Exam (elaborations)
CLC Section 3A & 3B EXAM/113 QUESTIONS & ANSWERS 2023
- Course
- Institution
CLC Section 3A & 3B EXAM/113 QUESTIONS & ANSWERS 2023
[Show more]
Seller
Follow
Victorious23
Reviews received
Content preview
CLC Section 3A & 3B EXAM/113 QUESTIONS &ANSWERS 2023
Lactation Counseling - --observe, explore, and coach
-parents, baby, & other family members know more about their situation &
resources than we do
-our job to observe, collect info, & explore mature of presenting issues, & to
coach families regarding feeding & nurturing their babies
-as we seek to understand the nature of the presenting issues, other
problems & concerns may be uncovered
-in our conceptual framework, problems & symptoms are not the same thing
(for example, pain w/ BF is a symptom of a different problem perhaps a poor
latch)
-thru BF counseling we seek to ID the true nature of the underlying problems
rather than only removing the presenting symptoms
-once we have gathered enough info about the nature of the problems at
hand, we can formulate potential solutions & propose them to the family
-it is up to the family to choose the solutions they are willing to implement &
to carry them out
-it's our responsibility to provide info & suggestions in an open, transparent,
non-judgmental manner, IDing strategies that may be useful for the family,
sharing pros & cons of IDed strategies, all in full acknowledgement that the
family will make the final determination regarding what actions to take, if
any, to address IDed challenges
-it's our responsibility to refer families for additional clinical support or other
eval as needed, if it is not available at our workplace or within our scope of
practice
-it's our responsibility to ensure adequate follow up for IDed BF problems
-Normal BF - --should be enjoyable experience
-shouldnt have pain or discomfort, but they are common
-follow feeding cues signaled by REM, bringing fist to mouth, seeking food w/
lips tongue & head, smack lips, extend tongue
-crying is late feeding cue
-Getting Started w/ BF - --in first hours and days the dyad learn to BF
together and move gradually from self-attached BF to collaborative BF
-each dyad moves in a unique pattern: one feed may be self-attachment and
the next collaborative
-BF moves into more collaborative after baby is able to locate the breast
-both will become more & more comfortable w/ collaborative feeding as they
learn together
-baby's arms should not cross over his/her body, but should embrace the
breast
-baby's hands knead breast while suckling, do not swaddle hands away
,-shouldn't be pain while nursing; after feed. nipple shouldn't be misshapen,
abraded, fissured, bruised, or blanched
-if there is pain, baby should be gently removed and allowed to relatch
-Self-Attached BF - --healthy baby should be dried after birth & placed on
chest for prolonged S2S
-dyad covers w/ warm blanket
-mom & newborn assessment, eye care, & other procedures are done w/
baby in S2S
-babies warm better in S2S compared to electric warmers (breasts will
increase and decrease in temp according to baby's needs)
-allow newborn baby to find breast & self attach. This may take more than 2
hours when labor analgesia has been used; do not force baby to breast,
doing so may stress baby, decrease willingness, & cause baby to place
tongue on roof of mouth
-S2S 9 Distinct Behaviors in Prep for Feeding - --birth cry
-relaxation
-awakening
-activity
-rest
-crawling/sliding
-familiarization
-suckling
-sleeping
-Collaborative BF - --as the baby seeks the breast the parent gently assists
-Sequence of Successful Feeding - --newborn held S2S or close to breast so
feeding cues may be observed
-when baby has cues, baby is brought to breast
-breast should be at normal angle (not held or shaped w/ hand; if large
breast put rolled up towel under breast, do not fold breast upward to see the
nipple)
-collaborative BF may bb initiated when baby exhibits appropriate cues:
rooting, increasing alertness/REM, flexing of legs & arms, mouthing w/ little
sucking motions, attempting to bring hand to mouth, sucking on fist or
finger, mouthing motions of lips and tongue
-crying is late feeding cue because it does not usually begin in full term
babies until more subtle cues have failed to elicit the parents attention
-less mature & more disorganized babies may pass quickly from deep sleep
(no REM) to crying
-when using collaborative BF strategy, baby is supported by the frame of the
parent's body which provides support needed to keep the baby at the breast
-parent finds a comfortable posture & makes breast accessible to baby
,-baby is allowed the freedom to achieve pain-free suckling w/ maximal milk
transfer
-BF sessions are best ended by the baby, when feeding ends baby is relaxed,
hands are open, arms are floppy, brow is smooth, toes are curled
-Baby Position At Breast For Maximal Milk Transfer - --baby is near breast
-baby's shoulders are supported at base of the neck
-no pressure on back of baby's head, baby must be able to tilt head
-baby's body rotated toward parent's chest (tummy to mummy)
-baby moved towards breast, lining up nose at nipple
-breast is not moved to baby; breast should lie in natural position & baby be
brought to breast
-start feed w/ nose opposite nipple assists baby to orient to breast via well-
developed sense of smell & aligns mouth at breast when baby's head tilts
back
-as baby chin comes closer to breast, he will gape, opening mouth very wide
as head tilts back (if baby fails to gape, repeat this maneuver)
-consider additional S2S to improve baby's motor state organization for baby
who fails to gape or nurse
-do not push nipple into baby's mouth, doing this can result in optimal
positioning of nipple or appropriate compression & release of breast & nipple
tissue (can cause pain, damage, & slow flow of milk)
-head tilt allows lower lip to seal to breast first followed by upper lip
-baby's mouth will appear off-center when compared w/ areola, baby's lower
lip will be against breast much father from nipple than upper lip (asymmetric
latch)
-baby seals to breast & begins to suck rapidly (could be 8 or more sucks to 1
swallow), then shifts into pattern of 2 sucks to 1 swallow or 1 suck to 1
swallow
-2:1 or 1:1 suck to swallow is a time of greater milk transfer; these are
interspersed w/ more rapid sucking sequences & occasional rest periods
-after colostral stage, baby can transfer several oz of milk in very few
minutes when appropriately latched & hungry
-there is no right length of feed to ensure adequate milk transfer, however
babies with consistently short (<5 min) or long (>20 min) feeds should be
assessed to ensure adequate milk transfer
-Proof of Success of BF Baby - --baby who is responsive & interactive
-growing well (about an oz a day after 5th day)
-producing at least 6 wet and 4 dirty diapers starting on day 4 and
continuing into the early weeks
-Concern: Baby Won't Latch: Feeding Refusal That is Continuous - --baby
refuses to feed from breast; baby won't latch, or will & immediately pull off &
cry
*Ask yourself: -have baby's weight gain & output been appropriate?
, -does baby look dehydrated, jaundice, or malnourished? does baby seem
alert & active or lethargic?
-are breasts so full & hard that baby is unable to form teat?
-has baby been forced to breast w/ pressure on back of head?
-what is family's response to baby's refusal?
-if onset is sudden & refusal is continuous, what has changed recently, (i.e.
has milk volume increased, change in family routine, nursing parent taking
new meds, nutritional supplements, etc)
*Watch out for: -presence of feeding cues prior to feeding
-process used to bring baby to breast
-visible signs of pain for either members of dyad
*What to do about it: -if breasts are hard & full, sufficient softening should be
done before attempting to feed
-is aggressive latch techniques are used, or pressure on back of baby's head
do S2S & allow baby to self-attach
-baby has trouble w/ increased volume or milk flow, make sure baby is able
to move head away from breast & let milk spray
-observe feed using feeding observation checklist
-is baby refuses to latch, ask that baby be held S2S until feeding cues are
observed & baby moves toward breast
-encourage bringing baby close to breast immediately upon observation of
feeding cues, & allow baby to find breast and self attach (babies need to
familiarize before latching as they learn sounds & smells & tastes of feeding
at breast)
-suggest alternate positions, encourage hand expression to release few
drops to offer baby to smell and lap; if baby latches can use alternate
massage / breast compression to increase flow if baby becomes fidgety
-suggest other changes to feeding process indicated by feeding observation
-persist in trying to uncover underlying reason for difficulty in coming to
breast; babies should show desire; not doing so raises a concern; continuing
demonstration of lack of desire warrants comprehensive pediatric exam
-schedule follow up & ensure appropriate referrals
*Expected resolution: -comfortable & effective feeding postures & positions
will be found
-is baby can't be helped to BF & PCP has prescribed supplementation,
frequent S2S is encourages in order to assist baby in developing comfort
when being held to breast
-consider at breast supplementation if supplementation is prescribed
-work to ensure adequate milk expression in order to build &/or maintain
abundant milk supply
*What else to consider: -if observation & positioning guidance do not resolve
refusal, referral for immediate broader eval is required; stuffy nose,
respiratory problems, ear or other infections, trauma (fractured collar bone,
torticollis) need to be ruled out
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Victorious23. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $15.49. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
77858 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now