NURS 3024 Maternal Infant Nursing Exam #3 Study Guide Chapters, 23-25 Chapter 27: Newborn Nutrition and Feeding ? approx. 8 questions Vocabulary: Colostrum- creamy white to yellowish premilk fluid that may be expressed from the nipples as early as 16 weeks of gestation, more concentrated than mature milk and rich in immunoglobulins demand feeding- feeding a newborn every third hour or when the baby cries to be fed whichever comes first engorgement- distention or vascular congestion of breast tissue brought about by increase in blood and lymph supply to the breast as the body produces milk. 72-96 hours after birth feeding-readiness cues- infant responses that indicate optimal times to begin a feeding, the baby may make mouthing motions, suck a fist, or awaken and cry growth spurts- times of increased neonatal growth that usually occur at approximately 6-10 days, 6 weeks, 3 months, and 4-5 months. inverted nipples- lactation consultants- a health care professional who has specialized training in breastfeeding lactogenesis- symthesis of milk latch-on- placement of the infants mouth over the nipple areola and breast making a seal between the mouth and breast to create adequate suction for milk removal nipple confusion- difficulty experienced by some infants in mastering breastfeeding after having been given a paci or bottle. The problem appears to be more related to tactile sensation than flow of liquid. plugged milk ducts- milk ducts blocked by small curds of dried milk prolactin-a pituitary hormone that triggers milk production suppy-meets-demand system- physiologic basis for determining milk production. The volume of milk produced equals the amount of milk removed from the breast. AAP recommendations for infant feeding for the first year of life Exclusive BF for first 6 months, and continue as the source of milk for first year Benefits of breastfeeding Moms benefits- decreased pp bleeding and more rapid uterine involution, reduced risk of ovarian cancer, lower risk of htn, hypercholesterolemia, and cardiovascular disease, earlier return to prepregnancy weight, decreased risk of postmenopausal osteoporosis, unique bonding, increased maternal role attainment Infant benefits- decreased incidence and severity of infections diseases, reduced postneonatal infant mortality, decreased rate of sids, decreased incidence of type one and two diabetes, decreased incidence of lymphoma, leukemia, Hodgkin disease, reduced risk of obesity and hypercholesterolemia, decreased incidence and severity of asthma and other allergies, possible enhanced cognitive development, enhanced jaw development, decreased problems with malocclusions an malalignment of teeth, analgesic effect for infants undergoing painful procedures such as venipuncture Society benefits- convenient, no bottles or other nessesary equiptment, less expensive, reduced annual health care costs, less parental absence from work for ill infant, reduced environmental burden related to disposal of formula care Uniqueness of human milk Changes composition to meet nutritional needs, specific to needs of each baby, passes on immunities, increases in production as babys needs increases. Feeding readiness cues. Hand to mouth or hand to hand movements, sucking motions, rooting reflex, mouthing Breastfeeding Lactogenesis & Let-down reflex. ? as the baby sucks this reflex is stimulated. Mom may feel tingling, babys suck changes from fast to slow, audible swallowing, may feel uterine cramping, mom relaxed during feedings, opposite breast may leak Positioning.- football hold, cradle, modified cradle or across the lap and side lying. Proper latching & proper way to remove infant. ? mouth over the nipple areola and breast making a seal between the mouth and breast to create suction to express milk. To take off insert a finger into the babys mouth to break suction. Effective breastfeeding (Box 27-2)- infant: latches without difficulty, has bursts of 15-20 sucks/swallowsat a time, audible swallowing is present, easily releases breast at end of feeding, appears contented after feeding, has at least 3 BM and 6-8 wet diapers every 24 hrs after day 4. Interventions for slow weight gain. ? improve feeding technique, adding a feeding or two, breast massage, Special Considerations: Preterm infants.- pump to establish adequate milk supply. Kangaroo (skin to skin) care is advised until baby is able to breastfeed and while breastfeeding is established. Techniques for expressing breast milk. - Proper storage of breast milk. Green box p. 728. - Measures to decrease breast engorgement, sore nipples, plugged milk ducts and mastitis- engorgement- feed every two hours, pump, ice packs after breastfeeding, chilled cabbage leaves, warm showers before breastfeeding, anti-inflammatory meds, breast massage Sore nipples- prevent, latch correctly, fix the problem, open to air as much as possible, breast shells to allow air to circulate, warm water Plugged milk ducts- application of warm compresses before feeding to promote emptying, frequent feeding with baby beginning on the affected side and massage the area. Mastitis- inadequate emptying of breasts, abrupt weaning or wearing underwire bras, stress, breast trauma, poor nutrition, tx is antibiotics, analgesics, rest and breastfeed or pump frequently. Warm compresses before feeding, adequate fluid intake balanced diet, When is formula recommended over breastfeeding? - with newborns who have glactosemia, active TB, HIV, herpes lesions on the breasts Formula feeding p. 739
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