Exam

What is the physiology of milk production?

The breast is composed of 4 to 18 segments (lobes) embedded in fat, within each lobe are alveoli (the milk-producing cells) surrounded by myoepithelial cells which contract to send milk forward into the ductules.

-Ductules enlarge into lactiferous ducts and sinuses, where milk collects behind nipple.

-Each nipple has pores through which milk is transferred to the suckling infant.

What is Lactogenesis stage I?

Breasts start preparing for milk production around week 16 in the pregnancy. Colostrum is present.

- After birth, decrease in estrogen and progesterone levels triggers release of prolactin from anterior pituitary gland

What is Lactogenesis stage II?

-By day 3-5, the breasts begin producing mature milk, often referred to as “the milk coming in.”

• Colostrum is still present, until up to day 21.

• Prolactin produced in response to infant suckling and emptying of breasts.

• As nipple is stimulated by suckling infant, posterior pituitary prompted by hypothalamus produces oxytocin.

  -Responsible for milk-ejection reflex or let-down reflex

What are health implications of breastfeeding (to the newborn)? (10)

• Contributes to the development of a strong immune system.

• Reduces incidence of stomach upset, diarrhea, and colic (early childhood), and Crohn’s disease and colitis (later in life),

• Begins the immunization process at birth by providing passive immunity,

• Reduces risk of constipation,

• Promotes greater developmental gains in preterm infants,

• Prevents obesity.

• Promotes better tooth and jaw development as a result of sucking motions,

• Provides protection against food allergies

•Lower incience of SIDS

• Is associated with reduced incidence of type 1 diabetes and heart disease later in life.

What are health implications of breastfeeding (to the parent)? (9)

• Can facilitate postpartum weight loss by burning extra calories,

• Stimulates uterine contractions to control bleeding,

• Lowers risk for breast, ovarian, and endometrial cancers,

• Facilitates bonding with newborn infant,

• Lowers risk of type 2 diabetes,

• Reduces risk of postpartum depression,

• Promotes uterine involution as a result of release of oxytocin,

• Lowers risk of osteoporosis,

• Provides some contraceptive benefits.

What is the baby-friendly initiative?

Hospital Initiative to encourage health facilities worldwide to better support breastfeeding by education about breastfeeding, assisting breastfeeding, promoting cue-based feeding, and informing of risks of artificial nipples / bottles.

What are the unique properties of breastmilk? (3)

• Contains antimicrobial factors

• Contains Lactoferrin (antibacterial, antifungal, and antiviral)

• Colostrum is extremely rich in immune globulins, protein, vitamins and minerals.

What are early feeding cues? (4)

• stirring

• mouth opening

• turning head

• seeking / rooting

What are mid feeding cues? (3)

• stretching

• increasing physical movement

• hand to mouth

What are late feeding cues? (3)

• Crying

• Agitated body

• Color turning red

When should babies be burped?

Stop every 5 to 10 mls to burp (in the beginning). Then maybe only once mid-feed. Eventually just burp after each feeding.

How are bottles and nipples sterilized?

Boil all equipment for 2 minutes, allow to air dry

What are the 3 types of infant formula?

• Ready-to-drink: No mixing

• Liquid concentrate: Add sterile water, pay attention to amounts

• Powder: Add sterile water, pay attention to amounts (NOT a sterile product (unlike the liquid formulations). Therefore added risk for babies with a compromised immune system (premature, small birth weight…)

What is the “baby blues”?

-Emotional lability - rapid cycling moods: anxiety, irritability, mood swings, tearfulness, increased sensitivity, despondency, feelings of being overwhelmed, difficulty thinking clearly, and fatigue

-Typically peaks on postpartum days 4 and 5 and usually resolve by postpartum day 10.

What are symptoms of postpartum depression? (10)

•Restless

•Worthless

•Guilty

•Hopeless

•Moody

•Sad

•Overwhelmed

•Loss of enjoyment

•Low energy level

•Loss of libido

What are symptoms of postpartum anxiety disorder? (11)

•constant or near-constant worry that can’t be eased

•feelings of dread about things that are feared to happen

•sleep disruption (as in unable to sleep even when the baby is sleeping)

•racing thoughts,

And can include physical symptoms:

•fatigue

•heart palpitations

•hyperventilation

•sweating

•nausea or vomiting

•shakiness or trembling

•Panic attacks – SOB, chest pain, dizziness…

What are symptoms of postpartum psychosis? (4)

-mood lability,

-delusional beliefs,

-hallucinations, and

-disorganized thinking.

-If untreated, risk of child abuse, suicide, and/or infanticide.

-> Requires (inpatient) acute psychiatric care.

What are the types of abuse? (5)

• Physical abuse

• Emotional abuse

• Sexual abuse

• Financial abuse

• Neglect

What is the cycle of violence? (3)

1. Tension building

2. Acute battering

3. Honeymoon / reconciliation

What are risk factors for intimate partner violence during pregnancy? (13)

•Inability to cope with the stressors of pregnancy

•Young age at time of pregnancy

•Having less than a high school education for both partners

•Unemployment for either or both in partnership

•Heavy drinking by partner

•Resentment toward the interference of the growing fetus and change in the pregnant person’s shape

•Doubts about paternity or the expectant person’s fidelity during pregnancy

•Outside attention the pregnancy brings to the pregnant individual

•Unwanted pregnancy

•Insecurity and jealousy about the pregnancy and the responsibilities it brings

•Financial burden related to expense of pregnancy and loss of income

•Stress of role transition from adult man to becoming the father of a child

•Physical and emotional changes of pregnancy that make the pregnant person vulnerable

What are the ABCDES of nursing care after someone discloses abuse?

A - reassure the client that they are not alone

B - convey belief

C - explain confidentiality

D - document the findings

E - educate about the cycle of violence

S - help the client identify a plan for safety

What is the impact of substance use on pregnancy? (5)

Risk of:

• spontaneous abortion

• preterm labour / birth

• low birth weight

• CNS and fetal anomalies

• long-term developmental consequences

What can opioid maintenance therapies do for a pregnancy? (3)

Withdrawal from opiates during pregnancy is extremely dangerous for a fetus, so this treatment:

• reduces withdrawal symptoms in the newborn

• reduces drug cravings

• blocks the euphoric effects of narcotic drugs.

What is Neonatal Abstinence Syndrome (NAS)?

a group of conditions caused when a baby withdraws from certain drugs its exposed to in the womb before birth

What are the common effects of opioids on newborns? (10)

• Irritability, hypertonicity, jitteriness

• Excessive and often high-pitched cry

• Vomiting

• Diarrhea

• Diaphoresis

• Fever

• Disturbed feeding, sucking, sleeping

• Respiratory distress, nasal stuffiness

• Excessive sneezing and yawning

• Tremors and seizures

What is the eat sleep console program?

helping parents identify the newborn’s ability to eat, sleep and be consoled through non-pharmacological care interventions such as skin-to-skin contact, breastfeeding, pacifiers as needed, rhythmic movement, and a quiet, low light environment.

How long should babies be exclusively breast fed?

• Exclusive breastfeeding for 6 months.

How long should babies be breast fed? (non-exclusively)

Babies should be breastfed for 2 years and beyond.

When should complimentary foods be introduced to babies?

• Introduction of complimentary foods at 6 months.

For how long should babies be given a vitamin D supplement?

• Vitamin D supplement daily until age 1

When does birth weight double?

by 6 months

When does birth weight triple?

by 1 year

How much does height increase per month, up to 6 months?

2.5 cm

When do infants gain head control?

4-6 months

When can infants roll over?

5-6 months

When can infants crawl?

6-7 months

When can infants sit unsupported?

8 months

When can infants walk alone?

12 months

When can infants grasp objects as a reflex?

2-3 months

When can infants grasp objects voluntarily?

5 months

When can infants use the pincer grasp? (2)

• 8 months crude

• 11 months refined

When can infants remove objects from a container?

11 months

When can infants build a tower of two blocks?

12 months

What Erickson phase is from birth to 1 year

Trust vs. mistrust

When can infants vocalize?

5-6 weeks

When can infants imitate sounds?

by 8 months

When can infants assign meanings to words?

10-11 months

What is positional plagiocephaly

when a baby develops a flat spot on one side of the head or the whole back of the head

When do children have improved coordination?

between 2-3 years

When do children experiences improved manual dexterity?

12-15 months

When can children throw a ball?

by 18 months

What is telegraphic speech?

two-word sentences

What Ericksons phase do toddlers go through?

Autonomy vs. shame and doubt

How much sleep is needed per day for 24 month olds?

13 hours

How much sleep is needed for 3 year olds?

12 hours

How much weight is gained per year for preschoolers?

4-5 lbs

What Ericksons phase do preschoolers go through?

Initiative vs. guilt

What is animism?

the belief that inanimate objects are alive

When should children develop telegraphic speech?

3 years

When can children develop adult-like sentence structure?

5 years

What Ericksons phase do school-age children go through?

Industry vs. interiority

How much sleep do 6-8 year olds need?

12 hours

How much sleep do 8-10 year olds need?

10 hours

How much sleep do 10-12 year olds need?

9-10 hours