Term
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Definition
| extend from 3rd to 5th rib (instead of 2nd to 6th) and have a space between them of 1.5 inches - correllated to low milk supply |
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Term
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Definition
| ductular openings on areola, become more prominent in pregnancy |
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Term
| Where is the nipple found? How many openings? |
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Definition
4th intercostal space
4-18, average of 9 openings |
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Term
| What do you do with a mom who has a true inverted nipple? |
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Definition
Pump and bottle feed - she will likely need to supplement
If not true inverted (umbilicated): an inverted syringe will help pull them out |
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Term
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Definition
| extra nipples along the "milk" lines, from axilla to groin |
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Term
| what to do when moms has inverted nipples (not "true" inversion)? |
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Definition
| Try for 5 min on each side and if doesn't work, pump for 10 minutes (and try again?). |
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Term
| breast compostion (glandular and fat) |
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Definition
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Term
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Definition
| fibrous bands which divide adipose (fat) and glandular tissue of breast ... keeps breast together - no other gland needs this |
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Term
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Definition
extra tissue that extends to axilla (armpit), swelling recedes in 3-4 days, ice OK, cabbage OK
if has nipple ducts - polymastia |
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Term
| Which intercostal nerves supply the nerves to the breast? |
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Definition
4, 5, and 6
4 enters the breast from behind and supplies greatest amount of sensation |
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Term
| which is most and least sensitive (nipple, areola, skin) |
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Definition
| most: areola least: nipple |
|
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Term
| what do you look for in a breast assessment? |
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Definition
size, shape, symmetry, elasticity of skin
look for lumps, inflammation, swelling (edema) |
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Term
| hypermastia or gigantimastia? |
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Definition
| when breasts become extremely large during pregnancy, flat nipple, returns with next preg, need to supplement |
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Term
| describe the internal features of the breast |
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Definition
Breast is divided in sections or lobes around the nipple
Each lobe is divided into smaller divisions called lobuli
Each lobuli is comprised of many alveoli, sites where breastmilk is stored
Within each alveoli there are secretory units called lactocytes (aka mammary secretory epithelial cells) where milk is synthesized
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Term
| what coats the drainage tract from the aveoli to the nipple? |
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Definition
| myoepithelial cells - they contract when stimulated by oxytocin and propel the breastmilk toward the nipple |
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Term
| Name the six parts of the breast starting with the lactocytes |
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Definition
| Lactocytes, aveoli, small ductile channel, larger ducts, large mammary ducts, nipple openings |
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Term
| How do breasts increase in size after puberty? |
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Definition
| laying down of adipose tissue |
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Term
| What hormone might be to blame if a woman has trouble keeping a pregnancy and her breast are underdeveloped (leading to difficulty in breastfeeding)? |
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Definition
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Term
| explain the roles of estrogen, progesterone, serum prolactin, serum placental lactogen in role of breast development in pregnancy |
|
Definition
estrogen-causes ductile system to proliferate
progesterone-increases size of lobes, lobules, and alveoli
serum prolactin-nipple growth
serum placental lactogen-areolar growth |
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Term
| What happens to the breasts in the first trimester of pregnancy? |
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Definition
rapid growth and branching of ductile system
weight increases 400 to 600 grams |
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Term
What happens to the breasts in the last trimester of pregnancy?
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Definition
| distention of the alveoli with early colostrum, alveolar proliferation |
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Term
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Definition
| 16th week of pregnancy to when the milk "comes in" |
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Term
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Definition
When copious milk secretions start 24-102 hours after birth (requires the withdrawl of progesterone, and maybe removal of milk from breasts)
MAY BE DELAYED IF MOM HAS TYPE I DIABETES (insulin dependent) |
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Term
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Definition
| the maintenance of the established milk production (supply and demand, will continue as long as milk is removed) |
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Term
| What do the FILs do? (feedback inhibitors of lactation) |
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Definition
| suppress lactation if milk is not removed from the breast, so less prolactin and oxytocin are produced |
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Term
| what is special about weaning milk |
|
Definition
increased sodium and increased immunoglobins
process of weaning is called involution |
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Term
| what should be suggested to moms over 35? |
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Definition
| insurance pumping and herbs because alveoli are starting to be replaced by stroma (connective tissue) |
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Term
| name three things that colostrum does |
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Definition
| seals the gut, laxative effect; clears meconium, teaches baby suck and swallow, less jaundice |
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Term
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Definition
| sodium, potassium, chloride, protein, fat-soluble vit and minerals, immunoglobins |
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Term
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Definition
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Term
| describe transitional milk |
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Definition
| days 6-13 postpartum, rise in lactose increase milk volume, beginning to change from yellow to white |
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Term
| Markers of lactogenesis II |
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Definition
| increase of lactose and citrate, decrease of protein and sodium |
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Term
| how many calories per ounce does mature milk have? |
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Definition
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Term
| The longer a mom breastfeeds, the higher or lower the fat content of the milk is? |
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Definition
|
|
Term
| what happens to caloric content of milk at the end of a feeding? |
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Definition
|
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Term
| the milk in the second year of lactation has a increase or decrease of fat and calories? |
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Definition
|
|
Term
| what effect does high weight gain in pregnancy have on milk? |
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Definition
|
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Term
| true/false: human milk has highest lactose content of all animals |
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Definition
|
|
Term
| What enzyme breaks down lactose into glucose and galactose (brain food)? |
|
Definition
| brush border enzyme lactase |
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Term
| What does lactose do for an infant? |
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Definition
increase calcium absorbtion, prevent rickets, CNS development
Not dependent on mother's diet! |
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Term
| What do oligosacchrides do for babies? |
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Definition
(carbohydrate) probiotic for baby, promotes growth of bifidus factor, helps prevent infections
it is not digested, all along the GI tract |
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Term
| what increases the fat in milk? |
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Definition
| lots of things affect it, but the shorter the duration between feeds, the higher the fat |
|
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Term
| what affects fat composition of milk? |
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Definition
| stage of lactation, gestational age, parity, and diet of mother (most important) |
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Term
| Protein (whey) decreases or increases as lactation progresses? |
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Definition
|
|
Term
| how does the ratio of whey to casein change over time? |
|
Definition
early 90:10
mature milk 60:40
late lactation 50:50
most formulas are 60:40 |
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Term
| Casein breaks down into casomorphins - what do the do for babies and why is the amount in formula dangerous? |
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Definition
| Make baby sleepy and too much might increase SIDS |
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Term
| What are the big three proteins that contribute to the bacteriostatic and batericidal properties of breastmilk? |
|
Definition
| lactoferrin, lysozome, sIgA |
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Term
| How many cal/day does a 2 week old need compared to a 6 mo old? |
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Definition
124 kcal/kg/day vs. 96 kcal/kg/day
So caloric needs go down as baby gets bigger!
a 9lb baby needs 17 oz/day
a 17lb baby needs about 25oz/day |
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Term
| difference between iron absorbtion of breastfed baby and formula fed baby |
|
Definition
49% for breastfed baby, can go 6 mo without need of supplementation
4% for formula baby, but the more in formula, lower IQ |
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Term
| Does maternal diet affect composition of minerals like calcium, phosphorus and magnesium, iron, copper and zinc? |
|
Definition
| No (unless hemmorage makes mom extremely iron deficient) |
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Term
| difference between fat soluble and water soluble vitamins in composition of milk related to mother's status |
|
Definition
fat soluble stored in mom, not as fragile as water soluble
water soluble changes depending on mom, easy to increase through mother supplementation |
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Term
| preterm milk - what's higher? |
|
Definition
immunoprotective factors (good for immature GI tract)
protein
nitrogen
long, medium, short chain fatty acids
sodium chloride
magnesium
iron
growth factors
hormones
anti inflammatory factors |
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Term
| preterm milk - what stays the same? |
|
Definition
volume
calories
fat (not really sure)
lactose
linolenic acid
potassium
calcium
phosphorus
copper
vit b12
zinc |
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Term
| gestational age of preterm, late preterm, early term, term, and postterm |
|
Definition
preterm <34 weeks
late preterm 34-37 (6/7)
early term 37 (0/7) - 38 (6/7)
term 39-41 (6/7)
postterm>42 weeks |
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Term
| what to look for infant assessment? |
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Definition
| when crying, look at palate, tongue, approach/avoidance behavior, tone |
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Term
| what is the best time to breastfeed? |
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Definition
|
|
Term
| what do babies with high tone need? |
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Definition
| more calories, they are hard to cuddle, maybe mom smoked or took antidepressants when preg |
|
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Term
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Definition
| a lot of water loss from baby after birth because of IV fluids (24 hour weight is closer to true birth weight) |
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Term
|
Definition
|
|
Term
| why would you treat a "full term" baby like a preemie? |
|
Definition
| when showing signs of immaturity (hands open) |
|
|
Term
| what is the driving force of a baby in the first few months of life? |
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Definition
|
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Term
|
Definition
| 1. ready to nurse 2. position of infant with nose to nipple 3. wide gape, grasp nipple |
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Term
|
Definition
| using tongue to compress the teat up against baby's palate to squeeze milk out |
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Term
|
Definition
|
|
Term
| what 4 things are required for successful lactation? |
|
Definition
| stimulation of breasts (quality feeding or pumping), breast tissue, hormone levels, receptor sites |
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