State your diagnosis and define. 2. List four risk factors of the condition. 3. Identify the signs and symptoms and shown in the scenario. 4. What complications or dangers may occur if the condition is not treated? 5. Outline the management and treatment for the patient. 6. What nursing care and support should be provided to the mother and family?

Step 1: Diagnosis and definition

Primary diagnosis: Postpartum endometritis

Definition: An infection of the uterine lining (endometrium) following childbirth, typically caused by polymicrobial ascension of vaginal flora (e.g., group B Streptococcus, E. coli, anaerobes like Bacteroides). Common after vaginal delivery, presenting with fever, tachycardia, abdominal pain, and boggy tender uterus.

Differential diagnosis: \begin{itemize} \item Retained products of conception \item Uterine atony with hemorrhage \item Urinary tract infection/pyelonephritis \item Septic pelvic thrombophlebitis \item Wound infection (episiotomy) \item Appendicitis or other intra-abdominal infection \end{itemize}

Postpartum endometritis

Step 2: Signs to look for in the baby (5-day-old neonate) if concerned

\begin{itemize} \item Lethargy or poor responsiveness \item Poor feeding or refusal to suck \item Fever (>38°C) or hypothermia (<36.5°C rectal) \item Respiratory distress (tachypnea >60/min, grunting, retractions) \item Weak or high-pitched cry \item Jaundice \item Vomiting, diarrhea, or abdominal distension \item Poor perfusion (capillary refill >3 sec, cool extremities) \item Bulging anterior fontanelle or seizures (meningitis) \end{itemize}

Step 3: Labs and imaging studies to order

Labs: \begin{itemize} \item CBC with differential (leukocytosis >15,000/μL expected) \item Blood cultures (2 sets) \item Urinalysis and urine culture \item High vaginal swab for aerobic/anaerobic culture and sensitivity \item C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) \item Renal function tests, liver function tests \item Lactate (if septic shock suspected) \end{itemize}

Imaging: \begin{itemize} \item Pelvic ultrasound (transabdominal/transvaginal): assess endometrial thickness, retained products, collections, or abscess \item Chest X-ray if respiratory symptoms \item CT abdomen/pelvis if no improvement or suspect thrombosis \end{itemize}

Step 4: Management and support for patient and family

Management for patient: \begin{itemize} \item Admit to postpartum ward/high-dependency unit \item IV fluids (crystalloids) for tachycardia/hypotension \item Broad-spectrum IV antibiotics: e.g., Ampicillin 2g IV Q6H + Gentamicin 5 mg/kg/day IV + Metronidazole 500mg IV Q8H (adjust per local protocol) \item Uterine massage + IV Oxytocin infusion if boggy/bleeding \item Analgesia: Paracetamol 1g IV Q6H + Ibuprofen if no contraindication \item Antiemetics: Ondansetron 4-8mg IV \item Monitor vitals, urine output, lochia; daily bimanual exam \item If no response in 48-72h: change antibiotics based on cultures, consider D&C if retained products \end{itemize}

Support: \begin{itemize} \item Reassure family about mother's condition and prognosis (excellent with prompt treatment) \item Assess baby at home/clinic: full neonatal exam, sepsis workup if unwell \item Involve multidisciplinary team: neonatologist, social worker (if neglect concerns from confusion) \item Psychological support: screen for postpartum depression/psychosis \item Lactation consultant: encourage pumping/breastfeeding when stable \item Family education on warning signs, hygiene, follow-up \item Nutrition, rest, involve husband in care \end{itemize}