Exam (elaborations)
CLC Exam 2023/366 Questions with complete Answers
CLC Exam 2023/366 Questions with complete Answers
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CLC Exam 2023/366 Questions with completeAnswers
What are green/shiny stools a sign of? - --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 - -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? - -Improper latch--> need lactation support to
help with proper latch on, good seal
-True/false: baby should be pulled into breast. - -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? - -Asymmetric! A baby should
form a teat with breast tissue underneath the nipple as part of a latch
-What is a symmetric latch - -Not a good latch, causes nipple damage
-Asymmetric latch - -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? - -Continued questions of effectiveness, fear of
ingestion by baby
-Should a frenotomy be suggested for tongue tie? - -No study was able to
report that frenotomy led to better long term breastfeeding
-Tongue tied breastfeeder - --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? - -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? - -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? - -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? - -normal milk production = 750-
1000 mL/day
-Thrush during BF - -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 - --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? - -Not candida
infection!
-Reynaud's Phenomenon - --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 - --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 -
--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 - -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 - -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 - -If plug hasn't moved in 24-48 hrs or
systemic signs of inflammation (flu like s/s)
-Causes of clogs/plug - -too tight nursing bra
-what is a bleb - -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 - -painful stabbing pinpoint pain
-how to get rid of blebs - -Same as clog treatment. Sometimes need t be
lanced by HCP
-Common mastitis - --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 - --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 - -systemic- fever, ill, malaise, redness, pain, one
inflamed breast
-What bacteria causes infective mastitis - -Staphylococcus
-tx common mastitis - -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 - -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? - -Usually for double mastitis, not generally
proscribed for one breast common mastitis. If treatment uneffective consider
anemia, ductal or inflammatory breast cancer
-Double mastitis - -EMERGENT AND UNCOMMON- tissue of both breasts
inflamed.
-organism cause of double mastitis - -strep -potentially fatal, whole body
inflammation, sepsis
-not a problem with milk
-signs of inflammatory breast cancer - -- breast tissue is red, warm, has
orange peel (peau d'orange), pitting appearance on skin surface
- breast mass may or may not be present
-True/false: MRSA can look like mastitis when on breast - -TRUE can
masquerade as mastitis. might see peeling skin, pitting. can also cause
lesions and abscess.
-Abscess on breast is full of ... - -PUS not MILK. as many as 60% positive for
MRSA.
-can you nurse on same side as abscess - -No should nurse on other breast.
must be aware of possible contamination on flanges, pump parts, can not
track infection from one side to other.
-abscess surgical intervention - -can cut through nerves and ducts. try to
avoid surgical intervention
-treatment of abscess - -drainage through ultrasound-guided technique is
first choice (needle aspiration often has to be repeated)
-Report any suspicious area of the breast to a qualified provider because it
could be... - -MRSA or herpes- fatal for babies
-Goldsmith's sign - -The association of a baby's persistent refusal of one
breast with possible breast cancer in the mother
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