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MATERNITY PERRY LOWDERMILK CASHION ALDEN OLSHANSKY :;;:ate
PEDIATRIC HOCKENBERRY IWILSON IRODGERS
 Introduction

Maternal Child Nursing Care, sixth edition, is a comprehensive textbook of maternity and pediatric nursing. This Study
Guide is designed to help students use the textbook more effectively. In addition to reviewing content of the text, this
Study Guide encourages students to think critically in applying their knowledge.

ORGANIZATION

Each chapter in this Study Guide is designed to incorporate learning activities that will help students meet the objectives
of the corresponding textbook chapter. The content is organized as follows:
• Learning Key Terms- Matching or fill-in-the-blank questions give students the opportunity to test their ability to
define all key terms in the corresponding textbook chapter.
• Reviewing Key Concepts A variety of questions (matching, fill-in-the-blank, true/false, short answer, and multiple
choice) are used to provide students with ample opportunity to assess their knowledge and comprehension of the in-
formation covered in the text. These activities are specifically designed to help students identify the important content
of the chapter and test their level of knowledge and understanding after reading the chapter.
• Thinking Critically- Students are required to apply concepts found in the chapter to solve problems, make decisions
concerning care management, and provide responses to patients' questions and concerns.
• Answer Key- Answers to all questions are provided at the end of this Study Guide.

..
VII

Copyright © 2018, Elsevier Inc. All rights reserved. Introduction

This page intentionally left blank
 Contents
Unit 1 Introduction to Maternity Nursing
1 21st Century Maternity Nursing, 1
2 The Family, Culture, Spirituality, and
Home Care, 5
Unit 2 Reproductive Years
3 Assessment and Health Promotion, 13
4 Reproductive System Concerns, 24
5 Infertility, Contraception, and Abortion, 35
Unit 3 Pregnancy
6 Genetics, Conception, and Fetal Development, 42
7 Anatomy and Physiology of Pregnancy, 48
8 Nursing Care of the Family During
Pregnancy,53
9 Maternal and Fetal Nutrition, 62
10 Assessment of High-Risk Pregnancy, 67
11 High-Risk Perinatal Care: Preexisting
Conditions, 72
12 High-Risk Perinatal Care: Gestational
Conditions, 80
Unit 4 Childbirth
13 Labor and Birth Processes, 91
14 Maximizing Comfort for the Laboring
Woman, 94
15 Fetal Assessment During Labor, 100
16 Nursing Care of the Family During Labor and
Birth,105
17 Labor and Birth Complications, 113
Unit 5 Postpartum Period
18 Postpartum Physiologic Changes, 121
19 Nursing Care of the Family During the Postpartum
Period, 124
20 Transition to Parenthood, 130
21 Postpartum Complications, 135
Unit 6 Newborn
22 Physiologic and Behavioral Adaptations of the
Newborn, 142
23 Nursing Care of the Newborn and Family, 148
24 Newborn Nutrition and Feeding, 154
25 The High-Risk Newborn, 159
Copyright © 2018, Elsevier Inc. All rights reserved.
Unit 7 Children, Their Families, and the Nurse
26 21st Century Pediatric Nursing, 166
27 Family, Social, Cultural, and Religious Influences
on Child Health Promotion, 170
28 Developmental and Genetic Influences on Child
Health Promotion, 174
Unit 8 Assessment of the Child and Family
29 Communication, History, and Physical
Assessment of the Child and Family, 179
30 Pain Assessment and Management in Children, 185
Unit 9 Health Promotion and Special Health
Problems
31 The Infant and Family, 188
32 The Toddler and Family, 192
33 The Preschooler and Family, 195
34 The School-Age Child and Family, 198
35 The Adolescent and Family, 201
Unit 10 Special Needs, Illness, and Hospitalization
36 Impact of Chronic Illness, Disability, or End-of-Life
Care for the Child and Family, 205
37 Impact of Cognitive or Sensory Impairment on the
Child and Family, 208
38 Family-Centered Care of the Child During Illness
and Hospitalization, 211
39 Pediatric Variations of Nursing Interventions, 214
Unit 11 Health Problems of Children
40 The Child with Respiratory Dysfunction, 218
41 The Child with Gastrointestinal Dysfunction, 223
42 The Child with Cardiovascular Dysfunction, 228
43 The Child with Hematologic and Immunologic
Dysfunction, 234
44 The Child with Cancer, 237
45 The Child with Genitourinary Dysfunction, 242
46 The Child with Cerebral Dysfunction, 246
47 The Child with Endocrine Dysfunction, 250
48 The Child with Musculoskeletal or Articular
Dysfunction, 253
49 The Child with Neuromuscular or Muscular
Dysfunction, 257
Answer Key, 260
.
IX
Contents
This page intentionally left blank
 UNIT 1 INTRODUCTION TO MATERNITY NURSING

21st Century Maternity Nursing

I. LEARNING KEY TERMS

MATCHING: Match each term with its corresponding description.

1. Number of live births in 1 year per 1000 population. a. Fertility rate

2. All deaths during pregnancy and within 1 year following the b. Infant mortality rate
end of pregnancy.
c. Birth rate
3. Number of maternal deaths from births and complications of
pregnancy, childbirth, and puerperium (the first 42 days after d. Maternal mortality rate
termination of the pregnancy) per 100,000 live births. e. Neonatal mortality rate
4. An infant who, at birth, demonstrates no signs of life, such as f. Perinatal mortality rate
breathing, heartbeat, or voluntary muscle movements.
g. Pregnancy-associated deaths
5. Number of stillbirths and number of neonatal deaths per
1000 live births. h. Pregnancy-related deaths
.
6. Number of births per 1000 women between the ages of 15 and 1. Stillbirth
44 years (inclusive), calculated on an annual basis.
j. Abortus
7. An embryo or fetus that is removed or expelled from the
uterus at 20 weeks of gestation or less, weighs 500 g or less,
or measures 25 cm or less.
8. _ _ _ Number of deaths of infants younger than 1 year of age per
1000 live births.
9. _ _ _ Number of deaths of infants younger than 28 days of age per
1000 live births.
10. _ _ _ Deaths that are a complication of pregnancy, an aggravation
of an unrelated condition by the physiology of pregnancy, or
a chain of events initiated by the pregnancy.

FILL IN THE BLANKS: Insert the term that 2. A set of goals

corresponds to each of the following definitions
or descriptions.
1. Specialty area
of nursing practice that focuses on the care of child-
bearing women and their families through all stages of
pregnancy and childbirth, as well as the first 4 weeks
after birth.
based on assessments of major risks to health and
wellness, changes in public health priorities, and is-
sues related to the health preparedness and prevention
of our nation.
3. A set of 17 goals
to be achieved by 2030 that respond to the world's
main development challenges and are replacing the
previous Millennium Development Goals.

Copyright © 2018, Elsevier Inc. All rights reserved. Chapter 1 21st Century Maternity Nursing
 4. Approach to
health care that encompasses complementary and
alternative therapies in combination with conven-
tional Western modalities of treatment.
5. An umbrella
term for the use of communication technologies and
electronic information to provide or support health
care when the participants are separated by distance.
6. This is the
leading cause of death in women.
7. Term that re-
fers to a spectrum of abilities, ranging from reading an
appointment slip to interpreting medication instruc-
tions.
8. Health care
that is based on information gained through research
and clinical trials.
9. Guidelines for
nursing practice that reflect current knowledge, rep-
resent levels of practice agreed on by leaders in the
specialty, and can be used for clinical benchmarking.
10. A list of ab-
breviations, acronyms, and symbols developed by
The Joint Commission to decrease the risk of errors
in the administration of medications.
11. Term used by
The Joint Commission to describe an unexpected
occurrence involving death or serious physical or
psychological injury, or risk thereof.
12. Failure to rec-
ognize or act on early signs of distress. Key compo-
nents include careful surveillance and identification
of complications and quick action to initiate appro-
priate interventions and activate a team response.
13. Level of prac-
tice that a reasonably prudent nurse would provide in
the same or similar circumstances.
14. An effort to pro-
vide nurses with the competencies to improve the qual-
ity and safety of the systems of health care in which
they practice. They were delineated by the IOM.
15. A teamwork
system for health professionals to provide higher
quality, safer patient care. It provides an evidence
base to improve communication and teamwork
skills.
2
Chapter 1 21st Century Maternity Nursing
II. REVIEWING KEY CONCEPTS
1. When assessing pregnant women, what factors would
you recognize as having the potential to contribute to
the rate of maternal mortality in the United States?
2. Briefly discuss the impact of technology on the grow-
ing number of ethical concerns and debates related to
perinatal nursing and women's health care.
3. An integrative health care approach implies which of
the following? (Circle all that apply.)
a. The focus is on the whole person.
b. Conventional Western modalities of treatment are
not included.
c. The beliefs, values, and desires of the patient in
terms of health and health care are respected.
d. Patient autonomy is limited in terms of choosing
alternative therapies.
e. The patient's disease complex is the primary con-
sideration when choosing treatment approaches.
4. A nurse manager of a prenatal clinic should recognize
that the most significant barrier encountered by preg-
nant women in accessing health care would be which
of the following?
a. Lack of transportation to the clinic
b. Child care responsibilities
c. Inability to pay
d. Deficient knowledge related to the benefits of pre-
natal care
5. In the United States, one of the leading causes of mater-
nal mortality is which one of the following?
a. Unsafe abortion
b. Infection
c. Gestational hypertension
d. Diabetes
6. Pregnant women who are obese are more likely to
develop one or both of the two most frequently re-
ported maternal risk factors. These factors include
which of the following combinations?
a. Premature labor and infection
b. Hemorrhage and hypertension associated with
pregnancy
c. Infection and diabetes
d. Diabetes and hypertension associated with preg-
nancy
Copyright© 2018, Elsevier Inc. All rights reserved.
Ill. THINKING CRITICALLY

1. Imagine that you are the nursing director of an inner-city prenatal clinic that serves a large number of minority
women, many of whom are younger than 20 years of age. Describe five nursing services you would provide for these
women that would help reduce the potential for maternal and infant morbidity and mortality and low birth weight.
Use the statistical data and risk behaviors presented in Chapter 1 to support the types of services you propose.

2. Support the accuracy of the following statement: An emphasis on high-technology medical care and lifesaving tech-
niques will not reduce the rate of preterm and low-birth-weight infants in the United States.

3. Explain how a nurse could use social media to improve the health care provided to pregnant women and their families.
Identify the precautions the nurse must take to ensure that patient confidentiality and privacy are respected.

4. Many barriers interfere with a woman's participation in early and ongoing prenatal care. Describe incentives and
services that you would offer to pregnant women to encourage their participation in prenatal care. State the rationale
for your proposals. Your answer should reflect an understanding of the barriers.

5. Discuss community-based care as it relates to pregnancy and women's health care.

3
Copyright © 2018, Elsevier Inc. All rights reserved. Chapter 1 21st Century Maternity Nursing
6. Discuss measures that can be taken to ensure that the health literacy needs of patients are met.

7. Medical errors are the leading cause of death in the United States. Explain the process that you will use as a student
to prevent medical errors.

8. Discuss two international concerns that have serious detrimental effects on the health and safety of women. Explain
how nurses can address these concerns.

4
Chapter 1 21st Century Maternity Nursing Copyright © 2018, Elsevier Inc. All rights reserved.
 The Family, Culture, Spirituality,
and Home Care

LEARNING KEY TERMS

MATCHING: Match the family described with the appropriate family category.

1. - - - Miss M. lives with her 4-year-old adopted Korean daughter, Kim. a. Multigenerational family
2. - - - Anne and Duane are married and live with their daughter, Susan, and b. Single-parent family
Duane's aunt and uncle.
c. Homosexual family
3. - - - Gloria and Andy are a married couple living with their new baby girl,
Annie. d. Nuclear family
e. Extended family
4. - - - Carl and Allan are a gay couple living with Carl's daughter, Sally,
whom they are raising together. f. Married-blended family
5. - - - The S. family consists of Jim; his second wife, Jane; and Jim's two g. No-parent family
daughters by a previous marriage.
6. - - - Tammy and Joseph live with their grandmother Irene who has been
caring for them since their mother died.

7. - - - Ruth lives with her son, Peter, his wife Anne, and their twin sons.

MATCHING: Match the description with the appropriate cultural concept.

8. - - - Mrs. M., a Mexican-American who just gave birth, tells the nurse not a. Cultural relativism
to include certain foods on her meal tray because her mother told her
to avoid those foods while breastfeeding. The nurse tells her that she b. Ethnocentrism
doesn't have to avoid any foods and should eat whatever she desires. c. Assimilation
9. _ _ Ms. P., an immigrant from Vietnam, has lived in the United States for d. Subculture
1 year. She tells you that while she enjoys the comfort of wearing blue
jeans and sneakers for casual occasions, like shopping, she still wears e. Acculturation
traditional or "conservative" clothing for family gatherings.
10. - - A Cambodian family immigrated to the United States and has been liv-
ing in Denver for over 5 years. The parents express concern about their
children, ages 10, 13, and 16, stating, "The children act so differently
now. They are less respectful to us, want to eat only American food, and
go to rock concerts. It's hard to believe they are our children."

11. - - The Amish represent an important ethnic community in Lancaster,

Pennsylvania.
12. - - The nurse is preparing a healthy diet plan for Mrs. 0. In doing so, she
takes the time to include the Polish foods that Mrs. 0. enjoys.

Copyright © 2018, Elsevier Inc. All rights reserved. Chapter 2 The Family, Culture, Spirituality, and Home Care
FILL IN THE BLANKS: Insert the cultural concept
that corresponds to each of the following
definitions.
13. An ongoing
process that influences a person throughout his or her
life. It provides an individual with beliefs and values
about each facet of life that are passed from one
generation to the next.
14. A group exist-
ing within a larger cultural system that retains its
own characteristics.
15. Recognizing
that people from different cultural backgrounds com-
prehend the same objects and situations differently;
that a culture determines a person's viewpoint.
16. Changes that
occur within one group or among several groups
when people from different cultures come in contact
with one another and exchange and adopt each
other's mannerisms, styles, and practices.
17. Process in
which one cultural group loses its identity and be-
comes a part of the dominant culture.
18. -------------- A belief that
One's cultural way of doing things is the right way,
supporting the notion that "My group is the best."
19. Approach that
involves the ability to think, feel, and act in ways that
acknowledge, respect, and build upon ethnic, cul-
tural, and linguistic diversity; to act in ways that
meet the needs of the patient and are respectful of
ways and traditions that may be different from one's
own.
20. Type of time
orientation that maintains a focus on achieving long-
term goals; families or people who practice this time
orientation are more likely to return for follow-up
visits related to health care and to participate in
primary prevention activities.
21. Type of time
orientation of families or people who are more likely
to strive to maintain tradition or the status quo and
have little motivation for formulating future goals.
22. Type of time
orientation of families or people who may have
difficulty adhering to strict schedules and are often
described as living for the moment.
6
Chapter 2 The Family, Culture, Spirituality, and Home Care
23. Cultural con-
cept that reflects dimensions of personal comfort
zones. Actions such as touching, placing the woman in
proximity to others, taldng away personal possessions,
and making decisions for the woman can decrease
personal security and heighten anxiety.
24. A unit of so-
cialization and nurturing within a community that
preserves and transmits culture. It is a social network
that acts as a potent support system for its members.
25. Family cate-
gory in which husband and wife and their children
live as an independent unit, sharing roles, responsi-
bilities, and economic resources.
26. Family cate-
gory that includes the nuclear family and other peo-
ple related by blood (kin) such as grandparents,
aunts, uncles, and cousins.
27. Family cate-
gory in which an unmarried biologic or adoptive
parent heads the household; it is becoming an in-
creasingly recognized structure in our society. These
families tend to be vulnerable both socially and eco-
nomically.
28. Family cate-
gory that forms as a result of divorce and remarriage.
It includes stepparents, stepchildren, and stepsib-
lings who join to create a new household.
29. Family cate-
gory comprised of gay, lesbian, bisexual and trans-
gender couples who live together with or without
children.
30. Family cate-
gory consisting of grandparents, children, and grand-
children. This family form is becoming increasingly
common.
31. Family cate-
gory in which children live independently in foster or
kinship care such as living with a grandparent.
32. Family cate-
gory in which children live with two unmarried bio-
logic parents or two adoptive parents.
33. Term for the
family tree format that depicts relationships of fam-
ily members over at least three generations; it pro-
vides valuable information about a family and its
health.
Copyright© 2018, Elsevier Inc. All rights reserved.
34. Term for a 2. State the rationale for the increasing emphasis on
graphic portrayal of social relationships of the pa- home- and community-based health care. How has this
tient and family including school, work, religious trend changed the demands placed on the community-
affiliations, and club memberships. based nurse?

35. Groups within

the community who are more likely to experience
health status problems and negative health outcomes
as a result of a variety of sociocultural, economic,
and environmental risk factors that contribute to dis-
parities in health.
3. Community health promotion requires the collabora-
36. An aspect of tive efforts of many individuals and groups within a
humans that is above and beyond the mind and body, community. Cite several programs that could be estab-
ultimately giving meaning and purpose to one's life. lished to promote the health of a community's child-
bearing families.
37. Questions
asked to patients related to spirituality and religion.

38. A type of
nursing that works through their, church, synagogue,
mosque or a faith community.

II. REVIEWING KEY CONCEPTS 4. Explain why each of the groups listed below have
1. Discuss why the nurse should take each of the follow- been identified as vulnerable populations:
ing "products of culture" into consideration when
providing care within a cultural context: • Women in general

a. Communication

• Adolescent girls and older women

b. Personal space

• Racial and ethnic minorities

c. Time orientation

• Incarcerated women

d. Family roles
• Refugee, immigrant, and migrant women

Copyright © 2018, Elsevier Inc. All rights reserved. Chapter 2 The Family, Culture, Spirituality, and Home Care
5. Describe the ways that nurses can provide care to
perinatal patients using the telephone.
6. Which one of the following nursing actions is most
likely to reduce a patient's anxiety and enhance the
patient's personal security as it relates to the concept
of personal space needs?
a. Touching the patient before and during procedures
b. Providing explanations when performing tasks
c. Making eye contact as much as possible
d. Reducing the need for the patient to make decisions
7. A Native-American woman gave birth to a baby girl
12 hours ago. The nurse notes that the woman keeps
her baby in the bassinet except for feeding and states
that she will wait until she gets home to begin breast-
feeding. The nurse recognizes that this behavior is
most likely a reflection of:
a. embarrassment.
b. delayed attachment.
c. disappointment that the baby is a girl.
d. cultural beliefs regarding the care of newborns.
8. When caring for a pregnant woman who is Hispanic,
the nurse should recognize that the woman may be
guided by which of the following cultural beliefs and
practices during her pregnancy? (Circle all that apply.)
a. Warm breezes can be dangerous during pregnancy.
b. Prenatal care should begin very early in pregnancy.
c. Milk should be avoided because it results in big
babies and difficult births.
d. Drinking chamomile tea should be avoided because
it can cause preterm labor.
e. The advice of both mother and mother-in-law
should be followed during pregnancy.
f. Pelvic examinations should not be performed by a
male health care provider.
9. European-American women are likely to believe
which of the following regarding pregnancy and
childbirth? (Circle all that apply.)
a. The father of the baby should be actively involved
in the labor and birth.
b. Pregnancy requires medical attention so prenatal
care should begin early in pregnancy.
c. Birthing at home should be valued.
d. Pregnant women should participate in childbirth
education.
e. The doctor is the head of the obstetrical care team.
f. Mothers should not begin to breastfeed until milk
•
comes 1n.
Chapter 2 The Family, Culture, Spirituality, and Home Care
10. A student nurse is planning to communicate with her
postpartum patient using an interpreter. Her instruc-
tor should provide further guidance if the student
does which of the following?
a. Chooses a female interpreter from the woman's
country of origin.
b. Stops periodically during the interaction to ask
the interpreter how things are going.
c. Asks questions while looking at the interpreter.
d. Gathers culturally appropriate learning aids and
reading materials to use during the interaction.
11. Which of the following strategies are used to deliver
culturally appropriate care (Circle all that apply.)
a. Ask about traditional beliefs such as the role of
hot and cold
b. Ask about woman's fears and those of her family
regarding an unfamiliar care setting
c. Provide hospital menu for meals and let the
patient know the set meals
d. Be sensitive regarding interpreters and language
barriers
e. Ask about group practices and beliefs
12. A student nurse is planning a presentation on Spiri-
tual Wellness. Which of the following questions
would help the student cover this topic.? Select all
that apply
a. What does suffering mean to the patient?
b. Who or what provides the patient with strength
and hope?
c. When was the last time you attended church?
d. How does your faith help the patient cope
13. When making a home visit, it is essential that the
nurse use appropriate infection control measures. Of
the measures listed below, which one is the most
important?
a. Including personal protective equipment in the
home care bag
b. Designating a dirty area with a trash bag to collect
soiled equipment and supplies
c. Wearing clean vinyl gloves for procedures that
involve touching the patient
d. Performing hand hygiene using either soap and
running water or a self-drying antiseptic solution.
Copyright© 2018, Elsevier Inc. All rights reserved.
Ill. THINKING CRITICALLY

1. Imagine that you are a nurse working in a clinic that provides prenatal services to a multicultural community pre-
dominated by Hispanic, African-American, and Asian-American families. Describe how you would adapt care mea-
sures to reflect the cultural beliefs and practices of pregnant women and their families from each of the following
cultural groups.

a. Hispanic

b. African-American

c. Asian-American

2. Pamela is a 20-year-old Native-American woman. She is 3 months pregnant and has come to the prenatal clinic on
the reservation where she lives for her first visit to obtain some prenatal vitamins, which her friends at work told her
are important.

a. State the questions the nurse should ask to determine Pamela's cultural expectations about childbearing.

b. Describe the communication approach you would consider when interviewing Pamela.

c. Identify the Native-American beliefs and practices regarding childbearing that may influence Pamela's approach
to her pregnancy and the birth of her child.

3. A nurse has been providing care to a Hispanic family. This family recently experienced the birth of twin girls at
38 weeks of gestation. It is the first birth experience for both parents and the first grandchildren for the extended
family. Both newborns are healthy and living at home. Describe the cultural beliefs and practices that the family,
being Hispanic, might use as guidelines to provide care to their newborn twin girls.

9
Copyright © 2018, Elsevier Inc. All rights reserved. Chapter 2 The Family, Culture, Spirituality, and Home Care
4. The nurse-midwife at a prenatal clinic has been assigned to care for a refugee couple from Thailand who recently
immigrated to the United States. The woman has just been diagnosed as being 2 months pregnant. Neither she nor
her husband speaks English. Outline the process that this nurse should use when working with a translator to facilitate
communication with this couple to enhance care management.

5. Imagine that you are a nurse who has just been hired to provide in-home health care. Before you begin seeing your
patients, you realize that it would be helpful for you to become familiar with the neighborhood and resources in the
community where your patients live. You decide to conduct a walking survey of this community.

a. Describe how you would go about conducting this survey and gathering data.

b. List the data you believe it would be essential to gather.

c. Discuss how you would use the findings from your walking survey when providing health care to the patients you
will be visiting.

6. Marie is a single parent of two young children ages 4 years and 1 year. She and her children have been homeless for
3 months because her husband abandoned her and she lost her job because she had no one to help her care for her
children.

a. Discuss the basis for the types of health problems to which Marie and her children are most vulnerable.

b. What factors related to being homeless could increase Marie's risk for becoming pregnant? If she did become
pregnant, explain why it would be considered a high risk pregnancy.

c. How would you, as a nurse, provide health care services to Marie and her children?

10

Chapter 2 The Family, Culture, Spirituality, and Home Care Copyright © 2018, Elsevier Inc. All rights reserved.
7. Consuelo is the wife of a migrant laborer. She and her husband, along with their two children, have been working on
a California farm for 2 weeks. She has arrived at a health center established for migrant laborers. Consuelo states that
she is 4 months pregnant. As the women's health nurse practitioner assigned to care for Consuelo, what approaches
would you use to ensure that she obtains quality health care that addresses her unique health risks as a migrant
worker?

8. Write a series of questions that you would ask when making a postpartum follow-up call to a woman who gave birth
3 days ago.

9. Eileen gave birth to a son 36 hours ago. A home care nurse has been assigned to visit Eileen and her husband in their
home to assess the progress of her recovery after birth, the health status of her newborn son, and the adaptation of
family processes to the responsibilities of newborn care.

a. Outline the approach the nurse should take in preparing for this visit.

b. Describe the nurse's actions during the visit using the care management process as a format.

c. Discuss how the nurse should end the visit.

d. Identify interventions the nurse should implement at the conclusion of the visit with Eileen and her husband.

e. Specify how the nurse should protect her personal safety both outside and inside Eileen's home.

f. Cite the infection control measures the nurse should use when conducting the visit and providing care in Eileen's
home.

11
Copyright © 2018, Elsevier Inc. All rights reserved. Chapter 2 The Family, Culture, Spirituality, and Home Care
10. Angela has recently been diagnosed with hyperemesis gravidarum and has been hospitalized to stabilize her fluid
and electrolyte balance. The hospital-based nurse must evaluate Angela for referral to home care.

a. State the criteria that this nurse should follow to determine Angela's readiness for discharge from hospital to
home care.

b. Angela has been discharged and will be receiving parenteral nutrition in her home. Discuss the additional infor-
mation required related to high technology home care.

c. Identify specific home environment criteria that must be met to ensure the safety and effectiveness of Angela's
treatment.

11. A nurse is seeking funding to start a home care agency designed to provide home visits to postpartum women and
their families within 1 week of birth and follow-up visits as indicated. State the points the nurse should emphasize
as a rationale for the importance of this health care service and the cost-effectiveness of funding such a service.

12. A nurse is calling a hospital chaplain to assist in spiritual care for a patient in preterm labor.

a. Discuss what spiritual care encompasses.

b. How does spirituality affect the family?

c. Identify ways a nurse could include spirituality in her care.

12

Chapter 2 The Family, Culture, Spirituality, and Home Care Copyright© 2018, Elsevier Inc. All rights reserved.

Assessment and Health Promotion
I. LEARNING KEY TERMS
FILL IN THE BLANKS: Insert the term that
corresponds to each of the following definitions
related to the female reproductive system and
breasts. Use the anatomic drawings (Figs. 3-1, 3-2,
3-4, 3-5, and 3-6 in your textbook) to visualize each
of the structures as you are inserting the terms.
1. Fatty pad that
lies over the anterior surface of the symphysis pubis.
2. Two rounded
folds of fatty tissue covered with skin that extend
downward and backward from the mons pubis; their
purpose is to protect the inner vulvar structures.
3. Two flat, red-
dish folds composed of connective tissue and smooth
muscle, which are supplied with nerve endings that
are extremely sensitive.
4. Hood-like
covering of the clitoris.
5. Fold of tissue
--------------
under the clitoris.
6. - - - - - - - - - - - - - - - - Thin flat
tissue formed by the joining of the labia minora; it
lies underneath the vaginal opening at the midline.
7. Small struc-
ture underneath the prepuce composed of erectile
tissue with numerous sensory nerve endings; it in-
creases in size during sexual arousal.
8. - - - - - - - - - - - - - - - - Almond-
shaped area enclosed by the labia minora that con-
tains openings to the urethra, Skene's glands, vagina,
and Bartholin's glands.
9. Bladder open-
ing found between the clitoris and the vagina.
10. Skin-covered
muscular area between the fourchette and the anus
that covers the pelvic structures.
Copyright © 2018, Elsevier Inc. All rights reserved.
UNIT 2 REPRODUCTIVE YEARS
Fibromuscu-
lar, collapsible tubular structure that extends from
the vulva to the uterus and lies between the bladder
and rectum. Its mucosal lining is arranged in trans-
verse folds called - - - - - - - - - - - - -.
_ _ _ _ _ _ _ _ _ _ glands (located on each
side of the urethra), and _ _ _ _ _ _ _ __
glands (located on each side of the vagina) secrete
mucus that lubricates the vagina. The _ _ _ __
- - - - - - - is a connective tissue membrane
that surrounds the vaginal opening and can be perfo-
rated during strenuous exercise, insertion of tam-
pons, masturbation, and vaginal intercourse.
12. Anterior, pos-
terior, and lateral pockets that surround the cervix.
13. Muscular pel-
vic organ located between the bladder and the rec-
tum and just above the vagina. The _ _ _ _ __
______ is a deep pouch, or recess, posterior
to the cervix formed by the posterior ligament.
14. _ _ _ _ _ _ _ _ _ _ _ _ _ Upper trian-
gular portion of the uterus.
15. Also known as
the lower uterine segment, it is the short constricted
portion that separates the corpus of the uterus from
the cervix.
16. _ _ _ _ _ _ _ _ _ _ _ _ _ Dome-shaped
top of the uterus.
17. _ _ _ _ _ _ _ _ _ _ _ _ _ Highly vascu-
lar lining of the uterus.
18. Layer of the
uterus composed of smooth muscles that extend in
three different directions.
13
Chapter 3 Assessment and Health Promotion
19. Lower cylin-
dric portion of the uterus composed of fibrous con-
nective tissue and elastic tissue.
20. Canal con-
necting the uterine cavity to the vagina. The
opening between the uterus and this canal is the
_ _ _ _ _ _ _ _ _ _ _. The opening between
the canal and the vagina is the _ _ _ _ _ _ _ _.
21. Location
in the cervix where the squamous and columnar
epithelium meet; it is also known as the
_ _ _ _ _ _ _ _ _ _ _ zone; it is the most
common site for neoplastic changes; cells from this
site are scraped for the Pap smear.
22. Passageways
between the ovaries and the uterus; they are attached
at each side of the dome-shaped uterine fundus.
23. Almond-shaped
organs located on each side of the uterus; their two
functions are - - - - - - - - - - - and the
production of the hormones _ _ _ _ _ _ _ _,
_ _ _ _ _ _ _ _,and _ _ _ _ _ _ _ _ _.
24. -------------- Structure that
protects the bladder, uterus, and rectum; accommo-
dates the growing fetus during pregnancy; and an-
chors support structures.
25. _ _ _ _ _ _ _ _ _ _ _ _ _ _ The paired
mammary glands.
26. Segment of
mammary tissue that extends into the axilla.
27. Mammary papilla.
28. Pigmented
section of the breast that surrounds the nipple.
29. Sebaceous glands
that secrete a fatty substance to lubricate the nipple
and cause the areola to appear rough.
FILL IN THE BLANKS: Insert the term that
corresponds to each of the following definitions
related to the menstrual cycle. Use the illustration
of the Menstrual Cycle (Fig. 3-7 in your textbook) to
visualize the cycle as you are inserting the terms.
30. The first
menstruation.
14
Chapter 3 Assessment and Health Promotion
31. Transitional
stage between childhood and sexual maturity.
32. Transitional
phase during which ovarian function and hormone
production decline.
33. _ _ _ _ _ _ _ _ _ _ _ _ _ The last men-
strual period dated with certainty once one year has
passed after menstruation ceases.
34. _ _ _ _ _ _ _ _ _ _ _ _ _ Period preced-
ing the last menstrual period that lasts about 4 years;
during this time ovarian function declines, ova di-
minish, more menstrual cycles become anovulatory,
and irregular bleeding occurs.
35. _ _ _ _ _ _ _ _ _ _ _ _ _ _ Periodic uter-
ine bleeding that begins approximately 14 days after
ovulation. It is controlled by the feedback system of
three cycles, namely _ _ _ _ _ _ _ _ _ _ _,
_________, and .
The average length of each menstrual cycle is
_ _ _ _ _ _ _ _ but variations are normal. Day
one of the cycle is considered to be _ _ _ _ _ __
_ _ _ _ _ _. The average duration of menstrual
flow is _ _ _ _ _ _ _ _ _ _ _ with a range of
-----------·
36. Cycle that in-
volves cyclic changes in the lining of the uterus. It
consists of four phases, namely _ _ _ _ _ _ _,
_________, _________,
and - - - - - - - - - - -.
37. Cycle that in-
volves secretion of hormones required to stimulate
ovulation.
38. Cycle that in-
volves the changes in the ovary leading to ovulation.
It consists of two phases, namely _ _ _ _ _ __
and - - - - - - - - - - -.
39. Hormone se-
creted by the hypothalamus when ovarian hormones
are reduced to a low level. It stimulates the pituitary
gland to secrete two critical hormones for the men-
strual cycle, namely _ _ _ _ _ _ _ _ _ __
and - - - - - - - - - - -.
Copyright© 2018, Elsevier Inc. All rights reserved.
Another random document with
no related content on Scribd:
Diamond H as long as he was running it. So you might say the trip
was more or less of a holiday.”
Hinman allowed his gaze to rove through the window and settle upon
a covered wagon crawling slowly southward.
“He’ll be crowded clear off the map inside another year,” Hinman
said. “I don’t suppose you told him about how glad I’d be to have him
swarm over here on my grass with all his cows whenever he’s finally
ordered out down there; now did you?”
“I did sort of intimate that your range would always be wide open,”
Carver stated. “I was straining every little point to save the taxes on
that bunch of cows. I’ll bet it would have totalled up to anyhow six
hundred dollars, those taxes would.”
“Well, that’s all you agreed to do,” said Hinman. “And I guess I’d
better pay you off and have it over with, even if you did get me into
considerable of a snarl. Only one thing I can do now, since you made
all those arrangements, and that’s to back up anything you told Nate.
I never figured you’d let me in for anything like this.”
“I’d prefer to take my pay in some other form than cash,” Carver
announced as Hinman produced his check book. “Suppose you give
me a bill of sale for a hundred head of coming yearlings instead of
nine hundred cash and let ’em range with your stuff up on the west
place till November.”
“You can’t spend calves,” said Hinman.
“I could borrow against them if I was needing money,” Carver
explained.
“But coming yearlings are worth twelve dollars a head,” Hinman
objected.
“I’ll owe you the rest,” Carver offered.
“And when I deliver in November they’ll be worth more’n that. They’ll
bring round sixteen dollars a head by then.”
“That’s what I was counting on,” said Carver. “I like to feel every
morning that I’m worth just a little more than I was the night before.”
Hinman laid down the check book and regarded him.
“Now it’s always struck me that you put yourself out to be worth just
a mite less each morning than you was the night before,” he stated.
“Surely you haven’t gone and deserted the ranks of the tumbleweeds
in favor of the pumpkins. I never knew you to set a value on a dollar.”
“That’s because I never chanced across just the right sort of dollar,”
Carver explained. “Now this is different.” He produced his lucky coin
and handed it over for inspection. “I’m aiming to accumulate a
number of others just like this to keep it company.”
Hinman inspected the silver dollar.
“Yes,” he said. “This is a right unusual appearing sort of coin. Don’t
know as I ever see one just like it. Now if you really think there’s a
chance for you to collect some more like this and take an interest in
holding on to them, why we might make a deal. You’ve just effected
quite a saving on my taxes, so I can maybe stretch a point. But if I
don’t deliver till November, and run ’em meantime on my grass,
those critters will cost you fourteen apiece instead of twelve. You’ll
be owing me five hundred in place of three.”
“I don’t mind owing you,” said Carver. “We’ll close the deal.”
As he rode away from the Box T he sang:
“Oh, I’ve risked many dollars
On the rambling tumbleweed
And only one on pumpkins
But that one went to seed.”
 III
The crest of the watershed separating the flow between the Salt
Fork and the Cimarron was also the dividing line between Crowfoot’s
range and the leases of the Half Diamond H. Carver crossed over
this low divide and angled toward Turkey Creek to intersect its
course at a point near Crowfoot’s place. Here the majority of the
range stock wore the straggling brand intended to represent a bird’s
claw, the badge of Crowfoot’s ownership.
Carver viewed the ranch buildings from the shoulder of a hill, noting
particularly the corral which was fashioned as a solid stockade some
ten feet high. Crowfoot had entered into a beef contract with the
railroad and his slaughtering was conducted within this small
enclosure. Carver entertained positive convictions as to the purpose
of this arrangement but in common with others of his kind he made a
religion of remaining strictly incurious regarding the calling or
customs of acquaintances except in so far as they might affect his
own immediate affairs.
He turned his horse up the Turkey Creek bottoms and followed that
stream for a dozen miles, then angled away to the right toward the
Half Diamond H range. When well up the gentle slope he rode out on
to the rim of a pocket. The scattering trees in the bottoms indicated
the presence of water. A spring branch probably headed in the
pocket and drained back toward Turkey Creek, he reflected. He
pulled up his horse as a woman’s voice floated up to him.
Somewhere down below him a girl was singing, and Carver headed
his horse down the slope toward the sound.
A sod house nestled under the hill beside the trickling spring-creek.
The singing ceased abruptly and a girl appeared in the door of the
sod house at the sound of his horse’s hoofs in the yard.
For the second time Carver saw her framed in a doorway and he
was conscious of a sudden pleased conviction that she should
always choose a similar setting. The drab surroundings served only
as a background to hold her vivid youth and charm in more startling
relief. Carver recollected that he had mauled one brother in no gentle
fashion and was held accountable for another’s day of
transgressions; in consequence he feared a cool reception from the
sister. Instead, her face lighted with sudden recognition.
“Oh, it’s you!” she greeted. “Bart will be coming home any time now
and he’d be so sorry if he missed you. Won’t you step down off your
horse and wait?”
She sat on the doorsill and motioned Carver to a seat on a bench
against the cabin. He removed his hat and tilted back against the
sod wall as she explained that Bart was even now overdue. As they
talked it was quite evident that all her thoughts centered round the
younger brother. Carver found the tones of her voice as pleasant to
his ear as the sight of her was pleasing to his eyes, and he was
content to listen, hoping meanwhile that Bart would never come.
He knew this for a Crowfoot line camp, recently installed, which
accounted for the fact that he had not chanced across it the year
before. The Lassiters, therefore, must ride for Crowfoot, he decided.
“Bart and I only came down last week,” she said. “We’ve been living
in your little house in Caldwell. Did you know?”
“I gave him the key and told him the place was his,” Carver said. “But
I’d have straightened it up a bit if I’d known he was going to install
you there.”
“It was supremely tidy,” she complimented. “Which was a distinct
surprise. Most men’s housekeeping is rather the reverse.”
Her gaze kept wandering off down the bottoms for some sign of
Bart’s return.
“I do hope he comes,” she said.
“I’m real anxious to see Bart,” he confessed. “I certainly hope he
turns up sometime inside of the next three or four hours for this is my
busy day and I couldn’t conscientiously wait on him longer than that.”
His tones expressed only a mild anxiety over the possible non-arrival
of his friend.
“Do please stay the very limit, at least,” she urged, and laughed up at
him. “You know, you’re like Bart in a great many ways.” Carver
someway felt that he knew her better after that laugh. “Don’t you
think you two are somewhat alike?”
He had divined the close bond between this girl and her brother and
now made swift use of the knowledge.
“Bart and I are so similar that we might easy be mistaken for twins,”
he admitted. “You might say we’re almost identical.”
“He means a lot to me Bart does,” she said. “In most ways he’s a
lovable youngster, but——”
Carver leaned back with an audible sigh.
“Tell me all about Bart,” he urged.
“I will,” she agreed. “In most ways he’s likable but he’s as wild as a
hawk. He is absolutely irresponsible and will commit any reckless
folly on a second’s notice without a thought of future consequences.
The future means not one thing to him. He’s sublimely confident that
every new day stands by itself, entirely unrelated to either yesterday
or to-morrow. And he’s too easily led. Now don’t you think you two
are considerably alike?”
Carver considered this at some length.
“There’s some few particulars wherein our make-ups branch way out
apart,” he testified. “On those points we’re altogether dissimilar. Now
me, I just can’t be led. I’m sometimes misled, maybe, but never plain
led. And so far as the relation of one day to another”—he produced a
silver dollar and regarded it—“why nothing could possibly convince
me that five weeks ago last Tuesday wasn’t close kin to to-day.” The
girl’s mind flashed back to that first meeting as he smiled across at
her and continued: “And I’m hoping that there’ll be other days in the
future that’ll belong to the same family group. You’d be downright
surprised to know how far my mind wanders into the future—and you
accusing me of not looking ahead.”
“He’s told me a lot about you,” she said. “You’re the supreme chief of
the tumbleweeds, from what I gather; openly irresponsible.”
“On the contrary, I’m apt to take my responsibilities too much to heart
if I don’t watch myself,” he defended. “Do you consider a state of
responsibility one to strive for?” Then, as she nodded, “Hereafter I’ll
track down responsibilities like a duck collects Junebugs, and
assume one after the next.”
“I’ve raised Bart from a baby,” she said. “And I don’t want to see him
go over to the wild bunch. He likes you a lot. Use that influence to
steady him, won’t you, instead of the other way?”
“Just what is the main thing you want Bart to stay clear of?” he
asked.
“I want him to run straight,” she said.
Carver rose to take his leave, his departure hastened by the sight of
a horseman through the trees far down the bottoms. And the rider
was not Bart. He had no desire to meet Noll Lassiter during his first
real visit with the girl, and he somehow knew the identity of the man
who approached.
“Maybe I can do Bart a trifle of good in spots,” he said, as he stood
before her. “And I’ll guarantee not to do him any great amount of
harm.”
“Thanks,” she said, rising to face him and extending her hand. “I
knew you’d do it.”
Carver retained the hand and leaned to kiss her as she stood looking
up at him. The girl stepped back and studied him, evidencing no
annoyance but seeming rather to try to determine the thought which
had occasioned the act and searching for a possible trace of
disrespect. Carver met her eyes fairly.
“You oughtn’t to have smiled just at that particular moment,” he said.
“You see, you are irresponsible,” she pointed out. “That’s exactly
what Bart would have done. You yield to any passing whim.”
“That wasn’t any passing whim,” he corrected. “It was one powerful
impulse; and it’s permanent—not passing. It’s related to to-day and
five weeks ago Tuesday, and I’m hoping it’s related to to-morrow.”
She disregarded this except for an almost imperceptible shake of her
head.
“But you will remember about Bart,” she urged.
“I’ll try and collect all Bart’s loose ends and shape him up into one
solid pattern of propriety,” he promised. “You won’t hardly know him
for the same party after I’ve worked him over.” He swung to the
saddle. “But I’ll have to put in considerable time over here conferring
with you if we’re going to make a success out of Bart.”
He turned his horse to leave but the approaching rider had hastened
through the last belt of trees and he now held up a hand and
signalled Carver to wait. Lassiter pulled up his horse abruptly as he
discovered Carver’s identity.
“I thought it was Wellman,” he stated surlily. “Who asked you here?
This is a little off your range.”
“I travel on a roving permit,” Carver said. He explored his pockets as
if seeking the document and an expression of mock concern
overspread his face. “I declare, I must have mislaid it somehow. But I
believe I showed it to you once before; and anyway, I’m going now.”
He nodded a casual good-by to the girl, turned his back on Lassiter
and departed. As he mounted the cow trail leading out of the head of
the pocket he met Bart Lassiter coming down.
“I’ve just been over to your house visiting round with Miss Molly,”
Carver greeted. “Noll came riding up and I someway gathered the
impression that he wasn’t glad to see me.”
The two lolled sidewise in their saddles. Bart looked down the
bottoms toward the sod house.
“I’d keep an eye peeled for Noll,” he advised. “He’s out for you if he
sees the right chance. If you don’t watch sharp your horse will come
dangling in some day without a rider.”
“Sho!” Carver deprecated. “It’s been against the law to kill folks for a
long time now.”
“I know,” said Bart. “But the mere fact that we’ve got a law like that
proves that maybe some one did get killed once and there’s a
chance it might happen again.”
“He’s been telling you things,” Carver guessed. “Likely he was just
easing his mind.”
“Noll didn’t tell me a word,” Bart denied. “He don’t need to. I know
him. He rode hard on me with a club, up until I outgrew him, and I
can read what’s going on in his mind. I put in all my early years
dodging, until one day he cuffed Molly; then I forgot my timidity and
pulled down his meat house. It was weeks before he was up and
around. He’ll bear watching. I don’t mean to infer that Noll’s all
charged with valor, which he’s not, but he’s certainly loaded to the
ears with meanness and he’ll take a chance if the odds are all his
way and no one looking on.”
“Then I’ll take to surveying my back track,” Carver promised.
“Because if we meet it will likely be from the rear.”
“That’s where,” Bart agreed.
“What’s to hinder my taking you on as a bodyguard, sort of?” Carver
suggested. “I’m going in with the Half Diamond H wagon. Old Nate
would put you on.”
“The three of us are leaving for the X I L in a day or two,” said Bart.
“Otherwise I’d go with you. Milt has been trail boss for the X I L for
the last four summers and brought their trail herds through. Always
before we’ve gone on back and wintered there, but this season we
laid over to help Crowfoot.”
Carver turned this arrangement over in his mind. The X I L was a
Texas brand running south of the Washita country.
“I’ll have a little deal on this fall after round-up,” he said. “And I’d like
to have you cut in with me, provided you don’t hang out at
Crowfoot’s. I’m not over-squeamish and there’s one time and
another when I’ve rode for outfits whose methods was open to
question. Most riders have. But folks are coming to frown on
irregularities and it’s time a man reads his signs right and quits
before it’s just too late.”
“Oh, absolutely,” Bart agreed easily. “I can see that plain.”
“It’s my surmise that there’s a right small percentage of the meat that
goes to fill Crowfoot’s contracts with the railroad that is dressed out
of steers wearing his own brand,” Carver said. “Of course, he’s too
smart to cut in on his neighbors, and they don’t bother to get curious
as long as they know their own strays are safe on his range. But it’s
my guess that if a steer from some foreign outfit turns up on the
Turkey Creek range he’ll get converted into beef overnight.”
Lassiter grinned and wagged a negative head.
“Now you wouldn’t go and suspect Crowfoot of filling his beef
contracts at other folks’ expense,” he reproved. “Besides, how could
he when it’s the law that whenever a cow critter is butchered its hide
must be hung on the fence till it’s been inspected and passed?”
“And our present hide inspector would ride miles out of his way
rather than meet a fresh hide face to face,” Carver testified. “I expect
maybe Crowfoot kills out a batch of his own steers, about every third
slaughtering. That way there’d always be enough fresh hides of his
own brand hanging round the place to make it look right. But he
wouldn’t dress out any more of his own till after one batch of pelts
was too dried out to answer. He’s not that improvident.”
“Well, maybe not,” Bart said. “I couldn’t say for sure. What has
Crowfoot done to you to start you commenting on his habits?”
“Not anything!” Carver confessed. “I don’t even lose sleep over what
he’s doing to other folks. I’m generalizing, kind of. Things are
changing rapid and a man had better let his glance rove a few years
ahead.”
“Hadn’t he, though?” Bart concurred. He didn’t inquire as to the
nature of Carver’s proposition, for it mattered not at all. “We’ll put on
our telescopes and spy out a soft berth for the future. That’s us. You
can count me in till the hair slips.”
With this casual promise they separated. Carver reviewed his recent
utterances with some doubt as he rode across the divide.
“That’s the first time I ever aspired to turn evangelist,” he said. “And
I’m awkward at it. The rôle don’t become me any to speak of, but I’ve
committed myself to take Bart in hand.”
Three days later he rode again to the little sod house on the spring-
creek. He came upon it from behind, his horse’s hoofs making but
slight sound on the springy turf. Not until he had dismounted and
rounded the corner on foot did he discover that a saddled horse
stood on the far side of the house. He stopped short, wondering
which of the three brothers might be at home. While he hesitated a
man’s voice sounded from within, and it was not that of any one of
the Lassiters. He took another step toward the door but halted again
as he detected a threat in the tones of the man inside.
“You listen to reason or I’ll have Bart locked up for the rest of his
natural life,” the voice proclaimed. “And that within the next two days.
I know his whereabouts on a certain night two years ago, when a
saloon in Taosin was ransacked.”
“You’ve told me all that,” said the girl. “But even if you could prove it,
why Bart was only seventeen then.”
“There’s places where they keep such naughty children,” the man
pointed out. “Then he was into that Casa affair, when the station was
burned.”
This statement enabled Carver to identify the man whose voice had
seemed vaguely familiar. It could be no other than Freel.
“I’ve got a line on the whole past of the Lassiters,” Freel resumed.
“Clear back prior to when the old man was alive. He’d be wanted too,
on a dozen counts, if he was still above ground. You know what it is
to have the law always barking at your door. If you take up with me
folks would respect you. But any one in this whole country will tell
you that Freel is a bad man to have on the other side. You don’t want
me lined up against the Lassiters, girl.”
Carver stepped to the door. Freel’s back was toward him but he
could see the girl’s face. There was no trace of apprehension there,
only distaste for the man before her. Her eyes widened with surprise
as they met Carver’s and as she divined his purpose she made a
move to station herself between the two men but Carver held up a
hand to halt her. Freel had whirled to face the door when the girl’s
face betrayed the presence of a third party. He recovered his self-
confidence, shaken for the moment, with the discovery of the
intruder’s identity.
“Morning,” he greeted casually. “Any more wagers on your mind to-
day?”
“Yes,” said Carver. “Step outside. I’m going to make you another little
bet.”
He stepped aside as the marshal passed through the door, then
followed and closed it behind him.
“This wager’s not going to be in money,” Carver said. “If I lose I’ll
look you up and explain to you what the stakes are. I’m betting that
you don’t ever pass out any remarks about Bart Lassiter or his sister.
The bridle’s off as far as the other two boys are concerned. You can
go as far as you like with them.”
Freel sized him up, sensing a new quality in the man before him, a
certain tenseness which Carver concealed beneath the cloak of
casual speech.
“You drop out of this,” he advised. “I was offering to marry Miss
Lassiter when you romped in.”
“Offering to,” said Carver. “I thought maybe you was threatening to.”
“Any girl of the Lassiter tribe ought to be damn glad of an opportunity
to marry and live respectable,” Freel stated, and was instantly aware
that he had made a grave mistake, for that quality which he had
sensed in Carver was now quite openly apparent in his eyes.
“So you’re going to make her respectable,” Carver said. “That’s real
generous of you, I’d say. It’s rumored around that you set up to be a
bad one. I just heard you confess it. Let’s see how wicked you can
be when your badness all boils over.”
He took a step toward Freel and the marshal backed away, reading
Carver’s purpose in his eyes.
“It’s never my policy to start a quarrel without good reason,” he
announced.
“I’m laying myself out to supply the reason,” Carver said. “I always
did want to see a regular desperado working at his trade.” He
removed his hat with his left hand and brought it with a back-handed
slash across the marshal’s face. “You’re wicked clear through,” he
said. “You’re just as bad as you can be.”
He swung the hat twice again but Freel turned and walked toward
his horse.
“You’re not bad; you’re just tainted,” Carver stated. “I always felt that
about you and now I know for sure.”
The marshal mounted and turned upon Carver a face set in lines of
stern disapproval.
“I refuse to force an issue except in the regular routine of duty,” he
proclaimed. “This is not a matter of official business. Otherwise——”
He intended that the unfinished statement should carry an
impressive implication of power held in reserve and which he
controlled only with the greatest difficulty. He turned and rode off
down the bottoms.
“I feel like I’d just come in off a spree,” Carver told himself. “It shakes
a man up something fearful to let his temper go running wild all over
the lot. I oughtn’t to have lost hold of myself.”
He regarded the closed door. A sharp rap sounded from the inside of
it and Carver smiled as he speculated as to how many people of his
acquaintance would have respected his unspoken wish that the door
remain closed. The rap sounded again.
“Come in,” he called.
She opened the door and answered his smile, her eyes following the
marshal as he disappeared in the scattering black-jacks of the
bottoms.
“Thank you,” she said. “I’m glad you came just when you did. But I’m
sorry if you made an enemy of him. I really don’t mind him—much.”
“He’s right harmless,” said Carver. “But apt to be annoying. I don’t
surmise he’ll be turning up here again.”
He knew that the marshal operated only on safe ground. Freel had
known that both elder brothers would be entirely indifferent to any
course he might adopt toward Molly Lassiter if only it afforded a
measure of protection for themselves; and she would not mention
any such occurrence to Bart lest it precipitate trouble between
himself and Freel.
The girl motioned him to a seat on the bench.
“You did remember your promise of the other day,” she commended.
“About Bart, I mean. He said you’d pointed out the narrow pathway
and invited him to join forces.”
“I never did set up as a reformer,” Carver admitted, “and it likely
sounded a mite unnatural, coming from me.”
“Bart was a little vague about the plans,” she said. “Do you mind
telling me what the proposition was?”
“I couldn’t say any offhand,” he confessed. “You see I just put it up to
him and was intending to work out the details later on. There, now!”
he complained, as she laughed at this lack of definiteness. “You’re
doubting my stability again. There’s numerous ways open for me to
follow.” He checked them off on his fingers. “I might get appointed
marshal in Freel’s place and there’s any number of folks would
contribute to my success. I could assist Crowfoot to fill his beef
contracts; or I could get the job of hide inspector and Crowfoot would
then assist me.”
Beneath this facetious recitation of possibilities she read in his
reference to Crowfoot a deliberate intention to apprise her of the fact
that the man’s methods were open to question, leaving her to devise
her own means of utilizing the knowledge in so far as it related to
Bart’s employment by Crowfoot.
“The boys are all leaving for the X I L in a few days now,” she
returned.
“This man Bronson that owns the X I L—he’s someway related to
Crowfoot,” said Carver. “Seems like I’ve heard he was. Anyway,
there’s some connection. I spoke for a job for Bart with the Half
Diamond H wagon and was hoping he’d take it on.”
When Carver rose to leave he rested his hands on her shoulders as
she stood facing him.
“The round-up will cut into our conferences but I’m looking forward to
resuming them after it’s over.”
She stepped back and shook her head as he leaned toward her.
“Don’t forget how much I’m like Bart,” he urged. “And you know you’d
do that much for him. You might try it on me once, just for similarity’s
sake.”
The girl faced him gravely.
“I’m going to absolve you from that promise,” she said. “Try and
forget all about the Lassiters. We bring bad luck.”
“It’s too late to start forgetting; and besides, I cut my first baby teeth
on a horseshoe,” he returned; “and from that day on down to date
I’ve been the greatest sort of a hand to counteract bad luck. It
positively refuses to settle in my neighborhood. I’ll tell you all about
it, Honey, as soon as the round-up’s over.”
She stood and watched him ride off up the country, returning his
salutation when he turned in his saddle and waved to her as he
reached the rim of the pocket.
He spent the night at a line camp and the next day made a long ride
into Caldwell, dismounting before his little cabin in the early evening.
A blanketed figure prowled uneasily at the far side of the street as
Carver unsaddled, then crossed over and padded silently along the
path that led to the house.
“Me like whiskey,” the Indian stated.
“Yes,” said Carver. “So do I. But they do say it’s a sinful appetite.”
The red man pondered this.
“Me buy whiskey,” he amended, exhibiting a gold piece.
“I’m just out,” said Carver. “Try next door.”
The Indian departed, only to be replaced some few minutes later by
a second applicant. Carver recalled the incident of the two black
bottles on that other day when he had first met Bart Lassiter in the
Silver Dollar.
“Bart has been up to some more financing,” he reflected. “While
Molly was downtown somewhere, he was busy irrigating the
Cherokee nation at a profit. I’ve heard somewheres that if you do
any one thing better than your neighbors the world will beat a
pathway to your door—and this path looks well-worn and much-
traveled. I’ll have to speak to Bart about this.”
He retired for the night after a third thirsty soul had made the
pilgrimage down the pathway to the door.
“Before I can straighten out Molly’s affairs,” he said, “it does look as if
I’d have to discharge a marshal, reform one brother and practice
homicide on another.”
With this disquieting reflection he dropped instantly asleep. An hour
later his awakening was equally abrupt. It is given only to those who
live much in the open to wake suddenly from profound slumber with
every faculty alert. When Carver opened his eyes he was conscious
that something was amiss. He continued his regular deep breathing
as if still wrapped in sleep. His horse fidgeted nervously in the lean-
to shed behind; but he knew that this sound, being one to which he
was accustomed, would not have roused him. The spring lock on the
door had clicked slightly as if under the manipulation of a stealthy
hand and the sound had penetrated his consciousness even while
he slept. Probably another parched but hopeful Cherokee, he
reflected, but he rose noiselessly and stepped to the window.
“I didn’t start discharging and homiciding soon enough,” he told
himself.
Freel and Noll Lassiter stood outside in the bright moonlight, the
latter having just stepped back within Carver’s range of vision after
testing the spring lock on the door. Carver turned swiftly and donned
shirt and trousers. The latch clicked again as he pulled on his chaps;
then came a sharp knock at the door. Carver did not answer but
finished buckling his belt and drew on one boot. The rap was
repeated.
“Ho!” Carver called loudly, as if suddenly roused from heavy sleep.
“What’s going on?”
“It’s Freel,” the deputy’s voice answered.
“Oh,” said Carver. “Come on in. I’m in bed.”
“Door’s locked,” Freel returned.
“Must have blown shut,” Carver stated. “There’s a spring lock on it.
Wait a minute and I’ll pile into some clothes and let you in. What do
you want, anyway, at this time of night?”
“There’s been complaints lodged against you for selling whiskey to
the Cherokees,” Freel explained apologetically. “I don’t suppose
there’s anything to it but I was ordered to make the arrest. You can
clear yourself likely.”
Carver laughed easily.
“Why, man! This is the first time I’ve been here in two months,” he
scoffed. “They won’t keep me overnight.”
“I hope not,” said Freel. “It’s the pen if they cinch you—Federal law,
you know. I didn’t like the idea of coming after you but I was ordered
to do it.”
“I’ll be with you in a minute,” Carver answered cheerfully. “I can
explain it easy enough.”
He thumped the bed with the edge of his hand in imitation of a bare
foot descending upon the floor.
“Killed while resisting arrest,” he said to himself, his mind working
swiftly. “This is just a plain old-fashioned killing. Freel knows I
wouldn’t be so simple as to start shooting over being picked up on a
fool charge like this. I’d take it more as a joke. He’ll step in to talk it
over while Noll pots me from outside. Neighbors hear shots—a
regular battle in progress—and later, at the inquest, it transpires that
my gun’s been shot empty. They can prove that Cherokees have
been buying bottles here, whether I did it or not, and Freel, having
heard about it, had come out to investigate. I put up a desperate fight
but went down in the smoke—died hard as it were, but real dead.
But they wouldn’t do it before I was dressed. That might appear like
they’d slaughtered me in my sleep.”
Meanwhile he commented in disjointed fragments to Freel.
“I’ll go on down with you and explain it. It’s a right foolish charge.” He
was now fully dressed. “They’ll let me out by to-morrow so it don’t
matter any.” And to himself, “After Noll’s first shot there’s two from
inside. Neighbors look out into the moonlight. Freel has ducked back
outside and they see him prone on the ground shooting into the
house. He rushes the open door, calling out to me to surrender in the
name of the law, and the neighbors all hear him. There’s sounds of a
struggle inside; chairs overturned, and there’s shooting. A regular
hell-roaring combat—and me dead on the floor all the time.”
He moved to the window. Lassiter was nowhere in sight.
“Flat against the house between the window and the door,” he
decided; then aloud to Freel, “Anyone with you?”
“Not a soul,” Freel lied.
“Better so; maybe we can figure out some little bet whereby it would
be to your advantage to help me come clear of this charge.” He was
now fully clothed and he crossed to the door without permitting his
boot heels to touch the floor. “Can’t find a match,” he complained,
fumbling at the catch. “Come in and strike a light while I hop into my
clothes. I’m in my nightie.” He opened the door, standing back from
the streak of moonlight which streamed through. Freel would shoot if
he saw that Carver was already dressed.
“I’ll just wait here,” Freel said.
“And pot me as I step out,” Carver mentally completed.
“You’ll be out on bond in an hour,” Freel resumed. His head was
within a foot of the door as he attempted to peer inside.
Carver swung his gun with deadly precision and Freel collapsed
without a word as the heavy weapon descended solidly upon his
skull. Before the deputy had fairly struck the ground Carver was
peering round the door jamb with the gun levelled on Lassiter who
was flattened against the house some three feet from the door.
“Steady! Let it slide out of your hand!” Carver ordered.
Lassiter’s slow brain had scarcely grasped the fact that his plans had
gone amiss, and even as the hand which held his gun relaxed in
response to the order, Carver took one swift half step round the door
and swung his own weapon again.
Ten minutes later he had saddled and was riding out of town. As he
cleared it, he chanted a verse wherein the tumbleweed rebuked the
sluggish pumpkin for sticking to its garden patch as Thanksgiving
day approached.
“You can lay right there and wait
To be turned into pies and tarts,
But me, I’ll jump the fence right now
And head for other parts.”
“Freel’s bringing me in feet first, like he’d planned, could be easy
explained,” Carver reflected. “But a live active prisoner is different.
The last thing in this world he’d want is to book me for trial. I couldn’t
force myself on him as a captive. Next time I meet Freel out in
company I’ll surrender and insist that he puts me under arrest.”
 IV
The cook wagon lumbered down Cabin Creek toward the Salt Fork
of the Arkansas. A dozen hands, riding in couplets, straggled
irregularly behind. The bed wagon followed and the horse wrangler
brought up the rear with the remuda which numbered some two
hundred head of horses, including the string of extra mounts for each
round-up hand who rode with the Half Diamond H wagon.
A rider waited on the far bank of the Salt Fork with his string of extra
horses and the men speculated idly as to whether he represented
Crowfoot or the Coldstream Pool, it being the custom to exchange
“reps” to ride with neighboring wagons. The horseman proved to be
Bart Lassiter, repping for Crowfoot. Carver’s intimation as to
Crowfoot’s methods and their possible connection with the X I L trail
herd, dropped on the occasion of his last visit with Molly Lassiter,
had borne fruit. The Half Diamond H crew had been full-handed but
the girl had induced Bart to ride with their wagon as Crowfoot’s rep
instead of accompanying his half-brothers to the X I L.
Lassiter threw his extra mounts in with the remuda and joined
Carver, who opened up on him without parley.
“I tendered you the key to my little house so that you could use it for
living purposes,” he said, “but without any notion that you’d start up
in business. From all that I can gather you set out to abate the thirst
of the whole Cherokee Nation.”
“Well, the poor devils are fixed up every other way,” Bart explained.
“They draw beef rations, flour rations, blanket issues and so on, but
nobody’s ever been thoughtful enough to provide them with licker
rations, so they’re forced to live a one-sided, unbalanced kind of
existence and I was striving to supply the lack and sort of round out
their lives.”
“An’ you came near to finishing mine,” Carver stated.
“It was only that once,” Bart defended. “I did dispose of several
cases at a right handsome profit and you’ve no notion how much
they enjoyed theirselves the next night. It would have done your
heart good to have heard it. All Caldwell turned out to listen to the
expansive sounds emanating from the Cherokee camp south of
town.”
Carver had placed that first illusive impression that Molly Lassiter
was in grave need of something without which her life was not quite
complete. It was no material requirement but a need that was deeper
than that. She despised the ways of the two older half-brothers, who
had been practically strangers to her during her own early life,
showing up at her father’s home but infrequently. Later, after her own
mother’s death, they had returned and made it their home. There
had never been any bond between them and herself, and she had
feared the effect their ways might exercise upon Bart. Freel had
spoken the truth when he asserted that she knew what it was to
have the law always barking at her door. Carver knew now that what
she most needed was peace,—assurance that the same old
conditions would not pertain to her life and Bart’s.
“Why do you put Molly up against that sort of thing?” he demanded.
“She didn’t know,” Bart returned.
“But she’d know if they happened to clamp down on you for it,”
Carver insisted. “And that’s what she’s guarding against. She’s
always had that sort of thing to fight off.”
“She has for a fact,” Bart admitted. “The old man was a hard citizen
himself, way back in his youth. He’d quieted down for a good many
years but after the two boys came back he sort of leaned their way
again. There’s been times when Molly and me was kids, and left all
alone in the house or wherever we happened to be at the time, that
folks would come round inquiring about his whereabouts, and the old
man hiding out in the hills about them. She thought a lot of him,
Molly did, and hated Milt and Noll for leading him off.”
“Then why don’t you shake them?” Carver demanded. “There’s no
common bond between you and them, and Molly would be way