Chegg CLC
constructed knowers are
- Have abandoned either/or thinking - have learned to live with conflict - believe all knowledge is constructed -want to embrace all the pieces of the self in some ultimate sense of the whole. -aspire to work that contributes to the empowerment and improvement in the quality of life of others
Subjective knowers believe
- Sense of self is embedded in external definitions and roles. - sense of authority arises primary from the power of the group - trust their own intuition - distrust Male authority figures - .experts don't know what they are talking about.
what are the suboptimal breast anatomy
- anatomical concerns - absence of breast change- in pregnancy or early postpartum - no postpartum breast fullnuss or signs of abundant milk production - hypoplastic breastts -discrepant breast size (one implant)
goldsmith sign
- baby wont latch on breast - persistent - rule out common problems such as ear infections, teething, birth trauma
common mastitis
- blocked ducts from engorgement, hurried feedings, use of nipple - attachement difficuties - tight bra - use of breast shell - nipple pain - anemia in the mother - tongue tie - systemic, fever, ill feeling, reddness, pain, one infmaled breast
Normal fullness looks like
- breast soft to touch - body temp normal - mother feels well - breast may be hot - baby can grasp nipple
What does engorgement look like
- breasts hard - temp normal - feels discomfort - breasts hot and shiny - nipple difficult to grasp
symptoms of candida/yeast/thrush
- causes pain for mother and baby - may or may not be visible - mother will usually be itchy, flaky, and shiny skin
Silence - how to help
- few words - familiar words - nothing to remember -you may need to be an advocate
babies born during night and early morning
- had double the odds of supplementation
mothers should temp. not breastfeed
- mothers infected with untreated brucellosis - mothers taking certain meds - mothers undergoing diagnostic imaging - mothers who have an active simple virus infection
breastfedding is not advisable
- mothers with HIV - mother is infected with human t cell - lymphotropic virus type 1 and 2 - PCP pr cocaine - suspected or confirmed ebola cases
Treatment of raynauds
- preventing or decreasing cold exposure - avoiding vasoconstructive drugs, caffeine, and nicotine
reciever of knowledge believe
-Believe that all authorities tell the truth. - like to learn the right answer and repeat it to the teacher - submit to the command of authority
Negative influences on milk production
-Long spaces between feedings. -long, slow feedings -excessive pressure in the breast. - breast injury or surgery
How can we assure an adequate milk supply is there?
-Universal understanding of how breastfeeding works. -early initiation and adequate breastfeeding (10-12x). -appropriate breastfeeding assessment. -appropriate HCP and LCP follow up pp
Silence (women known)
-Voiceless, powerless and mindless - afraid of words - dependent on others for survival - do not trust their abilities to develop relationship
Why do some infants lose more weight in the first postpartum days?
-When labor meds are used. -when more intrapartum fluids have been given. -when there was no labor prior to cesarean.
sysmptoms of neonatal hypoglycemia
-jitteriness -cyanosis - apnea - hypothermia - poor body time - poor feeding -seizures
why is iron deficiency anemia associated with milk supply problems
-poor oxygen to milk making cells - 20% of PP have iron deficiency anemia
blep on nipple
-women describe stabbing pinpoint pain -blebs may exit when treated as clogs. - sometimes blebs may need to be lanced
hierarchy of infant feeding choices
1. baby at breast 2. mothers own expressed milk 3. milk from Human milk bank or state licensed milk bank 4. cow milk formula 5. soy formula
what are the risks for delayed breastfeeding in the hours after birth? MOM
1. decrease in prolactin receptors activated 2. decrease in oxytocin/uterine contractions 3. decrease in milk volume 4. decrease in confidence 5. increase in risk of supplementation
What are the risks for delayed breastfeeding in the hours after birth? BABY
1. increased risk of jaundice 2. increase risk of hypoglycemia 3. decrease opportunities to practice with colostrum 4. increase risk of supplementation 5. increase PH and opportunistic microorganisms in gut
How to start breast feeding
1. line up the nose to nipple- move the baby back an inch 2. as the baby is moved toward the breast, the head tilts back. 3. a hand should not be on the back of the head 4. the bottom lip and chin meet the breast first 5. when the baby is latched optimally, there is more of the lower part of the breast drawn in 6. Nose and chin should be close to breast. 7. the angle at the corner of the mouth should be at least 140 8. both lips should optimally seal 9. the cheek line should optimally be the rounded cheek line 10. not broken, not dimpled 11. bursts of 1:1 or 2:1 in an irregular pattern equals nutritive suck 12. asymmetric latch. More of the lower part of the breast goes into the baby's mouth. 13.rocker motion optimal 14. feeding ends with hands relaxed.
Oxytocin release mechanisms
1: Conditioned response conditioned milk ejection (let down)2: nipple stretching3: baby hand massage
What do you see with oversupply
1: Rapid weight gain unsettled baby, esp. after feedings 2: recurrent plugged ducts and mastitis 3: painful feeding4: high volume of stools often green and shiny.
Pseudoephedrine causes
60 mg decreases 24 hour milk production by 24%
How much milk do we make?
750-1000 mls per day 235 mls per day (twins)
Mucosal wall protectors such as mucins and oligosaccharides in mother's milk
Adhere to microbes binding them so they can't attach to the gut wall
B12 in mothers milk
B12 binding factor reduces the amount of B12 in the intestines available to microbes
Lactogenesis I (secretory differentiation)
Beginning in mid-pregnancy to day two or day three postpartum, the breasts develop the capacity to secrete breast milk, including the secretion of colostrum.
Lactogenesis II (secretory activation)
Beginning on day two or day three postpartum until day eight, breast milk volume increases rapidly and then abruptly levels off. - complete delivery of placenta - rapid drop in progesterone
What do mothers IgA do to baby
Bind to microbes in the babies intestinal tract and prevent them from being absorbed into the rest of the body. Protects against necrotizing enterocolitis
prolactin during labor
Decreases the amount of oxytocin released curbing suckling.higher relative risk of a mother receiving a documented depressive or anxiety diagnoses.
Nursing a baby for a year or more
Decreases the risk of hypertension, diabetes, hyperlipidemia, cardiovascular disease by 10-15%
Less than 4 solid diapers on day 4
Delayed lactation may indicate breastfeeding inadequacy
PCOS
Excess insulin increases production of androgen. High androgen causes acne, excessive hair growth, weight gain, problems with ovulation and lactation.
Breastfeeding promotion
Focuses on advantages of breastfeeding on a personal, community, country or global level.
Breastfeeding protection
Focuses on government, manufacturer and social responsibility to assure breastfeeding's ability to compete with commercial interests.
Breastfeeding support
Focuses on the interaction of "helpers" with family as well as program development and implementation
Lactogenesis lll(galactopoiesis)
From approximately day nine postpartum and onwards, the volume of breast milk produced is maintained through a supply and demand mechanism. prolactin, frequent nipple stimulation, frequent removal of milk
Presence of hormones in breast milk
Growth factors that stimulate growth and development of the GI tract. Such as; GI hormonesprolactin EFG (epidermal growth factor) prostoglandins.
Breastfeeding has been recognized as a public health priority
In tropical climates since the 1930's. 1990's in the US
procedural knowers are
Invested in learning interested in obtaining and applying knowledge assume that every one including themselves can be wrong want very technical information about breastfeeding be knowledgeable about multiple sources of reference.
What to look for with green shiny stools?
Is there a deep latch with nipple stretching - if the nipple is not stretched deeply into the mouth- less oxytocin flow- less fat. Milk is digested too fast and lactase can't digest lactose. over active let down/ overproduction of milk - decrease additional stimulation/ milk removal -consider block feeding (nurse one side)try Australian posture - watch for mastitis
How is it possible for humans to make milk with such a small amount of energy expenditure
Maternal plasma prolactin concentration generally increases under conditions of negative energy balance.large fat reserves from pregnancy. changes in maternal processes can spare energy.
breast milk composition changes
Over the course of lactationpre-term vs Term milkpreterm milk appears to have different composition for the first 5-7 weeks after delivery.preterm milk is higher in protein, fat and electrolytesSGA and LGA does not seem to make a difference in milk composition
Babies with down syndrome and breast feeding
Struggle with breastfeeding • low tones •depressed reflexes. •weak suck, piston, ratio, sustain •deficiency in the smooth tongue movement
what increases gastrin and decreases somatostatin in babies
Sucking babies have cutaneous receptors In their mouths that respond to sucking starting at 27 weeks gestation species - own milk -decreased stress - wellness -touch
Corticosteroids affects milk.
Temporary suppression of lactation after a local injection of 24 mg prednisone.
Presence of bifidus factor in breast milk promotes.
The intestinal presence of lactobacillus bifidus that maintains the low PH and crowds out pathogenic organisms
Symptoms of kernicterus
Unconjugated bilirubin is fat soluble and crosses the blood brain barrier. - can cause damage to the brain. warning signs include •jaundice advancing from upper to lower body •fussiness •lethargy •feeding difficulty •fewer than 4 wet or dirty
Why is breastfeeding so difficult mothers need help?
Unrealistic expectationsLack of timely interventions.
Prolactin in breast feeding
When a baby suckles, the level of prolactin in the blood increases, and stimulates production of milk by the alveoli. The prolactin level is highest about 30 minutes after the beginning of the feed, so its most important effect is to make milk for the next feed
Adult GI hormones are also impacted by suckling
When the mother suckles, her gastrin and cholecystokinin go up. This increases the efficacy of insulin and increases the storage of ingested nutrients.
Are pacifiers good for premies?
Yes.have earlier hospital discharge.Tube fed babies gain faster with pacifiers
grade 1 inverted nipple classification
are easily pulled out with a pump or infant
breastfed babies gut
are more acidic while formula feeding is more neutral
When do engorgement symptoms typically occur
between 3 and 5 days. Mothers with IV fluids in labor and PP have higher levels of swelling up to day 9
maternal obesity and overweight causes
delay in lactogenesis 2 first 7 days
grade 3 nipples are
difficult or impossible to pull out
how to treat clogs, plugs or cakes
find out cause (like bras) massage, warmth, double nursing may help
why is there such a difference of weight gain patterns in formula fed and breastfed.
formula fed infants have hyperinsulinemia production of insulin that does not move glucose into cells
How much weight should the baby have regained by week 2
its birthweight
how to treat common mastitis
keep milk flowing and breasts soft
retained placental fragments causes
lactogenesis 11
Symptoms of sheehan
low blood pressure, anemia, fatigue, profound hair loss, dull or dry hair
clogs or plugs or cakes
lumps of milk within the lumen or duct system- usually not visible
as the pressure inside the breast increases
milk production decreases
oxytocin is increased by
nipple streching
prolactin is increased by:
nipple stroking
Breastfeeding composition changes
over the course of lactation within the day
Oxytocin
oxytocin causes the muscles around the milk-making glands in your breast to contract. When the glands contract, they squeeze the breast milk into the milk ducts. The milk ducts also contract to push the breast milkthrough your breast, and out of the nipple to your baby.
grade 2 nipples can be
pulled out but dont maintain their projection
uncommon and and emergent mastitis
the tissues if both breasts are inflamed - possible strep
receiver of knowledge (how to help)
to develop a relationship with a receiver of knowledge: teacher or counselor must project authority never be ambiguous
Subjective knowers help
to develop a relationship with subjective knowers.create time for them to talk about themselves and what they think about breastfeeding (otherwise they can take over classes or group sessions)
Raynaud's phenomenon of the nipple
vasosapsm of the nipple, pain is extreme and spasmodic