. Aureus): Symptoms include breast tenderness, erythema, flu-like symptoms, fever.
    • Treatment: Frequent breastfeeding/pumping for affected breast, warm compresses, over-the-counter pain relievers, rest, fluids, antibiotics (Cephalexin, Cloxacillin, Clindamycin, Amoxicillin-clavulanic acid) if symptoms persist.
  • Acute UTI/Pyelonephritis: Symptoms: pelvic pressure, dysuria, pyrexia, chills, malaise.
    • Treatment: Antibiotics, anti-pyretics, hydration, increased urination (frequent urination).
  • Postpartum Wound Infection (perineal or C-section): Symptoms:
    • Treatment: Antibiotics, anti-pyretics, hydration, open air.
  • Endometritis: Symptoms: tender, soft, subinvoluted uterus, chills, malaise, foul-smelling lochia.
    • Treatment: Antibiotics, anti-pyretics, hydration.
  • Dehydration: Symptoms: headache, fatigue.
    • Treatment: Oral/IV hydration, analgesics, rest.

Important Diagnostics

  • CBC (Complete Blood Count): May indicate leukocytosis (15,000-30,000 cells/µL).
  • Other Lab Tests: Cytokines (interleukins, lymphokines), lactoferrin, and sIgA levels may also be evaluated.

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Description

This quiz covers the clinical assessment and history taking for postpartum fever. It includes vital signs, pain management, and evaluations of the uterus, bleeding, and wound healing. Test your knowledge on recognizing and addressing complications in the postpartum period.

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