CLC Exam (Q&A A+ Graded 100% Verified)

CLC Exam (Q&A A+ Graded 100% Verified) The International Code ANS: addresses improper marketing practices ex hospital giving out discharge packages with formula Milking Stool- 3 legs ANS: Protect, promote & Support-want all to be equal Levels of evidence based pyramid ANS: 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? ANS: 3-7 days (after going home from hospital) Top reasons people stop breastfeeding ANS: baby won't latch, breast pain/soreness, work/school Russ Labs Marketing Survey ANS: survey formula company tracking breastfeeding goals Races in Order most likely to BF ANS: spanish speaking-hispanic, white, hispanic, black Global Strategy for Infant and young feeding ANS: 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 ANS: help track how they are doing on global outcomes innocenti ospitale -florence ANS: BF orphan babies increased rate of survival-today UNICEF child resource nutrition center path of messages to make milk ANS: message to breast-to nervous system -to brain- to hormones to travel to breast- then to blood stream what cells make milk ANS: alveolar cells alveolar cells are what? what are they surrounded by ANS: layer of cells with milk inside, surrounded by myoepitheal cells Myoepitheal cells will contract when what hits them ANS: oxytocin Are the ducts in breast evenly spaced? ANS: No varies woman to woman How many nipple pores each breast? ANS: 3-5 Milk is ____ &_____ from sebaceous gland ANS: antimicrobial and sticky what are the two major hormone of lactation? Where are they secreted from? ANS: oxytocin and prolactin, pituitary gland Prolactin is the hormone responsible for? ANS: Milk production What is the passage of prolactin being produced ANS: 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 ANS: 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. ANS: down, rise _______ nursing leads to lower levels of prolactin and less rise with same amount of contact. ANS: 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 ______ _______. ANS: low, not, start shutting down What is in receptor site during pregnancy? ANS: Progesterone When placenta leaves the body, the body responds by pushing ______ out of the receptor sites? ANS: 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? ANS: Prolactin If prolactin is not set during first few hours after birth- ANS: there will be fewer sites and cause issues with milk supply Ongoing milk supply is associated with suckling within first ______ hours after birth ANS: 2 For mothers with preemies initation of milk expression before _______ hours resulted in significantly more milk by day 7 ANS: one What hormone T3, T4, T5 ANS: Oxytocin When oxytocin hits myoepitheal cells what happens? ANS: They start retracting Oxytocin helps ducts to ______ in size and lumen to get ______ ANS: increase, smaller What triggers oxytocin? ANS: 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? ANS: pituitary gland ______ is excreted from posterior pituitary? ANS: Oxytocin ______ is excreted from anterior pituitary? ANS: Prolactin Prolactin is produced mainly by nipple ______, by presence of baby stimulation T ____ & T____ ANS: stimulation, 4 and 5 ________ hormone is affected by stress and ______ hormone is not affected by stress ANS: oxytocin (extreme situation, will stop flowing), prolactin Milk is species ______. ANS: Specific Mammal species with high fat/protein and low water content have ______ feeds. ANS: infrequent Lactose is essential for milk production because it provides the driving ______ force behind the formation of milk. ANS: osmotic Human milk has the highest _______ of all mammal milk. ANS: lactose human milk is ideal for ______ growth ANS: 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 ________. ANS: 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 ______. ANS: progesterone, prolactin, mature, down Lactogensis stage 3 is also called ( has two other names) ANS: lactation or galactopoesis Lactogensis stage 3 has _____ from frequent nipple stimulation, there is ______removal of milk and long term production of ______ ANS: prolactin, frequent, milk As prolactin goes into receptor sites and makes milk the ______ disappear ANS: spaces Preterm milk appears to have higher ______, _______ and _____ than term milk (sga, lga does not matter) ANS: protein, fat and electrolytes Breastmilk changes after 6 months it is more _____, fat _____ and after a year fat _________ and energy content ______ ANS: dense, increases, increases, increases does it matter if it is foremilk, hindmilk ANS: no think of kalahari desert nurse for 2.5 min at a time Breastmilk composition ______ during a feed. ANS: changes when doing before and after breastfeeding weight even if volume is low, fat content can be _______. ANS: high the degree of breast ______ influences the amount of milk available and breast storage _____ influences the amount of fat transfered. ANS: emptying, capacity longer times in between feed leds to ______ fat concentration ANS: lower faster milk removal is associated with _____fat content and longer feeding time is associated with ______ levels of milk transfer and _____ fat ANS: higher, lower, lower Does one breast or two breast feed matter? ANS: doesnt matter just do whatever seems better for baby Do male babies haver higher energy content in milk? ANS: yes Can men produce milk? What situation? Men can never produce? ANS: yes, tumor/drugs, colustrum Formula fed babies have ______ extra in the gut ANS: iron Presence of bifidus factor in milk promotes presence of _________ ________ maintaing. a ____ PH and crowd out pathogenic _______. ANS: lactobicillus bifidus, low, organisms Formula fed babies have increased number of species and over representation of ANS: 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. ANS: microbes What do human milk oligosaccharides (HMOs) do? ANS: 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 ANS: 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. ANS: parasympathetic , somatostatin and gastrin Pregnancy can increase risk for type 2 diabetes, breastfeeding can negate this, suckling changes insulin back to ________. ANS: 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? ANS: less that 7% according to AAP, by day 5, by 2 weeks Breastfeeding stool color change ANS: meconium-dark to start then greenish tinge then seedy orange or yellow Need at least _____ breastfeeds per day? ANS: AAP says should be at least _____ formal evaluation and documentation of trained caregiver per shift ANS: one Does it make a difference if mother is undernourished for breastfeeding? In refugee camp what is safer breastfeeding or formula? ANS: No, breastfeeding - no access to clean water, heating sterilization Breast size affects milk production? T/F ANS: False Does increasing fluid increase milk production T/F? ANS: False Too much exercise can impact milk production? T/F ANS: False Does stress impact milk production? T/F ANS: False although stress can change behavior When infant suckles at breast there is outpoor of ___ different GI hormones? ANS: 19 How many extra calories per day are required when breastfeeding? ANS: 500 secretory activation is also called ANS: lactogensis stage 2 the absence of the placenta leads to lactogensis stage, then drop in progesterone leads to lactogensis stage ___ ANS: 2, 3 In nipple engorgement breast is _____, body temp ____, brest can be hot and ____ ANS: hard, increased , shiny Engorgement typically happens days ___-___, women with c-sections may experience engorgement ______ ANS: 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. ANS: engorgement, negative Engorgement can be natures _____ ANS: 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? ANS: Engorgement Will pumping help engorgement ANS: No can bust capillaries and cause bleeding How to help with engorgement? ANS: 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? ANS: too much milk left in breast (baby is too weak), breast implants, tight bra What is a marker that they had a breast augmentation ANS: really round aeorola, or incision Can woman with implants/ breast reduction breast feed? ANS: 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? ANS: Yes baby can form teat, although thing about the need for nipple stroking (prolactin) and nipple stretching (oxytocin) 3 classification of inverted nipples ANS: 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? ANS: Poor oxygen to milk making cells, or causing mom to feel exhausted or depressed causing lack of bf Sheehan's syndrome (postpartum pituitary necrosis) ANS: 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 ___ ANS: 2 PCOS excess insulin increases production of _____, higher androgens cause acne, excessive hair growth, wt gain and problems with ovulation and _______, possible treatment with ANS: androgens, lactation, metformin Drug that cause milk delay? ANS: 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 Mothers who smoke have lower _____ levels if smoked within 12 hrs. ANS: prolactin Are nicotine patches safe during BF ANS: refer to healthcare provider Cadmimum is a heavy metal found in _____ and _____ ANS: cigarettes and formula What types of formulas have more cadmimum? ANS: Soy based 22% of all SIDs contributed deaths can be contributed to ANS: maternal smoking during pregnancy Are electronic cigarettes safe in pregnancy? ANS: tested by FDA some contain nicotine and carcinogens, nicotrine transfer appears minimal Cannabis and Breastfeeding? ANS: passive exposure is a concern, no safe threshold, lack of studies and high fat solubility makes cannabis difficult to analyaze in breast milk, opinions vary THC is still measurable in EBM ____ days after maternal marijuana use ANS: 6 Pacifiers increase risk for ______ and _____ ANS: diarrhea and ear infections Pacifiers for preemies? ANS: May have earlier hospital discharge, tube fed may gain weight faster, improve physiologic and behavioral responses and reduce the time to oral feeds, will not affect breastfeeding for preemies Babies that recieve additional water are at risk for? And this can cause ANS: Water intoxication- can cause seizures, stroke, death Early cessation/negative experience of breastfeeding has a increased risk of postpartum _______ ANS: depression What is postpartum depression scale? ANS: Edinburgh Postnatal Depression Scale -EPDS Mothers with EPDS scores greater than ____ are likely to d/c breastfeeding by week 4-12. ANS: 12 Womans ways of knowing is by ANS: Mary Belenky What are the 5 characteristics of womans ways of knowing? ANS: 1. Silence 2. Recievers of knowledge 3. subjective knowing 4. Procedural knowing 5. Constructive Knowing Silence way os knowling ANS: afraid of words, feels powerless, depends on others, little awareness of intellectual capabilities, having powerful person in charge ex paulette legally blonde How do we develop relationship with person in Silence? ANS: Few words, short easy, comfortable, nothing to remember advocate Recievers of Knowledge? ANS: Believe all authorities tell truth, like to learn right answer and tell it to the teacher, cannot tolerate ambiguity ex: vivian pretty woman How to teach to receiver of knowledge? ANS: only show right way and have them do return demo Subjective Knowers? ANS: knowing is personal and based on inuition or thought, inner voice guides them , distrust male figure, find female support groups helpful, trust woman with similar experiences ex: Cher How to teach subjective knowers? ANS: create time for them to talk about themselves and what they know about BF, offer help with possible misconceptions Procedural Knowing? ANS: position in which techniques for acquiring, validating and evaluating knowledge claims are developed and honored, invested in learning and takin in new info, want diff point of view How to teach procedural knowers? ANS: Limit personal stories, understand the option change is part of the process Constructed Knowing ANS: truth is contextual, knowledge is tentative, avoid compartments, they want to be same person no matter who they are with, empathetic Hierarchy of Infant feeding choices? ANS: 1. baby at mothers breast 2. Mother own expressed milk 3. cow milk formula 4. soy formula No one flange size for each mom- too tight if nipple is rubbing against______ ANS: tunnel milk hand expression has a higher ____ content then pumped with electric pumped and is the _____way to collect milk ANS: fat, cleanest how to hand express ANS: push back and squeeze gently thawed milk is good at room temp for? ANS: 1-2 hrs _____ and its spores has been found in infant formula. ANS: clostridia WHO and CDC recommend mixing water at what temp with powder formula? ANS: 70 degrees Other issues associated with formula fed babies is? ANS: Reflux (cow milk allergy), reflux, colic, anaphylaxis LCPUFAs ANS: do not lead to better outcomes Complication of improper use of almond drink in first year? ANS: Scurvy Babies that are fed goat milk may have? ANS: electrolyte imbalances, metabolic acidosis, folate deficiency How much milk does a woman make a day? ANS: 750-1000 mls per day WHO study in 2006 said what are the growth standard for babies? ANS: exclusively BF babies weight gain pattern of formula fed babies at 2 mo might be sign of ANS: hyperinsulinemia higher weight gain by 3 mo of formula fed babies is because of ANS: hyperinsulinemia, also higher protein in cows milk _____ is part of CDC prevention of obesity? ANS: breastfeeding Condition to not breastfeed ANS: galactosemia Galactosemia ANS: recessive genetic disorder; characterized by body's inability to tolerate galactose, causes damage to liver, cns and body system Viruses in which you should not breastfeed? ANS: HIV, T cell lymphotrophic virus or type 2, ebola, untreated brucellosis, HSV with lesions present, untreated TB or chicken pox Can a mom breastfeed while using illicit drugs? ANS: No unless on methadone program What medications can a mom not breastfeed? ANS: chemo drugs, rheumatoid arthritis, check book, undergoing radiopharmaceuticals What is a example of loaded language? ANS: you have a good baby Late preterm babies are what age? What is our concern about them? ANS: 34-37 weeks pretend to be swallowing go home and tank How should a counseling session go? ANS: Listen and gather information, use questions that cant be answered with a single word, verify what youve heard, offer individualized information, work together and form a plan, fine tune plan and ask what they are going to be doing when leaving, make sure they understand, listen and help with referrals, document Women with history of what are at higher risk for post partum disorder ANS: premenstrual syndrome and dysphoric disorder When discussing things postpartum should you give a ton of information? ANS: No recall is less during post partum tiredness, limit discussion keep it client centered, educate with truth, validate confidence and counter negativity Babies born during what time of the day are more likely to be supplemented? ANS: the night and early morning Pitocin decreases what needed for breastfeeding? Risk factors? Apgar, NICU? ANS: Oxytocin, lower apgar and increased nicu risk What to do for clogs? ANS: Find out cause if recurring, massage (side of hand) warmth, double nursing (start on the side of the clog, go to the other breast go back to clog) when to contact health care provider about clog? ANS: Does not move 24-48 hours or parent develops systemic issues-achey, fever, flu like may need antibiotics What is a bleb? ANS: clog on nipple tip, look like milk blisters, one duct opening covered, stabbing pin point pain, may exit like clog, may need to be lanced common mastitis ANS: breast inflammation, infective or non-infective, milk making cells squeeze out of normal compartment and body reacts like invader What can cause mastitis? ANS: blocked ducts from engorgement, hurried feeding, use of nipple shield, attachment difficulties, tight bra, use of breast shield First things to try to help with mastitis ANS: NSAIDS, keep milk flowing and breasts soft and comfortable, avoid abcess develop, if you dont want to feed can hand express or pump If mastitis treatments do not help what should be considered? ANS: anemia ductal or inflammatory breast cancer uncommon and emergent mastitis ANS: 2 hot red inflammed breasts, tissues of both breasts inflammed, strep is propable organism, potential fatal whole body inflammation MRSA on breasts ANS: can look like mastitis, new issues, lesion or abcess Abscess on breast ANS: pus not milk, 60% positive for MRSA, nursing on other breast is possible, no clear answer nursing on breast, ultrasound guide with needle aspiration What is deadly concerns of something appearing on breast? ANS: MRSA or herpes What is torticollis? ANS: neck muscles contract, causing the head to twist to one side, can cause feeding issues Goldsmith sign ANS: baby will only nurse on one breast, try nursing on the one breast then without moving baby move to other breast cutoff for hypoglycemia, symptoms ANS: 40m cyanosis, apnea, hypothermia, poor body tone, lethargy, seizures hypoglycemia occurs commonly in what babies? ANS: SGA, LGA, diabetic mother, late preterm What can give for low blood sugar and can still nurse? ANS: gel in cheek, can still breastfeed What is jaundice caused by? ANS: uncongugated bilirubin (waste product of hemoglobin breakdown taken up by the liver, it is converted by the enzyme into uncongugated bilirubin), recycling problem, baby's liver enzymes and intestines are immature and took a while to get out of baby's system, can cross blood brain barried, damage brain, spinal cord and become kerniicterus, bilirubin encelopothy, CP, dental impairements, mental retardation, death Kernicterus ANS: severe jaundice, untreated too long, is a type of brain damage, can cause CP and hearing loss what is considered late preterm? ANS: 34-35/6 early term babies ANS: 37-38/6 how might preterm and early term babies struggle with breastfeeding? ANS: less alert, less stamina, greater difficulty latching, issues transfering milk PIBBS ANS: preterm infant breastfeeding behavior scale what breastfeeding technique is good for hypotonic like down syndrome ANS: dancer breastfeeding position breastfeeding with cleft lip or palate ANS: making a seal/vaccum the challenge, use alternitive massage, mother nipple point to intact part of palate, mother keep up coordinate with baby suck and swallow Does breastfeeding lower cases of otitis media? ANS: yes What can you do right away to increase milk volume? ANS: hand expression within 1 hour of birth, express in proximity to infant, double stimulation (send x3 messages to brain), collect milk on one breast while nursing on other Power pumping ANS: for a day or 2 might increase volume, pump 5 min, pause 5 min, pump 5 min What is protocolitis? When might it occur? ANS: rectal bleeding may occur in exclusively breastfeeding- cows milk protein allergy, standard treamtent offending protein from mothers diet (cows milk, corn, soy, milk, egg and chocolate), resolution of visible rectal bleeding took place 72-96 hrs in most babies Why is it important to support calcium needs in breastfeeding? ANS: breastmilk calcium is met by renal calcium conservation and lost of bone (3-9% decrease in bone density during lactation) but gain after weaning how much alcohol per kg is safe for breastfeeding mother ANS: 0.5 g of alcohol per kg 9 stages of skin to skin ANS: 1. birth cry 2. relaxation 3. Awakening 4. activity 5. rest 6. crawling/sliding 7. famerilization 8. suckling 9. sleeping WBTi ANS: World breastfeeding trends initative-assists countries to assess the status and benchmark progress of the global strategy for infant and young child breastfeeding considerations at 4-6 months ANS: easily distractible, may need to be quieter place, seperation anxiety, sore nipple can happen as teething and saliva changes and new enzymes Complementary feeding ANS: refers to anything other than breastmilk and infant formula-both solids and liquids, when milk no longer sufficient to meet nutritional requirements 6-9 months development ANS: mobile, teething, regular naps, periods of concentration, nught feeding, may bite breast-say no end feeding be calm and offer breast normal at next feed 9-12 development ANS: stand/walk regular mealtimes, snack nursing, nursing before bed and naps