NUR244 TOPIC 3 TUTORIAL

TUTORIAL THREE: Breastfeeding and Immunisation

  • Breastfeeding Preparation and Maintenance: Develop practices that support the preparation, initiation, establishment, and maintenance of breastfeeding.

  • Information Resources: Determine which information sites are appropriate to recommend to clients.

  • Childhood Immunisations: Understand various immunisations that are offered in childhood and the diseases they protect against.

  • IV Calculations: Understand calculations used to determine flow rates in drops per minute.

  • IV Line Priming: Demonstrate an understanding of priming intravenous (IV) lines.

REGULATION OF MILK SYNTHESIS

  • Hormonal Control: Breast milk production is primarily regulated by the hormones prolactin and oxytocin. These hormones have different roles:

    • Prolactin: Produced by the anterior pituitary gland, it is responsible for the synthesis of milk.

    • Oxytocin: Produced by the posterior pituitary gland, it triggers the ejection of milk during breastfeeding.

  • Influence of Other Hormones: Hormones such as oestrogen and human placental lactogen support milk production. After the delivery of the placenta, the levels of progesterone drop, allowing prolactin to function effectively.

  • Stimulation Mechanism: The baby suckling at the breast stimulates nerve endings in the nipple and areola, leading to the release of:

    • Prolactin: Stimulates milk production; increased suckling leads to heightened prolactin receptor sensitivity in the alveoli.

    • Oxytocin: Triggers the milk ejection reflex (let-down) by prompting myoepithelial cells around the alveoli to contract, allowing milk to flow.

FEEDBACK INHIBITOR OF LACTATION

  • Autocrine Control: After the initial hormonal phase, milk production is regulated locally at the breast through the Feedback Inhibitor of Lactation (FIL), a whey protein found in breast milk.

  • Negative Feedback Mechanism:

    • More milk in the breast leads to increased FIL levels, which subsequently slows down milk production.

    • Conversely, less milk in the breast results in reduced FIL levels and a boost in milk production.

  • Key Points:

    • Frequent and effective milk removal is essential to maintain milk supply.

    • Full breasts decrease the sensitivity of prolactin receptors and thus reduce milk synthesis.

    • Emptying the breast promotes milk production by ensuring normal functioning of prolactin.

STORAGE CAPACITY OF THE BREAST

  • Variability: The storage capacity of the breasts can differ significantly among women and even between their breasts, affecting how much milk can be stored.

  • Small Storage Capacity:

    • Less milk is stored before the breast feels full, necessitating more frequent feeding to sustain milk supply.

  • Large Storage Capacity:

    • More milk is stored, allowing for less frequent feeding without diminishing supply.

  • General Requirement: Regardless of capacity, regular milk removal is critical to prevent FIL buildup and support continued milk production.

SKIN-TO-SKIN CONTACT

  • Definition and Importance: Skin-to-skin contact involves holding a naked baby against the mother’s bare chest and is ideally initiated at birth, continuing until the first breastfeeding session.

  • Benefits of Skin-to-Skin:

    • Promotes bonding and attachment between mother and baby.

    • Supports the initiation of breastfeeding.

    • Aids in maternal and infant physiology, including temperature regulation.

  • Physiological Responses:

    • Touch, warmth, and movements stimulate oxytocin release in the mother, enhancing relaxation, milk release, and emotional connection.

  • Evidence-Based Outcomes: According to Cochrane reviews, skin-to-skin contact reduces newborn pain and speeds recovery after medical procedures.

EDUCATIONAL ACTIVITY EXAMPLES

Scenario: Education for Pregnant Clients

Client: Ivy, who is expecting her first baby, seeks information on several topics related to breastfeeding and infant care:

  • Signs of Infant Hunger: How to recognize when her baby is hungry.

  • Correct Attachment: How to assess if the baby is attached properly to the breast.

  • Milk Intake: How to determine if the baby is receiving enough milk.

  • Medication and Alcohol Influence: Information regarding the consumption of medications and alcohol during pregnancy.

  • Dietary Recommendations: Foods to avoid and foods that may help enhance milk production.

RECOMMENDED RESOURCES FOR INFORMATION

In consideration of Ivy’s questions, the following websites may provide valuable information and support:

  • Australian Breastfeeding Association

  • KellyMom.com

  • King Edward Memorial Hospital

  • La Leche Australia

  • SheKnows.com

  • The International Breastfeeding Centre

  • Chronicles of a Nursing Mom

ATTACHMENT TECHNIQUES FOR BREASTFEEDING

Guidelines for Correct Attachment

  1. Baby Positioning:

    • Nose to nipple alignment

    • Chin touching the breast

  2. Nipple Stimulation:

    • Stroke the baby’s lower lip with breast tissue until the mouth opens wide (gape).

  3. Breast Guidance:

    • Aim the breast tissue towards the baby's tongue and roll the nipple under the top lip.

  4. Latch Confirmation:

    • Ensure the baby’s chin is well into the breast, with the nose clear and lips flanged outward.

    • Aim for an asymmetrical latch, with more of the breast taken in on the underside.

  5. Pain Expectation:

    • Initial attachment pain is common for the first few weeks; however, this should dissipate within 10-30 seconds, and no pain should be experienced during feeding.

POSITIONING PRINCIPLES

  • Baby-Breast Relationship: The baby should be brought to the breast rather than bringing the breast to the baby.

  • Proximity: The baby's chest should be positioned against the mother's chest.

  • Alignment: The baby’s back and neck should be aligned properly to ensure comfort and effective feeding.

  • Nipple Stimulus: Use the nipple to stimulate a wide mouth by brushing from the nose to the upper lip.

  • Chin Contacts: Baby’s chin should come to the breast first and after attachment, the nose should be uncovered.

  • Feeding Guidelines: Ensure a good amount of breast is taken in, focusing on the underside where more breast tissue is present.

FEEDING PATTERNS

  • Frequency:

    • Typical average is 8 to 12 feeds within a 24-hour period.

    • At least 6 feeds are necessary for healthy, term infants following an uncomplicated birth.

  • Feeding variations may occur due to factors such as infant temperament and breast storage capacity.

  • Day 1 Initial Feeding:

    • First feed should occur within the first hour after birth, often followed by an extended recovery sleep.

  • Expected Feeding Behavior:

    • Minimum of 6-8 feeds within 24 hours is normal.

    • Monitoring for milk transfer, breast softening, and baby satiety is crucial.

  • Cluster Feeding: This behavior is common and can be observed, especially with periods of unsettled behavior.

    • Breastfeeding patterns may not stabilize until 4-6 weeks postpartum.

IMMUNISATION

Western Australian Immunisation Schedule
Birth to <7 Days

  • Nirsevimab (Beyfortus)

    • Administered preferably at birth.

    • Considerations for maternal vaccination (Abrysvo) > 2 weeks prior to birth.

  • Hepatitis B (H-B-Vax® II Paed / Engerix B Paed)

    • Administered at 6-8 weeks of age.

Scheduled Vaccinations

  • 6-8 weeks:

    • DTPa-hepB-IPV-Hib (Infanrix® hexa or Vaxelis®)

  • 4 months:

    • 13vPCV (Prevenar 13), Rotavirus (Rotarixe), MenACWY (Nimenrix), MenB (Bexsero®)

  • 6 months, 12 months, 18 months:

    • Continued scheduled vaccinations with specific brand recommendations.

  • <32 weeks gestation or <2000g birth weight:

    • Specific immunisation recommendations.

Disease-Specific Information
Diphtheria

  • Caused by: Corynebacterium diphtheriae

  • Symptoms: Respiratory obstruction due to membrane formation in the pharynx.

  • Transmission: Aerosol, direct contact, and contact with soiled articles.

Pertussis (Whooping Cough)

  • Caused by: Bordetella pertussis

  • Transmission: Highly infectious, primarily through aerosols.

  • Impact: Major risk for unvaccinated infants, with significant morbidity.

Tetanus

  • Caused by: Bacterium in soil; neurotoxin produced leads to muscle rigidity.

  • Prevention: Tetanus-toxoid vaccinations generate antibodies against the toxin.

Hepatitis B

  • Transmission: Through mucosal contact with infected fluids (blood, semen).

  • Infectious Period: Begins weeks before illness onset, often lasts months.

Haemophilus Influenzae Type B (Hib)

  • Normal Flora: Upper respiratory tract; can cause serious invasive disease.

Mumps

  • Caused by: Rubulavirus

  • Incubation: 12-25 days; transmitted via respiratory secretions.

Measles

  • Highly Infectious: Spread by respiratory aerosols; severe complications.

Meningococcal Disease

  • Caused by: Neisseria meningitidis; presents as septicaemia and/or meningitis.

Calculations of IV Flow Rates

  • For flow in drops per minute (dpm):

    • When provided in minutes:
      extRate(drops/min)=racextVolume(mL)imesextDropFactor(drops/mL)extTime(minutes)ext{Rate (drops/min)} = rac{ ext{Volume (mL)} imes ext{Drop Factor (drops/mL)}}{ ext{Time (minutes)}}

    • Example: For 500 mL over 240 minutes:
      extRate=rac500imes20240extdpm<br>ightarrow42extdpmext{Rate} = rac{500 imes 20}{240} ext{dpm} <br>ightarrow 42 ext{dpm}

  • When provided in hours:
    extRate(drops/min)=racextVolume(mL)imesextDropFactor(drops/mL)extTime(hours)imes60ext{Rate (drops/min)} = rac{ ext{Volume (mL)} imes ext{Drop Factor (drops/mL)}}{ ext{Time (hours)} imes 60}

    • Example: For 1000 mL over 7 hours:
      extRate=rac1000imes207imes60extdpm<br>ightarrow48extdpmext{Rate} = rac{1000 imes 20}{7 imes 60} ext{dpm} <br>ightarrow 48 ext{dpm}

  • Upcoming lab assignments will include setting up:

    • A gravity intravenous infusion.

    • An intravenous infusion using an Alaris pump.

  • [Refer to provided questions for further engagement and understanding related to the content discussed].