Lactation Conditions and Interventions Flashcards
what is the second highest reason mothers discontinue breastfeeding?
sore nipples
early mild nipple discomfort is common, but usually subsides after ___________
first week to 1 month
sore nipples can be prevented by ___________________
proper positioning of baby on breast
list some main reasons for nipple pain
bad latch
improper release of suction
infection
wrong size flanges in pumping
oversupply
what is flat nipple
nipple appears level with surrounding tissue
what is inverted nipple
nipple drawn into the surrounding tissue
does inverted nipple or flat nipple affect breastfeeding?
not if the latch is correct
what is letdown failure?
treatment?
when milk does not eject from the breast
- very uncommon
- relaxation techniques
- oxytocin nasal spray
what is hyperactive letdown?
streams of milk coming from the breast is too active, and maya use baby to choke/gulp/cough while nursing
what is the management for hyperactive letdown?
wait for milk flow to slow down before putting the infant to the breast
- express milk until flow is lower, then allow baby to latch
what is hyperlaction?
management for hyper lactation?
milk volume exceeds intake of the baby
-reduce production through cabbage leaves or cold compress
what is engorgement?
breasts are overfilled with milk
- results when supplies;y and demand process is not yet established and milk is abundant
what is the prevention for engorgement?
nurse frequently
- newborns may nurse every hour and a half
what is a plugged duct?
hard, often painful area of the breast, swollen with milk because of temporarily poor milk drainage
how to treat plugged duct?
massage and warm compress
complete emptying of breasts and changing position while feeding
what is mastitis?
infection/inflammation in breast that occurs in 33% of breastfeeding women
- may result from sore or cracked nipples, and missing a feeding
mastitis can be infective or non-infective and is most common at _____ weeks postpartum.
2 to 3 weeks
what is the most common reason for cessation of breastfeeding
low milk supply
a few causes we can consider when there is low milk supply?
insufficient breastfeeding or pumping
ineffective emptying
inadequate milk removal
suboptimal hormone balance
how to manage low milk supply
assessing the pumping
try guided imagery while expressing milk
nutritional management
many herbs like traditional ______ are not currently considered appropriate during lactation. avoid herbs such as ___, ____, _____, and ____.
galactogogues
castor bean
jasmine flower
fresh parsley
sage
data on the specific herbs…
- echinacea
- ginseng root
- St. John’s wort
- Fenugreek
- Goat’s rue and milk thisle/blessed thistle
echinacea - insufficient data
ginseng root - not advisable
St. John’s wort - may reduce milk supply
Fenugreek - may increase milk supply,infants may have rxns
Goat’s rue and milk thistle - increasingly used as galactogue
most maternal medications are likely to be prescribed to the nursing mother have ____ effect on milk supply or on infant well being
little
radioactive compounds (_______), and street drugs are always _____
antimetabolites
contraindicated (should not be used)
what is the ratio of the concentration of drug in milk to the concentration of the drug in maternal plasma
milk/plasma drug concentration ratio (M/P ratio)
what is the exposure index
average infant milk intake per kilogram body weight per day x 100
does oral contraceptives mess with milk ?
OC’s may reduce milk volume
recommendation for OCs while breastfeeding
avoid use of combined Ocs from 6 weeks to 6 months postpartum
progestin-only OCs (“mini pill”)
level of alcohol in breastmilk is ____
peak plasma levels occur at _____ after consumption without food.
_____ if with food
same as in maternal plasma
30-60 min
60-90 min
nicotine risks for infants include?
otitis media
asthma
respiratory infections
GI dysregulation
recommendation for nicotine and breastfeeding
better to smoke and breastfeed than smoke and not breastfeed
affects of marijuana to baby from breastmilk include ?
may change DNA/RNA and proteins needed for growth
caffeine affect on infants from lactation
moderate intake causes no problems
1% in milk compared to blood plasma
may accumulate in infants 3-4 months old
may interfere with sleep or hyperactivity & fussiness
amphetamines, cocaine, heroin, and phencyclidine (angel dust, PCP) are classified by the _____ as drugs of abuse
AAP
opioids such as ____ and ____ should not be continued if breastfeeding
codeine
tramadol
jaundice (_________) is a yellow color of the skin seen in about ____ of full term and ____ of preterm infants
hyperbilirubinemia
40%
80%
most frequent readmission for newborns is _____
jaundice
want jandice to be under ______
7 ml/dL
what is a form of brain damage caused by excessive jaundice
neonatal kernicterus
what is biliruben?
byproduct of the normal physiologic degradation of hemoglobin
- a pigment produced as heme from RBC break down
after birth, released hemoglobin is broken down by ________________. production in neonate is double an adult because of _______
reticuloendothelial system
breakdown of fetal erythrocytes
yellowing from jaundice should disappear from ____ first
feet
bilirubin is usually processed by ____ and excreted in babys stool
liver
why is jaundice so common
newborns liver not fully mature
Physiological newborn jaundice
- time frame?
- levels?
- resolution?
- cause?
- begins after 1st day of birth and rises with peak at day 5
- bilirubin less than 12 mg/dL
- resolves withing a few days
- normal heme breakdown
Pathological newborn jaundice
- time frame?
- levels?
- resolution?
- cause?
- begins within 1st day and rises rapidly and lasts longer
- levels more than 8 mg/dL
- medical intervention with phototherapy
- various pathological conditions
bilirubin encephalopathy or kernicterus mortality rate is ______. May cause _______-
50%
- cerebral palsy
- hearing loss
- paralysis of upward gaze
- intellectual handicaps
early jaundice vs. late jandice
early
- breast-nonfeeding jaundice
- breastfeeding jaundice
late
- breast milk jaundice
breast-nonfeeding jaundice babies may occur because _________, usually resolves in _____ of birth
nursing infrequently or inefficiently
1-2 weeks
breast-milk jaundice syndrome become apparent after the _______. Some causes could invlove__________
3rd day
- substance in most mothers milk that increases intestinal absorption
- individual variations in the infants’s ability to process bilirubin
The AAP guidelines recommend phototherapy using ______________
Light is absorbed in bilirubin changing it to ____________ that can be excreted via the _____
AAP guidelines encourage continuation of breastfeeding
fluorescent lights
a water soluble product
kidneys
main obsticle of breastfeeding multiples is _______
time and fatigue of the mother
exclusive breastfeeding for ≥4 months protects against ______ and _____
dermatitis and wheezing
evidence on gassy foods in mothers diet causing baby to have gas?
no relation
low allergin maternal diet can help resuce distressed behavior in ____
colic
Late preterm infants are born ____ weeks and may have subtle immaturity making _____ difficult.
several complications include _____
breastfeeding
- carido-respiratory instability
- poor temoerature control
- lower glycogen and fat stores
- immature immune system
- week suck-swallow coordination
in a preterm baby, they should be fed through _________ and should be _______ if they weigh less than_____
breastmilk
fortified
1.5 kg
infant should not be brestfed if diagnosed with _______
galactosemia
- genetic metabolic disorder
HIV ______ be transmitted to infant by breastmilk.
can be
transmission rates of HIV thru breastmilk is ________ depending on duration of breastfeeding
5-20%
breastfeeding during pregnancy is _____
safe and the mothers choice
Milk banking provides human milk to infants who_____________
___________ infants are most likely to receive banked milk
Women are carefully ______ before they can donate extra milk to milk bank
- cannot be breastfed by their mothers
- Premature and sick
- screened
