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Maternal/child Postpartum Nursing

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Question
Answer
1. Postpartum nurse provides care that focuses on what?   Transition to parenting  
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2. Woman’s physiologic recovery    
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3. Physiologic wellbeing    
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4. Needs of other family members includes:   strategies in plan of care to assist family in adjusting to baby  
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5. Who should the nurse be concerned with other than the mother   those who will be around the baby i.e. other family members, friends, significant others and their response to the new baby  
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6. Transfer from recovery, what happens in the traditional setting   woman is moved to PP room after recovery  
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7. Transfer from recovery, what happens in LDRP setting   woman and infant remain together where both occurred  
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8. Post anesthesia recovery – when should the woman be discharged from recovery?   regardless of obstetric status NO woman should be discharged from recovery area until completely recovered from anesthesia  
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9. Transfer from recovery area (table 21-1 – p534)    
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10. Who are report given to and what information is given?    
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11. Discharge pre-24 // post 48- what are some of the terms used for decreasing length of stay of mothers and newborns after low birth risk?   early postpartum discharge; shortened hospital stay; 1-day maternity stay  
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12. Laws relating to discharge – what does the newborns’ and mothers’ Health Protection act of 1996 refer to?   vaginal delivery 48 hours and C-section 96 hours stay in the hospital  
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13. What are the criteria for early discharge- before 24 hours?   the woman as recovered and is able to take care of herself and her newborn  
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14. Criteria for early discharge – what happens if the mother is discharged before her condition is stable?   the Nurse and provider are still legally responsible  
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15. couplet or mother – baby care   -  
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16. infant security    
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17. prevention of excessive bleeding    
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18. maintenance of uterine tone;    
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19. prevention of bladder distention ;    
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20. estimate blood loss on pad (21-2 figure)    
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21. Prevention of infection    
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22. Promotion of comfort    
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23. Nonpharmacologic interventions – same as in labor    
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24. Pharmacologic interventions    
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25. Promotion of rest   fatigue common  
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26. Promotion of ambulation   early and frequently  
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27. Promotion of exercises   start with kegel  
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28. Promotion of nutrition   continue Prenatal vitamins and FE(iron) ~6 weeks post-partum  
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29. Promotion of normal bladder function   150 mL per void  
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30. Promotion of normal bowel function   fiber, fluid, ambulation  
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31. Promotion of breast feeding    
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32. Suppression of lactation    
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33. Rubella vaccination   if woman is not immune vaccine is recommended; can give to breast feeding mother; must use contraception for one month  
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34. Rh isoimmunization   Rh immunoglobulin should be given within 72 hours for Rh negative woman who delivers and Rh + Positive infant  
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35. Cultural / religious concern with Rh immunoglobulin   some consider this a blood product and will refuse  
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36. Maternal assessment should include   impact of birth experience; maternal self-image; adaptation to parenthood and parent infant interactions; family y structure and functioning; impact of cultural diversity;  
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37. Plan of care and implementation   (box 21-5)  
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38. Discharge teaching-    
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39. Sexual activity/ contraception    
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40. Prescribed medications    
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41. Routine mother and baby checkups    
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42. Dealing with activities of daily living at home    
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43. Dealing with visitors    
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44. Follow-up after discharge    
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45. Home visits   should occur shortly after birth to bridge early discharge  
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46. Telephone follow-up   may use instead of home visits  
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47. Warm lines-   help line of consultation service  
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48. Support groups   for sharing and support  
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49. Referral to community resources   nurse needs to know family needs and availability of community resources  
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50. Postpartum care is modeled on what   concept of health  
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51. Cultural beliefs and practices affect   patients response to puerperium  
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52. Nursing plan of care includes   assessment to detect deviations from normal; comfort measure to relieve discomfort or/and pain; safety measure- prevent injury/infection  
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53. Teaching/counseling   to promote woman’s own feeling of competence in self and baby care  
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54. Common nursing interventions include   eval/treat boggy uterus & full bladder; pharmacy & non-pharmacy relief of pain/discomfort associated w/episiotomy/lacerations ; measures to promote/suppress lactation  
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55. Meeting psychosocial needs of new mothers involves :   planning care that considers composition and function of entire family  
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56. Early postpartum discharge will continue to be trend as a result of   consumer demand; medical necessity ; discharge criteria for low risk childbirth; cost-containment measures  
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57. Effective means to prevent crisis and facilitate physiologic and Psychologic adjustments in combination include:   early discharge classes; telephone follow-up; home visits; warm lines; support groups  
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58. Post-partum physiologic adaptations    
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59. Involution of uterus   return of the uterus to a non-pregnant state following birth  
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60. Atrophy of uterine cells    
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61. Decidua- shed? What is it called?   Lochia  
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62. What is the basal layer    
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63. 1st layer shed    
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64. 2nd layer – new endometrium    
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65. Time process   three weeks  
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66. Factors to enhance uterine involution   uncomplicated L & D ; complete expulsion of products of conception; breast feeding ; early ambulation  
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67. Uncomplicated L&D    
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68. Complete expulsion of products of conception include what    
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69. Early ambulation   prevents stasis and blood clotting  
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70. Involution of placental site    
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71. Placental site    
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72. Large blood vessels   clotted blood, absorbed  
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73. Some vessels obliterated    
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74. New smaller vessels form    
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75. Time of process   6-8 weeks  
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76. Site heals by exfoliation    
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77. Changes in fundal position    
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78. Placenta expelled- between umbilicus & symphysis pubis    
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79. The fundal rises to the umbilicus- midline approximately when   within 6-12 hours after birth  
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80. What should the fundus feel like   **contracted (firm-large grapefruit ) **relaxed (boggy)  
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81. What is the concern with a boggy fundus, and what should be done   Hemorrhage- massage to promote contractions which will help the fundus firm up  
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82. What is the approximate daily descent of the fundus   1 cm./day  
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83. Lochia is classified by what   appearance and contents  
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84. What is rubra and how long does it last   Dark red discharge and lasts approximately 2-3 days (it may have some cellular tissues)  
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85. What is Serosa and how long does it lasts-   pinkish – brown discharge lasting 3-10 days (placental site wound healing)  
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86. What is Alba and how long does it last   yellowish discharge lasting 1-2 weeks if Not breastfeeding, can last up to 6 weeks when breast feeding (contractions caused by breastfeeding disrupt the wound site )  
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87. What type of odor should be associated with a normal discharge   stale, musty , not offensive  
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88. When do cervical changes occur   immediately after birth it should feel spongy and formless  
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89. What natural process reduces the risk for infection of the cervix, what other things can be done to reduce the risk of infection   outflow of excess product reduces the risk of infection, client should also be taught to wipe front to back; proper perineal care and regular changing of the pad  
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90. How long does it generally take the cervix to return to original form   a few hours  
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91. When is the shape of the external os changed? Is the change permanent? Describe the pre and post shape   the shape of the os is changes after the first birth- It is a permanent change and it goes from being ___________________ to being _____________________  
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92. When does the cervix close?   when the Lochia ceases, (the placental wound site has healed) the cervix will then close  
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93. When can a patient begin using tampons after birth?   ONLY AFTER the cervix is closed, it is recommended that nothing be placed inside the vagina/cervix until it has completely closed  
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94. Vaginal changes –what does the vaginal area look like after child birth   bruised, edematous and no rugae (folds)  
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95. Does the rugae (folds) return and if no when, if not why?   returns generally about 3 weeks in non-lactating women Lactating women may have pale or no rugae  
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96. When does the vaginal area begin to decrease in size? Normal – nonlactating women in about 6 weeks    
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97. What is Kegal’s   and exercise for tone and contractibility – done by cutting the flow of urine mid-stream (or curling toes around a pencil)  
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98. Perineal changes -   is expected to have some bruising and be edematous – the labia can also be bruised  
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99. What is the episiotomy   approximated?  
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100. Lacerations 1st degree    
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101. Lacerations 2 degree    
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102. Lacerations 3rd degree    
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103. Lacerations 4th degree    
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104. What should the abdomen look like   stretched , loose, flabby  
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105. When should a new mother regain her shape   2-3 months- exercise can help  
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106. What is striae – what is the difference between a light vs. dark skinned person   stretch marks – light skin fades to silver or white color, darker skin – darker than surrounding skin  
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107. Gastrointestinal system –    
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108. Hunger and thirst    
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109. Decreased peristalsis-is influenced by   hormones  
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110. What fears may be related to incisional pain and what nursing intervention could be used   clients can become constipated by fear of hurting at the incisional site, stool softeners as prescribed, push fluids and juices with high fiber intake  
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111. C-section delivery -   clients will have more flatulence- encourage early ambulation, stool softer increase fiber /fluids enema may be necessary  
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112. Significant change in the Urinary tract after birth -   bladder capacity becomes increased, bruising and edema around the urethra may cause painful urination  
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113. Why would you encourage the client to void after birth (and post removal of catheters)   the client has a decreased sensitivity to bladder filling  
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114. What is the average postpartal diuresis amount in 12-24 hours   2000-3000 mL  
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115. Why would you stop at 100 mL on a direct catheter?   to prevent bladder spasms  
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116. Hematuria can be masked by what   lochia  
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117. Urine specimens can often be contaminated by   lochia Discharge  
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118. Why do we not want to cath a client?   because we are introducing organisms from the outside of the body to a sterile inside  
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119. What is the most common cause of low grade fever (<100.4) in a postpartum woman)   slight temp elevations are common due to exertion during labor and dehydration – this is treated by replenishing fluids  
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120. Blood pressure of a postpartum female   would be stable or slightly decreased  
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121. Pulse of a postpartum female   Bradycardia is common as the pulse slows down to get rid of volume  
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122. If the postpartum woman is tachycardia   this is a sign of hemorrhage and the source must be identified  
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123. Postpartum chill   happens immediately after delivery and is Neurologic, and vasomotor changes  
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124. Blood values- is it normal to have increased leukocytes   yes- the body is fighting infection and microorganisms  
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125. What is normal vaginal delivery blood loss   250-500 mL  
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126. What is normal C-section delivery blood loss   7009100 mL  
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127. Who determines the estimated blood loss during delivery?   this is estimated by the primary health care provider  
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128. What is normal by the end of the post-partum period    
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129. Weight loss initially is what and why   10-12 lbs. Initially (fetus /placenta) and 5 lbs. diuresis (water) normal weight returns when  
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130. Maternal comfort and well-being    
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131. Monitor the uterine status    
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132. Fundus    
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133. Umbilical -0   1 cm down per postpartum day  
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134. Status firm /boggy   firm – proper contraction Boggy- Hemorrhage  
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135. Perineal discomfort    
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136. Use of ice pack   to reduce swelling and provide comfort from edema  
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137. Proper cleansing procedure   clean from front to back to decrease transmission of microorganisms  
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138. Sitz bath    
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139. Topical anesthetics   epi foam – witch hazel pads  
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140. Self-care   promoting self-care is essential for the mothers wellbeing after discharge , hand hygiene  
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141. Hemorrhoids    
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142. After pains –    
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143. Primipara   not felt as strong- Breast feeding may feel a little stronger  
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144. Multipara   2nd (+) child- pains are stronger due to weakened muscles – more relaxation and stronger contractions  
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145. Medication   is given to suppress pains (generally same as used in labor)  
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146. Breastfeeding   the release of oxytocin stimulates uterus contraction – stronger pains are felt during and shortly after breast feeding  
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147. Suppression of lactations   non breast feeding mothers – no stimulation of breast, binding of breast, use of ice packs for edema , Cabbage leaf for engorgement  
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148. Rest and activity -   promote bed rest based on pts., needs  
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149. Resumption of activity    
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150. Postpartum exercises    
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151. Resumption of sexual activity    
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152. Contraception    
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153. Foley -   client needs to void within 4 hours of removal; if not client may need to be straight cathed  
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154. PCA pump    
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155. Epidural PCA    
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156. Early ambulation    
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157. Wound care   only the health care provide removes the dressing, the nurse is responsible for marking and measuring any drainage by circle date and time on the bandage , always assess vital signs  
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158. Assistance with infant    
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159. Nutrition   diet as tolerated- monitors clients bowels – anesthesia, analgesics, NSAIDs, or other meds- stool softeners may be necessary (only given with doctors’ orders)  
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160. Nursing care for the adolescent patient   assist with new born bonding – the younger the mother is – an older adult female member generally takes over care- you must promote bonding between the mother and the new born  
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161. Treatment of young mothers   they must be treated as adults , self-care , and child care teaching is essential  
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162. Postpartum psychological changes postpartum blues-   normal occurrence – pain , disturbed sleep; emotional imbalance; insecurity  
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163. Postpartum psychological changes infant bonding    
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164. ATI BONDING CHAPTER    
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165. Family and infant bonding    
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166. Maternal newborn bonding   assess pos(+) behaviors—considers infant family member; hold infant face-to-face(en-face);view infant behavior positive; identifie unique characteristics; maintain close contact; provide physical care; respond to infant cries; smile,talk,sing to infant  
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167. Assess negative behaviors   apathy when infant cries; disgust at infants body excretions; expresses disappointments; turns away from infant; does not seek close contact; handles infant roughly; ignores infant entirely  
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168. Assess mother for indications of depression   feeling of being down; feeling of inadequacy; anxiety related to breastfeeding; emotional labiality with frequent crying; flat affect, withdrawn; feeling unable to care for infant  
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169. Interventions to assist bonding:   provide quiet, private environment ; facilitate bonding process-place infant skin to skin, en face; give freq praise, support, reassurance; encourage to express fears, anxiety, feelings  
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170. Assess Paternal adaptation   does father hold, touch, maintain eye contact; look for physical similarities; talk, sing to infant  
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171. How long should transition to fatherhood take   process takes several weeks- * expectations- preconceived ideas; * reality- feel sad, frustrated, jealous or embraces need to be actively involved; * Mastery – actively involved in care  
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172. Development of father – infant bond involves what   * commitment- takes responsibility of parenting; * connected- feelings of attachment ; * room for infant- modifies life to include care of infant  
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173. Paternal adaptation nursing interventions   *assess for bonding * provide edu when father present * provide guidance, involve as full partner * encourage verbalization of concerns, expectations  
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174. Sibling adaptation – assess for   positive responses; interest, concern, increased self-independence  
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175. Assess for adverse responses   signs of rivalry , jealousy ; regression in toileting, sleeping habits; aggression towards infant; attention seeking behaviors , whining  
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176. Sibling adaptation nursing interventions -   provide tour of maternity unit;  
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177. encourage parental behavior/sibling adaptation   sibling one of first to see infant; gift from infant; one parent care for infant, other parent with sibling; allow siblings to help with care; preschooler doll to care for  
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178. impaired parenting   detachment,  
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179. Nursing interventions for impaired parenting   continued assessment; encourage support of grandparents; family members; home visits and group discussions; info on support groups  
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180. Recognize postpartum physical adaptations    
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181. Describe nursing assessment during the postpartum period    
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182. Develop a plan of care for the postpartum client    
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183. Describe psychosocial and maternal adjustment during postpartum period    
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184. Recognize postpartum disorders    
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185. Describe nursing assessment for postpartum disorders    
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186. Develop a plan of care for a client with postpartum disorder    
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187. Recognize postpartum infections    
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188. Describe nursing assessment for postpartum infections    
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189. Develop a plan of care for the client with a postpartum infection    
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190. Describe nursing assessment for postpartum depression    
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191. Recognize postpartum depression    
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192. Develop a plan of care for the client with postpartum depression    
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193. Post-partum complications    
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194. Deep vein thrombosis risk factors   pregnancy; immobility; obesity; smoking ; C-section; multiparty; age 35+ ; DM  
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195. DVT Assessment   Pt. – leg pain; swelling, warmth, redness; warm extremity; calf tenderness; cough, tachycardia;  
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196. DVT- cough/tachycardia is most significant why?   both are indicators of pulmonary embolism  
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197. DVT Dx Procedures   Doppler ultrasound scanning; CAT. MRI  
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198. DVT Prevention/ Pt. education   early/ freq ambulation; avoid prolonged standing, sitting, immobility; elevate legs when sitting; do not cross legs; fluid intake 2-3 L /day; No smoking; anti-embolic hose (SCDs)  
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199. DVT_ Nursing interventions   encourage client to rest; elevate extremity/ No pillow under knees ; warm compress-intermittent , continuous; Do Not massage affected extremity ; this high antiembolism stocking; analgesics- NSAIDs; anticoagulants  
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200. DVT Medications_    
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201. Heparin   * IV 5-7 days/ adjust based on PTT – antidote is Protamine sulfate  
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202. Warfarin   Oral 3 months; Monitor PT and PTT; Phytonadione available for prolonged clotting times ; antidote Vitamin K (green leafy veg’s)  
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203. DVT client education   avoid ASA, ibuprophen; electric shavers; avoid ETOH; brush teeth gently; avoid rubbing, massaging legs; avoid prolonged sitting/crossing legs  
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204. Postpartum hemorrhage risk factors   uterine atony; admin of mag sulfate; lacerations/hematoma ; inversion of uterus; sub involution of uterus; retained placental fragments; coagulopathies (DIC)  
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205. Postpartum hemorrhage nursing interventions   monitor VS; assess for source of bleeding; fundus; lochia; signs from lacerations, episiotomies, hematomas  
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206. Assess for bladder distention    
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207. Maintain IV fluids    
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208. Provide oxygen    
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209. Elevate legs to increase venous return    
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210. Postpartum medications *    
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211. Oxytocin    
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212. Methylergonovine (methergine) Not for hypertension    
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213. Misoprostol (cytotec)    
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214. Carboprost tromethamine (Hemabate)    
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215. Monitor and assess for   monitor for adverse reactions; assess uterine tone, vaginal bleeding  
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216. Uterine atony – what can cause this   Retained placental fragments ; Over distention of uterine muscle ; Prolonged labor ; Oxytocin augmentation , induction ;Precipitate labor ;Mag sulfate administration ;Anesthesia, analgesia administration ;Trauma during labor, birth  
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217. Uterine atony interventions:   ensure bladder is empty; monitor; express clots; monitor VS; Maintain IV fluids; Provide Oxygen; Administer medications  
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218. Sub involution of the uterus risk factors   Endometrioses (MOST COMMON) ; pelvic inflammation  
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219. Nursing interventions;   monitor fundus, lochia; encourage breast-feeding, ambulation, voiding  
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220. Administer medications   Pitocin, antibiotics  
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221. Inversion of uterus risk factors   retained placenta; uterine atony; excessive fundal pressure; extreme traction to umbilical cord (pulled placenta – pulled uterine out) ; adherent placental tissue ; multiparty ( overstressed) fibroid tumors  
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222. Inversion of uterus    
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223. Complete    
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224. Partial    
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225. Replace uterus    
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226. Nursing interventions   assess for inverted uterus, maintain IV fluids; admin Oxygen ; D?C Pitocin, admin terbutaline (Pitocin must be stopped before administering terbutaline)  
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227. Inversion of uterus following replacement   observe close; assess hemodynamics; avoid aggressive fundal massage; administer oxytocic’s, antibiotics, (prophylactic tx) Client education ( c-birth with subsequent pregnancies)  
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228. Retained placenta risk factors   partial separation of placenta; entrapment of placenta; excessive traction on cord prior to placental separation (breaking/leaving pieces) adherent placental tissue; COMMON IN PRETERM BIRTHS 20-24 WEEKS)  
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229. Retained placenta nursing interventions   assess for uterine atony, sub involution, inversion; monitor fundus, lochia , VS; maintain IV fluids; admin oxygen; admin Pitocin(contractions) /terbutaline (relaxation) ; possible surgery- D&C , hysterectomy  
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230. Lacerations and or hematomas risk factors   operative vaginal birth- forceps, suction, CPD (big Head); macrocosmic infant, abnormal presentation; prolonged pressure on vaginal mucosa, scarring of vagina- infections, injury, surgery, Nullipara, light skinned, reddish hair  
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231. Lacerations and or hematomas assess   vaginal bleeding, is the uterus firm or contracted; continuous slow bleed- bright red; sever rectal, perineal pain, pressure  
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232. Nursing interventions   attempt to identify the source, use Ice packs (edema) sitz bath, pain meds (as prescribed) May require surgical intervention  
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233. Infections- what is the most common and what S/S are present   Endometrtis- most common, uterine tenderness, Lochia-profuse, odor, bloody; fever; tachycardia  
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234. Wound types, what do we assess?   Lacerations and episiotomies , assess REEDA, fever , pain  
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235. Cesarean wound Risk and Rx   risk- emergency C-section, assess REEDA; Rx- identify microorganism; antibiotics; wound tx , treat of sx  
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236. Mastitis risk factors   milk stasis-(blocked ducts) ; cracked nipples; poor breast feeding techniques; decrease in breastfeeding – supplementation; poor hygiene (inadequate hand washing)  
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237. Nursing interventions for mastitis   assess reddened areas , enlarged nodes; encourage hand hygiene; proper feeding positions; ice pack/warm pack; rest, analgesic, increased fluids; well-fitting bra; admin antibiotics, teach importance of completion of therapy  
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238. UTI risk factors   hypotonic bladder; epidural anesthesia; Catherization; freq pelvic exam; genital tract injuries; Hx of UTI; C-birth  
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239. UTI nursing interventions   Assess for UTI; obtain urine sample; admin antibiotics; teach proper perineal hygiene; encourage increased fluid intake ; recommend cranberry juice (increases acid in urine to help flush microorganisms)  
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240. Postpartum blues/ depression risk factors   hormonal changes; physical discomfort/pain; socioeconomic factors; decreased support system; anxiety new role as mother; unplanned/unwanted pregnancy; Hx prev depressive episodes; low self-esteem; Hx domestic violence  
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241. Postpartum blues assessment   sadness; lack of appetite; sleep pattern disturbance; feelings of inadequacies; intense mood swings; crying  
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242. Postpartum depression assessment   feeling of guilt and inadequacy; irritability; anxiety; persistent fatigue; feeling of loss; lack of appetite; sadness, mood swings, sleep disturbance  
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243. Postpartum depression signs and symptoms   crying; weight loss; flat effect; postpartum psychosis (hallucinations, delusional thoughts of self-harm or harming the infant)  
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244. Postpartum depression nursing interventions   interactions mother-infant; client’s mood /affect; encourage communication of feelings; compliance w/med therapy; sched f/u visit at home; sleep when infant sleeps; take time out for self  
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245. Cesarean delivery   nursing care, Foley, PCA pump, epidural PCA , early ambulation, wound care, assistance w/ infant, nutrition  
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246. Adolescent mother   nursing care – adolescent pt. ; assist w/ pt.- newborn bonding; treat as adult; teach self-care  
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247. Postpartum complications risk factors   c-delivery; prolonged ROM; Prolonged labor; Bladder cath; hemorrhage; mastitis; URI ; UTI; thrombophlebitis; hematoma, abscess formation, endometritis; perineal cellulitis ***Maintain fowlers position***  
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