Exam (elaborations)
CLC EXAM QUESTIONS AND ANSWERS
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CLC EXAM QUESTIONS AND ANSWERS
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CLC EXAM QUESTIONS AND ANSWERSWhat are green/shiny stools a sign of? - Answers --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 - Answers -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? - Answers -Improper latch--> need lactation support to help
with proper latch on, good seal
True/false: baby should be pulled into breast. - Answers -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? - Answers -Asymmetric! A baby should
form a teat with breast tissue underneath the nipple as part of a latch
Causes of clogs/plug - Answers -too tight nursing bra
what is a bleb - Answers -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 - Answers -painful stabbing pinpoint pain
how to get rid of blebs - Answers -Same as clog treatment. Sometimes need t be lanced
by HCP
Common mastitis - Answers --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 - Answers --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 - Answers -systemic- fever, ill, malaise, redness, pain, one
inflamed breast
What bacteria causes infective mastitis - Answers -Staphylococcus
,tx common mastitis - Answers -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 - Answers -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? - Answers -Usually for double mastitis, not generally proscribed
for one breast common mastitis. If treatment uneffective consider anemia, ductal or
inflammatory breast cancer
Double mastitis - Answers -EMERGENT AND UNCOMMON- tissue of both breasts
inflamed.
organism cause of double mastitis - Answers -strep -potentially fatal, whole body
inflammation, sepsis
-not a problem with milk
signs of inflammatory breast cancer - Answers -- 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 - Answers -TRUE can
masquerade as mastitis. might see peeling skin, pitting. can also cause lesions and
abscess.
Abscess on breast is full of ... - Answers -PUS not MILK. as many as 60% positive for
MRSA.
can you nurse on same side as abscess - Answers -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 - Answers -can cut through nerves and ducts. try to avoid
surgical intervention
treatment of abscess - Answers -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... -
Answers -MRSA or herpes- fatal for babies
Goldsmith's sign - Answers -The association of a baby's persistent refusal of one breast
with possible breast cancer in the mother
-can also happen suddenly with older babies
-rule out common problems such as ear infection, teething, birth trauma
-CA may be diagnosed as late as 5 yrs after this sign
Neonatal hypoglycemia - Answers --symptomatic infants = glucose of 40 requires per
APP
-dextrose & BF = first line tx
-SGA, LGA, diabetic moms, late preterm infants at gretest risk
Signs of neonatal hypoglycemia - Answers -• Jitteriness, tremors
• Poor muscle tone
• Diaphoresis (sweating)
• Poor suck, failing to sustain latch
• Tachypnea
• Tachycardia
• Dyspnea
• Grunting
• Cyanosis
• Apnea
• Low temperature
• High-pitched cry
• Irritability
• Lethargy & poor feeding
• Seizures, coma
• No signs (some infants may be asymptomatic)
Do healthy term newborns need glucose checks - Answers -No
Jaundice is caused by - Answers -Unconjugated bilirubin that accumulates in blood
stream of newborn because fetal-type blood cells are broken down and live and
intestines too immature to excrete at fast pace.
Pathologic jaundice - Answers -Result of an underlying disease appearing before 24
hours (or persistent after day 7)
-due to sepsis, blood incompatibility
Bhutani curve - Answers -Chart that can be used to determine when bilirubin levels
require treatment
What is a symmetric latch - Answers -Not a good latch, causes nipple damage
, Asymmetric latch - Answers -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? - Answers -Continued questions of effectiveness, fear of
ingestion by baby
Should a frenotomy be suggested for tongue tie? - Answers -No study was able to
report that frenotomy led to better long term breastfeeding
Tongue tied breastfeeder - Answers --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? - Answers -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? - Answers -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? - Answers -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? - Answers -normal milk production = 750-1000
mL/day
Thrush during BF - Answers -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 - Answers --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
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