Chapter 28: The Woman With a Postpartum Complication

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Hello everyone and welcome back to the Deep Dive.

Today is Monday, January 19th, 2026.

It's good to be back.

We are continuing our journey through the Last Minute Lecture series and today we have a really heavy hitter on the docket.

We are opening up Chapter 28 of Maternal Child Nursing, sixth edition.

Yeah, this is a significant chapter.

You know, up until this point in a nursing curriculum, so much of the focus is on the physiology of a normal birth.

Right, the miracle of life side of things.

Exactly.

But Chapter 28 is the reality check.

The title itself is The Woman with a Postpartum Complication.

It does sound a bit chapter.

It is.

This is the information that stands between a patient and a potentially catastrophic outcome.

So what's our mission for this deep dive?

Well, while childbirth is, you know, a natural process, the complications we're talking about today, hemorrhage, clots, infection, mood disorders, these are the primary drivers of maternal morbidity and mortality.

So we're translating the textbook lists and diagrams into actual clinical judgment.

Precisely.

We want to help nursing students and really any curious learner understand not just what can go wrong, but why it goes wrong.

And most importantly, how you as the nurse can intervene safely.

Because as the chapter intro states, the nurse is the primary line of defense.

That's it.

You're the surveillance system.

You are the one measuring blood loss, assessing the fundus and noticing those first really subtle signs of shock or depression.

Okay, so where are we starting?

We're going to break it down into what I call the big four.

The big four.

Postpartum hemorrhage, thromboembolic disorders, perpuparal infections, and affective disorders.

We'll walk through the physiology, the assessments, everything.

All right, let's dive in.

Let's start with what feels like the most immediate threat in the delivery room.

Postpartum hemorrhage or PPH?

PPH is the leading cause of maternal death worldwide.

So understanding the definition is just, it's critical.

Historically, it was a little ambiguous.

Older texts would differentiate.

They'd say, you know, over 500 mL for a vaginal birth is a hemorrhage, but over 1 ,000 mL for a C -section.

But chapter 28 gives a much clearer modern standard.

It does.

The current definition is a cumulative blood loss of 1 ,000 mL or more.

Okay, 1 ,000 mL.

And this is the important part, accompanied by signs or symptoms of hypovolemia.

Meaning low blood volume.

So dizziness, tachycardia.

Exactly.

And this happens within 24 hours of the birth process, and it applies regardless of the delivery method.

Vaginal or cesarean, 1 ,000 mL is the line.

That threshold simplifies things, but the text highlights a huge practical problem.

How do we actually know it's 1 ,000 mL?

I mean, just looking at blood on the sheets.

Isn't that just a guess?

It's notoriously difficult.

The text calls it visual estimation, and the evidence shows that healthcare providers are, frankly, terrible at it.

We underestimate.

Almost always.

We significantly underestimate the volume.

And that is why the standard of care has shifted to quantification of blood loss.

This is where we start weighing things.

Exactly.

The rule you have to memorize is this.

1 gram of weight equals 1 mL of blood.

Simple enough.

So now nurses are trained to weigh everything that's blood soaked.

The pads, the chucks, the linens.

And then you just subtract the dry weight of those items.

And that turns a subjective guess into real objective data.

It does.

It changes everything.

So we have the definition, we have the measurement.

The text then categorizes PPH based on timing,

early versus late.

Right.

Early PPH happens within the first 24 hours.

This is the acute danger zone.

And late PPH.

That's anything from 12 -4 hours up to 12 weeks postpartum.

We'll get to the causes for that, but we really need to spend some time on early PPH because it is overwhelmingly caused by one specific mechanical failure,

uterine atony.

Let's break down that term.

Atony literally means a lack of tone.

A lazy muscle.

That's a great way to put it.

To understand why atony causes bleeding, you have to visualize the anatomy that's in figure 28 .1 of the text.

The figure shows these interleasing muscle fibers of the uterus.

They crisscross all around the blood vessels where the placenta was attached.

Like a net or something.

Think of it like a living tourniquet.

It's a brilliant design.

When the placenta separates from the uterine wall, it leaves these wide open severed blood vessels.

And the only thing stopping them from bleeding out is the muscle itself.

Correct.

The only mechanism is the uterine muscle contracting, clamping down like a fist to physically pinch those vessels shut.

So if the muscle is relaxed or atonic.

Then those vessels just pump blood directly into the uterine cavity, completely unrestricted.

The text lists a lot of risk factors for this in box 28 .1.

It seems like they all boil down to the uterus being either overstretched or just exhausted.

That's a perfect way to categorize them.

So first you've got overdistension.

Stretched too far.

Right.

If those muscle fibers are stretched too thin, they lose their elasticity.

They just can't snap back into place.

And this happens with twins?

Twins, triplets, hydramneos.

That's excess amniotic fluid.

Or just a very large baby, what we call macrosomia.

Okay, that's overdistension.

What about the exhaustion factor?

Muscle fatigue.

I mean, if a woman has had a really prolonged labor, that muscle is just tired.

Makes sense.

But interestingly,

a precipitate labor, which is a very fast labor under three hours, is also a risk factor.

Why is that?

Because the uterus works so hard and so fast that it effectively just gives out afterward.

It's exhausted.

We also see it with high multi -parity, someone who has had many babies.

The muscle tone can decrease over time.

And we also need to look at our own interventions, right?

Yeah.

The text points out that using oxytocin to induce labor can actually be a risk factor.

It can, yeah.

The idea is that the uterus can become desensitized to oxytocin after a long induction.

So when you need it to work postpartum, the receptors are just, they're tired of listening.

And what about magnesium sulfate?

Oh, that's a big one.

You have to be on high alert for that.

We use mag sulfate to prevent seizures and preeclampsia or sometimes to stop preterm labor.

And it works by relaxing smooth muscle.

Exactly.

And the uterus is a giant smooth muscle.

So if your patient has been on mag sulfate, you've been actively giving her a medication to keep her uterus relaxed.

You have to anticipate adeny.

So let's move to the bedside.

You're the nurse.

You're doing your postpartum assessment.

What are the signs of uterine adeny?

Okay.

So you're performing a fundal assessment.

Normally you expect to feel a firm, round, almost grapefruit -sized mass right around the level of the umbilicus.

Nice and hard.

Yes.

In adeny, the fundus is boggy.

It feels soft.

It's mushy.

And sometimes it's really difficult to even locate.

And it might be in the wrong place.

It's often higher than you'd expect because it's filling up with blood and clots, which pushes it upward.

And what about the bleeding itself?

You'd see heavy lochia, lots of clots.

You would, but there's a really specific warning in the text about the trickle.

The trickle.

This is a crucial clinical insight.

Don't just wait for a dramatic gush of blood, a steady constant trickle is just as dangerous.

It just adds up over time.

It does.

And sometimes nurses can miss that slow steady trickle until the patients suddenly start showing signs of shock.

Okay.

So you're in the room.

You find a boggy fundus.

What is the immediate first line nursing intervention?

Fundal massage.

But you have to.

Have to do it correctly.

Figure 28 .2 in the text illustrates the technique and it emphasizes a critical safety measure.

Which is?

This is about hand placement, right?

One hand on the fundus, the other somewhere else.

Yes.

You place one hand flat just above the pubic bone.

That supports the lower uterine segment.

Your other hand cups the fundus and massages in a firm circular motion.

Why is that bottom hand so important?

Because if you just push down hard on a boggy unsupported uterus, you can cause uterine inversion.

Which sounds absolutely horrific.

It is.

You can literally turn the uterus inside out and push it out through the vagina.

It's a life -threatening emergency, so you always, always support that lower segment.

And what about the clots that are formed inside?

The text says we need to express them, but it has a warning about the timing.

Yes.

This is key.

You massage until the uterus is firm.

Only then do you apply steady pressure to express the clots.

So never push on a boggy uterus.

Never.

That's how you cause an inversion.

Once it firms up, then you push to clear out the clots because those clots act like a doorstop.

They physically prevent the muscle from clamping down all the way.

The text also highlights another really common physical factor.

The bladder.

Ah, yes.

A full bladder is a very common and thankfully fixable cause of addity.

How does that work?

Well, if the bladder is full, it pushes the uterus up and usually off to the side, most often to the right side.

And it can't contract properly when it's displaced like that.

It just can't.

So if you feel a boggy fundus that's deviated to the right, your very first thought should be empty the bladder.

Have her try to void or if she can't.

Straight catheterize her if necessary.

That alone will often resolve the hemorrhage.

Okay.

So if the mechanical interventions, massage, bladder, emptying, if they don't work, we move to pharmacology.

The text lists four main drugs.

Right.

And it's important to think of these as a decision tree, not just a list, especially when you consider the contraindications.

So what's first line?

Almost always oxytocin or pedocin.

It's usually given IV, often in a bolus, diluted in fluids.

It mimics the body's natural contraction signal.

It's effective and generally very safe.

But if pedocin isn't enough, we escalate.

Second line is methylurganavine.

Methargyne.

Yes.

Methargyne is more powerful.

It is.

It's typically an IM injection and it causes a really strong, sustained uterine contraction.

But, and the text puts a massive red flag here, hypertension.

It raises blood pressure.

Significantly, it causes vasoconstriction.

So if you have a mom with preeclampsia or chronic hypertension, you absolutely cannot give methargyne.

You have to check the BP before you give it.

Every single time.

If she's hypertensive, you skip methargyne and you move to the next option, which is carboprostromethamine, brand name hemabate.

Hemabate.

That's a prostaglandin.

It is.

And it's very effective at causing contractions, but it comes with some pretty intense side effects.

Like what?

Primarily diarrhea.

It stimulates smooth muscle everywhere, including the GI tract.

But the big safety contraindication here is asthma.

Because it can cause bronchoconstriction.

Exactly.

So if your patient has a history of asthma, hemabate is very risky and often contraindicated.

Okay.

So that leaves us with the last drug on the list.

Mesoprostol.

Cytotec.

Yeah.

Cytotec is a synthetic prostaglandin E1.

It's super versatile.

How so?

You can give it orally, sublingually, rectally.

It's often the go -to when the other options are either contraindicated or just not working.

And if the drugs fail,

the text describes moving to much more invasive procedures.

It does.

Figure 28 .3 shows bimanual compression.

This is where the provider, the doctor or midwife, inserts a fist into the vagina and physically compresses the uterus against a hand on the abdomen.

That sounds extremely painful.

It is.

But it can manually stop the bleeding.

Beyond that, you're looking at things like a uterine balloon surgical packing, compression sutures, and as a last resort, a hysterectomy to save the mother's life.

Now, we've focused really heavily on uterine adenine, but the text makes a clear point.

Yeah.

Not all hemorrhage is from a relaxed uterus.

So what if you do your assessment and the fundus feels rock hard?

It's firm.

It's central.

But the patient is still bleeding heavily.

That is the classic presentation of trauma.

If the tone is good, the problem isn't the muscle.

The bleeding is likely coming from a laceration.

That's hair.

A tear in the cervix, the vagina or the perineum.

And you can't massage a laceration closed.

It needs to be found and sutured by the provider.

And related to trauma, there's another condition where the bleeding isn't even external.

Hematomas.

Hematomas are so insidious.

It's a collection of blood in the loose connective tissue.

It could be vulvar, vaginal or even retroperitoneal, which is deep in the pelvis.

And the scary part is you might not see much blood on the pad at all.

Exactly.

So what is the hallmark sign the nurse has to be watching for?

Pain.

Pain.

But not just any pain.

Deep, severe, unrelenting pain.

The patient might describe it as an intense rectal pressure or a feeling that something is tearing inside her.

So if a postpartum woman's pain is way out of proportion and pain meds aren't touching it.

Especially if she's also showing signs of shock, like a rising heart rate, but has minimal visible bleeding, you have to suspect a hematoma.

We should also touch on late postpartum hemorrhage.

This is after that first 24 -hour window.

Right.

This is often after the patient has gone home, which makes patient education so important.

It can happen any time from 24 hours to 12 weeks.

And what are the main causes here?

The two big ones are sub -involution and retained placental fragments.

Sub -involution.

So the uterus isn't shrinking back down the way it's supposed to.

Exactly.

Normally, the fundus should descend about one centimeter or one finger breadth every day.

By about two weeks, you shouldn't be able to feel it abdominally anymore.

So if a patient calls the clinic a week after discharge and says, my bleeding has started up again and it's bright red, or I just feel this heaviness in my pelvis.

Those are classic signs of sub -involution.

Or if her lochia just fails to progress from red to pink to white.

Treatment is usually methadone to encourage that long -term contraction.

And sometimes antibiotics if there's an infection involved.

Okay, let's move from the cause of the bleeding to the systemic result.

Hycovolemic shock.

The text gives a really good explanation of the physiology, specifically how the body tries to compensate.

This is so critical for nurses to understand because the body is really good at masking the early stages of shock.

How does it do that?

When blood volume starts to drop, the sympathetic nervous system kicks in.

It's a massive adrenaline response.

It causes vasoconstriction.

It clamps down on blood vessels in the skin, the gut, the extremities.

You shunt all the remaining blood to the vital organs,

the brain, and the heart.

Precisely.

Which means the standard vital signs, especially blood pressure, might look deceptively normal for a while.

So if you wait for her blood pressure to drop, you're already behind.

You're in late shock.

You are.

The text is very clear that tachycardia, a rapid heart rate, is one of the earliest and most reliable signs.

And what about pulse pressure?

Yes, that's another subtle but important sign.

The pulse pressure, which is the difference between the systolic and diastolic numbers, will start to narrow.

And the skin?

The skin will be pale, cool, and clammy because all the blood is being pulled away from the surface to go to the core.

Management is aggressive.

The text talks about safety bundles, hemorrhage carts.

It's all about readiness and response.

Calling for help, getting a second large bore IV.

We're talking 14 or 18 gauge for rapid fluid and blood replacement.

But there's one specific metric the text gives for monitoring if your resuscitation efforts are actually working.

Urine output.

The kidneys are exquisitely sensitive to perfusion.

If they're getting enough blood, they will make urine.

The magic number, the rule to remember, is 30 LFLR per hour.

So if your patient is putting out at least 30 ml an hour?

It's a really good indicator that her vital organs are being perfused.

If that output drops below 30, her shock is getting worse.

Let's pivot to the second major category in the chapter.

Thromboembolic disorders.

In simple terms, blood plots.

Yeah, pregnancy and the postpartum period create what's basically a perfect storm for clotting.

Why is that?

The text implicitly refers to Virchhaus triad, which describes the three factors you need for a thrombus to form.

You need venous stasis, hypercoagulation, and vessel injury.

And pregnancy gives you all three.

It gives you all three in spades.

You get venous stasis because the weight of the pregnant uterus compresses the large veins in the pelvis, which slows down blood return from the legs.

So the blood is just pooling.

It is.

Then you have hypercoagulation, which is actually a protective physiologic change.

Your clotting factors increase during pregnancy to prevent you from hemorrhaging at birth.

But that same protection becomes a risk.

And finally, you have vessel injury, which happens during the birth process itself.

So you've checked all three boxes.

The text outlines three main types of these disorders.

SVT, DVT, and PE.

Right.

SVT is superficial venous thrombosis.

This is usually in varicose veins down in the calf area.

You'll see redness, warmth, and the vein might feel like a hard cord under the skin.

It's uncomfortable but generally managed with analgesics, rest, and support hose.

But DVT, deep vein thrombosis, is the more serious concern.

Much more serious because of the risk of that clot breaking loose and traveling.

And how does a DVT present?

The classic signs are unilateral leg swelling.

So one leg is bigger than the other, erythema, or redness, and heat.

The leg will be painful to the touch.

The text mentions a specific assessment, home and sign.

Is that still used?

That's a great question.

Home and sign is where you dorsiflex the foot to check for calf pain.

But the text correctly notes that it is unreliable and is no longer a recommended screening tool.

Why not?

It gives way too many false positives and false negatives.

So if you suspect a DVT based on swelling and pain, the real diagnostic tool is an ultrasound, a Doppler study.

And if a DVT dislodges, it can travel to the lungs.

And that's a pulmonary embolism, or PE.

Which is a life -threatening emergency.

Absolutely.

The symptoms come on suddenly.

We're talking severe dyspnea, difficulty breathing, sharp chest pain, tachycardia, and sometimes hemoptysis, which is coughing up blood.

And there's a psychological symptom too, right?

Yes.

Patients often report a profound sense of impending doom.

They just know something is terribly wrong.

Given the danger,

prevention seems to be the main strategy the text emphasizes.

It is.

The single most effective preventative measure is early ambulation.

Just get the patient up and walking.

As soon as it's safe.

Walking contracts the calf muscles, which pumps the blood back up to the heart.

If they have to be in bed, you encourage range of motion exercises.

And the text has a specific warning about how patients are positioned.

Yes, you want to avoid anything that causes blood to pool in the legs.

So don't put pillows directly under the knees.

And if they're in stirps for a delivery or repair, the text recommends for less than an hour and to make sure the stirps are well padded.

What about compression stockings or devices?

They're very useful, but the technique for putting them on matters.

How so?

You have to put them on before the patient gets out of bed in the morning.

Oh, why is that?

Because if the patient stands up first, the veins in the legs fill with blood.

If you then put the stocking on, you're just trapping that pooled blood in the leg, which completely defeats the purpose.

That makes sense.

For anticoagulation therapy, there's an important distinction made between heparin and warfarin or coumadin.

A very important one.

Heparin and its low molecular weight version, lovinox, do not cross the placenta.

That makes them the drugs of choice for anticoagulation during pregnancy.

But warfarin is different.

Warfarin is teratogenic.

It can cause birth defects, so it is absolutely contraindicated during pregnancy.

But it can be used postpartum.

Postpartum, warfarin is considered safe and can be used even if the mother is breastfeeding.

Okay, let's move to the third of the big four complications.

Purebril infections.

Right.

The definition of a purebril infection is a fever of 38 degrees Celsius, which is 100 .4 Fahrenheit or higher after the first 24 hours postpartum and occurring on at least two of the first 10 days.

Why the specific exclusion of the first 24 hours?

Because a slight temperature elevation in that first day is actually quite common.

It's usually due to dehydration and just the sheer exertion of labor.

It's a persistent fever after that first day that makes us suspect an infection.

Table 28 .2 in the text lists the risk factors, and the one right at the very top is cesarean birth.

A c -section is the single biggest risk factor, period.

I mean, it's major abdominal surgery.

You have an incision, direct trauma to the tissues.

It's a huge portal of entry for bacteria.

What are some of the other risks?

Prolonged rupture of membranes is a big one.

The longer the amniotic sac is open, the more time bacteria have to ascend up into the uterus.

Also, multiple vaginal exams and retained placental fragments, which can just become a breeding ground for bacteria.

The text also mentions a physiological change involving pH.

It does.

The normal vaginal environment is acidic, which helps keep bacteria in check, but amniotic fluid, lochia, and blood are all alkaline.

Postpartum, that shift in pH creates a much more hospitable environment for bacteria to multiply.

Let's break down the specific infections.

The most common one is endometritis.

Endometritis is an infection of the endometrium, the lining of the uterus.

Aside from the typical fever and chills, the key signs you need to look for are uterine tenderness on palpation and foul -smelling lochia.

Foul -smelling is the key word there.

Absolutely.

It'll have a very distinct necrotic odor that you won't mistake.

And management is IV antibiotics.

But there's a positioning intervention mentioned.

Yes.

You want to place the woman in foulers or semi -foulers position, basically sitting up, to promote drainage of the infected lochia by gravity so it doesn't pool inside the uterus and worsen the infection.

Then there are wound infections, like from a c -section incision or an episiotomy.

The text suggests using the RETA acronym for assessment.

RETA is a great tool.

It stands for redness, edema, ecumosis, which is bruising, discharge, and approximation.

Approximation being how well the wound edges are coming together.

Exactly.

So if the edges are separating or if you see purulent discharge, you've got an infection.

Urinary tract infections, or UTIs, are also really common postpartum.

Why is that?

It's a combination of trauma to the bladder and urethra during the birth, plus the frequent use of catheters.

On top of that, the bladder often has reduced sensation after birth, especially with an epidural, which can lead to urinary retention.

And stagnant urine is a perfect place for bacteria to grow.

Exactly.

The key patient teaching here is to help acidify the urine things, like cranberry juice or apricot juice, to inhibit that bacterial growth.

Okay, finally, in the infection category, we have mastitis,

an infection of the breast tissue.

Yes, and figure 28 .4 in the text shows the classic visual presentation.

It's a hard, tender, wedge -shaped area of redness and heat, usually on just one breast.

And it happens a little later.

Typically two to four weeks postpartum, the woman will feel flu -like symptoms, fever, chills, body aches, and her lymph nodes in her armpit might be swollen and tender.

For a mom in that much pain, the natural instinct might be to stop breastfeeding on that affected side.

But the text says that's the wrong thing to do.

That is probably the most important teaching point for mastitis.

You absolutely must advise her against that.

Why?

Because mastitis is often caused by milk stasis, a blocked duct or engorgement that lets bacteria proliferate.

If you stop emptying the breast, the stasis gets worse and the infection can progress to a full -blown abscess.

So the protocol is antibiotics and continued emptying of the breast.

Yes.

She must continue to breastfeed or pump from that breast, as painful as it is.

Using moist heat before feeding can help with the letdown reflex.

Emptying the breast is a critical part of the cure.

Wow.

Okay.

We have covered hemorrhage, clots, and infection.

The final section of Chapter 28 deals with affective disorders.

This feels like a shift from physical safety to mental and emotional safety.

And it is so, so vital.

The text does a good job of categorizing these disorders by severity.

And as a nurse, you need to be able to distinguish between them.

You have the baby blues, peripartum depression, and postpartum psychosis.

Let's start with the baby blues.

That one seems really common.

It's extremely common, affecting up to 80 % of new mothers.

It's characterized by mood swings, tearfulness, anxiety, feeling overwhelmed.

But what makes it the blues and not depression?

The key features are that it is transient and self -limiting.

It usually peaks around day five and resolves entirely within two weeks.

And importantly, it doesn't impair the mother's ability to function and care for her baby.

Okay.

So contrast that with peripartum depression.

Peripartum depression is a major mood disorder.

It can begin during pregnancy or in those first four weeks postpartum, but it lasts for more than two weeks.

And the symptoms are more severe.

Much more severe.

We're talking about intense sadness, guilt, feelings of worthlessness, and a loss of interest or pleasure in usual activities.

The text mentions a specific cognitive distortion that the mother sees herself as incompetent.

Yes, she feels inept, like a failure as a mother.

And this has a huge ripple effect on the infant.

How so?

If the mother is withdrawn, sad, and emotionally flat, she doesn't respond to the baby's cues for interaction.

And the text notes that this lack of early bonding and stimulation can actually lead to developmental delays for the child.

And then there's the most severe form, the psychiatric emergency, postpartum psychosis.

This is rare, thank goodness, but it is incredibly dangerous.

This involves a complete break from reality.

So what does that look like?

You'll see hallucinations, delusions, severe agitation, bizarre behavior, and rapid mood cycling.

The mother might have delusions that the baby is evil or that she needs to harm the baby to save it.

The nursing intervention here is immediate.

No waiting.

Immediate referral and usually hospitalization.

The number one priority is ensuring the safety of the infant.

You cannot leave the mother alone with the baby if you suspect psychosis.

The chapter really emphasizes the nurse's role in screening and anticipatory guidance for all of these.

You can't fix what you don't find.

Using screening tools like the Edinburgh Postnatal Depression Scale should be standard practice.

And teaching the family, not just the patient.

Yes, teaching the family before they go home.

Telling the partner or another support person, hey, if she seems unusually withdrawn or if she's not sleeping, even when the baby is sleeping, that's a red flag.

You need to call us.

We have covered a massive amount of ground today.

I mean, from the mechanics of uterine muscles to the chemistry of clotting and the huge complexity of maternal mental health.

We have.

And if you look at the big picture of chapter 28, the single unifying theme is vigilance.

Let's do a quick recap of the big four takeaways for our listeners.

Okay, number one, hemorrhage.

Quantify your blood loss.

Don't just guess.

Watch for that boggy uterus and the steady trickle.

And when you massage, support the lower segment to prevent inversion.

Two,

clots.

Prevention is everything.

Ambulate early.

Watch for that one -sided leg swelling and never, ever ignore sudden chest pain or difficulty breathing.

Three, infection.

A fever after the first 24 hours is a red flag.

Know the signs of endometritis, that foul smell and mastitis, that wedge -shaped redness.

And for mastitis, keep emptying the breast.

And finally, four,

mood.

Know how to distinguish the transient blues from persistent depression or dangerous psychosis.

Screen everyone early and involve the family in the safety plan.

It really drives home the point that the nurse is the bridge between a textbook complication and a safe outcome.

It's about spotting a deviation from normal before it becomes a full -blown crisis.

Absolutely.

The ability to distinguish normal postpartum tired

from hypovolemic shock tired or normal perineal soreness from hematoma pain,

that is what defines expert nursing care.

Thank you so much for breaking this incredibly important chapter down with us.

To all the nursing students out there cramming for exams and the nurses on the floor, thank you for the work that you do.

Speak curious and stay safe out there.

This has been the Last Minute Lecture Team on the Deep Dive.

We'll see you next time.