12: Burns Chapter 11 & Thureen Chapter 8 Flashcards Preview

Simmons NURP 501 Exam 3 Weeks 12 and 13 > 12: Burns Chapter 11 & Thureen Chapter 8 > Flashcards

Flashcards in 12: Burns Chapter 11 & Thureen Chapter 8 Deck (68):

What are the breastfeeding recommendations

Exclusive breastfeeding for 6 mo, then combined with other nutrients for at least the first year.
Healthy people 2020 initiative: increase education and support


What is Hospital-Based Support?

The baby-friendly hospital initiative:
10 criteria every facility must meet to be baby-friendly.
Educate all staff on breastfeeding


What are the benefits of breastfeeding?

As the infant grows and develops the properties of the breastmilk changes to fit the needs of the infant

Provides the best nutrition possible for infants

Lowers risk of gastroenteritis, necrotizing enterocolitis, acute OM, severe lower respiratory tract infections, asthma, atopic dermatitis, DM Type 1 & 2, obesity, SIDS, and childhood leukemia, allergic diseases

Reduces fever after immunization

Lowers rates of atopic disease - asthma

Lower cholesterol in adult

Need to add complementary foods by 6 months to reduce risk of allergens

Enhances bonding

Enhances cognitive development


Contraindications to breastfeeding

Herpetic lesions on the mother's nipples, areolas, or breast

Maternal diagnosis and treatment of cancer

Maternal HIV

Infant with Galactosemia

Significant maternal or infant illness affecting the ability to feed

Maternal illness, such as TB, chickenpox, or Hep B

Invasive breast surgery

Documented hx of milk supple problems


Colostrum: When does production begin? Composition? Benefits?

Production begins at 20 weeks gestation - Pregnancy woman may notice small amount of yellow discharge

Thick, rich, and yellow has fewer calories than mature milk

Immunoglobulins (IgA) and other antibodies

Higher in: Na, Cl, protein, fat-soluble vitamins, and cholesterol

Facilitates passage of meconium

Often referred to as the infants "first immunization"


Transitional Milk: When does production begin? Composition?

Appears several days after delivery

Has more lactose, calories, and fat and less total protein than colostrum


Mature milk: When does production begin?

Replaces transition milk by week 2

Lipids-fat content is higher at the end of feedings (hindmilk) than at the beginning (foremilk)
Various lipids
Fatty acids (DHA) - may play a role in brain and retinal growth, beneficial effect on neurobehavior functioning
Carbohydrates - Primary carb is Lactoase
Vitamins and Minerals - except Vitamin D - must supplement about 400 IU/day or sun exposure


Anatomy and Physiology of Milk Production

By 20 weeks OB mammary glands are capable for milk production

Breast Milk production is signaled by the fall of progesterone. Suckling stimulates the hypothalamus to decrease prolactin-INHibiting factors to permit prolactin by the anterior pituitary which leads to a rise in the level of prolactin. Suckling by the infant is essential to establish and maintain lactation by increasing prolactin levels. The hypothalamus also stimulates the synthesis and release of oxytocin by the posterior pituitary to cause "letdown reflex".

Amount of milk production depends on stimulation of the breast - "supply and demand"


Assessment of the Breastfeeding Dyad

Maternal History - breast feeding hx, culture, expectations, drug use

Infant History - Health status, congenital conditions, trauma, complications, medications, gestational age, how is feeding going?

Maternal Examinations -Type of nipples, Presence of surgical scars, nipple bruising or bleeding

Infant Examination - oral motor skills


Maternal History

Overall health
previous breastfeeding experience
cultural expectations, routine use of medications/etoh/drugs/ect,
surgical interventions
nutritional status
family and community support
pregnancy history
L & D history


Infant History

Overall health
Congenital conditions
Trauma or complications during delivery
medications received during labor
activities or procedures (circumcision, bili lights, tube feedings)
gestational age
early responses to feeding attempts


Maternal Examinations

Types of nipples
Presence of surgical scars on the breast or thoracic area
Any nipple bruising or bleeding


Infant Examination

Evaluate oral-motor skills and structures


Principle of correct positioning

good body position
Audible "glug" or swallow from the infant


Positions for breastfeeding

Cradle position
Side-lying position
Football hold


How long should an infant breast feed on each nipple?

Encourage infant to go to each breast for 10-15 minutes up to 20-30 min


After the first 24 hours how often should the mother breastfeed

8-12 times or every 2-3 hours a day

*Be aware of the infant that goes 4 hours between feedings and falls asleep in 5 minutes at the breast, these infants need to be woken up to feed


Urine output Guidelines

In first 24 hours infant may only urinate 1-3 times
By day 3: 4 wet diapers
By day 4: 4-6 wet diapers
Eventually: 6-8 wet diapers


Stool Output Guidelines

First 24 hours: one meconium followed by another the second day.
Day 3: transition stools - loose, yellow, seedy


How often should a mother pump?

Pump 6-8 times in 24 hours for 15 min on a double pump, or 10 min per breast on a single pump set up


What are collection and storage of breastmilk?

Clean pump parts after each use
Milk defrosted, but not used within 24 hours needs to be thrown away
Pump milk can be stored in the fridge for 8 days or a "blue ice" cooler for 24 hours
Refrigerator freezer - 3 months
Deep Freeze - 12 months


Infant Weight Gain:
What is an acceptable percentage weight loss in first few days?

Normal to lose 5-8% of BW in first few days


How much weight should an infant gain per day?

0.5-1 oz per day, or 4-7 oz per week


When should the infant's weight be back to birth weight?

2 weeks


When is an infant considered Failure to Thrive?

3 Week


What should an infant's weight be by 6 months and 1 year?

The infant's weight should be double the infants birth weight by 6 months and triple the infant's body weight by 1 year


What are the characteristics of a healthy breastfed infant:

active and alert state
Developmentally appropriate progress
Age appropriate height and head circumference
Good skin turgor and color
Sufficient output of at least 6 wet diapers a day
Content and satisfied behavior after feeding


How often do growth spurts occur?

Periods lasting 2-4 days where infant seems to be hungry all the time
Tend to occur every 3-4 weeks


When does weaning naturally occur?

When the infant participates with self-feeding


How many total calories should a breastfeeding mother eat or how many extra calories per day

Minimum 1800 calories per day or extra 500 calories more than nonpregnant diet


How much weight should a breastfeeding mother expect to lose per month?

1-2 LBS per month


What drugs should a breastfeeding mother avoid or receive?

ergot compounds

* may give breastfeeding mothers medications that infants can receive


What are some common breastfeeding problems?

Flat or inverted nipples
Sore nipples
Severe engorgement
Nipple confusion
Breastfeeding jaundice
Poor weight gain


How to determine if a mother has flat or inverted nipples?

Pinch test


What causes flat or inverted nipples?

Adhesions cause retraction or inversion.
Flat nipples more often found in women with larger breasts


How are flat or inverted nipples managed?

Prenatal: breast shields during 3rd trimester if woman is not at risk of preterm labor

Football hold
Wear breast shells between feedings
Use pump for 1-2 minute before feeding
Avoid pacifiers or bottle nipples until infant is 4-6 weeks old


What are the complications of flat or inverted nipples?

Loss of self-confidence
Inadequate infant nutrition and its sequelae
Severe maternal engorgement
Plugged ducts or mastitis
Discontinued breastfeeding


What causes sore nipples?

Improper latch
Prolonged negative pressure
Inappropriate suction release
Use of sensitivity to nipple creams
Incorrect use of breastfeeding supplies
Leaking nipples that are not properly air-dried


What are the typical clinical findings of sore nipples?

Nipples, areola, and breasts are tender are bruised, raw, cracked, bleeding, blistered, discolored, swollen or traumatized


How are sore nipples managed?

Rub a few drops of colostrum or hindmilk onto the nipple and areola after every feeding and let air-dry

Expose nipples to air for short periods of time during the day
Breast shields
Pump affected breast if pain is too severe to allow nursing
Mild analgesics
Lactation specialist


What is severe engorgement?

Extremely full, sore, and swollen breasts, beyond the normal fullness experienced as the milk comes in


What causes severe engorgement?

Milk stasis in the breast from inadequate emptying


What are the clinical findings of severe engorgement?

Painful, hard, lumpy, swollen breast
Warm to touch
nipples flattened by swelling
bruising or trauma to the nipples and areola


How is severe engorgement managed?

Hot showers
Wrap breasts in warm, wet compress for 5-10 min before nursing
Gentle massage
manual expression before feeding to soften the areola
Nurse frequently


What is mastitis?

Infection of the breast usually by S. Aureus


What are predisposing factors of mastitis?

Cracked nipples
Plugged ducts
Constricting, ill-fitting bra
Inadequate emptying of the breast
sudden weaning or a significant decrease in the number of feedings
Use of manual pump


What are the clinical findings of mastitis?

Breast tenderness or pain
A reddened, warm lump in any quadrant
Some times streaking
Flu like symptoms
Body aches


How is mastitis managed?

Empty the breast
Nurse frequently
Use analgesics as necessary
ABX: PCN or Cephalosporin that covers S. Aureus - Dicloxacillin, Augmentin, Cefuroxime
Increased fluids
Warm showers
Do NOT abruptly wean


What are the complications of mastitis?

abscess and sepsis


What is nipple confusion? What is the problem with switching between breastfeeding, bottle feeding, and pacifier use?

confusing a nipple with a bottle or pacifier

The problem is they use different oral-mouth skills are used in sucking from a breast and bottle


What are the clinical findings of nipple confusion?

Ineffective sucking, breast refusal, sore nipples


How is nipple confusion managed?

Nipple confusion is managed by:

Avoiding baby bottle nipples and pacifiers for 4-6 week
Consulting a lactational specialist
If supplements are needed give them with a dropper, spoon, syringe, 5 french feeding tube attached to breast
Nipple shield


What are the complications of nipple confusion?

Colic and crying
Prolonged feedings
Sore and cracked nipples
Plugged ducts


What is breastmilk jaundice?

Late onset jaundice occurring 7-10 days of life in an infant drinking an adequate amount of breastmilk with no other signs of liver abnormality


What causes breastmilk jaundice?

It is possible due to an enzyme in mother's breastmilk,
(glucuronyl transferase)
Siblings are often affected


What are the clinical findings of breastmilk jaundice?

Healthy and thriving infant with adequate stooling and voiding, appropriate weight gain with the appearance of elevated bili between days 7-10 days that persists into the third month of life

Diagnostic studies: Serum bili, urine and other cultures to r/o infection


How is breastmilk jaundice managed?

Continue to breast feed unless clinical signs of pathologic jaundice are observed


What is thrush?

Oral candidiasis on the nipple and/or in the infant's mouth


What can cause poor weight gain?

Infrequent or inadequate feeding bc of poorly managed breastfeeding
Inadequate milk production
Genetic predisposition
Organic disease
Physical anomaly that prevents good sucking/swallowing


What are the clinical manifestations of poor weight gain?

Continued weight loss after 5-7 days
Failure to regain birthweight by 2-3 weeks old
Failure to maintain an ongoing weight gain of 0.5-1 oz /day
Weight below 3rd percentile for age
Lethargic/sleepy/inactive/unresponsive infant
Poor skin turgor
Dry mucous membranes
Newborn or young infant sleeping longer than 4 hours between feedings


What are technique factors can cause poor weight gain?

Ineffective latch/sucking
Short time at the breast
Infant kept on schedule despite cues from more feeding
Infant given water between feedings
Infant encouraged or allowed to slep through the night before 8-12 weeks old
Fewer than 8 feedings in 24 hours
Infant fed in a distracting environment


What maternal factors can lead to poor infant weight gain?

Mother does not respond to infant's cues for feeding
Hectic schedule with limited time for feeding
Recent illness or significant weight loss
Uses oral contraceptives or other hormones


How is poor infant weight gain managed?

Assess breastfeeding
Lactation specialist
Use supplemental system if needed


What are complications of poor infant weight gain managed?

Developmental delay
Poor bonding
Severe dehydration
Hospitalization for rehydration


What are the maternal benefits of breastfeeding?

Uterine involution
Decreases Post partum bleeding
Earlier pregnancy weight loss
Improved bone mineralization
Decreased risk ovarian and breast cancer


Bottle Feeding

Feeding and Frequency:
0.5-1 oz every 2-4 hours for first 24-48 hours
Then increase to 12-24 oz/day for first month

Iron-fortified is only acceptable alternative to breastfeeding
Fluoride supplementation (0.25 mg/day) may be recommended at 6 months of age
Bottles can be safely stored in the fridge for up to 24 hours
Warm to room temp - NEVER MICROWAVE


When should an infant be burped?

Attempt every 0.5-1 oz and at end of feeding to help remove swallowed air



"wet burp" containing small amounts of formula are physiologically normal in the first 6 weeks of life

Projectile vomiting is NOT normal