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NURP 1 FINAL > Week 12 > Flashcards

Week 12 Flashcards

(78 cards)

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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
Transitional milk
5-10 days white/blue tint
26
Mature milk
10-14 days bright white 2 phase foremilk first 5-10 min hindmilk last 10min (higher in fat/cals)
27
Growth spurt
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
28
Breastpump
all insurance covers someone can come to house sanitize bottles La Leche (strict) Kelly mom (soft)
29
breastmilk
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
30
Supplements VIT D
first few days VIT D 400 IU, use syringe daily
31
Supplements Iron
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*
32
Issues with breastfeeding
nipple breakdown d/t -inappropriate latch -yeast infection
33
Nipple ointment
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
Trush
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
sx of thrush infant
white plaques mouth is painful feeding refusal monilia diaper rash w satellite lesions
36
sx of thrush mom
dry/cracked itchy nips shooting burning pain vag yeast infection
37
who do u treat and with what?
Mom and baby must be treated mom-fluconazole baby/nips-nystatin
38
Mastitis
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
treatment with mastitis
abx, heat, massage, cont to feed, fluids, pain relievers
40
causes of mastitis
milk stasis, nipple trauma, engorgement, maternal fatigue/stress
41
Formula
1-2oz every 2-3hrs in the first days of life 2.5oz for every lb follow hunger cues
42
Types of formula
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
how to prep/store
do not want baby laying down (prop up baby not bottle) do not reuse without cleaning do not heat in microwave
44
issues related to feeding
reflux, constipation, colic
45
reflux
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
treatment for reflux
frequent feeds, burps try pre-thickened formula zantac, famotidine
47
Constipation
difficult or rare defecation for more than 2 weeks
48
Breastfed stools
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
Formula stools
brown, tan, green 1-4x or 1x every 3-4 days
50
BAD STOOLS
hard or formed stools blood/mucus
51
cures for constipation
prune juice suppository/rectal stim formula change lactulose <6mon miralax >6months
52
red flags for constipation
is the anus patent is there bilirubin no meconium in 24hrs FTT bloody stools abdominal distension
53
Colic
develops suddenly age 1month-3months common in 6 weeks usually gone by 3 months no etiology, but rule out a pathologic cause
54
Colic 3's rule
3 or more episodes of ear-pierce crying 3 or more days a week /3hrs 3 weeks or longer
55
Treatment
self-limiting try a different formula- partially hydrolyzed formula
56
Hyperbilirubinemia
57
bilirubin
naturally occurs, yellow pigment-cleared by the liver excreted in urine/stool
58
unconjugated
indirect, breakdown of RBCs that travel to the liver to be processed can be patho or non patho
59
conjugated
direct, undergone the chemical changes, moving to intestines (always PATHOLOGIC)
60
jaudice
the marker to identify the risk of hyperbilirubinemia
61
causes of hyperbili
immature liver function decreased ability to conjugate decreased rate of excretion *poor feed/dehydration premature <38
62
Symptoms of hyperbili
yellow skin, sclera (more severe) itchy skin pale stools drowsiness dark urine poor suck delayed nursing can cause hyperbili*
63
can breastfeeding help decrease hyperbili?
yes
63
physiologic jaundice
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
breast milk jaundice
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
pathologic jaundice
jaundice within 24hrs of life total serum bili 5mg/dl per day or >15mg
66
potential causes of patho jaundice
electrolyte defects, structural abnormalities in the liver (bili atresia), infection, sequestered blood cephalohematoma
67
Screening tools
visual inspection serum/transcutaneous nomogram
68
RF for hyperbili
Jaundice within 24hrs A sibling Unrecognized hemolysis Non-optimal feeds Deficiency in G6PD Infection Cephalohematoma East Asian or Mediterranean decent ABO incompatibility
69
screening after birth
3-5 days after birth earlier if jaundice in 24hrs *looking at levels until 5 days old (120hrs)
70
low intermediate risk
come back next day
71
low risk
come back in 2 days
72
Complications of hyperbili
can cross BBB acute bilirubin encephalopathy: reversible. fever, lethargy, high pitched cry, arching of body, poor feed
73
kernicterus
nuclear jaundice - can cause sight or hearing deficits, CP, cognitive delays, death NONreversible
74
Phototherapy
gestational age post-natal age risk factors keep eyes covered risk of dehydration
75
Rebound bili
first 24 hrs after stopping is normal rebound 18-24 hrs
76
S/e of phototherapy
dehydration skin rash loose stools bronze baby (tan) urine is dark
77
high risk
transfusion IVIG (if RH incompatibility)

NURP 1 FINAL (2 decks)

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