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96 Cards in this Set
- Front
- Back
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What is the glandular tissue of the breast made up of?
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15-20 lobuals containing:
10-100 alveoli further consisting of: lactocytes (increasing surface area) surrounded by: myoepithelial cells |
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What is mamogenesis?
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mammary growth in stages of:
embryology pre-puberty puberty pregnancy all initiated by hormones |
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What are the hormonal influences of breast milk during pregnancy?
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Placental hormones:
lactogen prolactin chorionic gonadotropin e/p Supportive metabolic hormones like insulin all resulting inductular and globular formation |
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What is lactogenesis and what are the stages?
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initiation of milk secretion, I, II, III
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What occurs in lactogenesis stage one?
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in the second trimester (28weeks) placental lactogen begins to secrete colostrum
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What occurs in stage II of lactogenesis?
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large amts of milk is visible
begins 2-3 days after delivery from a fall in progesterone and high prolactin levels supply does not depend on infant sucking until the 3rd or 4th day |
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What occurs in lactogenesis stage III?
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it’s the maintence of established milk secretion stimulated by sucking and oxytocin
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How does sucking promote maintenance of established milk?
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releases prolactin from the anterior pituitary and oxytocin from the posterior pituitary
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How does oxytocin promote maintenance of established milk?
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Through Let-Down-Reflex (LDR) and UC
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What is the LDR?
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ejection of milk from the alveoli into the lactiferous ducts
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What are the S/S of LDR?
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tingling lasting a min. occuring 4-10 in a 10 min period
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Name other times when oxytocin is secreted causing a LDR?
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orgasm and after pains
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What does colostrum look like and what are its benefits?
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Lasts from birth to 7days
yellow in color mild smell Benefits: Carotene content high than mature milk Inc protein, Lower in CHO lactose and fat inc IG, aids in est. normal flora in intestines laxative effect (dec jaundice) (then it changes to high in Fat and lactose and low in protein and minerals) |
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What is the transformation of milk?
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Colostrum
transition mature milk |
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When does transition milk occur?
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7-21 days PP slowly changing to mature milk
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What is mature milk?
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14-21days PP
thin, blue-ish color often mistaken for bad quality foremilk and hindmilk |
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What are the components of foremilk?
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high lactose content
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What are the components of hindmilk?
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high fat content - makes the baby feel more full
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What factors affect the make up of the milk?
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varies according to infant needs:
# of days lactating beginning to end of feeding mothers diet growth spurts time between feedings time of day |
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What are the components of breast milk?
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CHO, proteins, fats, vitamins, enzymes, minerals
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What types of CHO are found in breast milk, and what are their importance?
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Lactose (disacchrides, glucose, galactose)
Importance: critical to mothers milk volume major energy source assists Ca absorptions inc intestinal acidity and dec pathogen growth (oligosaccharides) |
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What types of fats are in BM, and what are their importance?
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Triglycerides (Cholesterol, essential fatty acids (DHA, ARA))
Importance: 50% of calories delivery of fat soluable vitamins |
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What is the importance of DHA?
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increase the brain and visual development (inc IQ)
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What is the importance of proteins in BM?
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Whey (curd making it easily digested - soft stool)
proteins specific to BM (no where else) IgA in whey binding to iron preventing bacterial growth |
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What vitamins are in BM?
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ACE but Vit D is low - needs supplementation
Give Vit K to every baby to prevent hemorrhage vegans should take B12 if BF |
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What minerals are in BM?
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iron which is easily absorbed from BM (vs Cow milk)
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What enzymes are in BM?
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Amylase (for CHO digestion) and Lipase (fat digestions)
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What are the components of immune cells in BM?
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Macrophage, Neutraphils, B lymphocytes, T lymphocytes
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What is the function of the macrophage?
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kill microbes in baby's GI tract
manufactures lysozyme to destroy bacteria activates other immune components involved in vagocytosis recruits lymphocytes to infection site |
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What are the functions of neutrophils?
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ingest bacteria in GI tract
involved in immune development protects mother |
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What are the functions of B lymphocytes?
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gives rise to antibodies
targeted against specific microbes |
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What are the functions of t lymphocytes?
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activated in presence of organisms
kills infected cells by activating chemical messangers to mobilize other defenses strengthening the infant immune system |
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What are the benefits of BF for the baby?
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perfect composistion for the baby
healthier uncontaminated milk easily digested |
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How can BM make babies healthier?
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Fewer infections
economic advantages dec SIDS infant mortality DM obesity cancers improved visual acuity and IQ fewer allergies |
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What are the BF benefits for mothers?
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assists with uterine involution
delays mensus reduces stress hormones enhances bonding convenient economical reduces breast cancer and ovarian cancer risk |
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What are the societal benefits to BF?
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lower infant mortality/morbidity rates
lower medical costs less missed work higher employer productivity lower employer costs less waste from formula cans and bottle supplies |
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What are the cultural influences of BF?
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Breasts a sexual organ
invisible acitivity in US embarrassing/discomforting to others if BF in public WIC supplementation acculturation |
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Who and what influences a mother's attitudes, beliefs, and behaviors about BF?
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partners
mothers (and in-laws) HCP peers percieved pain or discomfort embarrassment ties me down partners preference |
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What life experiences would affect the mothers BF?
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exposure to BF
previous attempts birth experiences returning to school or work |
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When is BF contraindicated?
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in infants with galactosemia
moms with TB, HIV chemo radiation drugs |
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How can mothers be encouraged to BF?
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Skin-to-skin contact
BF asap (in first 2hrs) keep baby with mom BF on demand (when baby hungry) BF often without a time limit (8-12x in 24hrs) avoid formula or pacifier until milk is established |
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What are the signs that the baby is hungry?
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rooting
suckling motions hands to mouth flexion of arms bicycle leg movement tense with clenched fists crying (last sign, best to offer in a quiet alert state) |
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What is rooting?
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infant moves toward whatever touches the area around the mouth and sucks
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What are the signs of satiety in the baby?
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audible swallowing
inc non-nutritive sucking longer pauses b/w sucking bursts takes self off breast absence of hunger cues arms/legs relaxed drowsy sleeping |
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What are the newborn sucking styles?
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Barracudas, excited ineffectives, procrastinators, gourmets, resters/snackers
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What is the barracuda sucking style?
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attacks breasts
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What is excited ineffective sucking style?
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the nipple goes in and out of the babys mouth
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What is the procrastinator sucking style?
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sleepy, longer time to latch on (wake up, take off clothes, play with toes)
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What is resters/gourmet sucking style?
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like wine tasting, takes time with feeding
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Why is it important for the mother understand newborn sucking styles?
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recognizes her infant individuality - different styles r/t differing emptying time, discourages clock watching
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What are the signs of ineffective sucking?
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choppy jaw motions
gumming nipple or areola clicking/smacking (not enough nipple in mouth) lack of swallowing biting dimpling |
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What are the nipple types?
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Protruding, inverted, flat
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What is important to understand about protruding nipples?
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point outwards, most common, good target
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What is important to understand about inverted nipples?
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sunken below the natural curve of the breast, indented in, difficult
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What is important to understand about flat nipples?
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lies flush along the natural curve of the breast, difficult
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What can you do to improve latch on?
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nipple roll
breast pump nipple shield (warm, H2O) |
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How can you assist with latch on?
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nose-to-nipple
stimulate infant with nipple allow infant time to open mouth avoid pushing infants head (stimulate hyperextention of neck) infant comes to breast chin first (mouth comes up and over) quickly pull to breast with arm that’s holding him gums bypass the nipple and cover 1" of areola baby's lips should be everted (press on babys chin to evert the lip) poor latch causes sore nipples |
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What are the general rules about hand placement for BF?
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avoid occluding milk ducts (hands outside areola)
avoid pushing infant down to make space for nose bring infants buttocks close look for reassuring breathing signs (C hold/palmer grasp or V hold/scissors hold) |
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What are some general rules about BF positions?
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chest-to-chest or tummy-to-tummy
lots of pillows for maternal posture unswaddle newborn for skin-to-skin contact bring baby to breast vs breast to baby |
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What are the babys BF positions?
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Cradle hold, side-lying, football
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What is the cradle hold?
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mom sitting up right
infant chest to chest infant head in forearm not AC hold newborn at the base of the neck |
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What is the side-lying position?
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helpful after cessarian or sore bottom
great for night time feeding more restful |
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What is the football hold?
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helpful after cessarian or woman with large breasts
better visualization of latch on process |
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How often should you BF?
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variable: 7-8 feedings in 24hrs or 10-15 feedings in 24hrs
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What is the babys anatomy r/t feeding?
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designed for cont. feedings
stomach capacity (when satiety reached, on day one 7mL/feeding teaspoon or 1.5) amt held when stuffed (30-35mL) GI empting time 90mins |
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Should you wake the baby for feeding?
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in the afternoon, no but wake q3-4hrs at PM
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Is it ok to feed from both sides of the breasts?
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yes, can do one side per feedings
offer second breast if still awake and not showing signs of fullness (1st for dinner 2nd for dessert) avoid feeding timing (ensures receiving hindmilk) start on the breast that had the least stimulation during last feeding |
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What is the RN responsible for r/t BF?
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Observing, recording, I/O, intervenening if I/O inadequate
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When evaluating BF, what is important for the RN to note for intake?
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Audible swallowing
2-3 days (1st): suck 20mins before enough volume stimulates swallow (swallow is quiet) day 4: swallow at every nutritive suck at the beginning of feeding, toward feeding end 2 sucks/swallow |
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What happens if you switch breasts too soon?
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babys don't receive hindmilk with fat and the baby isn't calmed
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When evaluating BF, what is important for the RN to note for output?
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Day1: 1v/1s
Day 2-3: 3v/24hrs and 2s/24hrs Day 4-4 weeks: 6-8V/24hrs and 3-4s/24hrs |
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What is important to teach about breast care?
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Support Boobs: bra, proper fit (too tight blocks ducts)
Avoid soap wash once a day change nursing pad when wet wash hands before feeding plastic holds moisture causing skin breakdown IG of BM protects nipple use lanolin (no cremes) |
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What are the causes of sore nipples?
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initial limited milk volume
infrequent infant swallowing to relieve sucking pressure incorrect attachment or removal of baby breast pumps and short frenulum (tounge tied) |
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What is the treatment for limited milk volume?
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assess attachment
reassure improves with transitional milk offer least sore breast first, if cracked use opposite boob until LDR has occurred alternate nursing positions |
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How can you correct attachment or removal of infant in sore nipples?
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observe feedings
assist with proper positioning and latch on soften nipple by hand expressing milk when engorged break suctioning properly Heal nipples with BM, lanolin, air dry nipples and soothies (on boob) |
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How do you break suction properly?
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put finger in the baby's mouth and remove when nipple fully out
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What are the s/s of sore nipples r/t attachment and latch problems?
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inflammation, blisters, cracks, taunt, shiney
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How can you fix breast pump caused sore nipples?
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ensure proper size suction cup and suction pressure
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Why is being tounge tied a problem with sore nipples?
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tounge doesn't extend over gum line
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What are the causes of insufficient milk supply?
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under developed glandular tissue (PCOS, tubular shape)
breast reduction (interuption of the milk ducts) hormonal estrogen containing contraceptives signs of adequate milk supply not apparent |
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What are the percieved causes of inadequate milk supply?
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lack of understanding of normal lactation physiology
lack of maternal motivation don't act the same with the bottle |
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What are the signs of adequate milk supply?
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Prenatal breast enlargement
PP engorgement dripping milk from opposite breast when infant nursing audible swallowing (eventually sustained for 10mins) Birth weight regained by 7-10 days of age 6-8 wet diapers/day newborn ends feeding and appears full after |
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What are the causes engorgement?
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congestions
increased vascularization accumulation of milk |
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What are the S/S of engorgement?
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"coming-in" (2-3daysPP)
amt of engorgement doesn't equal milk supply amt Shiney, Hot, Taught |
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What is the treatment for Engorgement?
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Can cut off milk supply
hand expression to soften areola frequent BF supportive bra 24hrs/day warm showers and packs prior to BF (aids in milk flow) Cold packs after BF (dec congestion) - cabbage leaves Ibprofen |
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What are the causes of Blocked milk duct?
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inadequate emptying of breast
tight bra - pressure on the breast nipple cream |
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What are the S/S of blocked milk duct?
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tender, sore lump
no fever or signs of infection small white pearl on nipple |
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What is the treatment for a blocked milk duct?
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alternate BF positions (no purse on that side)
chin towards blocked duct gentle massage toward nipple while nursing hand expression leaning over a warm basin of water frequent feeding on affected side |
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What are the causes of mastitis?
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milk stasis: blocked duct
cracked nipples abrupt change in feeding patterns |
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What are the S/S of mastitis?
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one side upper outter quadrants (pie shaped)
red, hot, swollen chills, fever, flu-like, malaise |
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What is the treatment for mastitis?
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warm compresses to affected area
frequent nursing rest antibiotics |
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What is unique about BM made for premature babies?
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Increased:
calories total nitrogen/protein nitrogen long-chain med-chain and short chain fatty acids sodium chloride iron (varies depending on age of baby) |
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What are benefits of BF for premature infants?
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Meets needs for increased:
energy tissue building regulation of body fx improved retinal fx improved IQ less water loss anti-infectives (use donor milk) easier to digest (dec necrotizing enterocolitis) |
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What is important to educate about going back to work and BF?
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express when baby would normally eat
continue expression a few minutes after milk sprays diminish Encourage LDR (gravity, warmth, relaxation, comfortable, private area, stimulation, breast massage) |
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What are the types of pumps?
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Electric breast pump
Hand held pump (cheapest) hand expression (massage outward) |
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How long should you store the milk at room temperature, cooler with 3 frozen icepacks, fridge, freezer, and thawed BM?
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Rm Temp: 4-6hrs (66-78*)
Cooler: 24hrs (59*) Fridge: 3-8days (39*) Freezer: 6-12months (0-4*) Thawed: use within 24hrs |
