NURS 131 Exam 2 Notes 2

jasmine's version from 2016-05-04 05:08

Section 1

Question Answer
Risks for infants formula feed Increased otitis media, allergies, asthma, lower respiratory infections, obesity, sudden infant death syndrome, diabetes, diarrhea, higher adult blood pressure, immune system problems, cancers such as lymphoma, Crohn’s disease, juvenile arthritis and on and on and on
Maternal benefits of breast feeding Decreased anemia, increased involution of uterus, increased weight loss, decreased incidence of pre-menopausal breast and uterine cancer, decreased osteoporosis (hormones increase Calcium absorption and limit the amount excreted)
Colostrum contents Low in fat, high in proteins and carbohydrates, and very easy to digest; High concentration of antibodies, especially IgA antibody that helps protect the lungs, throat, and intestines
What does colostrum help “seal?” The permeable newborn intestines to prevent harmful substances from penetrating the gut
Colostrum has a laxative effect that helps what? the baby to pass first bowel movements and prevent newborn jaundice
All mothers have colostrum. What must stop? Telling mothers they do not have any milk, as this is a fallacy (mistaken belief) and is not practicing evidence-based practice
The importance of breast feeding in the first hour Failure to initiate breast feeding within the first hours of life was one of the strongest predictors of early termination of breast feeding at two months
During the first 30-60 minutes of the newborn’s life Newborn’s have the natural ability to latch and suck effectively; Newborn’s typically are alert and rooting; and feeding in the first hour imprints the newborn with unique sucking movements
Remember in latching It must be comfortable for the mother; If she says it hurts or is painful, then you must investigate and figure out why
Newborn latching Nose to nipple; head tipped back; tongue down and forward; mouth open wide; scoop on gently yet quickly
During feedings, do not time newborn per side This will not allow the newborn to regulate milk flow and intake requirements (e.g., every 1-3 hours per 24 hours; 1st side dinner, 2nd side dessert)
Remember! Supply and demand (there may not be enough milk available due to growth spurts)
Night time feedings Stimulates milk production during the time period when their hormonal levels are at their highest, which is typically between 0200 and 1000
Breast feed problems in late pre-term newborn (34-37 weeks) Primary problems: hyperbilirubinemia and breast feeding
Breast feed problems in pre-mature newborn Mother makes specific milk for the preemie!! Important to get pumping and establish the milk supply
Assessment of painful and/or cracked nipples Look at the nipple as it comes out of the baby’s mouth-pinched, misshapen, deformed?; Assess newborn’s mouth-tongue tied? Instruct in correct latching and positioning; Allow the newborn to explore and latch on own (baby’s resist if physically pushed on)
When decreased volume of milk may occur On demand feedings (growth spurt): No supplementation unless medically necessary; Breast massage before and during feedings; Possibly use breast pump after feedings for about 5 minutes for added stimulation
Possible issues with maternal breast feeding Breast physiology; Augmentations (silicon in front of or behind breast muscle? If in front of, interfering with mammary glands?); Reductions; History of sexual abuse; Pre-maturity of self and interventions that interfered with breast tissue development; Transgender-Female to male (FTM)
Possible issues with newborn breast feeding Congenital anomalies such as cleft lip/palate; Pre-maturity; Illness; Tongue tie (ankyloglossia) anteriorly and/or posteriorly
Ten steps to successful breast feeding A written breast feeding policy; Train staff to implement this policy; Inform all pregnant women of the benefits of breast feeding; Help mothers initiate breast feeding within the first half hour; Help mothers maintain lactation if separated; Provide NO food or drink other than breast milk unless medically indicated; Encourage rooming in; Encourage breast feeding on demand; Provide NO artificial teats or pacifiers; Promote follow up breast feeding services and support post-discharge
Milk ejection reflex Release of milk from the breast following tactile stimulation of the nipple; the afferent path is postulated (suggest, assume, fact or truth) to exist from the nipple to the hypothalamus; the efferent limb is represented by the neurohypophysial release of oxytocin into the systemic circulation; contraction of myoepithelial elements within the breast, caused by oxytocin, moves milk into the collecting ducts and toward the nipple
Let-down reflex The movement of breast milk from the alveoli into the lactiferous ducts in response to oxytocin-stimulated contractions. The reflex may be stimulated by suckling or by an infant's crying. Stimulation of the nipple increases the secretion of oxytocin. This technique may be used to stimulate contraction of the postpartum uterus
At what trimester(s) a woman's body produce hormones that stimulate the growth of the milk duct system in the breasts? Second and third trimesters (Weeks 13-28 and Weeks 29-40, respectively)

Section 2

Question Answer
Post-term newborn potential complications Greater than 42 weeks; 2-3 higher mortality rate; hypoglycemia, meconium aspiration, polycythemia, congenital anomalies, seizures, and cold stress
Post-term newborn therapies Many will adapt well to extra-uterine life; Monitor serum blood sugar; Assess respiratory status, especially in the presence of possible meconium aspiration; Maintain neutral thermal environment until newborn demonstrates temperature stability
Meconium aspiration syndrome (MAS) Is passed in-utero secondary to stress and/or hypoxia; Fluid may be aspirated into the tracheobronchial tree in utero or during the first few breaths taken by the newborn; It causes chemical irritation and also forms small balls that become lodged in terminal airways, allowing some air to enter the alveoli, yet not allowing air to escape; As alveoli continue to expand, they eventually rupture; Complete respiratory collapse may be seen in severe cases
Hypoxic newborns Should not be fed due to oxygen is shunted from the gut; total parenteral nutrition may be administered to meet nutritional demands
Small for gestational age (SGA) Less than 10 percentile for birth weight; Newborn may be preterm, term, or post-term; Often seen in women who smoke, have high blood pressure, or any condition that reduces blood flow to the fetus; Increased risk of perinatal asphyxia, perinatal mortality, polycythemia, and hypoglycemia
Small for gestational age therapies Care aimed at promoting growth; Requires ongoing screening for potential complications related to SGA, including polycythemia, cold stress, asphyxia, hypothermia, and hyperbilirubinemia; Assess parents and family members due to SGA may be an expected finding if short stature runs in the family
Very small for gestational age (VSGA) Less than the third percentile for birth weight; Newborn may be preterm, term, or post-term
Very small for gestational age therapies Promote weight gain; Monitor blood sugar levels for hypoglycemia; Promote smoking cessation or substance abstinence if that is a factor in the newborn’s VSGA status
Large for gestational age (LGA) Newborn’s weight is at or above the 90the percentile; Often associated with maternal diabetes, genetic predisposition, multiparous women, erythroblastosis fetalis, Beckwith-Wiedemann syndrome, or transposition of the great vessels
Large for gestational age therapies Accurate estimation of gestational age is important to determining LGA status; Carefully assess for potential birth trauma, including effects of cephalopelvic disproportion and macrosomia, fractured clavicle, fractured femur as a result of shoulder dystocia; Monitor for hypoglycemia, polycythemia, and hyperbilirubinemia
Intrauterine growth restriction (IUGR) Pregnancy circumstances of advanced gestation and limited fetal growth most commonly associated with lack of prenatal care, age extremes in the mother, low socioeconomic status, multiple gestation pregnancy, grand multiparity, and primiparity; Environmental factors such as excessive exercise, exposure to toxins, high altitudes, and maternal drug use have also been implicated
Intrauterine growth restriction therapies Early identification is important to early intervention; If IUGR is unexplained, an in utero infection must be ruled out; Monitor newborn for hypoglycemia; Provide client teaching to promote growth after discharge and participation in neonatal stimulation programs to promote neurological function
Newborn of a mother with diabetes Often LGA, macrosomic, ruddy in color, and have excessive adipose tissue, decreased total body water, edema, cardiomegaly, and often trouble regulating blood sugar levels initially due to higher-than-normal insulin production in utero to cope with the mother’s elevated blood sugar levels
Newborn of a mother with diabetes therapies Assess blood sugar levels frequently; Monitor for signs of hypoglycemia, including tremors, cyanosis, apnea, temperature instability, poor feeding, and hypotonia; Seizures may occur in severe cases; Assess lab results for hypocalcemia, hyperbilirubinemia, and polycythemia; Initial assessment should observe for birth trauma due to large size