OB EXAM THREE COMPREHENSIVE STUDY GUIDE
OB EXAM THREE COMPREHENSIVE STUDY GUIDE
Complete Core Review: Chapters twenty-one to twenty-six, three point one to three point four, five, nine, six to eight. Obstetrical and Gynecological Nursing TABLE OF CONTENTS
Chapter twenty-one: Postpartum Complications
Chapter twenty-one: Postpartum Complications
One. Postpartum Infections
Postpartum infections occur from birth up to six weeks (or up to one year) postpartum. Defined as a temperature of thirty-eight degrees Celsius or higher on any two consecutive days during the first ten days postpartum (excluding the first twenty-four hours). Common general signs include fever, tachycardia, chills, lethargy, pelvic pain, and purulent discharge.
Endometritis: Infection of the uterine lining, most commonly occurring after cesarean birth, chorioamnionitis, or prolonged rupture of membranes greater than twenty-four hours. Symptoms: uterine tenderness or pain during palpation, foul-smelling lochia, fever, chills, and lethargy. Nursing Care: Administer IV broad-spectrum antibiotics (e.g., clindamycin plus gentamicin or ampicillin), monitor lochia, assess fundal tone, promote hydration, and monitor for signs of pelvic sepsis.
Mastitis: Infection or inflammation of breast tissue, typically unilateral, occurring during lactational stasis or through nipple cracks or fissures caused by poor latch. Symptoms: localized hard, red, warm, intensely painful breast area, flu-like symptoms, high fever, and chills. Nursing Care: Continue frequent breastfeeding or pumping every two to three hours to clear stasis (milk is safe for infant), apply warm compresses before feeding and cold packs after, administer antibiotics (e.g., dicloxacillin or cephalexin), take NSAIDs for pain, and ensure proper latch mechanics.
Wound Infections: Infections affecting surgical incisions (cesarean) or perineal lacerations or episiotomies. Evaluated using REEDA (Redness, Edema, Ecchymosis, Discharge [purulent], Approximation). Nursing Care: Maintain clean or dry wound site, sitz baths for perineal wounds, antibiotic administration, hand hygiene education, and wound debridement or packing if incisional abscess forms.
Postpartum Urinary Tract Infections: Risk heightened by intrapartum urinary catheterization, birth trauma, and regional anesthesia. Symptoms: dysuria, urgency, frequency, suprapubic pain, hematuria. Pyelonephritis adds high fever, severe chills, and Costovertebral Angle tenderness. Treatment: oral or IV antibiotics, continuous urine output monitoring, and encouraging fluid intake (greater than three liters per day).
Thrush (Candida Infection): Fungal infection affecting nipples or areola and infant's oral mucosa. Symptoms: severe, deep shooting or burning nipple pain during or after feeds, pink, shiny, or flaking nipples. Nursing Care: Simultaneous antifungal treatment for parent (topical nystatin or miconazole) and infant (oral nystatin suspension) to prevent cross-infection.