Exam 2 Flashcards
(191 cards)
1
Q
Mammary gland
A
Source of milk “breast”
2
Q
alveoli
A
round/oblong shapes cavities in breast
functional units in mammary gland
3
Q
secretory cells
A
cluster of cells in each alveolus with a duct in the center to secrete milk
4
Q
myoepithelial cells
A
surround secretory cells and contracts to secrete milk into ducts in presents of oxytocin
5
Q
what two hormones are responsible for breast development and lactation?
A
estrogen and progesterone
6
Q
what is lactogenesis?
A
breast milk production
7
Q
what are the 3 stages of lactogenesis?
A
- birth to 2-5 days = milk formation begins, lactose and protein content increase
- 2-5 days after birth = high blood to boobs, milk “comes in”, changes in milk composition and quality
- about 10 days after birth = milk composition becomes stable
8
Q
role of prolactin in lactation?
A
milk production, release in response to sucking
9
Q
role of oxytocin in lactation and physical effect is has on mother postpardum?
A
used for milk let down of milk from alveoli (milk glands) into milk ducts “tingle in breast”
postpardum = uterus contracts
10
Q
factors that change human milk composition? (4)
A
over a single feeding
over a day
based on age of baby
maternal nutrition status
11
Q
what is colostrum?
A
first milk secreted during the first few days postpartum
12
Q
how is colostrum different from mature milk?
A
its lower in carbs and fat
its thick and yellow
very high in protein (immumoglobins) good for babys immune system
13
Q
what is foremilk?
A
low in fat and high in carb at start of the feeding
14
Q
what is hindmilk?
A
high in fat at end of the feeding
15
Q
why is it important for baby to get foremilk and hindmilk?
A
key for child to get both at each feeding to prevent diarrhea and promote satiety
16
Q
what role/benefit does DHA have in human milk?
A
- retinal development
- higher IQ score
- may benefit preterm babies
17
Q
what role/benefit does cholesterol have in human milk?
A
- cell growth
- cell replication
- higher in breast milk than formula
18
Q
how does the protein casein in human milk benefit a child?
A
major class of protein in mature milk, keeps calcium in soluble for to absorb better
19
Q
how does the protein whey in human milk benefit a child?
A
aid in digestion and protection from bacteria
20
Q
what is the dominant carb in milk?
A
lactose
- it enhances calcium absorption
21
Q
what fat soluble vitamin is high in colostrum?
A
vitamin A
22
Q
what fat soluble vitamin is given to all babys at birth?
A
vitamin K
23
Q
the water soluble vitamin content of breast milk is reflective of?
A
mothers diet
one to be most likely deficient is B6
24
Q
how does mothers diet influence flavor of breast milk?
A
breast milk is sweet and taste slightly like what mom eats
25
how does this impact future child food preferences?
exposing baby to many flavors may contribute to trying new foods later in life
26
hormonal benefit of breastfeeding for mom?
- higher oxytocin so uterus can go back to normal and lowers bleeding
27
physical benefits of breastfeeding for mom?
- delay period so longer to get pregnant again
| - lower breast/ovarian cancer risk
28
phychosocial benefits of breastfeeding for mom?
- higher confidence
| - higher bond with baby
29
nutritional benefit of breastfeeding for baby?
best for baby
30
immunological benefit of breastfeeding for baby?
protects from viral and bacterial infection (colostrum)
| and fewer acute illnesses (diarrhea, ear and GI infections, less coughing)
31
cognitive benefit of breastfeeding for baby?
higher IQ
32
socioeconomic benefit of breastfeeding for baby?
lower medical care cost
33
what physical impact does oxytocin have on the mom?
- contracts uterus to normal size
- contracts breast to squeeze milk
- delays monthly ovulation
34
should breastfeeding be used as a reliable form of birth control?
no
35
what determines the rate of human milk synthesis?
15-40 oz per day per baby
1. how often baby nurses
2. how much time baby nurses
3. times per day
4. pumping
36
does breast size matter when breastfeeding?
no
37
limits that occur when breastfeeding with small breasts?
lower milk storage
| may have to feed more frequently
38
AAP current recommendations for optimal duration of breastfeeding?
1 year or longer
39
U.S current recommendations for optimal duration of breastfeeding?
exclusively 6 months and best for 12 months
40
why is it key to identify proper hunger/satiety cues when nursing?
to feed them before they get too fussy and to know when the baby is full. this is important for proper nutrition needs for baby.
41
how many feedings for baby are normal per day?
10-12
42
how many wet and soiled diapers indicate adequate nourishment?
6 wet
| 3-5 soiled
43
what % of birth weight loss is normal for a baby?
7% of birth weight is normal
44
what % of weight loss is concern for a baby?
10% of birth weight
45
DRI energy recommendations for mom during lactation?
500 additional calories for 6 months
| then 400 additional calories per day after 6 months
46
how is adequacy of maternal calorie intake assessed? (3)
- overall nutrition status
- maternal weight change
- infant growth
47
does protein malnutrition impact lactation, quality or composition of milk?
results in milk reduction of volume NOT the quality or composition of the milk itself
48
DRI for energy that supports weight loss in a mom?
to lose weight consume the calories you ate before pregnancy but dont go under 1,800
49
does maternal weight loss impact milk production during lactation?
a 500 calorie reduction doesnt impact production but dont go lower than 1,800
50
is exercise good for lactation?
had slightly increase in breast milk volume
you can eat more calories
no reduction in immunological factors
51
6 vitamins/minerals a lactating womean most likely defiecient in?
- folate
- thiamin
- vitamin A
- calcium
- iron
- zinc
52
recommendations surrounding fluid intake for lactating women?
drink to thirst
keep pee pale yellow
about 16 cups per day
53
what factors affect fluid needs?
where you live
temperature
activity
lifestyle
54
what vitamins/minerals may lactating VEGAN women be deficient in?
should they take a supplement?
- calcium
- zinc
- vitamin D
- vitamin B12
- iron
yes they should take a supplement
55
what is colic?
crying more than 3x a day
56
what foods increase likelihood of colic?
- cows milk
- onion
- cabbage
- broccoli
- chocolate
- potential allergic foods
- caffine
57
what are current recommendations for reducing infant colic?
women should avoid foods if the baby has colic
58
barriers women face when initiating breastfeeding?
(family, society, employers, ect)
(6)
- embarrassment
- time and social constraints
- lack of support from family and friends
- lack of confidence
- concern about diet and health
- fear of pain
59
effective strategies to promote breastfeeding?
- having a support system
- positive education
- exposure to other breast feeding women
60
man goal of breastfeeding education?
empower the women on how to feed their baby
61
what are hospital practices that promote and encourage breastfeeding?
- have lactation support
- no formula coupons
- baby put to breast right after delivery
- support and help if needed
- baby not taken after delivery "rooming in"
- staff support and encourage breastfeeding
62
why do women discontinue breastfeeding?
- sore nips
- inadequate milk supply
- feeling infant not satisfied
- infant problems with breast feeding
63
workplace barriers to breastfeeding?
- lack of onsite daycare
- bad pay maternity leave
- ridged work schedule
- lack of knowledge
- lack of support from workers
64
workplace benefits of breastfeeding?
- women miss less work from less sick babies
- shower work absences if babies are sick
- high work loyalty
- save in health care
65
WIC's "loving support makes breastfeeding work" what are the 3 goals?
1. increase breastfeeding initiation/ duration in clients
2. increase referrals to WIC for breastfeeding support
3. provide support
66
what are the causes of nipple pain? (4)
- poor positioning
- infection
- pumping with high suction
- improper cleaning
67
what are the treatment of nipple pain? (3)
- let boobs air dry after feeding
- rubbing ointment or breast milk on boobs
- warm moist compress
68
what is letdown failure?
milk doesnt eject from breast
69
what is the cause of letdown failure?
stress, alcohol, distraction
70
what is the treatment for letdown failure?
oxytocin nasal spray, relaxation techniques
71
why is hyperactive letdown a concern for baby?
could be overwhelmed by volume
could choke/cough or gulp
may take in air and cause gas pain
72
what are the symptoms of hyperlactation in mom? (4)
- breast not drained totally
- chronic plugged ducts
- leaking
- pain
73
what are the symptoms of hyperlactation in baby? (3)
- spitting up, poor weight gain
- difficult maintaining latch
- lots of gas, green poop
74
what is engorgement?
breast overfilled with milk
75
what causes engorgement? (3)
- supply and demand not established and milk abundant
- sleepy baby
- away long time from baby
76
what is management for engorgement? (3)
- nurse frequently
- make boob less hard before feeding
- use cold compress
77
what are plugged ducts?
caused by milk fat staying in ducts
| painful in breast (knot)
78
what is management of plugged ducts?
dont stop feeding
massage
warm compress
lecithine medication
79
what is mastitis?
chronic plugged ducts, inflammation of breast
80
symptoms of mastitis?
FEVER
tender
hot to touch
flu symptoms
81
treatment of mastitis?
```
keep nursing
ibuprofen
stay healthy
sleep
anibiotics
```
82
what is the cause of low milk supply?
- not enough feeding
- ineffective emptying
- stress
83
what is treatment for low milk supply?
- nurse every 2-3 hr.
- adequate diet
- complete breast emptying
- rest
84
are all meds excreted in breast milk?
yes
85
what are the two questions to address when it comes to medication when breast feeding?
1. how much of the drug is in milk?
| 2. what are the risk of adverse side effects to infants
86
what meds to avoid while breast feeding?
cancer drugs
illegal drugs
cold remedies
87
what are the recommendations regarding use of combined oral contraceptives during lactation?
- may reduce milk volume
- dont use for 6 weeks - 6 months
- use birth control after 6 weeks (progestin only)
88
is alcohol excreted into breastmilk?
quickly passes to breast milk
89
how does alcohol impact breast feeding?
alcohol can concentrate in breast milk inhibiting milk production
90
what are recommendations with alcohol and breast feeding?
only drink on special occasions (1-2 drinks) wait several hours to feed or pump and dump
91
does nicotene pass though breast milk?
yes levels are higher in breast milk
92
what impact does nicotene have on a baby?
- otitis media (ear infection)
- asthma
- respiratory infection
- gastrintestinal dysregulation
93
recommendation for breastfeeding while smoking?
shouldnt do it
| if you do smoke right after feeding because chemicals are less harsh an hour later
94
how does excessive caffeine intake affect baby?
- interfear with sleep
- infant awake/hyper
- fussy
95
recommendations regarding caffeine while nursing?
300mg
| or 16oz of coffee a day
96
what is neonatal jaundice?
yellowing of skin caused by too much bilirubin
97
how is jaundice treated?
phototherpy and or breastfeeding so they poop it out
98
what is bilirubin?
pigment produced by hemoglobin breakdown in RBC
99
how does jaundice occur?
bilirubin is processed by liver which isnt fully developed for babies so they turn yellow
100
what is physiological jaundice?
begins 1st day
peaks at day 6-7
normal and temporary
no treatment
101
what is pathological jaundice?
begins earlier and rises faster and last longer
phototherapy
frequent feeding to stimulate poop
102
what is meconium and what is its role in hyperbilirubinemia?
it is the first stool a baby passes
its black and oily
high in bilirubin so they wont be jaundice
103
is it possible to breastfeed multiples?
yes but its hard because mom doesnt have time and she is tired
104
what is the role of breastfeeding and infant allergies?
breast milk can protect against allergies
105
what are common allergens in babies?
- cows milk
- wheat
- eggs
- peanuts
- soybeans
106
what is the treatment for baby allergies?
mother needs to avoid these foods while breast feeding
| try to feed for a year
107
what weeks are you born to be late preterm?
34-37 weeks
108
what is the nutrition or health benefits to nursing in late preterm babies?
- help baby get proper nutrients
- help baby grow
- help baby get what they need moms breast milk has what the baby needs
109
what is human milk fortifier?
to provide additional protein and minerals especially calcium and phosphorous
110
why might human milk fortifier be needed for late preterm babies?
early babies need all the nutrients they can get
111
recommendation for nursing in women with HIV?
they SHOULDNT breastfeed
112
full term baby born when?
37-42 weeks gestation
113
preterm baby born when?
before 37 weeks gestation
114
what is infant mortality?
death that occurs 1st year of life
115
what are the indicators used to assess newborn health status?
- weight
- length
- head circumference
116
what motor developments happen in womb?
suckle (32-36 weeks)
| root, swallowing and breathing (32-34 weeks)
117
how does the progression of baby develop?
from top down and for muscles central to peripheral
118
how might missing a critical period of development affect future baby development?
critical period is when a certain behavior or development occurs. certain skills must be learned before subsequent behaviors or development can be estrablished
119
how long does it take for an infant GI tract to mature?
6 months
120
GI development of GI tract in 3rd trimester?
amniotic fluid stimulates intestinal maturation growth
121
GI development of tract at birth?
GI functional for digestion
122
GI development in early infancy?
coordination of peristalsis improves
123
what are the gains in infant weight and height in first year of life?
newborn 2x birth weight by 4-6 months
| 3x by 1 year
124
what does a newborn growth reflect?
- nutritional adequacy
- health status
-economic and environmental
-
125
signs to indicate readiness to feed?
- move tongue side to side without moving head
- sit with little support
- keep head up
- playing with food/spoon
- watching others eat
126
what is infant readiness based off of?
developmental signs
127
```
recommendation for intro to solid foods?
age
portion
type
times a day
food
feeding position
```
```
introduce at 4-6 months
small portions (1-2 Tbsp)
semi soft
on spoon
1-2x a day
start with cereal for iron
feed sitting up
```
128
recommendations for feeding from a cup?
cup before 18 months of age
ready at 6-8 months
sips of water or juice after 8 months
129
texture of appropriate foods for ages?
6 months = pureed, soupy foods
6-8 months = lumpy, soft texture
8-10 months= chew and swallow soft foods
130
infant energy needs birth- 3 months?
(89 x wt in kg - 100) + 175 kcals
131
infant energy needs 4-6 months?
(89 x wt in kg - 100) + 56 kcals
132
infant energy needs 7-12 months?
(89 x wt in kg -100) + 22 kcals
133
protein needs for birth- 12 months?
1.5 g/kg/day
| mostly related to body composition
134
infant at risk for too much protein?
too much formula or cereal added to formula
135
infant at risk for too little protein?
dilute infant formula
136
is fat restriction recommended?
no
AI 0-6 months = 31g/day
AI 7-12 months = 30g/day
137
when does baby need fluoride supplement?
when they have well water
| taken as drops
138
when does baby need vitamin D supplement?
if baby is only breastfed
139
how do elevated blood levels of lead impact a baby?
- toxic to developing brain
- interfere with calcium and iron absorption
- slow growth/shorter stature
140
AAP and ADA recommendation for feeding?
exclusive breast feeding
141
how many calories per oz does standard formula have?
20 cal/oz
142
how many calories per oz does preterm formula have?
| what does it provide?
22-24 cal/oz
| has higher levels of vitamins and minerals especially calcium and phosphorus
143
what food should be eaten at 6 months of life?
iron fortified baby cereal mixed with breast milk
| fruits and veggies, only 1 new food every 2-3 days to check for intolerance
144
what foods should be eaten at 9-12 months?
any foods, just soft and cut small
145
what foods are coke foods?(4)
peanuts
whole grapes
hot dogs
hard fruits and veggies
146
what drinks should you not have?
cows milk in first year of life
| NO JUICE for 1st 6 months, it is not needed but limit to 4-6oz
147
what is Failure to Thrive (FTT)?
inadequate weight or length gain (3 or 5 %tile) or drop in +2 %tiles
148
what are organic causes of FTT?
untreated GER
cardiac problems
chronic respiratory illness
149
what are inorganic causes of FTT?
maternal depression
alcohol
neglect
150
does etiology matter to figure out FTT?
yes you need to know the problem so you can have a solution
151
what are 5 nutrition interventions for FTT?
team approach
1. establish calorie/protein goal
2. develop a feeding schedule
3. do weight checks
4. early intervention program
5. assure food supply
152
what is an infants iron stores directly reflective of?
the mothers
153
what is treatment for infant constipation?
- assure adequate fluids through breastmilk
- after 1 month can use apple or pear juice 1oz per month of age
- dont exceed 4oz per day
- if eating food try puree prunes, peas or barley cereal
- glycerine suppositories may be given if needed
154
what formula is used for protein allergies?
hydrolyzed protein formula
155
what lowers the risk for food allergies?
breast fed for a year and introduce the foods before 6 months of age
156
can baby grow normally on vegetarian diet?
yes if they are eating well planned meals
157
LBW weight?
<2500 g (about 5lbs 8oz)
158
VLBW weight?
<1500 g (about 3lbs 5oz)
159
ELBW weight?
<1000 g (2lbs 3oz)
160
micropreme birth weight?
<500 g
161
medical conditions that increase calorie needs? (5)
```
difficulty breathing
temp regulation
recovery from surgery
infection/fever
cardiac concerns
```
162
medical conditions that decrease calorie needs? (2)
```
born with small muscles (down syndrome)
low activity (spina bifida)
```
163
AAP guidelines for preterm calorie needs?
120 kcal/kg
164
recovering infants may need as much calories as...?
180 kcal/kg
165
how much protein do you need for regular growth and digestion?
1.52 g/kg
166
how much protein do you need for preterm/illness recovery?
3-3.5 g/kg
167
how much protein do you need for ELBW?
4 g/kg
168
when do you need lower protein needs?
rare,
low muscle mass
low movement
169
why is MCT oil beneficial to provide fat needs for LBW and ELBW infants?
good due to low pancreatic and liver enzymes as well as not mature liver which is required to digest long chain FA
170
what is human milk fortifier?
provides additional calories/nutrients
171
why is human milk fortifier utilized?
for preterm infants to help grow especially for low tolerance feedings
172
what is catch up growth?
period of slow growth followed by fast gains
173
how long does it take for a 32week+ baby to catch up?
1 year
174
how long does it take for VLBW/ELBW to catch up?
3+ years
175
what is microcephaly?
small head for age
176
what is macrocephaly?
big head for age
177
both conditions (macro and microcephaly) may indicate?
neurological disorders and affect
1. muscle mass
2. body composition
3. subsequent growth
178
what are nutrition concerns in infants with down's syndrome? (5)
1. feeding difficulties due to weak face muscles
2. high risk of overweight (excess cal. intake)
3. high risk of constipation
4. heart/intestinal conditions
5. slower motor development and lower physical activity
179
nutritional problems associated with LBW and ELBW?
- difficulties nursing due to respiratory support
- obtaining adequate calories/nutrients
- difficulty taking in adequate energy due to high metabolic rate
180
nasogastric feeding?
slow feeds from the mouth/nose to the belly
181
nasoduodenal feeding?
enternal feeding from nose/mouth to upper part of intestine
182
nasojejunal feeding?
enternal feeding from nose/mouth to the jejunum
183
preferred choice in feeding preterm baby? why?
breast milk
has colostrum
high protein
lowers risk of mortality
184
how can breast milk be supplemented?
human milk fortifier
MCT oil
vitamin and mineral supplementation
185
caloric density of preterm formula?
22/24/28/30 cal/oz
186
caloric density of standard formula?
20 cal/oz
187
what items can be used to boost caloric content?
MCT oil (fat)
polycal (CHO)
human milk fortifier (protein + minerals)
188
what are congenital anomalies?
condition (genetic or chronic) evident in a new born that is diagnosed at/near birth
spina bifida and cleft palate are examples
189
what is cleft palate?
upper lip and roof of mouth are not formed completely and need surgical correction
190
how does cleft palate affect nutrition?
may effect feeding difficulties (eating position and feeding devices)
191
how do inborn errors of metabolism impact an infants nutrition?
- be more irritable
| - less able to signal wants and needs
