Week 5 part 2 Flashcards
(35 cards)
Guidelines for breast feeding?
For at least 6 months within one hour and on demand
What can these cause:
Poor positioning and incorrect attachment
Mechanical pumping,
Tearing the nipple/ areola junction
Detaching the baby or pump from the breast incorrectly.
Sore and cracked nipples
Pain - specifically to area of the nipple. Worsens at the start of feeding Nipple wedge shaped after feed. Breasts may also be engorged Redness, blisters, bleeding and scabs Baby may vomit blood.
Sore/cracked nipples
What are these causes for: Delay in first feed Ineffective positioning and attachment Restricted feeding Ineffective emptying Supplementation
Engorgement
The breasts look shiny because of the oedema and can be painful.
The milk does not flow well due to increased pressure in the breast.
The breast (s) may be red
The mother may be feverish.
Engorgement
What are these causes for: Plugged milk duct Breast infection Poor positioning and attachment Infrequent feeds Consistent breast pressure (bra, clothing) Dummies Supplementation Trauma
Mastitis
Tender spot, redness, sore lump without fever
– blocked duct
A tender spot or lump and a low grade fever
– breast infection
May have nausea, vomiting.
Mastitis
What might infected mastitis have?
Cracked nipple
Pus and blood in milk
Red streaks from site back into breast
Recommended antibiotic treamtent for mastitis?
1g flucloxacillin four times a day
An agonising pain in both breasts
Pain is felt equally in both breasts
Pain AFTER every feed
No change in nipple colour after feeds
No change in nipple shape after feeds
Frenotomy has been performed where required
Positioning and attachment assessment has identified no issues
Thrush
In newborn systemic head to toe exam, what is looked for on: head?
- Shape of head, fontanelles whether normal , sunken or bulging
- Measure and record head circumference on the growth chart
- Assess facial appearance and eye position
- Look for asymmetry or abnormality of facial characteristics
In newborn systemic head to toe exam, what is looked for on: eyes and ears?
- Normal shape and appearance
- Red reflex presence - retinoblastoma, cataract
- Normal or low set, patency of external auditory meatus
In newborn systemic head to toe exam, what is looked for on: mouth arms and hands
- Colour of mucous membrane; observe palate form and fusion
- Check suckling reflex by inserting CLEAN little finger gently inside baby’s mouth
- Are hands moving normally, shape normal ?
- Look for evidence of traction birth injury (eg Erb’s palsy) by checking neck , shoulders and clavicles.
- Count fingers and observe shape and any deformities
- Check palmar creases, multiple or single?
Single crease can be a sign of Down’s syndrome.
In newborn systemic head to toe exam, what is looked for on: heart and peripheral pulses
- Check brachial, radial and femoral pulses for rate, rhythm and volume.
- A hyperdynamic pulse may suggest a patent ductus arteriosus
- A weak pulse may suggest a congenital cardiac anomaly, impairing cardiac output, (and in conjunction with other indications from the examination.)
- Check the cardiac position by palpation and feel for any thrill or heave
- Listen carefully to heart sounds and any added sounds and murmurs
- Suspected abnormalities require further examination and opinion
In newborn systemic head to toe exam, what is looked for on: lungs?
- Watch the respiratory pattern, rate and depth for a few seconds
- Look for evidence of intercostal recession
- Listen for stridor
- Auscultate lung fields for added sounds
In newborn systemic head to toe exam, what is looked for on: abdomen?
- Observe abdominal girth and shape
- Carefully check the umbilical stump for signs of infection or hernia
- Palpate gently to feel for organs, masses and herniae
Note: it is normal to feel the liver and/spleen in healthy babies - Check external genitalia
- Palpate for testes in boys
- Inspect anus and establish whether or not meconium has been passed
In newborn systemic head to toe exam, what is looked for on: back and hips
- Inspect skin over back, and at spinal curvature, note symmetry
- Observe any evidence of spina bifida occulta or sinus hidden by flesh creases or dimples, and any hair tufts
- Palpate spine from neck to coccyx
- Specifically check for congenital dislocation of the hip (congenital hip dysplasia) using a combination of Barlow and Ortolani manoeuvres
In newborn systemic head to toe exam, what is looked for on: legs and CNS
- Observe movements at each joint
- Check for evidence of talipes equinovarus
- Count toes and check for shape and abnormal gaps
- Observe tone, behaviour, movements and posture
- Elict newborn reflexes if safe and appropriate
Referring to Modified Oxford Scale & ICS: what is a grade 0 contraction?
No discernible contraction ICS absent
Referring to Modified Oxford Scale & ICS: what is a grade 1 contraction?
Flicker - ICS weak
Referring to Modified Oxford Scale & ICS: what is a grade 2 contraction?
Weak contraction ICS weak
Referring to Modified Oxford Scale & ICS: what is a grade 3 contraction?
Moderate - ICS normal
Referring to Modified Oxford Scale & ICS: what is a grade 4 contraction?
Good contraction ICCS normal
Referring to Modified Oxford Scale & ICS: what is a grade 5 contraction?
Strong against maximal resistance - ICS strong
