Certified Lactation Consultant Exam: Strategies, Policies, and Breastfeeding Support, Exams of Nursing

Download Certified Lactation Consultant Exam: Strategies, Policies, and Breastfeeding Support and more Exams Nursing in PDF only on Docsity! Certified Lactation Consultant Exam QUESTIONS AND ANSWERS ALL CORRECT The World Health Organization and UNICEF have set out three strategies needed for increasing breastfeeding initiation and duration in every country. What are the 3 strategies? Correct answerBreastfeeding Promotion Breastfeeding Protection Breastfeeding Support Focuses on advantages of breastfeeding on a personal (personal connection), community, country (amount spent on healthcare), or global level (waste from formula & formula products) Focuses on the good "advantages" of breastfeeding Correct answerBreastfeeding Promotion Focuses on government, manufacturer, and social responsibility to assure breast feeding's ability to compete with commercial interests. Includes addressing improper marketing practices Addressing breastfeeding in public, at work, jury duty, family law, mothers in prison, etc.. Correct answerBreastfeeding Protection Focuses on the interaction of "helpers" with family as well as program development and implementation Correct answerBreastfeeding Support Women how do not breastfeed are at a greater risk for what diseases? Correct answerMyocardial infarction Metabolic syndrome Coronary artery disease Stroke DMII HTN Hyperlipidemia Cardiovascular disease Breast, endometrial, and ovarian cancer Reason #1 why women do not exclusively breastfeed Correct answerUnrealistic expectations from society about motherhood. Along with lack of preparation for what the newborn period would be like. Reason #2 why women do not exclusively breastfeed Correct answerLack of timely interventions. Mother's problems at 3-7 days posed the greatest risk for stopping which is when they are home from the hospital and alone with no support. The fastest drop-off is in the first 10 days following discharge from the hospital The International Code of Marketing of Breast milk Substitutions Correct answerAn international health policy framework to regulate the marketing of breast milk substitutes in order to protect breastfeeding. It was written in response to the marketing activities of the infant feeding industry which were promoting formula feeding over breastfeeding, which in turn was leading to a dramatic increase in maternal and infant morbidity and mortality. What does "The Code" do? Correct answerRegulates the marketing of breast milk substitutes which includes infant formulas and any other food or drink, together with feeding bottles, and teats, intended for babies and young children. Sets standards for the labeling and quality of products and for how the law should be implemented and monitored within countries. Aims to make sure that parental choices on feeding are based on full, impartial information, rather than misleading, inaccurate or biased marketing claims. The Global Strategy for Infant & Young Child Feeding Correct answerIs intended as a guide for action; it identifies interventions with a proven positive impact, it emphasizes providing mothers and families the support they need to carry out their crucial roles, and it explicitly defines the obligations and responsibilities in this regard of governments, international organizations, and other concerned parties. What contributes to low rates of exclusive breastfeeding globally? Correct answerCaregiver and societal beliefs favoring mixed feedings (believing that breast milk is not enough or that babies actions/issues are related to the breast milk/breastfeeding) Hospital and healthcare practices and policies that are not supportive of breastfeeding Lack of adequate skilled support Aggressive promotion of infant formula and other breast milk substitutes rather than promoting support for breastfeeding Inadequate maternity and paternity leave legislation and other workplace policies Lack of knowledge about the dangers of not exclusively breastfeeding and of proper breastfeeding techniques How does pH of the gut effect babies Correct answerGut pH of breastfed babies is higher than those who are formula fed or even mixed fed. Higher pH means less harmful bacteria is able to grow which helps have less issues with diarrhea How does iron effect baby's gut Correct answerLow iron in the gut is good, breastmilk has relativly low iron content Tons of different bacteria thrives on excess iron so having to much can cause issues How does the presence of lactobacillus bifidus affect baby's gut Correct answerPresence of bifidus factor in breast milk promotes the growth of lactobacillus bifidus which helps maintain the low pH and crowd out the harmful bacteria How does the presence of SIgA antibodies effect baby's gut Correct answerAntibodies such as SIgA bind to microbes in the baby's intestinal tract and prevent them from being absorbed into the rest of the body. Mothers IgA has been found to protect against the development of necrotizing enterocolitis in preterm infants Weight loss in breastfed infant Correct answerNo more than 7% weight loss from with birth weight and no more weight loss by day 5 and should be back to birth weight by 2 weeks Weight loss greater than 7% from birth weight indicates a possible breastfeeding problem and requires more intensive evaluation of breastfeeding and possibly intervention (not supplementation!) to correct problems and improve milk production and transfer What causes infants to lose weight in the first postpartum days Correct answerLabor medications More intrapartum fluids are given, they have more fluid to loss which is a normal process No labor prior to a c-section, maybe they weren't ready to be born How do I know my baby is getting enough milk? Correct answerOne wet diaper for how old the baby is (however this can be skewed by the diuresing process and is not a good indicator of adequate hydration) 4 wets on day 4 and each day after Multiple poops each day that change in consistency and color How much weight should my baby be gaining Correct answerApproximently 1 ounce per day is expected in the early months by more may be needed for babies with metabolic or respiratory distress because they tend to burn more calories breathing, keeping warm, etc.. Size of the breast relates to the amount of milk produced Correct answerNo!! the proportion of glandular and fat tissue and the number and size of the ducts are not related to milk production Need to drink a lot of fluids to produce a lot of milk Correct answerNo!! There is not enough evidence to support increasing fluid intake beyond what breastfeeding mothers are likely to require to meet their needs Maternal exercise is related to infant weight gain growth Correct answerNo!! Increased worry of stress my diminish milk supply Correct answerNot necessarily, worry/stress may alter behavior which could alter supply but not nursing enough or removing milk often enough How do we assure an adequate milk supply? Correct answerUniversal understanding of how breastfeeding works Early initiation and adequate breastfeeding (10-12x per day) Appropriate breastfeeding assessment Improved and early breastfeeding support Appropriate HCP and LCP follow-up in the postpartum period Admitting there is no magic bullet More nursing= more milk Negative influences on milk production Correct answerLong spaced between feedings Long, slow feedings-can effect prolactin production Negative influences on milk production: Excessive pressure in the breast Correct answerPressure on the milk making cells causes less milk to be made Pressure can result from: vascular, lymphatic, and third spacing forces Too much milk in the breast (engorgement) Missed feedings Restrictive bras and clothing Brest implants: decrease storage and capacity and also increase the pressure on the milk cells Engorgement Correct answerBreasts hard, hot, and shiny Temp above normal Feels discomfort in the breast Nipple difficult to grasp, makes difficult for baby to latch Occurs most commonly day 3-5 As the pressure builds up inside the breast milk production decreases, this is natures early dry up mechanism Failure to effectively resolve prolonged symptomatic engorgement may have a negative impact on continued adequate milk supply Placing breasts in a bowl of warm water will stimulate the milk to flow out to relieve some pressure so you can then feed Negative influences on milk production: Breast surgery or injury Correct answerWith surgery concern centers on damage to nerves which makes stimulation difficult or impossible, and damage to ducts which makes milk flowing out of breasts difficult or impossible Counseling implication after breast surgery: Likelyhood of full breastfeeding is unknown The hormonal exposure of pregnancy and lactation may mitigate some effects of surgery Assessment and close follow-up are the keys Assure adequate nutrition for the infant Negative influences on milk production: Sub-optimal breast anatomy Correct answerAnatomical concerns Absence of breast changes in pregnancy or early days postpartum No postpartum breast fullness or signs of abundant milk production Hypoplastic breast(s) (underdeveloped, tubular, or inadequate glandular tissue) Discrepant breast size (Unilateral underdeveloped breasts) Inverted Nipples Correct answerGrade 1: are easily pulled out with a breast pump or infant nursing (look inverted with rest but evert with use) Grade 2: can be pulled out but don't maintain their projection (may invert as soon as baby comes off breast) Grade 3: difficult or impossible to pull out Classification is about function during feeding not about how inverted or flat the nipple looks at rest Does the nipple ever evert? To develop a relationship with Receivers of knowledge: Teacher or counselor must project authority Never be ambiguous Advantages must be concrete and appropriate for her Teaching should be centered on the right way and include return demo Subjective knowing Correct answerBelieves knowing is personal, private, and based on intuition and/or feeling states, rather than on thought and articulated ideas that are defended with evidence Sense of self is embedded in external definitions and roles Sense of authority arises primarily from the power of a group Trust their own intuition Inner voice helps guide them Distrust male authority figures "Experts don't know what they are talking about" Trust other women with similar experiences Find female support groups helpful Attracted to natural things, like breastfeeding Want to be helped by someone who has breastfed Interested in breastfeeding from her own point of view To develop a relationship with Subjective knowers: Create time for them to talk about themselves and what they think about breastfeeding Offer help with possible misconceptions about breastfeeding Offer to make contacts and referrals Procedural Knowing Correct answerThe position at which techniques and procedures for acquiring, validating, and evaluating knowledge claims are developed and honored Invested learning, constantly taking in new information Interested in obtaining and applying knowledge Want to understand other people's points of view Assume that every one including themselves can be wrong Will read a variety of books with different points of view May attend several classes and change health care providers easily May be viewed as inconsistent by others May want very technical information about breastfeeding To develop a relationship with Procedural knowers: Be prepared to back up statements with evidence Be knowledgeable about multiple sources of reference Limit personal stories Understand that options and change are part of the process Constructed Knowing Correct answerThe position at which truth is understood to be contextual, knowledge is tentative, and it is understood that the knower is part of the known Have abandoned either/or thinking Have learned to live with conflict and have high tolerance for internal contradiction and ambiguity Believe all knowledge is constructed and the knower is an intimate part of the known Want to avoid compartmentalizing thought and feeling, home and work, self and other Want to embrace all the pieces of the self in some ultimate sense of the whole: mother-daughter-wife-artist Aspire to work that contributes to the empowerment and improvement in the quality of life of others Believe that ideas and values must be nurtured Have a unique and authentic voice Storing fresh expressed or pumped breast milk Correct answerUp to 4 hours on the countertop Up to 4 days in the refrigerator Within 6 months but up to 12 months in the freezer Storing thawed, previously frozen breast milk Correct answerUp to 1-2 hours on the countertop Up to 24 hours in the refrigerator Never re-freeze previously thawed milk Storing breast milk that is leftover from a feeding Correct answerUse within 2 hours after the baby is done feeding Formula preparation and storing Correct answerFormula needs to be mix with water that is at least 70ºC or 158ºF in order to kill Enerobacter Sakazakii Formula made with hot water need to be cooled quickly to body temperature if it is being fed to the baby immediately If the formula is not being fed immediately, refrigerate it right away and keep refrigerated until feeling Hierarchy of infant feeding choices Correct answer1. Baby at mothers breast 2. Mother's own expressed milk 3. Milk from a milk bank 4. Cows milk forumla 5. Soy formula Colic Correct answerAn easily identifiable childhood problem that has no clearly identified treatment Does not seem to be associated with GERD Colicky babies had more than double the abundance of microbia in the gut How much milk do moms make on average? Correct answer750-1000mL per day If baby is diagnosed with Galactosemia Correct answerrecessive genetic disorder; characterized by body's inability to tolerate galactose Can be rapidly fatal is lactose is not completely removed from the infants diet Breastfeeding is contraindicated If mother is infected with HIV Correct answerBreastfeeding or feeding at the breast is not advisable If mother is infected with T-cell lymphotopic virus Correct answerBreastfeeding or feeding at the breast is not advisable If mother is using illicit street drugs such as PCP or cocaine Correct answerBreastfeeding or feeding at the breast is not advisable Exceptions being narcotic dependent mothers who are enrolled in a supervised methadone program and have a negative screening for HIV infection If mother is suspected or confirmed of having Ebola Correct answerBreastfeeding or feeding at the breast is not advisable If mother is infected with untreated brucellosis Correct answerMothers should temporarily not breastfeed or feed expressed breast milk If mother is taking certain medications (medications and decrease cells proliferation: cancer drugs) Correct answerMothers should temporarily not breastfeed or feed expressed breast milk