CLC EXAM QUESTIONS WITH COMPLETE
SOLUTION
What type of breast pump do premies need?
hospital grade pumps
What tissue of the breast produces breast milk?
Glandular tissue.
What tissue will determine breast size?
Adipose (fat tissue)
Describe the anatomy of glandular tissue in the breast
Glandular tissue contains alveolus (modified sweat glands) which is where
alveolar cells are located. Alveolar cells in the alveolus produce breastmilk
when stimulated by prolactin. The alveolus is lined by myoepithelial cells
that contract and squeeze the breast milk into lactiferous ducts when
stimulated by oxytocin.
Why does fat content change during a breastfeeding session?
In the beginning of the BF session, fat globules are "stuck" in the alveolus
resulting in less fat in the milk initially taken from the lactiferous ducts. This
is also known as "fore milk". As the feeding continues, fat globules dislodge
and pass through the lactiferous duct resulting in more fat in BM. This is
known as "hind milk"
Foremilk
BM at the beginning of the feeding session.
Hindmilk
BM at the end of the feeding session.
BM production during pregnancy
The Placenta secretes human placental lactogen hormone and
progesterone hormone. The Anterior Pituitary secretes prolactin. This
stimulates granular tissue growth and prepares the alveolar cells to make
milk. Because progesterone levels are high during pregnancy, this inhibits
the milk let down. Their may be some leakage of milk from the nipple
during pregnancy.
BM production after birth
Placenta is delivered and progesterone levels drop. allowing the let down
reflex to occur. Colostrum is produced which has immune cells, antibodies
and nutrients for the newborn infant.
Milk Let Down Process
,Milk let down occurs when the infant has a proper latch at the breast.
Suckling stimulates the mechanism receptors in nipples to send signals
through the intercostal nerves that travel to the dorsal root ganglion of the
spine which signal to the hypothalamus to inhibit dopamine release to allow
the anterior pituitary to secrete prolactin and the posterior pituitary to
release oxytocin. Prolactin stimulates alveolar cells in alveolus to produce
milk and oxytocin stimulates the myoepethelial cells that line the alveolus to
contract and release milk.
What are the two hormone pathways that control lactation?
Prolactin and Oxytocin
Prolactin
Hormone secreted by pituitary gland that stimulates alveolar cells in
glandular tissue of breast to produce milk
oxytocin
Hormone released by the posterior pituitary responsible for milk let down
(milk ejection) during BF and uterine contractions during childbirth
Remaining fragments of placenta can cause what problem in
breastfeeding?
delay and decrease release of prolactin which impairs breastmilk
production and increases risk of hemorrhage postpartum.
what hormone can inhibit ovulation?
Prolactin
What is the main inhibitor of prolactin?
Progesterone
mammary cells aka
alveolar cells of glandular tissue
What are the 3 stages (think ages) of early breast development?
1. In utero
2. first 2 months of life
3. puberty
Estrogen is produced by what organs?
produced by placenta, ovaries, adrenal glands
Estrogen function
responsible for development of mammary glands and growth.
Progesterone function
aids in development of milk- secreting cells in the breast.
Progesterone is produced by?
produced by ovaries and placenta
How does Pitocin affect BF?
,Pitocin: synthetic, IV Pitocin induce contractions, may delay lactogenesis 2
(mature milk/copius milk day 3-8) because Pitocin uses up the oxytocin
receptors of brain.
Name the quadrants of the breasts
Montgomery Glands what are they/function:
Montgomery glands are sebaceous glands that lubricate breast tissue and
nipple. do not wash breast nipple using soap-dry skin out. no scented
products, interfere w/ newborns ability to smell milk
Nipple Variations
*variations :
- protrudes,
- flat/short
- pseudo-inverted nipple- appears inverted, but will evert with stimulation
- retracted nipple - retract with stimulation
- Inverted nipple ( retracts at rest and when stimulated)
What is the purpose of the vascular network surrounding breast
tissue?
- supplies nutrients, materials, hormones to each alveolus for milk
production
- supplies hormones to the myoepithelial cells for milk ejection
What is BM made of?
What is BM made of
* majority is h20 87%
protein 1.2% (amino acids needed for growth development,
lactoferrin iron binding protein decreases GI infection, lysozymes growth
of intestinal flora),
* carb 7%
* lipids 3.8 %(fatty acids3-5% of milk, 40-50% of infant nutrient
requirements),
* DHA needed for growth immune function,
* vitamins A K,
* minerals sodium small amount, Iron
importance of protein lactoferrin in BM
iron binding protein that decreases GI infection
DHA is needed for
DHA needed for growth immune function
Sugar in all mammal milk
Lactose
Why is lactose essential in BM production?
It provides driving osmotic force behind fluid formation of milk
, Colostrum definition and purpose for newborn
early milk, some people may express during pregnancy
o Rich in proteins, minerals, 1 drop colostrum denser in nutrients, facilitates
good GI flora, facilitates passage of meconium (stool in utero sooner out
decrease jaundice), low in volume due to infant stomach capacity
Milk Composition after 1 year of BF
Increased fat and energy.
milk volume stays constant but composition changes.
provides zin which supports immune system
Breastmilk is low in this nutrient but it's very bioavailable
Iron (sufficient iron is in baby's body until 4-6 months)
Which nerves innervate the breasts
T3-T5
Number one reason why moms stop breastfeeding is due to
perceived low milk supply
Elimination pattern that indicates BF problem. If any of these signs
are present- refer to pediatrician:
o No transitional or seedy stools by day 4
o Less than 6 voids by day 4
o Urate crystal after day 3- Orange crystal present in pee of diaper- in the
first few days is normal. After 3 days- require referral to pediatrician. Sign of
dehydration.
Transitional stools after meconium
as copious milk comes in- stool turns darker green color
When copious milk is in infant stool should appear
Yellow Seedy stool
o The seedy texture is undigested milk fat- WNL.
What is the infant's first stool called?
meconium- tarry sicky black appearance. Pass within first 24 hours
Normal Elimination Patterns of Newborn Infants?
Adequate urination: baby hydrated
o 3 days old-3 wet diapers per day
o 4 days old and older- around 6 wet diapers per day
Adequate stools: getting enough calories
o Increase in number the first few days of Life
o 4 days old- 4 stools per day
o Should be bigger than a quarter size
o B.M. poop not as odorous as formula poops
SOLUTION
What type of breast pump do premies need?
hospital grade pumps
What tissue of the breast produces breast milk?
Glandular tissue.
What tissue will determine breast size?
Adipose (fat tissue)
Describe the anatomy of glandular tissue in the breast
Glandular tissue contains alveolus (modified sweat glands) which is where
alveolar cells are located. Alveolar cells in the alveolus produce breastmilk
when stimulated by prolactin. The alveolus is lined by myoepithelial cells
that contract and squeeze the breast milk into lactiferous ducts when
stimulated by oxytocin.
Why does fat content change during a breastfeeding session?
In the beginning of the BF session, fat globules are "stuck" in the alveolus
resulting in less fat in the milk initially taken from the lactiferous ducts. This
is also known as "fore milk". As the feeding continues, fat globules dislodge
and pass through the lactiferous duct resulting in more fat in BM. This is
known as "hind milk"
Foremilk
BM at the beginning of the feeding session.
Hindmilk
BM at the end of the feeding session.
BM production during pregnancy
The Placenta secretes human placental lactogen hormone and
progesterone hormone. The Anterior Pituitary secretes prolactin. This
stimulates granular tissue growth and prepares the alveolar cells to make
milk. Because progesterone levels are high during pregnancy, this inhibits
the milk let down. Their may be some leakage of milk from the nipple
during pregnancy.
BM production after birth
Placenta is delivered and progesterone levels drop. allowing the let down
reflex to occur. Colostrum is produced which has immune cells, antibodies
and nutrients for the newborn infant.
Milk Let Down Process
,Milk let down occurs when the infant has a proper latch at the breast.
Suckling stimulates the mechanism receptors in nipples to send signals
through the intercostal nerves that travel to the dorsal root ganglion of the
spine which signal to the hypothalamus to inhibit dopamine release to allow
the anterior pituitary to secrete prolactin and the posterior pituitary to
release oxytocin. Prolactin stimulates alveolar cells in alveolus to produce
milk and oxytocin stimulates the myoepethelial cells that line the alveolus to
contract and release milk.
What are the two hormone pathways that control lactation?
Prolactin and Oxytocin
Prolactin
Hormone secreted by pituitary gland that stimulates alveolar cells in
glandular tissue of breast to produce milk
oxytocin
Hormone released by the posterior pituitary responsible for milk let down
(milk ejection) during BF and uterine contractions during childbirth
Remaining fragments of placenta can cause what problem in
breastfeeding?
delay and decrease release of prolactin which impairs breastmilk
production and increases risk of hemorrhage postpartum.
what hormone can inhibit ovulation?
Prolactin
What is the main inhibitor of prolactin?
Progesterone
mammary cells aka
alveolar cells of glandular tissue
What are the 3 stages (think ages) of early breast development?
1. In utero
2. first 2 months of life
3. puberty
Estrogen is produced by what organs?
produced by placenta, ovaries, adrenal glands
Estrogen function
responsible for development of mammary glands and growth.
Progesterone function
aids in development of milk- secreting cells in the breast.
Progesterone is produced by?
produced by ovaries and placenta
How does Pitocin affect BF?
,Pitocin: synthetic, IV Pitocin induce contractions, may delay lactogenesis 2
(mature milk/copius milk day 3-8) because Pitocin uses up the oxytocin
receptors of brain.
Name the quadrants of the breasts
Montgomery Glands what are they/function:
Montgomery glands are sebaceous glands that lubricate breast tissue and
nipple. do not wash breast nipple using soap-dry skin out. no scented
products, interfere w/ newborns ability to smell milk
Nipple Variations
*variations :
- protrudes,
- flat/short
- pseudo-inverted nipple- appears inverted, but will evert with stimulation
- retracted nipple - retract with stimulation
- Inverted nipple ( retracts at rest and when stimulated)
What is the purpose of the vascular network surrounding breast
tissue?
- supplies nutrients, materials, hormones to each alveolus for milk
production
- supplies hormones to the myoepithelial cells for milk ejection
What is BM made of?
What is BM made of
* majority is h20 87%
protein 1.2% (amino acids needed for growth development,
lactoferrin iron binding protein decreases GI infection, lysozymes growth
of intestinal flora),
* carb 7%
* lipids 3.8 %(fatty acids3-5% of milk, 40-50% of infant nutrient
requirements),
* DHA needed for growth immune function,
* vitamins A K,
* minerals sodium small amount, Iron
importance of protein lactoferrin in BM
iron binding protein that decreases GI infection
DHA is needed for
DHA needed for growth immune function
Sugar in all mammal milk
Lactose
Why is lactose essential in BM production?
It provides driving osmotic force behind fluid formation of milk
, Colostrum definition and purpose for newborn
early milk, some people may express during pregnancy
o Rich in proteins, minerals, 1 drop colostrum denser in nutrients, facilitates
good GI flora, facilitates passage of meconium (stool in utero sooner out
decrease jaundice), low in volume due to infant stomach capacity
Milk Composition after 1 year of BF
Increased fat and energy.
milk volume stays constant but composition changes.
provides zin which supports immune system
Breastmilk is low in this nutrient but it's very bioavailable
Iron (sufficient iron is in baby's body until 4-6 months)
Which nerves innervate the breasts
T3-T5
Number one reason why moms stop breastfeeding is due to
perceived low milk supply
Elimination pattern that indicates BF problem. If any of these signs
are present- refer to pediatrician:
o No transitional or seedy stools by day 4
o Less than 6 voids by day 4
o Urate crystal after day 3- Orange crystal present in pee of diaper- in the
first few days is normal. After 3 days- require referral to pediatrician. Sign of
dehydration.
Transitional stools after meconium
as copious milk comes in- stool turns darker green color
When copious milk is in infant stool should appear
Yellow Seedy stool
o The seedy texture is undigested milk fat- WNL.
What is the infant's first stool called?
meconium- tarry sicky black appearance. Pass within first 24 hours
Normal Elimination Patterns of Newborn Infants?
Adequate urination: baby hydrated
o 3 days old-3 wet diapers per day
o 4 days old and older- around 6 wet diapers per day
Adequate stools: getting enough calories
o Increase in number the first few days of Life
o 4 days old- 4 stools per day
o Should be bigger than a quarter size
o B.M. poop not as odorous as formula poops
