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General Information- breastfeeding > Core Curriculum - 3rd Edition > Flashcards

Core Curriculum - 3rd Edition Flashcards

1
Q

Describe lactocytes

A

Specialized epithelial cells that absorb nutrients, immunoglobulin and hormones from mother blood stream to compose milk

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2
Q

Where are prolactin receptor sites and what do they to

A

They are in the lactocytes and allow prolactin to be absorbed from the blood Baseline prolactin doubles during a nursing session from infant suck

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3
Q

What is the role of estrogen and progesterone in the pregnant breast.

A

Estrogen stimulates growth of the ducts

progesterone causes glandular tissue to expand

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4
Q

Where does excess lymph fluid drain?

A

To the axillary lymph nodes

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5
Q

Trauma to what nerve might result in some loss of sensation in the breast. Where is it located

A

the 4th intercostal nerve 4 oclock L breast and 8 o’clock R breast

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6
Q

Breast asymmetry is not uncommon. Which breast is often smaller?

A

Right often smaller.

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7
Q

Accessory nipples may be associated with ———–

A

renal or other organ anomalies.

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8
Q

What is Polands Syndrome

A

unilateral hypoplasia with hypoplasia of the thorax and pectoral muscles.

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9
Q

Cranial Nerves for Suck and swallow

A

V trigeminal -mastication
Vll- Facial——expression and taste
1X –Glossopharyngeal——taste, pharynx sensation swallow
X - Vagus– larynx and pharynx-
XII - Hypoglossal - innervates tongue muscle

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10
Q

muscles for swallowing

A

sternohyoid- depresses hyoid and larynx
omohyoid - dpresses the hyoid
sterno thyroid depresses thyroid cartilage
thyrohyoid raises and changes the form of the larynx

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11
Q

What is the function of the soft palate during swallowing

A

It elevates during swallowing contacting the pharyngeal walls and closing off the nasal cavity directing the bolus towards the hypo pharynx

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12
Q

What is the typical lenths of the hard palate

A

Approx 1 inch from the alveolar ridge to where the soft palate folds

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13
Q

What causes a channel palate

A

this is a midline groove from prolonged presence of orotracheal tubes.

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14
Q

Describe Epstien pearls and where are they commonly located.

A

acumulation of epithelial cells (retention cysts) at the juncture of the hard and soft palate

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15
Q

Where is the gag reflex elicited in a newborn

A

At the midtongue area

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16
Q

Prenatal breast changes hormonally affected by

A

Human Placental Lactogen
Prolactin
Human chorionic gonadotropin
all of the above accelerate growth

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17
Q

What is the funtion of Glucocorticoid during pregancy

A

Enhance the formation of the lobules

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18
Q

Purpose of estrogen

A

stimulates ductal sprouting

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19
Q

purpose of prgesteron

A

stimulates the lobuloalveolar growth and supressors secretory activity

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20
Q

What gland secretes prolactin inhibiting factor

A

Hypothalmus - negatively controls controls prolactins effects

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21
Q

When does lactogenesis 1 begin

A

16 weeks prenatally

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22
Q

Colostrum - antepartum shows presence of

A

lactose, casein and alpha lactalbumin

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23
Q

Colostrum after delivery increases

A

SIgA and lactoferrin

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24
Q

lactogenesis 11 - onset of copius milk production occurs

A

30-72 hours post delivery of the placenta when there is a decrease in levels of estrogen , progesterone and HUMAN PLacental Lactogen

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25
Q

What percentage does prolactin levels fall in the first week postpartum

A

50 %

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26
Q

What activity causes the release of prolactin

A

direct stimulation of the nipple areola in a neurohormonal feedback a pathway

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27
Q

Another name for lactogenesis 111 is

A

galactopoesis occurs later then 9 days after birth to the beginning of involution and is the maintenance phase dependent on local autocrine control

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28
Q

Describe prolactin uptake and the full breast.

A

As milk accumulates in the breast the shape of the lactocyte is distorted and the prolactin cannot bind to its receptor creating an inhibitory effect on level of milk production

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29
Q

Fat type and content are influenced by several factors

A 
maternal metabolism
Maternal weight
Maternal diet
Gestation age of infant
Duration of breastfeeding.
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30
Q

Complete breast involution varies but typically complete—–

A

40 days after complete cessation of breastfeeding.

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31
Q

where does milk synthese occur? AND

What are the 5 pathways involved in milk syntheses

A

Milk synthesis occurs in the lactocyte ( secretory epithelial cell)
1. protein secretion (casein,lactoferrin, alpha-lactalbumin and lysozyme
2.Lactose secretion
3 milk fat syntheses
4.Monovlent ion secretion (Na, K, and Cl)
5. Plasma protein secretion (IgA)

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32
Q

describe the two phase suck cycle

A
  1. first half of suck cycle—-.tongue down in piston like fashion, expanding the nipple, increasing nipple duct diameter, moving nipple to HSPJ an increasing Vacuum
    2second half- the tongue raised tip first and milk bolus is cleared from oral cavity under the SP.vacuum reduces and the nipple is compressed
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33
Q

true or false lactogenesis may be delayed in a mother with type 1 diabetes

A

true ( hartman) birth has some effect on insulin since there is no fetus making demands internally

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34
Q

what is the 5 of carbs, protein and fats recommended for a lactating woman

A

carbs 50%
Protien 12-15%
fats 20-30% ( unsaturated non trans)

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35
Q

what is the calorie cost of 1 Liter (33 oz) of breastmilk a day

A

about 940 calories ( most women produce 750mls (25oz)a day)

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36
Q

Micronutrients in breastmilk that are affected by low maternal status

A

b6, b12, vitamins d and a and selenium, thiamin and riboflavin

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37
Q

nutrients in breastmilk NOT affected by mothers status

A 
folate          (FIZ CC)
Iron
zinc
calcium
copper
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38
Q

true or false a diet mostly of whole grains can be deficient in ca due to calcium binding

A

true ( important for other countries)

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39
Q

calcium supplement recommended for dairy intolerant mom.

A

calcium citrate ( 600 mg) NOt calcium carbonate - poorly absorbe do NOT take with IRON.

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40
Q

Many Babies will tolerate caffeine in their mothers diet if it is less then___________

A

300 mg per day ( babies usually get 1.55 per hale.

coffee has 2=80-100mg per 8 oz cup.

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41
Q

average milk intake for infant 7-12 mos

A

600 mls plus complimentary foods.

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42
Q

after 6 mos children may be low in both IRon and zinc . name some food sources

A

iron - meant, bread, nuts, legumes, watermelon

zinc-neatm chicken, fortified cereal, oatmeal some legumes an nuts

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43
Q

B12 deficiency in breastfed children of vegan moms can develop at 4-8 mos

A

failure to thrive,developmental delay, weakness, muscle atropy, loss of developemntal milestones.
for mom a supplement and fortified cereal, nutritonal yeast and fortified meat substitutes

44
Q

vitamin d deficiency associated with

A

cancer, autoimmune disease and cardiovascular disease

45
Q

vitamin d found in________and foods_________

A

sun, flesh of fatty fish and some fish liver oils.

46
Q

what is DHA

A

a ply unsaturated long chain omega 3 fatty acid that is essetnaila for brain development and visual acuity.
Level s in human milk are based on maternal diet.
DHA foods - egg yok, chicken and oily fish.

47
Q

at what age can most children eat finger foods that they can feed themselves.

A

8 mos ( core curriculum)

48
Q

delaying lumpy foods past 10mos can result in________

A

feeding difficulties

49
Q

what has been found to reduce the risk of celiac disease in children

A

introducing small amts of gluten food ( wheat , barley, rye) before 7 mos and while the child is still breastfeeding.

50
Q

what is mammogenesis

A

the development of duct structure from the woman’s birth through her first pregnancy

51
Q

what is lactogenesis 2

A

the onset of copious milk secretion and is triggered with the delivery of the placenta which withdraws progesterone and then polactin is unopposed.

52
Q

what is lactogenesis 3

A

galactopoesis - the ongoing maintenacne of milk secretion

53
Q

what are the 3 components of fIL

A

retained peptides ( proteins) , fatty acid accumulation slows fat synthesis, and prolactin in milk downregulates prolacin receptors on the lactocytes

54
Q

describe components of milk express in the second year of lactation.

A

increased fat and energy
serotonin and lysozyme INCREASE over time.
zinc decreases over time

55
Q

at what gestation week does colosturm secretion begin

A

16 weeks

56
Q

what is the ;primary function of colostrum

A

Protective coats the gut to prevent adherence of pathogens and promotes gut closure

57
Q

at what day does a newborn have a stomach capacity of 57 mls

A

day 5

58
Q

what is the total protein in mature milk

A

0.8-1% lowest of all mammal

59
Q

Name whey Proteins available for digestion and perfrom specific function

A

1.alpha lactalbumin- regulates milk syntheses ( mucin is part
of this and binds pathogens and kills cancer cells)
2. LACTOFERRIN- iron transport and absorption, competes with bacteria to bind iron
3SIgA - most important as it coats mucosa surfaces
4.enzymes - lipase digest fats,
lysozyme attacks pathogen cell walls
stimulates neonatal development
5.HOrmones - prostaglandins - antiinflammatory
Oytocin
thyroid
6. non protein nitrogen compounds- nucleotides, creatinine, glucosamine

60
Q

what carbohydrate supplies 40 5 of babys energy needs

A

lactose ( galactose and glucose)

colostrum is 4% lactose on day one and then rapidly increases!

61
Q

how does lactose influence milk volume

A

the rise in lactose secreted in the cell draws water by osmosis .

62
Q

what is the least variable carbohydrate in milk – the most consistent

A

Lactose – also the primary carbohydrate

63
Q

List 3 functions of oligosaccharides

A

1.stimulate lactobacillus bifidus
2.block pathogens from attaching to gut
3. protect against enterotoxins in the gut as
Oligosaccharides bind to bacteria

64
Q

what is the bifidus factor

A

a combo of several oligosaccharides producing an acid detrimental to bacteral growth. also thought to be responsible for aromatic stool odor.

65
Q

How many calories provided by fats?

A

50 % - most variable compound in human milk

66
Q

what is the ratio of saturated to unsaturated fats

A

42%saturated and 57% unsaturated - numbers stable

67
Q

how much sunlight do infant require

A

2 hours per week fully clothes

68
Q

name fat soluble vitamins

A

a d e k

69
Q

water soluble vitamins are determined by moms diet

A

vit b , c thiamin riboflavin niacin folate

70
Q

cells found in milk

A 
1. Macrophages-- contain IgA
2 Leukocytes
3.lymphocytes t and b cells
4.epithelial cells
5.Neutrophil granulocytes
6. multipotent stem cells
71
Q

when are sodium levels highest in breastmilk

A

pregnancy, involution and mastitis

72
Q

what component of breastmilk aids in iron absorbtion

A

Lactose (higher in breast milk then formula)

73
Q

what is the milk constituent that is protective again NEC

A

LACTOFERRIN ( also helpful for other inflammatory conditions )

74
Q

the most important immunoglobulin

A

SIgA- prevents inflammation and viruses

75
Q

how can a newborn infant be protected from HIV

A
  1. Not breastfeed

2. breastfeed with arv’s

76
Q

What is an immature suck pattern

A

3-5 suck bursts followed by a pause of equal duration - and often detaching from the breast

77
Q

what is a transitional suck patter

A

6-10 suck bursts, pause of equal duration with occasional detaching and if a longer burst may have apneic espisode

78
Q

Mature suck pattern?

A

10-30 suck bursts , brief pauses and a 1:1 suck swallow ratio

79
Q

what is disorganized sucking

A

Lack of rhythm of the total sucking activity

80
Q

what is dysfunctional sucking

A

the interruption of the feeding process by abnormal movement of the tongue and jaw

81
Q

describe NNS characteristics

A
  1. Observed at 18 weeks gestation
  2. 2 sucks per second
  3. weak , uncoordinated flutter sucking
  4. absence of swallow.
82
Q

How soon should a mother of a premature infant begin milk expression

A

within 6 hours of birth.

83
Q

Mothers of premature infants should express milk 8-12 x in 24 hours for the first 7-10 days. what should her milk production be at the 7-10 day timeframe

A

800-1000 mls

84
Q

How much oversupply is considered a “good cushion”

A

50% more then the infant requires

85
Q

How long can breastmilk be stored in the refrigerator if feeing a premie.

A

24-48 hours

86
Q

define a late pre term infant by weeks

A

born at 34 weeks -36 weeks 6/7 days

87
Q

if a mother is nursing and pregnant again, when does her mature milk revert to colostrum

A

about 4-5 mos of pregnancy

88
Q

Normal intake of a 1 day old

A

30mls per day ( can be up to 100mls)

89
Q

average intake on day 7

A

300-450 mls per day (10 -15 oz)

90
Q

average intake at the breast 1 mos and beyone

A

60-120 mls per feed

91
Q

average in take per feeding in the first 24 hours

A

2-10 mls

92
Q

average intake in 24-48 hours

A

5-15mls per feed

93
Q

averate intake 48-72 hours

A

15-30 mls per feed

94
Q

Average intake at 72 -96 hours ( 4 days)

A

30-60 mls per feed

95
Q

what nerve is compressed in carpal tunnel syndrome

A

the median nerve - causing weakness , buring tingeling radiating to forearm and shoulder joint.

96
Q

how to diagnose de quervains tendonitis ( pain and inflamation where two tendons run through a very tight channel on the thumb side of the writst

A
  1. tenderness when pressure applied to thumb side of wrist
  2. Positive finkelstein test . bend fingers over thumb in a fist then bend wrist toward little finger. Positive if pain on the thumb side of the writst
97
Q

treatment for carpal tunnel-

A

ibuprofen, wrist and forearm splint, rest for 2 weeks, . PT exercises and ultrasound.

98
Q

damage to neck vertebrae at ___ to _____ affect all four limbs

A

c1-c7

99
Q

If a person has high paraplegia and affected trunk control , which vertebrae are likely damamged

A

T1-T12

100
Q

If a mother has SCI, reduced milk may occur if injury is at

A

T-4 ( perhpas decreased sensation to nipple)

101
Q

a woman will likely not have low milk production if the sci is below?

A

T6

102
Q

If a woman has RA and is treatedd with methotrexate, how long should she pump and dump

A

4 days per hale.

103
Q

average milk output at pospartum day 6/7 is predictive ,of mikl output at _________

A

6 weeks

104
Q

milk production less then ______mls by PPday 14 is a marker for long term low milk supply

A

500mls (16 1/2 oz)

105
Q

what percentage of available milk is released during the first milk ejection

A

45% ( may not be longer then 5 minute period. Mom can pump again in 15 mins to elicit another letdown (ramsey,2006)

General Information- breastfeeding (10 decks)

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