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Grace de Armas Answer Sheet Chapter 27 Open-Book Quiz 1.

Lochia is a vaginal discharge that occurs six weeks after labor, consisting of blood, tissue, and mucosa. It has a fleshy odor similar to a menstrual discharge. Lochia rubra is the blood content of bright red drainage and also the greatest amount.. As healing of the placental site occurs, the discharge becomes pink to brown and is called lochia serosa and usually occurs for seven days. After that, the drainage gets slightly yellow and white and is called lochia alba. 2. Episiotomy Interventions: Cleansing: Wash perineum with mild soap and warm water at least once daily. Cleanse from front to back and apply peripad. Change pad with each void with an average of four times daily. Assess the amount the lochea with each pad change. Ice packs: apply to perineum from front to back during first two hours to decrease edema formation and increase comfort; works as an anesthetic. Squeeze bottle: Fill bottle with tap water warmed to approximately 38 C. Instruct woman to position nozzle between her legs so that squirts of water reach perineum as she sits on the toilet. Explain that it will take a bottle of water to cleanse perineum. Blot dry with toilet paper or clean wipes. Sitz bath: Fill bath with half or one third of water 38-40 C. Encourage woman to use it 2 times a day for 20 min. Teach to enter bath by tightening gluteal muscles and then relaxing them after she is in the bath. Check woman in 15 minutes, asses pulse as needed. Warm water may cause hypotension. Topical applications: Apply anesthetic cream or spray; use sparingly three or four times a day. Offer witch hazel pads after voiding or defecating; woman pats perineum dry from front to back, then applies witch hazel pads. 3. Role of Prolactin Prolactin a hormone secreted by the anterior pituitary gland is responsible for stimulating milk production in the mammary alveolar cells. Lactation is a combination of hormonal, neurological and psychological responses. After delivery, estrogen and

progesterone levels drop rapidly. While levels of estrogen and progesterone are diminishing , the level of prolactin is increasing. 4. Passive reaction is either verbal or nonverbal. The parents will not touch, hold or examine baby or talk in affectionate terms or make eye contact. Hostile reactions, either verbal or nonverbal , parents make inappropriate verbalization, glances, or disparaging remarks about physical characteristics.Usually occurs when the baby is not the sex they wanted. 5. Lactating mothers generally continue with the diet recommended during pregnancy; the extra vitamins, calories and minerals are required by the body for lactation. The breast-feeding mother should increase her diet 300-500 kcal/day with a well balanced diet and should maintain a daily fluid intake of 2-3 L.

6. Postpartum exercise should begin gradually. Vigorous exercise is to be avoided until the 6 week examination, when the physician releases the new mother to do so. The nurse may teach isometric exercises that help toning without causing undue exertion.

7. Severe bleeding may result if the uterus does not tightly constrict the placenta site. A full bladder can displace the uterus and prevent contraction of the uterus.

8. It provides protection against infection in the infant. Immunoglobulins, lymphocytes, and other immune components are present in breastmilk Breast milk is specifically made for the human infant. The protein, carbs, and fat ratio is thought to be ideal for growth and development. Itreduces the risk of obesity in the child. Breast-feeding may reduce the incidence of allergies in infants high at risk for allergic conditions. Hormones produced in breastfeeding help contract and shrink the uterus. It requires no formula preparation or bottle sterilization and is more economical then formula feeding.

9. The cord should be assessed for bleeding or oozing during the early hours after birth. The cord clamp must be securely fastened with no skin caught in. Purulent drainage or redness or edema at the bade indicates an infection. The cord becomes brown and falls off within approximately 10-14 days. A few years ago, treatment was with alcohol cleansing. Now, they ask that the mother leave it alone until it falls off. Simply keep the cord clean and dry and diapers should be folded below the cord. 10.Meconium: the initial stool of the infant, it is odorless, black-green in color and sticky

in consistency (within the first 24-48 hours). Transitional stools: usually appear the third day after initiation of feeding. Greenish-brown to yellowish-brown, thin and less stick than meconium; may contain milk cords. Milk stool: usually appears by the fourth day. In breastfed infants stools are yellow to golden and seed-like. They are pasty in consistency and have an odor similar to sour milk. In formula fed infants, stools are pale yellow to light brown, are firmer inconsistency, and have more odor.