Long case

Personal history
Nehal mohamed , a 29 years old, housewife, lives in elshodaa, para 3+0,with 3
living offsprings , 3 male , married for 9 years from nadir masooad, 30 years, no
special habits with medical importance. Negative consanguinity
Complaint
She presents with fever after cs delivery
Present history
She presents with fever . she had cs 3 weeks ago and was recovering well until 2
days ago when she became very cold and shivery at night . she has be enunable to
keep herself warm despite several blankets and has reduced appetiate , nausea
,vomiting and lethargy . she is breastfeeding and has had very sore nipples since
birth and has had very sore nipples since birth but feels this is normal and use
ointment to treat it .in last 24 hours she has noticed left breast has become sore and
red. She has lower abdominal pain at site of cs wound . she no longer has vaginal
bleeding but has moderate brown discharge with an odour . bowel habit is normal
and she has no urinary symptoms
Obstetric history
All past\ previous 3 caeseren section, were in hospital, completed full term, no
intraoperative or postoperative complication.
Contraceptive history
She used contraceptive pills between every pregnancy with no complication
Menstrual history
Her menarche was at the age of 12 since that she had regular periods for 3-5 days
duration and average amount of 2 pads per day every 29days.
Past history
No history of previous operations, hospitalization, blood transfusion, allergy,
chronic illness such as liver or thyroid.
Family history
NO medical disorders or similar condition
Socioeconomic history
she lives with her sons in a home of 3 rooms with adequate air and water supply
and proper sewage disposal .
Examination
On examination , women is wearing jersy and jacket , with blanket over her . temp
is 38.6c. BP is 120\70. HR is 106\min . chest is clear .heart sound are normal . right
breast is normal but there is a well demarcated area of redness over superiolateral
aspect of left breast which is tender and hot to touch .uterus is firm and is non
tender , just palpable above symphysis pubis . there no leg edema or swelling
Investigations
Blood and protein on urine analysis are likely to be due to contamination from
persisting vaginal discharge lochia , but there is no evidience of UTI. Hb is
slightly low, which can occur with sepsis but is also common after pregnancy and
delivery . leukocytosis with neutrophilia and raised CRP suggest significant
bacterial septic process. Urea is raised while creatnine and potassium are normal ,
suggest de secondary to sepsis , pyrexia and vomiting.
Provisional diagnosis
Nehal Mohamed , 29 years old , para 3+0 , complain of fever after cs delivery ,
no complicated.
management
the women should be admitted for Iv antibiotics and fluids. Regular paracetamol ,
analgesia and antiemitics as nesseray . until culture are availiable and flucloxacin .
she should be encouraged to continue breastfeeding