Exam (elaborations)
CLC Exam 2023 __ Questions/Solutions
CLC Exam 2023 __ Questions/Solutions
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CLC Exam 2023 __ Questions/SolutionsWhat are green/shiny stools a sign of? Correct Ans - -sign of
overproduction leading to less fat in milk, faster digestion causing not enough
time for lactase to digest the lactose in milk. An improved latch could allow for
more fat flow
Signs of oversupply Correct Ans - Rapid weight gain in infant,
unsettled baby after feeding, recurrent plugged ducts and mastitis, painful
feedings, voluminous (huge volumes of) stools- often green & shiny
What causes nipple pain? Correct Ans - Improper latch--> need
lactation support to help with proper latch on, good seal
True/false: baby should be pulled into breast. Correct Ans - False! Do
not pull baby into breast, let baby tilt head back for optimal latch. Hand on
back of baby's head can interfere baby's interoral function by restricting the
movement of the cranio-cervical spine--> causes nipple trauma. Make sure
crook of arm in cradle position does not block baby from being able to fully tilt
back.
Should a latch be symmetric or asymmetric? Correct Ans -
Asymmetric! A baby should form a teat with breast tissue underneath the
nipple as part of a latch
What is a symmetric latch Correct Ans - Not a good latch, causes nipple
damage
Asymmetric latch Correct Ans - Optimal attachment to the breast,
where the baby's lips are not centered in relationship to the areolar, but
rather vertically off-centered with the baby's chin and lower lip closer to the
edge of the areola than the baby's upper lip. A baby should form a teat with
breast tissue underneath the nipple as part of a latch
Do nipple creams work? Correct Ans - Continued questions of
effectiveness, fear of ingestion by baby
,Should a frenotomy be suggested for tongue tie? Correct Ans - No
study was able to report that frenotomy led to better long term breastfeeding
Tongue tied breastfeeder Correct Ans - -complete feeding assessment
and suggest ways to optimize latch.
-refer onward for diagnosis (have PCP diagnose TT)
-provide support
What is a fissure straight down the nipple evidence of? Correct Ans - A
symmetric latch. Top lip needs to have good seal, moist part of lip should be
touching nipple, can roll out top lip, to reduce injury during BF
Is there a deep latch with nipple stretching? Correct Ans - If nipple not
stretched deeply into mouth, less oxytocin flows, less fat is in mix. With less
fat, milk digested quicker = not enough time for baby to make enough lactase
to digest lactose in milk.
What to do for oversupply? Correct Ans - Decrease additional
stimulation/milk removal if possible
Consider block feeding (only nursing on one side only per feeding)
Watch for mastitis
Try australian posture (mother down under, baby on top)
Consider donating to milk bank
Consult with HCP for medical dx
How many mL considered oversupply? Correct Ans - normal milk
production = 750-1000 mL/day
Thrush during BF Correct Ans - painful for mother & baby.
may be visible or may not (whiteness that can't be wiped off)
-mother will have itchy, flaky, shiny skin
-candida not found inside the ducts or milk
Treatment of candida on breast Correct Ans - -nystatin first line
-flucanizole second line
-throw out all yeast vectors (pacifiers sterilize breast pumps)
-flucanazole oral capsules may be used to clean yeast vectors due to the
biofilm created on pacifiers by candida
,What to do if antifungal treatment for yeast doesn't work? Correct Ans -
Not candida infection!
Reynaud's Phenomenon Correct Ans - -vasospasm of nipple,
recognized by triple color sign: from white--> blue--> raspberry or bicolor
sign white --> raspberry.
pain is extreme and spasmodic (not continuous)
-this happens after feeding once baby's mouth comes off nipple has
vasospasm, feels like frostbite
treatment of reynauds Correct Ans - -prevent/decrease cold exposure
-avoid vasoconstrictive drugs such as caffeine and hypertensive drugs,
nicotine
-can use nifedipine or calcium channel blocker
Nipple pain and poor milk transfer that is persistent despite optimal latch
Correct Ans - -can use nipple shield as a test to see if baby exerting too
much pressure?
-OT involvement
-in rare cases baby have a strong sucking vacuum as measured by a pressure
transducer or nipple shield
Clogs/plugs Correct Ans - Palpable lumps of milk within the lumen or
duct system, usually not visible. Solids dont get absorbed...could be too tight of
a bra slowing flow of milk
what to do for clogs/plugs Correct Ans - Encourage massage using side
of hand and warm compresses. Do double nursing by doubling up on side of
clog to push it out. point baby's chin toward clog
See PCP if clog hasnt moved in 24-48 hours or systemic symptoms of
inflammation (flu like s/s)
When to call PCP for clog/plug Correct Ans - If plug hasn't moved in
24-48 hrs or systemic signs of inflammation (flu like s/s)
Causes of clogs/plug Correct Ans - too tight nursing bra
what is a bleb Correct Ans - small white spots on the face of the nipple
that look like milk-filled blisters. one duct opening is usually covered
, what does a bleb feel like Correct Ans - painful stabbing pinpoint pain
how to get rid of blebs Correct Ans - Same as clog treatment.
Sometimes need t be lanced by HCP
Common mastitis Correct Ans - -can be non-infective or infective
-blocked ducts from engorgment, hurried feedings, nipple shield (pressure
will build until milk sneaks out of space, body reacts to this like invader)
causes of common mastitis Correct Ans - -tight bra (look for
indentation of breast straps)
-use of breast shell or nipple shell
-attachment difficulties
-anemia in the mother
-tongue tie in baby (ineffective milk emptying)
s/s common mastitis Correct Ans - systemic- fever, ill, malaise,
redness, pain, one inflamed breast
What bacteria causes infective mastitis Correct Ans - Staphylococcus
tx common mastitis Correct Ans - NSAIDS first line but make sure
diagnosed by PCP
-must keep pumping/breastfeeding to keep milk flowing. keeps breasts
soft/comfortable to avoid abscess development
Abscess on breast Correct Ans - Localized areas of pus and necrotic
tissue that can develop with a breast infection
•Can develop in the subcutaneous, intramammary, retromammarylayers
•Symptoms include pain, swelling, redness, fever, increased WBC count,
palpable mass
-pocket of pus forms in the breast
-from untreated mastitis
Antibiotics for mastitis? Correct Ans - Usually for double mastitis, not
generally proscribed for one breast common mastitis. If treatment uneffective
consider anemia, ductal or inflammatory breast cancer
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