CLC Exam Questions and Answers

CLC Exam Questions and Answers The International Code addresses improper marketing practices ex hospital giving out discharge packages with formula Milking Stool- 3 legs Protect, promote & Support-want all to be equal Levels of evidence based pyramid top - bottom: 1.Metanalysis &systemic reviews 2. Single randomized controlled studies 3. Cohort studies 4. Case Controlled Studies 5. Case Studies When is greatest risk of stopping breastfeeding? 3-7 days (after going home from hospital) Top reasons people stop breastfeeding baby won't latch, breast pain/soreness, work/school Russ Labs Marketing Survey survey formula company tracking breastfeeding goals Races in Order most likely to BF spanish speaking-hispanic, white, hispanic, black Global Strategy for Infant and young feeding WHO and UNICEF developed this global strategy to focus world attention on impact of feeding practices on the nutritional status, growth, development and health and thus the survival of infants and young children. World Breastfeeding trends innitive help track how they are doing on global outcomes innocenti ospitale -florence BF orphan babies increased rate of survival-today UNICEF child resource nutrition center path of messages to make milk message to breast-to nervous system -to brain- to hormones to travel to breast- then to blood stream what cells make milk alveolar cells alveolar cells are what? what are they surrounded by layer of cells with milk inside, surrounded by myoepitheal cells Myoepitheal cells will contract when what hits them oxytocin Are the ducts in breast evenly spaced? No varies woman to woman How many nipple pores each breast? 3-5 Milk is ____ &_____ from sebaceous gland antimicrobial and sticky what are the two major hormone of lactation? Where are they secreted from? oxytocin and prolactin, pituitary gland Prolactin is the hormone responsible for? Milk production What is the passage of prolactin being produced baby suckles- message to nervous system tells brain to secrete prolacin in blood- then tranverse into mother body into milk cells where milk is produced When doe humans have prolactin in them all the time (non pregnant, non lactating breast and nipples increase level of prolactin when touched) Prolactin levels go _____ in between nursing and _____ during nursing. down, rise _______ nursing leads to lower levels of prolactin and less rise with same amount of contact. infrequent If infants do no have frequent times at breast first few days prolactin will be _____ and sites will ____ be primed and receptor sites will start to ______ _______. low, not, start shutting down What is in receptor site during pregnancy? Progesterone When placenta leaves the body, the body responds by pushing ______ out of the receptor sites? progesterone When placenta is pushed out of body, progesterone leaves the receptor sites and they are open briefly, what goes inside to set site for lactation? Prolactin If prolactin is not set during first few hours after birth- there will be fewer sites and cause issues with milk supply Ongoing milk supply is associated with suckling within first ______ hours after birth 2 For mothers with preemies initation of milk expression before _______ hours resulted in significantly more milk by day 7 one What hormone T3, T4, T5 Oxytocin When oxytocin hits myoepitheal cells what happens? They start retracting Oxytocin helps ducts to ______ in size and lumen to get ______ increase, smaller What triggers oxytocin? 1. conditioned response (repeated stimuli over time) 2. Nipple Stretching (happens with proper latch- oxytocin levels goes up and down with suck and swallow) 3. baby hand massage (has to do with T3 and T5) each hand movement releases oxytocin Where is oxytocin and prolactin excreted? pituitary gland ______ is excreted from posterior pituitary? Oxytocin ______ is excreted from anterior pituitary? Prolactin Prolactin is produced mainly by nipple ______, by presence of baby stimulation T ____ & T____ stimulation, 4 and 5 ________ hormone is affected by stress and ______ hormone is not affected by stress oxytocin (extreme situation, will stop flowing), prolactin Milk is species ______. Specific Mammal species with high fat/protein and low water content have ______ feeds. infrequent Lactose is essential for milk production because it provides the driving ______ force behind the formation of milk. osmotic Human milk has the highest _______ of all mammal milk. lactose human milk is ideal for ______ growth brain Lactogensis stage 1 is secretory differentiation and production of _______ under influence of _______ hormones. When placenta is delivered _________ hormones is gone and _____ goes into receptor sites. Then we go to ________. colustrum, placental, progesterone, prolactin lactogensis stage 2 Lactogensis stage 2- rapid decrease in _______ and now ______ is in cells. The colustrum will change over to ______ milk and colustrum will go ______. progesterone, prolactin, mature, down Lactogensis stage 3 is also called ( has two other names) lactation or galactopoesis Lactogensis stage 3 has _____ from frequent nipple stimulation, there is ______removal of milk and long term production of ______ prolactin, frequent, milk As prolactin goes into receptor sites and makes milk the ______ disappear spaces Preterm milk appears to have higher ______, _______ and _____ than term milk (sga, lga does not matter) protein, fat and electrolytes Breastmilk changes after 6 months it is more _____, fat _____ and after a year fat _________ and energy content ______ dense, increases, increases, increases does it matter if it is foremilk, hindmilk no think of kalahari desert nurse for 2.5 min at a time Breastmilk composition ______ during a feed. changes when doing before and after breastfeeding weight even if volume is low, fat content can be _______. high the degree of breast ______ influences the amount of milk available and breast storage _____ influences the amount of fat transfered. emptying, capacity longer times in between feed leds to ______ fat concentration lower faster milk removal is associated with _____fat content and longer feeding time is associated with ______ levels of milk transfer and _____ fat higher, lower, lower Does one breast or two breast feed matter? doesnt matter just do whatever seems better for baby Do male babies haver higher energy content in milk? yes Can men produce milk? What situation? Men can never produce? yes, tumor/drugs, colustrum Formula fed babies have ______ extra in the gut iron Presence of bifidus factor in milk promotes presence of _________ ________ maintaing. a ____ PH and crowd out pathogenic _______. lactobicillus bifidus, low, organisms Formula fed babies have increased number of species and over representation of C-diff BF babies have antibiodies that bind to _______ in GI tract that keep them from getting absorbed. This helps to protect from NEC IN preemies. microbes What do human milk oligosaccharides (HMOs) do? Protect against pathogenic infection, promote development of intestine, help establish gut microbia, stimulate maturity of immune system Breastfeeding changes immune system in mother or baby both forever when baby is suckling it activates her _______nervous system. Decreasing levels of _________ and increasing levels of ____ causing a feeling of sedation and satiety. parasympathetic , somatostatin and gastrin Pregnancy can increase risk for type 2 diabetes, breastfeeding can negate this, suckling changes insulin back to ________. pre pregnancy state After first few days of birth most babies loose weight (diuresis-loosing fluid after birth) how much weight loss is acceptable? When should weight loss stop? When should baby be back to birth weight? less that 7% according to AAP, by day 5, by 2 weeks Breastfeeding stool color change meconium-dark to start then greenish tinge then seedy orange or yellow Need at least _____ breastfeeds per day? AAP says should be at least _____ formal evaluation and documentation of trained caregiver per shift one Does it make a difference if mother is undernourished for breastfeeding? In refugee camp what is safer breastfeeding or formula? No, breastfeeding - no access to clean water, heating sterilization Breast size affects milk production? T/F False Does increasing fluid increase milk production T/F? False Too much exercise can impact milk production? T/F False Does stress impact milk production? T/F False although stress can change behavior When infant suckles at breast there is outpoor of ___ different GI hormones? 19 How many extra calories per day are required when breastfeeding? 500 secretory activation is also called lactogensis stage 2 the absence of the placenta leads to lactogensis stage, then drop in progesterone leads to lactogensis stage ___ 2, 3 In nipple engorgement breast is _____, body temp ____, brest can be hot and ____ hard, increased , shiny Engorgement typically happens days ___-___, women with c-sections may experience engorgement ______ 3-5, laet With engorgement the more time spent breastfeeding in the first 48 hours will result in less _____, it pressure is not resolved it will have a ____ impact on breast milk supply. engorgement, negative Engorgement can be natures _____ dry up method Inbetween milk making cell systems there is a capillary network delivering nutrients for making milk, if those are crushed nutrient and hormones cannot go where they need to go. What can crush these and cause problems? Engorgement Will pumping help engorgement No can bust capillaries and cause bleeding How to help with engorgement? Bucket warm water-immerse breast and within seconds milk will come out, dont want to let all milk into bucket just get some out until plyable and softer, then feed rest to baby What can cause engorgement? too much milk left in breast (baby is too weak), breast implants, tight bra What is a marker that they had a breast augmentation really round aeorola, or incision Can woman with implants/ breast reduction breast feed? Yes do not know impact until trying, just because colostrum not sure if will get normal milk -colustrum is pregnancy hormone induced, need nerves for rest of milk Can a baby latch with inverted nipple? Yes baby can form teat, although thing about the need for nipple stroking (prolactin) and nipple stretching (oxytocin) 3 classification of inverted nipples grade 1- easily pulled out by breast pump or nursing, at reast look inverted grade 2 can be pulled out but dont maintain their projection grade 3 difficult or impossible to pull out iron deficiency anemia has been associated with milk supply problems due to? Poor oxygen to milk making cells, or causing mom to feel exhausted or depressed causing lack of bf Sheehan's syndrome (postpartum pituitary necrosis) A patient fails to lactate after an emergency C-section with marked blood loss. Pituitary has been deprived of blood and functions are impaired other symptoms included low blood pressure, anemia, fatigue, profound hair loss, dull hair. Can have symptoms partially or fully resolved. Maternal obesity/overweight can delay lactogenis ___ 2 PCOS excess insulin increases production of _____, higher androgens cause acne, excessive hair growth, wt gain and problems with ovulation and _______, possible treatment with androgens, lactation, metformin Drug that cause milk delay? peeudoephedrine (think pseudofed), corticosteriods, betamethason (giving to women who will deliver before 24 weeks) if given 3-9 days before delivery can delay lactogensis 2