Chapter 1 Flashcards

Question

Power

Answer 1

How likely you are to find a real difference if one exists (best if at least 80%)

Answer 2

Large sample get stat sig but not clinically relevant

Answer 3

Just review

Answer 4

Risk or odds of disease for groups that exposed or unexposed | Compares prob of getting the disease or condition in exposed vs unexposed

Answer 5

Odds of getting a disease in exposed vs unexposed. More complex than RR and doesn’t translate like RR hard to interpret if not rare events

Answer 6

Number needed to treat = 1/ RD

Answer 7

Multiple constructed realities, subject-object interaction, simultaneous mutual shaping, , value bound inquiry Have philosophies that govern Usually natural settings, purposive sampling, inductive analysis,

Answer 8

``` Identify the problem Conduct literature review Address ethical issues Gaining entry Focused exploration, confirmation and closure , dissemination ```

Answer 9

Purposive, convenience, max variation sampling, snowball sampling (people refer each other), theoretical (select participants to ensure accuracy of emerging groups)

Answer 10

Condition involving an atypically short, thic, or tight frenulum that tethers the bottom of the tongue to the floor of the mouth, restricting the range of motion

Answer 11

``` Anormal fissure or opening sesulting from failure of fusion during embyonic development (cleft lip or palate) In uppper lip and can extend into nose Congenital midline defect 2nd most common birth defect Can still nurse ```

Answer 12

Swallowing disorder characterized by difficulties swallowing foods or liquids

Answer 13

Haing an irregular rhythm

Answer 14

Resectin of the lingual frenulum to improve tongue movement

Answer 15

A small fold of tissue that helps secure or restrict the movement of a semimobile body part. Freula can be found throughht the body but in the oral cavity are under tongue and between upper lip and gums

Answer 16

Condition of muscle rigidity or too much (increased) muscle tone

Answer 17

A condition of muscle flaccidity or dereased muscle tone

Answer 18

Abnormally large tongue

Answer 19

Smaller than normal tongue

Answer 20

Sequence of abnormalities beginning in utero, romarily consisting of a small lower jaw (micrognathia), a retracted or displaced tongue (glossoptosis) and airway obstruction. Usually als cleft palate

Answer 21

Wavelike motion of tongue which assists in removving milk from the nipple and facilitates swallowing

Answer 22

Having a recession of one or both of the jaws (mandible and maxilla) but more common in lower (mandible)

Answer 23

1. Observation of infant’s oraofacial anatomy 2. Identification of deviations in oral anatomy and how may contribute to dysfunctional or poor feeding behavors 3. Observation of the infant’s feeding reflexes and indentification of abnormal presentations 4. Observation of the effectiveneess of feeding - suck-swallow-breathe coordination 5. Observation of the fit between infant’s mouth and nipple

Answer 24

Lips assist tongue in drawing in the nipple and stablilizing in mouth Lips in neutral position while nursing If hypotonia can’t maintain seal - more work and fatigue Hypertonic lips may be compensatory due to weakenss in cheeks, jaws or tone Tethered maxillary frenulum (upper lip or superior labial frenulum) - may lead to poor suck and later gap in teeth, monor congenital defect, can lead to lip curling, poor transfeer and pain in nipples

Answer 25

Look for blanching of frenulum when lift lip (too tight) Observe entire feed, breaks in seal? Lip retraction?, tremors?, leaking milk Sucking blisters can mean tight lip or tongue tie or hypertonia

Answer 26

Firm pressue (tapping) on lips prior to feeding Put finger in mouth and pull back so infant grabs - resistance training If distressed stop doing Show parent how to flip back Provide referrral for tight labial frenulum May need to pump or hand express to keep up supply Refer to OT or Speech language pathologist who specializes in infant feeding

Answer 27

Use finger or shape breast to seal cleft Prefers one breast - teach slide over to other Work with team, safe and effective to breastfeed after surgery

Answer 28

Low birth wt or prematurity can have low facial tone or pooly developed pads Hypotonia and thin cheeks - hard to maintain pressure - get exhausted Asses with gloved finger inside and push with thumb - should not be able to almost touch Deep creases under eyes - mean thin cheeks Look for collapsing - dimples when feeds Use Dancer HOLD - team to parents Provide supplementary food (breast best) until develop

Answer 29

Premature can have jaw instability due to underdeveloped muscles To assess: observe for asymmetry, micrognathia or retrognathis, while feeding look for jaw grading, clenching or tremors Glowed pinkie finger - in corner count reflexive bites, is it weak

Answer 30

Micro - abnormally small lower jaw, if severe can push tongue back and obstruct airway Retrognathia - abnormally receding lower job - both can be familial, can lead to nipple pain, can try tipping head back to bring jaw to correct position

Answer 31

Can cause breaks in seal, loss of suction, and increased work

Answer 32

Can be to manage rapid flow OR hyppertonia or weakness in another area

Answer 33

Hold finger under bony part of jaw Make sure body is positioned correctly Exercise jaw by eliciting bites - don’t stress - several times a day Refer for PT or chiropractic body work or speech therapist or OT if swallowing issue

Answer 34

Shapes structure of palate Must elevate and put pressure on nipple to work If can;t move properly will tire and ineffective transfer Anterior tongue ties - heart shape - easy to diagnose Posterior tongue ties - harder to diagnosis

Answer 35

Incidence - 0.02 to 10.7, more common in males | Fenotomy (release) or frenectomy (resectin)

Answer 36

Traumatic birth process, torticollis, ankyloglossia, hypertonia, or early bottle

Answer 37

Abnormal tongue development (macroglossia) or hypotony (Downs)

Answer 38

Adaptive compensatry behaviour make hard to latch, preemies, traumatic birth, hypotonia ankyloglossia or resporatory problems

Answer 39

Poor head position can neg influence tongue position Pull breast away and should see tongue cupping Clicking, smacking, milk dripping Press down should get resistance back While crying does tongue elevate Tap on lip or end of tongue - does it stick out beyond gums

Answer 40

``` Exercises Short frequent feeds Postition with head in extension so lower jaw close to breast Refer to specialist Supplement if needed ```

Answer 41

Should be intact, moderate slope and smooth, arc of tongue | Epstein pearls may be observed no big deal

Answer 42

Elevates during swallowing | Should have intact uvula

Answer 43

Unilateral or bilatera, partial or incomplete or complete Any type can make breastfeeding difficult or impossible Submucosal clefts are hard to diagnosis

Answer 44

Generalized hypotonia from prematurity, structural differnces n eurologic involvement or a syndromic condition

Answer 45

Cant close nasal cavity from oral cavity impact swallowing

Answer 46

Family history of cleft Visual assessment of palate - including intact uvula Gloved finger feel hard palate for ridges etc See whole feeding and make sure no nasal regurgitation

Answer 47

Usually not fixed until 10 months Palatial obturator - prosthetic but not routinely used in West Sit baby upright, demonstrate chin support , teach rhythmic compressions Keep track of weight gain, use weighted feeds Supplement with donor milk if needed Protect milk supply - pumping Try alternative feeding methods - make sure don’t develop aversion GI tube may be neccessary

Answer 48

Are nose breathers but can’t be mouth Deviated septum can impact breathing while feeding Choanal atresia - one or both nasal passages blocked (rare) To assess: visually assess if breathing is congested or infant struggles when feedng, were any instruments used in delivery Can use baby strength saline drops, bulb syringes can make swelling worse, refer to primary care

Answer 49

Rooting reflex - touch lips or cheek, head turns and gape response (begins at 32 weks), integrates at 4-6 months Sucking reflex light touch of nipple or finger to lips or tongue. At 15-18 weeks, integrates at 6-12 months Nutritive sucking: sucing burses and pauses in response to liquid, Slower, and only when there is liquid Non nutritive: fast shallow suck 6-8 per swallow, stimulates MER, helps self-soothe, increases peristalsis of GI tract, manage pain (wait to use pacifiers until BF established)

Answer 50

Absent - CNS immaturity, trisomy, premature, drugs during labor or congenital issues Weak - CNS issues, abnormalities of muscles, sick, doesnt provide adequate stimulation leading to reduction in milk supply

Answer 51

Immature pattern of 3-5 sucks with pause, dysrhythmic and uncoordinated

Answer 52

Elicit by bolus of fluid touching soft palate tongue and back of mouth 9-14 weeks gestational, continues to adulthood

Answer 53

Tongue moves down and foward to drawn in and grasp breast Appears at 28 weeks gestation Integrates by 6 months

Answer 54

Elicit by touching mid to posteriour tongue - first line of defense to choking 18 weeks gestation and have as adults Can by hyperactive (immaturity) - stimulate too often and can develop food aversion

Answer 55

No evidence of lung damage by aspiration of breast mik | Normal at begin of feeds when milk comes fast

Answer 56

1. Crawl to breast 2, Integrated by 5-6 months 3. Startle reflext - integrate by 3-6 months Also predictable hand movements to stimulate, move and shape breast

Answer 57

1. Downward movement of posterio tongue leads to increased negative intraoral pressure (increases vacuum) 2. Persistalic movement of tongue 1. Draws nipple in mouth by vaccuum, nipple in ideal place 2. Lips and cheeks make seal - negative pressure, jaw provides stable base for rest to move 3. Tongue drawn down and with milk ejection brings milk to oral cavity 4. Various movement moves bolus of milk back and then swallow reflex, soft palate elevates and prevents milk flowing to nose

Answer 58

Often not coordinated at first at birth Very variable as adapt to milk flow Anatomy different in babies - structures close which allow to develop suck-swallow-breath Matures in infants so pattern changes so decreased number of swallows during prolonged respiratory pauses See nonnutritive at beginning at end of feeds

Answer 59

Number varies based on flow - milk ejection vs slowing down

Answer 60

1. ORal - remove milk and bolus goes to back 2. Pharyngeal - complex and protective mechanisms, anatomy very different from adults believe to help learn to coordinate. Breathing ceases for 0.5 seconds while bolus goes toward esophagus away from airway 2. Esophageal - goes down to stomach

Answer 61

Weak swallow control

Answer 62

1. Respiratry noises - stridor (raspy) - narrowing or floppy obstructed airway Wheezing - high pitched noise during exalation - some constriction Apnea: prolonged periodic breath holding while trying to manage swallowing Fatigue: fall asleep due to stress or other causes Poor intake: follow by weighted feeds Poor growth: weight loss of 10% by the fifth day and failure to properly recover our markers for some optimal infant feeding (careful about fluids during labor) Feeding aversions; can result from aspiration respiratory compromise choking or other sensory-based factors or medical procedures