# A postpartum client is diagnosed with endometritis on the third day after delivery. Which nursing intervention should be the priority? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=543166 > language: ko > subject: Maternal Newborn Health ## 문제 A postpartum client is diagnosed with endometritis on the third day after delivery. Which nursing intervention should be the priority? ## 보기 1. Encourage early ambulation to promote circulation 2. Apply ice packs to the perineum to reduce inflammation 3. Restrict fluid intake to prevent fluid overload 4. Administer prescribed antibiotics as ordered **✔ 정답** **정답: 4** ## 해설 Endometritis requires immediate antibiotic administration to prevent sepsis. Other interventions are supportive but not the priority. ## 심화 해설 Understanding the Priority: Treating the Infection Source When a postpartum client develops endometritis, the underlying pathophysiology involves an infection of the uterine lining, most commonly caused by a polymicrobial mix of bacteria ascending from the lower genital tract. As noted in the literature, this condition is a frequent source of maternal sepsis and occurs in up to 7% of births [1]. Because the primary problem is an active bacterial infection, the highest priority nursing intervention must directly target the causative organisms to prevent progression to severe sepsis, which remains a major preventable contributor to maternal mortality [1]. Why Antibiotics Are the Priority Administering prescribed antibiotics as ordered directly addresses the root cause of the infection. The standard of care for postpartum endometritis involves prompt initiation of broad-spectrum antibiotics to cover the typical gram-positive, gram-negative, and anaerobic organisms involved [1]. Delaying antibiotic therapy can lead to clinical deterioration. This principle is so critical that in rare cases where a patient is unresponsive to conventional antibiotics—such as in herpes simplex virus (HSV) endometritis—the clinical priority remains the same: prompt diagnosis and early antimicrobial therapy, in that case with antivirals, are required for clinical improvement [2]. This reinforces the concept that the immediate priority is always to control the infectious source with the appropriate pharmacologic agent. Analyzing the Other Options The other listed interventions, while potentially valuable in other contexts, do not take precedence over treating the active infection. - Encouraging early ambulation is beneficial for preventing thromboembolic complications and promoting general circulation, but it does not treat the underlying polymicrobial infection. Ambulation is a supportive, not a curative, measure in this scenario. - Applying ice packs to the perineum may provide localized comfort for perineal edema or a hematoma, but it will not reduce the inflammation of the uterine lining. Endometritis is a deep pelvic infection, and a local cold application has no therapeutic effect on it. - Restricting fluid intake is contraindicated. Clients with a systemic infection are at risk for dehydration and are often managed with intravenous fluids to support hemodynamic stability. Fluid restriction could worsen the client's condition and does nothing to combat the infection itself. The nursing priority is grounded in the need to halt the infectious process at its source. The evidence clearly identifies that timely administration of the correct antibiotic regimen is the cornerstone of management for obstetric infections like endometritis [1, 3].References (research sources) - [1]Modernizing antibiotic regimens for obstetric infections through antimicrobial stewardship.Research articleDutra K, Hess B. (2026) · DOI: 10.1016/j.ajogmf.2026.102011 - [2]Not Just a Cold Sore: Postpartum Herpes Simplex Virus Endometritis.Research articleMoore O, Cottrell J. (2026) · DOI: 10.1155/crog/7459192 ## 임상 시나리오 Clinical Management of Postpartum Endometritis Postpartum endometritis is a polymicrobial infection of the uterine lining, most common after cesarean birth. Prompt recognition and treatment are essential to prevent maternal sepsis. The following outlines the priority nursing and medical interventions based on current clinical practice guidelines. Priority Intervention: Antibiotic Administration - **Immediate Action:** Administer prescribed broad-spectrum intravenous antibiotics as soon as possible after cultures are obtained. Common regimens include clindamycin plus gentamicin, with or without ampicillin. - **Rationale:** Antibiotics directly target the causative organisms, halting infection progression and reducing the risk of severe sepsis and septic shock. - **Monitoring:** Assess for clinical response within 48-72 hours, evidenced by defervescence, decreased uterine tenderness, and resolution of foul-smelling lochia. Supportive Nursing Care - **Vital Signs:** Monitor temperature, heart rate, blood pressure, and oxygen saturation every 2-4 hours. Tachycardia and hypotension may signal early sepsis. - **Hydration:** Encourage oral or intravenous fluids to maintain hydration, compensate for insensible losses from fever, and support hemodynamic stability. - **Comfort Measures:** Provide analgesics and antipyretics as ordered for pain and fever. Position the client in Fowler's position to facilitate lochia drainage. - **Uterine Assessment:** Evaluate fundal height, consistency, and tenderness every shift. A boggy, tender uterus warrants further evaluation. Ongoing Evaluation and Discharge Planning - **Lochia Monitoring:** Document color, odor, and amount. Foul-smelling or purulent lochia supports the diagnosis; increased bleeding may indicate retained products of conception. - **Patient Education:** Teach the client to complete the full antibiotic course, recognize signs of worsening infection (e.g., chills, increased pain, malaise), and maintain perineal hygiene. - **Follow-Up:** Ensure a scheduled postpartum visit within 1-2 weeks to confirm resolution and address any breastfeeding or contraceptive needs. ## 핵심 개념 - **Endometritis** — An infection of the uterine lining, typically caused by polymicrobial bacteria ascending from the lower genital tract, occurring in up to 7% of births. - **Maternal Sepsis** — A life-threatening organ dysfunction caused by a dysregulated host response to infection, remaining a major preventable cause of maternal mortality. - **Broad-spectrum Antibiotics** — Antimicrobial agents effective against a wide range of gram-positive, gram-negative, and anaerobic bacteria, the standard first-line treatment for postpartum endometritis. ## 같은 주제 문제 - [A nurse is assessing a 28-year-old postpartum client who delivered her first baby vaginall…](https://mymerci.kr/pages/nclex_q.php?qn_id=543162) - [A postpartum client is being assessed for possible endometritis. 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