CLC EXAM STUDYGUIDE 2024/2025. 350+ Questions and Answers Exam (100% Detailed and Correct)

CLC EXAM STUDYGUIDE 2024/2025. 350+ Questions and Answers Exam (100% Detailed And Correct) What are green/shiny stools a sign of? - Answer--sign of overproduction leading to less fat in milk, faster digestion causing not enough time for lactase to digest the lactose in milk. An improved latch could allow for more fat flow Signs of oversupply - Answer-Rapid weight gain in infant, unsettled baby after feeding, recurrent plugged ducts and mastitis, painful feedings, voluminous (huge volumes of) stools- often green & shiny What causes nipple pain? - Answer-Improper latch-- need lactation support to help with proper latch on, good seal True/false: baby should be pulled into breast. - Answer-False! Do not pull baby into breast, let baby tilt head back for optimal latch. Hand on back of baby's head can interfere baby's interoral function by restricting the movement of the cranio-cervical spine-- causes nipple trauma. Make sure crook of arm in cradle position does not block baby from being able to fully tilt back. Should a latch be symmetric or asymmetric? - Answer-Asymmetric! A baby should form a teat with breast tissue underneath the nipple as part of a latch What is a symmetric latch - Answer-Not a good latch, causes nipple damage Asymmetric latch - Answer-Optimal attachment to the breast, where the baby's lips are not centered in relationship to the areolar, but rather vertically off-centered with the baby's chin and lower lip closer to the edge of the areola than the baby's upper lip. A baby should form a teat with breast tissue underneath the nipple as part of a latch Do nipple creams work? - Answer-Continued questions of effectiveness, fear of ingestion by baby Should a frenotomy be suggested for tongue tie? - Answer-No study was able to report that frenotomy led to better long term breastfeeding Tongue tied breastfeeder - Answer--complete feeding assessment and suggest ways to optimize latch. -refer onward for diagnosis (have PCP diagnose TT) -provide support What is a fissure straight down the nipple evidence of? - Answer-A symmetric latch. Top lip needs to have good seal, moist part of lip should be touching nipple, can roll out top lip, to reduce injury during BF Is there a deep latch with nipple stretching? - Answer-If nipple not stretched deeply into mouth, less oxytocin flows, less fat is in mix. With less fat, milk digested quicker = not enough time for baby to make enough lactase to digest lactose in milk. What to do for oversupply? - Answer-Decrease additional stimulation/milk removal if possible Consider block feeding (only nursing on one side only per feeding) Watch for mastitis Try australian posture (mother down under, baby on top) Consider donating to milk bank Consult with HCP for medical dx How many ml considered oversupply? - Answer-normal milk production = 750-1000 ml/day Thrush during BF - Answer-painful for mother & baby. May be visible or may not (whiteness that can't be wiped off) -mother will have itchy, flaky, shiny skin -candida not found inside the ducts or milk Treatment of candida on breast - Answer--nystatin first line -flucanizole second line -throw out all yeast vectors (pacifiers sterilize breast pumps) -flucanazole oral capsules may be used to clean yeast vectors due to the biofilm created on pacifiers by candida What to do if antifungal treatment for yeast doesn't work? - Answer-Not candida infection! Reynaud's Phenomenon - Answer--vasospasm of nipple, recognized by triple color sign: from white-- blue-- raspberry or bicolor sign white -- raspberry. Pain is extreme and spasmodic (not continuous) -this happens after feeding once baby's mouth comes off nipple has vasospasm, feels like frostbite Treatment of reynauds - Answer--prevent/decrease cold exposure -avoid vasoconstrictive drugs such as caffeine and hypertensive drugs, nicotine -can use nifedipine or calcium channel blocker Nipple pain and poor milk transfer that is persistent despite optimal latch - Answer--can use nipple shield as a test to see if baby exerting too much pressure? -OT involvement -in rare cases baby have a strong sucking vacuum as measured by a pressure transducer or nipple shield Clogs/plugs - Answer-Palpable lumps of milk within the lumen or duct system, usually not visible. Solids dont get absorbed...could be too tight of a bra slowing flow of milk What to do for clogs/plugs - Answer-Encourage massage using side of hand and warm compresses. Do double nursing by doubling up on side of clog to push it out. Point baby's chin toward clog See PCP if clog hasn’t moved in 24-48 hours or systemic symptoms of inflammation (flu like s/s) When to call PCP for clog/plug - Answer-If plug hasn't moved in 24-48 hrs or systemic signs of inflammation (flu like s/s) Causes of clogs/plug - Answer-too tight nursing bra What is a bleb - Answer-small white spots on the face of the nipple that look like milk-filled blisters. One duct opening is usually covered What does a bleb feel like - Answer-painful stabbing pinpoint pain How to get rid of blebs - Answer-Same as clog treatment. Sometimes need t be lanced by HCP Common mastitis - Answer--can be non-infective or infective -blocked ducts from engorgment, hurried feedings, nipple shield (pressure will build until milk sneaks out of space, body reacts to this like invader) Causes of common mastitis - Answer--tight bra (look for indentation of breast straps) -use of breast shell or nipple shell -attachment difficulties -anemia in the mother -tongue tie in baby (ineffective milk emptying) S/s common mastitis - Answer-systemic- fever, ill, malaise, redness, pain, one inflamed breast What bacteria causes infective mastitis - Answer-Staphylococcus Tx common mastitis - Answer-NSAIDS first line but make sure diagnosed by PCP -must keep pumping/breastfeeding to keep milk flowing. Keeps breasts soft/comfortable to avoid abscess development Abscess on breast - Answer-Localized areas of pus and necrotic tissue that can develop with a breast infection • Can develop in the subcutaneous, intramammary, retromammarylayers • Symptoms include pain, swelling, redness, fever, increased WBC count, palpable mass -pocket of pus forms in the breast -from untreated mastitis Antibiotics for mastitis? - Answer-Usually for double mastitis, not generally proscribed for one breast common mastitis. If treatment uneffective consider anemia, ductal or inflammatory breast cancer Double mastitis - Answer-EMERGENT AND UNCOMMON- tissue of both breasts inflamed. Organism cause of double mastitis - Answer-strep -potentially fatal, whole body inflammation, sepsis -not a problem with milk Signs of inflammatory breast cancer - Answer-- breast tissue is red, warm, has orange peel (peau d'orange), pitting appearance on skin surface - breast mass may or may not be present True/false: MRSA can look like mastitis when on breast - Answer-TRUE can masquerade as mastitis. Might see peeling skin, pitting. Can also cause lesions and abscess. Abscess on breast is full of ... - Answer-PUS not MILK. As many as 60% positive for MRSA. Can you nurse on same side as abscess - Answer-No should nurse on other breast. Must be aware of possible contamination on flanges, pump parts, can not track infection from one side to other. Abscess surgical intervention - Answer-can cut through nerves and ducts. Try to avoid surgical intervention Treatment of abscess - Answer-drainage through ultrasound-guided technique is first choice (needle aspiration often has to be repeated) Report any suspicious area of the breast to a qualified provider because it could be... - Answer-MRSA or herpes- fatal for babies Goldsmith's sign - Answer-The association of a baby's persistent refusal of one breast with possible breast cancer in the mother -can also happen suddenly with older babies -rule out common problems such as ear infection, teething, birth trauma -CA may be diagnosed as late as 5 yrs after this sign Neonatal hypoglycemia - Answer--symptomatic infants = glucose of 40 requires per APP -dextrose & BF = first line tx -SGA, LGA, diabetic moms, late preterm infants at gretest risk Signs of neonatal hypoglycemia - Answer-• Jitteriness, tremors • Poor muscle tone • Diaphoresis (sweating) • Poor suck, failing to sustain latch • Tachypnea • Tachycardia • Dyspnea • Grunting • Cyanosis • Apnea • Low temperature • High-pitched cry • Irritability • Lethargy & poor feeding • Seizures, coma • No signs (some infants may be asymptomatic) Do healthy term newborns need glucose checks - Answer-No Jaundice is caused by - Answer-Unconjugated bilirubin that accumulates in blood stream of newborn because fetal-type blood cells are broken down and live and intestines too immature to excrete at fast pace. Pathologic jaundice - Answer-Result of an underlying disease appearing before 24 hours (or persistent after day 7) -due to sepsis, blood incompatibility Bhutani curve - Answer-Chart that can be used to determine when bilirubin levels require treatment Early onset jaundice - Answer-"Physiological" or "starvation" jaundice Peaks 72-96h after delivery Frequently related to underfeeding "lack of breastfeeding" jaundice Late onset jaundice - Answer-develops second week of life infant thriving, gaining wt, stooling Pathologic causes ruled out Factor in human milk increases the intestinal absorption of bilirubin -often called breastmilk jaundice actually related to metabolic issues with infant -do not discontinue breastfeeding, can persist for 12 weeks Kernicterus - Answer-Bilirubin encephalopathy, a form of brain damage resulting from unconjugated bilirubin entering the brain. Characterized by lethargy, poor feeding, vomiting, irregular respiration, perhaps death -can damage brain, spinal cord and nerve cells. Warning signs of kernicterus - Answer-extreme jaundice (advancing from upper body to lower body), lethargy, fussiness, feeding difficulties, muscle rigidity, high pitched cry -fewer than 4 wet or dirty diapers/24 hrs Can skin to skin help a latch? - Answer-yes- influences state organization and motor system modulation, can help with difficulty latching and sustaining a feed Skin to skin with twins- each breast... - Answer-warms up depending on the temperature of each baby closest to breast Preemies/skin to skin - Answer-decreased time of nicu stay, improved weight gain, more mature sleep patterns, improved cerebral blood flow, warmer/more stable, better breastfeeding Negative influences on milk production - Answer-Long spaced between feedings Long, slow feedings-can effect prolactin production Excessive pressure in breast Breast surgery/injury Suboptimal breast anatomy Why does pressure occur in breast? - Answer-Vascular, lymphatic, and third-spacing forces, especially early on Sensory activation- lactogenesis II Normal fullness vs engorgement - Answer-Normal fullness= breast soft, body temp normal, mother feels well, breast may be hot, baby can grasp nipple Engorgment = hard breast, temp normal or higher, feels discomfort, breast hot & shiny, nipple difficult to grasp, baby can't latch When do engorgment symptoms most commonly occur? - Answer-In days 3-5 Mothers who have had IV fluids in labor have higher levels of swelling up to day 9 C-section moms experience peak engorgement 24-48 hours later than those who deliver vaginally What can decrease risk of engorgement early on? - Answer-More time spent BF in the first 48 hours