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NURP 1 FINAL > Week 12 > Flashcards

Week 12 Flashcards

1
Q

After birth how much do infants lose?

A

10% of their body weight in the first 4 days of life
*born with extra fluid

*c-section and breastfed will lose the most amount of weight

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2
Q

excessive weight loss

A

leads to hypoglycemia, hyperbilirubinemia, dehydration, electrolyte imbalance which negatively effect brain development

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3
Q

normal weight gain

A

0.5-1oz per day

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4
Q

initial weight loss of 10% should be lost by when?

A

2 weeks of age
if not returned by 3 weeks of age considered FTT

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5
Q

birth wt doubles

A

6 months

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6
Q

birth wt triples

A

1 year

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7
Q

height

A

increase by 50%

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8
Q

CDC

A

> 2 (reference)
how different groups of children have grown

*WHO is standard for how all children should grow

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9
Q

Poor weight gain factors

A

infrequent or inadequate feeds
inadequate milk production (mom sick/dehydrated)
error in the formula mixture
genetic predisposition (hypermetabolic/poor absorption)
infection
physical anomaly

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10
Q

how long should you breastfeed?

A

20 min each side for hind-milk

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11
Q

factors for poor wt gain

A

no child should fall below <3%
lethargic, inactive
sleeps >4 hrs between feedings (allowed one 5hr stretch)
signs of dehydration (*look in the mucus membranes/poor skin turgor)

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12
Q

wet diapers in newborns 6 days of life on

A

6 (6 days old 6 diapers

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13
Q

stools in newborns

A

3

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14
Q

extrinsic factors

A

ineffective latch
short time <20min
ignore hunger cues
give water between feedings
8x (bottle) or 12x breast in a 24-hour period

*nothing between breast milk or formula <6mon

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15
Q

maternal factors of poor feeding

A

PPD/poor bonding
no hunger cues
recent illness/wt loss
dehydration
use of COCs or other hormones (estrogen)

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16
Q

hunger cues (early)

A

stirring, mouth open, turning head, seeking, rooting
tongue out, yawn

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17
Q

hunger cutes (mid)

A

stretching, irritability, increased physical movement, hand to mouth

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18
Q

hunger cues (late)

A

crying, agitated body movements, turning red

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19
Q

do breast fed babies have increased chance of obesity?

A

no, less chance of obesity later in life if the baby is breastfed
(heavier than a bottle-fed infant and this is OK)

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20
Q

Breastfeeding

A

recommends breastfeeding until 6 month
1:1:1
cont with breastfeeding until 1 yr with supplementation

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21
Q

factors that effect breastfeeding

A

induced (oxytocin can reduce breastmilk production)
epidural (effects sucking)
delayed first feed
breast surgery (reduction is more an issue than implants)
nipple breakdown/inverted nips
preterm
lip deformity
breast engorgement
inadequate milk supply

counteract s/e to do as much skin-to-skin

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22
Q

Colostrum

A

IGA
first-line defense against bacteria, fungi, viruses
prevent against obesity, asthma, allergies
decreases risk of sids
brain development

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23
Q

Contraindication to breastfeedings

A

cytotoxic/immunosuppressive drugs NO
maternal substance abuse NO
active tb (pumped milk OK) latent OK
HIV (NO in USA) not contraindicated in third world countries
Activer varicella (pumped OK)
HSV (NO pumped or feed), hep C
neonatal galactosemia

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24
Q

Colostrum (first milk)

A

1-5 days
aka “liquid gold”
considered first immunization
stimulates ketone/stabilizes blood glucose

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25
Q

Transitional milk

A

5-10 days
white/blue tint

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26
Q

Mature milk

A

10-14 days
bright white

2 phase
foremilk first 5-10 min
hindmilk last 10min (higher in fat/cals)

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27
Q

Growth spurt

A

common in 1st year
feed infant on demand
cluster feeding is OK

last 2-3 days. Baby will sleep a lot and feed every 2 hrs

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28
Q

Breastpump

A

all insurance covers
someone can come to house
sanitize bottles

La Leche (strict)
Kelly mom (soft)

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29
Q

breastmilk

A

pumped 4hrs only on the countertop, 4 days in fridge, freezer 6 months-12 months

thawed 1-2hrs
1 day in fridge
never re-freeze

leftovers (baby did not finish)
breastfed 2hrs
bottle 1hr

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30
Q

Supplements VIT D

A

first few days VIT D 400 IU, use syringe
daily

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31
Q

Supplements Iron

A

give @ 3-4 mon, H&H heel stick at a prenatal visit
at 6 months can begin to get iron through food

ONLY breastfed infants require supplements of iron/vit D

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32
Q

Issues with breastfeeding

A

nipple breakdown d/t

-inappropriate latch
-yeast infection

33
Q

Nipple ointment

A

mupirocin
betamethasone
miconazole
all-purpose nipple ointment (commonly used to treat yeast in the breast)

Avoid pacifiers and artificial nips - entices babies to BITE

Lanolin cream*(only to nipples)

34
Q

Trush

A

if a baby has thrush in the mouth, look at the diaper area for yeast
1-2 weeks commonly occurs (but can occur at any time)

freezer does not kill the yeast
recent abx therapy is a RF, like if mom got abx for GAS

boil equipment (breast pump and pacifier DAILY)

35
Q

sx of thrush infant

A

white plaques
mouth is painful
feeding refusal
monilia diaper rash w satellite lesions

36
Q

sx of thrush mom

A

dry/cracked itchy nips
shooting burning pain
vag yeast infection

37
Q

who do u treat and with what?

A

Mom and baby must be treated
mom-fluconazole
baby/nips-nystatin

38
Q

Mastitis

A

bacterial infection in the breast tissue
comes on QUICK, 6-7 weeks after birth
high fever >101(flu-like sx)
sudden unilateral hot, swollen breast
caused by S. aureus

*continue to feed or pump on that side w mastitis

39
Q

treatment with mastitis

A

abx, heat, massage, cont to feed, fluids, pain relievers

40
Q

causes of mastitis

A

milk stasis, nipple trauma, engorgement, maternal fatigue/stress

41
Q

Formula

A

1-2oz every 2-3hrs in the first days of life

2.5oz for every lb

follow hunger cues

42
Q

Types of formula

A

iron-fortified

cow’s milk: Similac,Enfamil

soy-based: prosobee, isomil

partially hydrolyzed formula (decreases daily crying w colic)
nutramgien, alimentin

amnio-acid
neocate/ elecare

specialize:
pre-thickened (reflux), low iron, low lactose
-help infants sleep

43
Q

how to prep/store

A

do not want baby laying down (prop up baby not bottle)
do not reuse without cleaning
do not heat in microwave

44
Q

issues related to feeding

A

reflux, constipation, colic

45
Q

reflux

A

75% can have this, NORMAL (immature GI tract)
might need to change the formula (change from cow-soy or hydrolyze)
cow milk protein allergy
“happy spitters”

<3mon and before 6mon

> 4 reguritation = evaluate

46
Q

treatment for reflux

A

frequent feeds, burps
try pre-thickened formula

zantac, famotidine

47
Q

Constipation

A

difficult or rare defecation for more than 2 weeks

48
Q

Breastfed stools

A

soft, seedy yellow/thin can be 7+ per day

1x per week stools is NOT concerning bc babies are using a lot of the nutrients do not need to excrete

49
Q

Formula stools

A

brown, tan, green 1-4x or 1x every 3-4 days

50
Q

BAD STOOLS

A

hard or formed stools
blood/mucus

51
Q

cures for constipation

A

prune juice
suppository/rectal stim
formula change
lactulose <6mon
miralax >6months

52
Q

red flags for constipation

A

is the anus patent
is there bilirubin
no meconium in 24hrs
FTT
bloody stools
abdominal distension

53
Q

Colic

A

develops suddenly age 1month-3months
common in 6 weeks usually gone by 3 months

no etiology, but rule out a pathologic cause

54
Q

Colic 3’s rule

A

3 or more episodes of ear-pierce crying
3 or more days a week /3hrs
3 weeks or longer

55
Q

Treatment

A

self-limiting
try a different formula- partially hydrolyzed formula

56
Q

Hyperbilirubinemia

A
57
Q

bilirubin

A

naturally occurs, yellow pigment-cleared by the liver
excreted in urine/stool

58
Q

unconjugated

A

indirect, breakdown of RBCs that travel to the liver to be processed
can be patho or non patho

59
Q

conjugated

A

direct, undergone the chemical changes, moving to intestines
(always PATHOLOGIC)

60
Q

jaudice

A

the marker to identify the risk of hyperbilirubinemia

61
Q

causes of hyperbili

A

immature liver function
decreased ability to conjugate
decreased rate of excretion
*poor feed/dehydration
premature <38

62
Q

Symptoms of hyperbili

A

yellow skin, sclera (more severe)
itchy skin
pale stools
drowsiness
dark urine
poor suck

delayed nursing can cause hyperbili*

63
Q

can breastfeeding help decrease hyperbili?

A

yes

63
Q

physiologic jaundice

A

most common- 80% in all newborns
gradual rise in total bili 48-120hrs (2-5 days)

requires surveillance
*resolves in 2 weeks

*more common with breastfed infants

64
Q

breast milk jaundice

A

immature liver/intestines
AFTER 7 days of life
peaks 2-3 weeks

as long as the infant is feeding well and gaining wt no reason to do anything but monitor

65
Q

pathologic jaundice

A

jaundice within 24hrs of life
total serum bili 5mg/dl per day or >15mg

66
Q

potential causes of patho jaundice

A

electrolyte defects, structural abnormalities in the liver (bili atresia), infection, sequestered blood

cephalohematoma

67
Q

Screening tools

A

visual inspection
serum/transcutaneous
nomogram

68
Q

RF for hyperbili

A

Jaundice within 24hrs
A sibling
Unrecognized hemolysis
Non-optimal feeds
Deficiency in G6PD
Infection
Cephalohematoma
East Asian or Mediterranean decent

ABO incompatibility

69
Q

screening after birth

A

3-5 days after birth
earlier if jaundice in 24hrs
*looking at levels until 5 days old (120hrs)

70
Q

low intermediate risk

A

come back next day

71
Q

low risk

A

come back in 2 days

72
Q

Complications of hyperbili

A

can cross BBB
acute bilirubin encephalopathy: reversible. fever, lethargy, high pitched cry, arching of body, poor feed

73
Q

kernicterus

A

nuclear jaundice -
can cause sight or hearing deficits, CP, cognitive delays, death

NONreversible

74
Q

Phototherapy

A

gestational age
post-natal age
risk factors

keep eyes covered

risk of dehydration

75
Q

Rebound bili

A

first 24 hrs after stopping is normal
rebound 18-24 hrs

76
Q

S/e of phototherapy

A

dehydration
skin rash
loose stools
bronze baby (tan)
urine is dark

77
Q

high risk

A

transfusion
IVIG (if RH incompatibility)

NURP 1 FINAL (2 decks)

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