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Nursing 401 > Breastfeeding > Flashcards

Breastfeeding Flashcards

1
Q

What are the recommendations for breastfeeding in Canada? (time frames)

A

Exclusive breastfeeding for up to 6 months.

To continue for up to 2 years of life or beyond.

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2
Q

What are some reasons women stop breastfeeding?

A

Returning to work
Unsupportive environments for breastfeeding
- work, public places

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3
Q

What are the benefits of breastfeeding for infants?

A

Right amount and properties of nutrients for infant (nutrients, vitamins, minerals, fluid, etc.).
Initially infant specific (eg. premature infant).
Human, easily digestible, lactobacillus flora in GI trace (protects against disease).
Contrains IgA
Laxative (decreases jaundice)
Decreases risk of diabetes, some cancers (acute lymphocytic and myeloid leukemia), jaundice, eczema, asthma, SIDS, otitis media, adolescent and adult obesity

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4
Q

What are the benefits of breastfeeding for the mother?

A

Decreased postpartum bleeding and more rapid involution.

Decreased risk for:
Ovarian and breast cancer
Type 2 diabetes
Hypertension
Cardiac disease
Rheumatoid arthritis
Postpartum depression
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5
Q

What are breasts? (anatomically)

A

Breasts are specialized sebaceous glands.
Composed of glandular, fibrous and adipose tissue
9 lobes

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6
Q

What are the functions of breasts?

A

Nourishment
Protective antibiotics
Sexual pleasure

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7
Q

What is the structure of a nipple?

A

0.5-1.3 cms in diameter, made of erectile tissue

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8
Q

What is the structure of the areola?

A

2.5-10 cms (Montgomery tubules secrete a fatty substance - helps lubricate and protect nipple)

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9
Q

What are lobules?

A

Lobules are the entire branches that filter down to the nipple opening (complicated network that intertwine with each other).

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10
Q

What part of the breast produces milk? (which cells)

A

Milk is produced by lactocytes (lining of the ducts/alveoli). Travels to nipple via the ducts and ductules (small ducts).

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11
Q

What is the role of estrogen in the breasts during pregnancy?

A

Estrogen develops breasts and prepares for lactation.

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12
Q

What is the role of progesterone in the breasts during pregnancy?

A

Increased progesterone promotes development of lobules and alveoli. Also suppresses lactation during pregnancy.

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13
Q

What promotes/controls lactation?

A

Lactation is under endocrine control initially.
Delivery of placenta = decreased progesterone levels, triggers milk production.
Prolactin released from Anterior Pituitary in response to breast stimulation. Causes lactocytes to produce mil products.

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14
Q

What is the role of oxytocin in breastfeeding? (what triggers it and what does it do)?

A

Stretching of the nipple and compression of the areola signals the hypothalamus to release oxytocin from the posterior pituitary.
Oxytocin causes the myoepithelial cells to contract and eject milk into the ducts (let-down reflex)

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15
Q

What is the difference between the role of prolactin and the role of oxytocin in lactation and breast feeding?

A

Prolactin is stimulated by drop in progesterone that follows the delivery of the placenta.
Prolactin makes milk.
Stimulation of the nipple releases oxytocin (from anterior pituitary).
Oxytocin ejects milk.

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16
Q

Which two hormones are only present in breast milk?

A

Leptin and adiponectin

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17
Q

What do the hormones leptin and adiponectin do? (in general)

A

Leptin and adiponectin are hormones that program the human body with a lifelong impact on the metabolism.

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18
Q

What are the specific functions of leptin? (4)

A

Regulation of body fat
Regulation of food intake and body weight
Recognition of hunger
Metabolism of sugar and lipids

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19
Q

What are the functions of adiponectin? (2)

A

Metabolism of sugars and lipids
Mediates insulin sensitization in peripheral tissues (lower levels of adiponectin are associated with decreased insulin sensitivity or increased insulin resistance).

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20
Q

Why is it recommended that all breastfed, healthy term infants in Canada receive a daily vitamin D supplement of 400 IU?

A

To prevent rickets
Instead of sunlight - Direct sun exposure is no longer advised
Formula and regular cow’s milk are fortified with vitamin D

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21
Q

How is breastfeeding maintained?

A

Once established, prolactin decreases

Production of milk depends on amount of milk suckled from breasts (supply and demand).

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22
Q

How does weaning occur? (stopping lactation)

A

Milk increases the pressure in the duct, therefore tells lactocytes to stop producing milk.
If the mother doesn’t want to breastfeed, she should wear a supportive bra and avoid touching her breasts, expressing milk, or having a warm shower to trigger letdown and lactation.

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23
Q

What is colostrum?

A

Yellowish/clear/creamy milk, increased protein, fat, soluble vitamins and minerals, IgA, 1-4 days postpartum.

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24
Q

What is transitional milk?

A

Has increased level of calories, lactose, H2O soluble vitamins and fat than colostrum.
Until 2 weeks postpartum.

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25
Q

What is mature milk?

A

13% solids - CHO’s, proteins, fats. Remainder is H2O. From 2 weeks postpartum and beyond.

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26
Q

What is foremilk?

A

Initially during feed, increased H2O, vitamins and protein, 1-2% fat

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27
Q

What is hindmilk?

A

Released after letdown. High in fat (10%)

28
Q

What are the signs of a good latch?

A

May feel a tug/discomfort at first
Nipple goes towards baby’s nose, chin is buried in breast
Cheeks full & rounded when sucking
Listen for the “Ca” sound when baby swallows (easier to hear when milk is in)
No clicking or smacking sounds
Nipple is round not flat when baby comes off
No cracks, blisters, or bleeding on nipples

29
Q

How often do newborns feed?

A

Newborns feed about every 1-3 hours

30
Q

How long does a feed take?

A

Each feed takes approximately 15-20 minutes - will decrease over time

31
Q

Why are night feeds important?

A

Prolactin levels are highest between 0200-0600

32
Q

What amount of weight loss is considered acceptable after birth?

A

8-10% (10% we might consider supplementation)

33
Q

When should birth weight be attained again after birth? (after loss of 8-10%)

A

Birth weight should be attained again by approximately 2 weeks of life

34
Q

When does weight loss usually stabilize after birth?

A

Weight lose usually stablizes by day 3-4 and by the fifth day a weight gain of 20-30 g a day is the norm.

35
Q

What amount of weight gain is expected per week for the first four months?

A

Expectant weight ganin is 140-200g per week for the first four months (PSBC)

36
Q

What are some common breastfeeding problems? (6)

A
  1. Ineffective br. feeding rt lack of knowledge
  2. Ineffective br. feeding rt formula
    supplementation…
  3. Ineffective br. feeding rt sore nipples…(Day 1/ 2)
  4. Ineffective br. feeding rt engorged breasts… (Day 3-5)
    Other topics:
  5. “Suppression of lactation” for the bottle feeding woman.
  6. Ways to assist breast feeding women from pregnancy to “weaning”.
37
Q

What are some nursing interventions for ineffective breastfeeding related to lack of knowledge?

A

Assess desire, knowledge & learning style preference initially
Teach/reinforce – STS, feeding cues, “baby led positioning & latch-on”, early initiation & benefits, supply & demand etc.
Provide pamphlets/resources prior to discharge
Evaluate learning after teaching episode

38
Q

What are some nursing interventions for ineffective breastfeeding related to formula supplementation?

A

Assess knowledge initioally
Teach re nipple preference, decrease lactogenesis, increase breast engorgement, decreased duration of breastfeeding and benefits of breast feeding initially
Provide handouts and resources
Document problem and teaching on patient’s chart. Update plan on Kardex prn.
Report to RN.

39
Q

What are some nursing interventions for ineffective breastfeeding related to sore nipples?

A

Assess ability and knowledge initially
Assess nipples, latch and position Q feed
Assist prn
Teach/reinforce feeding cues, frequency of feeds, LATCH, massage, EBM on nipples and cream to cracks, tea bags, change breast pads after each feed, no soap on nipples, cotton bra, keep feeding, analgesics PRN
Document and inform RN prn

40
Q

What is breast engorgement?

A

swollen tender, warm, red, throbbing breasts. Skin is taut, shiny, transparent. Low grade fever, flattened nipples. Milk may not flow easily & will be compromised if unrelieved.

41
Q

What are some contributing factors to breast engorgement?

A

Missed feeds
Babe not suckling and latching correctly
Separation of M&B infrequent/restricted feeds
Supplements

42
Q

How does lactogenesis appear/feel?

A

Breasts are heavy, hot, firm and milk flows well

43
Q

When does lactogenesis occur?

A

Usually occurs on day 3-4 when milk supply increases. Resolves in 24 hours

44
Q

What are some nursing interventions for ineffective breastfeeding related to engorged breasts?

A

Prevent engorgement!
Early initiation of breast feeding
Breast feed on demand (8-12 times in 24h)
Ensure correct latch and position
Wake a sleepy baby up q2-3 h during day
If separated from baby, hand express or pump to establish a good milk supply (8-10 in 24 hours)
Avoid unecessary supplementation

45
Q

What are some interventions to decrease discomfort due to engorged breasts?

A

Use anti-inflammatories
Use cold compresses between feeds (no ice directly on skin)
Can use cabbage leaves for discomfort (caution- can decrease milk supply)
Hand express prior to feed to soften areola

46
Q

What does the LATCH acronym stand for?

A 
Latch
Audible swallowing
Type of nipple
Comfort (breast/nipple)
Hold (positioning)
47
Q

What are some ways to resolve infant refusal to breast feed?

A

Usually temporary
Reassure
Explore reasons-menses, diet, soaps, teething
Minimize distractions during feeds
Offer breast when fully awake
Express to maintain supply until baby is fully br. feeding.

48
Q

What are signs and symptoms of a plugged lactiferous duct?

A

Red, sore, firm area/lump in breast

49
Q

What is the etiology of plugged lactiferous duct?

A

Milk builds up & doesn’t flow out (missed feed, restrictive bra/care seat belt)

50
Q

What is the treatment for plugged lactiferous duct?

A

Br. feed q 2-3 hrs, warm shower /compresses ac, massage breasts ac/during feed, drain breast before switching, change position to assist drainage, express if lump still present pc, avoid restrictive bras, rest & flds (for thirst)

51
Q

What are signs and symptoms of mastits?

A

Temp. >38 C, breast is red (or with red streaks), firm, swollen, painful . May c/o malaise, fever, chills, headache, and aching.

52
Q

What is the treatment for mastitis?

A

Antibiotic therapy prn, anti-inflamatories, rest, keep the breast well emptied by frequent br.feeding, if too painful to br.feed, express/pump q2-3h

53
Q

What are the signs and symptoms of breast abscess?

A

mastitis, pain, swollen lump with defined margins, redness, heat & edema in surrounding tissue

54
Q

What is the treatment for beast abscess?

A

needle aspiration / surgical drainage (U/S dx & guide), antibiotics, rest, feed on unaffected side and affected side once drained & antibiotics commenced.

55
Q

What are some causes of delayed/impaired lactogenesis?

A 
C section
Primp
Long 1st/2nd stage
Postpartum hemorrhage
Diabetes (type 1)
Obesity
Retained placental fragments
Decreased glandular tissue in the breasts
Stress
Breast surgery
Vitamin B6 deficiency
Polycystic ovary disease
Untreated hypothyroidism
Smoking
ETOH
OCP (combined)
56
Q

What should be assessed in the newborn when there is delayed/impaired lactogenesis?

A 
Intake and output
Active bowel sounds
No abdominal distention
Hydration
Weight
Behaviour
Jaundice
Feeding cues
57
Q

What should be assessed in the mother with delayed/impaired lactogenesis?

A 
Knowledge
Breasts
Intake and Output
Fatigue
Stress
Support
Knowledge of resources
58
Q

What are some treatments for “not enough milk”?

A
  • ↑freq. of feeds (8-12) rest, healthy diet (>1800 cal.) fluids, avoid caffeine, ↓stress
  • massage breasts & stimulate nipples ac feed
  • concentrate on baby & milk flow,
  • give baby adequate time to nurse (quiet)
  • use relaxation & breathing techniques,
  • see LC/midwife/MD for synthetic Oxytocin nasal spray, Domperidone, Fenugreek
59
Q

What needs to be documented when a supplement is given?

A 
That parents have made an “informed choice” 
Type and amount of formula given
Method of administration
Babe’s tolerance
Instructions given to mom
Communication with HCT
60
Q

What are some indications for supplementation?

A

Infant at risk for hypoglycemia (BS ≤2.6mmol) *
Mothers- severely ill/ conditions e.g.?
Some maternal medications e.g.?
Infants with inborn errors of metabolism
Infants with dehydration / failure to thrive
*May vary depending on hosp./Pediatrician

61
Q

What are some infant indications to consider supplementation?

A

Wt loss >8-10%
Insufficient intake by infant (not latching by 24hrs. refusal/ineffective feeds)
Delayed passing of meconium (5d.)
Hyperbilirubinia, preterm, low birth wt

62
Q

What are some interventions for an infant that is having trouble breastfeeding?

A

Interventions: initiate expressing into teaspoon, feed EBM, SNS, assist to Br. feed

63
Q

What are some maternal indications to consider supplementation?

A

Delayed lactogenesis (≥ 5 days pp)
Intolerable pain during feedings
Unavailable mother
Br. feeding is emotionally traumatic

64
Q

What are some interventions for maternal difficulty in breast feeding?

A

Assessment, follow-up by PHN and Lactation Specialist

65
Q

How does a woman who is not breast feeding suppress lactation?

A

Do not stimulate – i.e.
Express milk or expose to heat (hot showers)
Wear a supportive bra = pressure on lactocytes will decrease the production of prolactin therefore decrease milk production
Teach re how to access, safely make and store formula
D/c during day so parents can buy formula

66
Q

What are some nursing interventions to assist women breast feeding?

A

Teach re benefits during pregnancy
Maintain skin to skin contact & initiate br. Feeding in first hr. after birth
Teach re benefits of br. feeding, feeding/massage/hand expression, resources, options before returning to work
Identify those at risk for “sub-optimal” br.feeding
Advocate for supportive work environments & baby friendly public places
Refer to PHN/Midwife, Lactation Specialists, BC Nurseline or 8-1-1, LaLeche league www.LLLc.ca, Br feeding buddy

Nursing 401 (21 decks)

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