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by: Ian Spath

NHM201Ch6Notes.pdf NHM 201

Marketplace > NHM 201 > NHM201Ch6Notes pdf
Ian Spath
GPA 3.25
Nutrition 201 Midterm ( Chapters 1-9)
Karin Pennington

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Nutrition 201 Midterm ( Chapters 1-9)
Karin Pennington
Study Guide
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This 9 page Study Guide was uploaded by Ian Spath on Monday January 19, 2015. The Study Guide belongs to NHM 201 at a university taught by Karin Pennington in Fall. Since its upload, it has received 239 views.


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Date Created: 01/19/15
Chapter 6 Straight from the Experts Regarding nutrient composition the American Dietetic Association stated Human milk is uniquely tailored to meet the nutrition needs of human infants It has the appropriate balance of nutrients provided in easily digestible and bioavailable forms The AAP stated Human milk is speciesspecific and all substitute feeding preparations differ markedly from it making human milk uniquely superior for infant feeding Exclusive breastfeeding is the reference or normative model against which all alternative feeding methods must be measured with regard to growth health development and all other short and longterm outcomes Breastfeeding Rates Early 19003 Almost all infants breastfed 1950603 Below 30 19703 Rates began to increase 19803 Above 60 o Breastfeeding Goals for US HP 2020 Increase proportion of infants who were breastfed Ever Target819 Actual74 in 2006 6 months Target606 Actual435 in 2006 1 year Target 341 Actual 227 in 2006 Increase proportion of infants who were exclusively breastfed 3 months Target462 Actual336 in 2006 6 months Target255 Actual141 in 2006 25 at 12 months of age 22 13 AA Rates of breastfeeding our lower among African Americans 58 postpartum 28 at 6 mos 13 at 1 yr Breastfeeding Goals for US HP 2020 cont Increase the proportion of employers that have worksite lactation support programs Target 38 Actual 25 in 2009 Reduce the proportion of breastfed newborns who receive formula supplementation Within the first 2 days of life Target 142 Actual 242 in 2006 Breastfeeding Benefits for the mother Hormonal Suppression of ovulation and menstruation Physical Reduced risk of breast and ovarian cancers and osteoporosis Better health outcomes in general Psychosocial May lower risk of postpartum depression Fosters maternalinfant bonding Breastfeeding Benefits for the Infant Nutritional Benefits Nutrient balance matches human requirements Relatively low protein easily digestible whey Generous amounts of lipids especially essential fatty acids DHA Minerals mostly protein bound and balanced for enhanced availability Breastfeeding Benefits for the Infant Decreased risk of the following Diarrhea Ear infections Lower respiratory infections Leukemia SIDS Type 2 DM Asthma Childhood obesity Leukemia Necrotizing enterocolitis premature infants Breastfeeding Benefits for the Infant Immunological benefits Fewer acute illnesses Lower infant mortality rates in developing countries Reduction in chronic illnesses Childhood overweight Cognitive benefits Reduction in pain Breastfeeding Benefits cont d Economic 120015OO spent on formula in the first year more like 2500 Fewer health insurance claims if breastfed Less employee time off with sick children Reduce prevalence of illnesses and thus healthcare costs Environmental No packaging involved Transport of formula Important Notes Breastfed infants typically are leaner than HMSfed infants at one year of age Breastfed infants consume fewer kcalories than those fed HMSs Infants who are breastfed are thinner for their at 811 months but differences disappear by 1223 months Mammary Gland the source of milk for offspring also commonly called the breast the presence of mammary glands is a characteristic of mammals Common Barriers to Breastfeeding Lack of knowledge Lactation problems Embarrassment Time and social constraints Returning to work lnconvenience Lack of support from family and friends Concerns about diet and health practices Health care provider misinformation Inadequate health care provider lactation management training Disruptive hospital policies ex sent home with formula Media portrayal of bottle feeding as the norm Big is Healthy Alveoli a rounded or oblong shaped cavity present in the breast Secretory Cells Cells in the acinus milk gland that are responsible for secreting milk components into the ducts Myoepithelial Cells Specialized cells that line the alveoli and that can contract to cause milk to be secreted into the duct Oxytocin a hormone produced during letdown that causes milk to be ejected into the ducts Lobes rounded structures of the mammary gland Lactogenesis another term for human milk production Lactogenesis Stage 1 Last trimester through first few days postpartum milk begins to form Stage 2 Begins 25 days postpartum and goes to 10 days significant changes in milk quantity and composition when milk comes in Stage 3 o 10 days postpartum maintenance Hormonal Control of Lactation 1 Production Prolactin Stimulates milk production Infant sucking stimulus major stimulator of prolactin secretion secreted by anterior pituitary promotes continued milk production and release 2 Release Oxytocin triggers ejection of milk from breast stimulated by suckling the letdown reflex Qualities of Human Milk Colostrum Produced in stage 2 of lactogenesis 13 days after birth 210 ml 1 52 tsp per feeding 580700 kcallLiter Higher in protein electrolytes immune factors Lower in carbohydrate and fat Mature Milk Energy 65kcalml 65kcal1OO ml Clinicians use 20 kcaloz Lipids Fatty acid profile but not fat content varies with mother s diet DHA developmental advantages retinal development Cholesterol higher in breast milk About 4045 of calories from fat in foremilk watery milk coming from a full breast About 6080 of calories from fat in hindmilk creamy milk coming from a nearly empty breast Mature Milk Continued Protein Relatively low content Casein major class whey protein easily digestible Carbohydrate Lactose dominant Fat Soluble vitamins Vit A highest in colostrum Vitamin D varies with maternal diet and sun rickets is the deficiency Supplement rec of 400 lUs per day Vitamin E sufficient for term not preterm Risk for Hemolytic Anemia in preterm infants Vitamin K injection or oral dose at birth Mature Milk Continued WaterSoluble Vitamins Generally responsive to maternal diet or supplements Vitamin BB most likely to be deficient Vitamin B12 and Folate bound to whey proteins less influenced by maternal diet Mature Milk Continued Minerals Lower in content than cow s milk easier for kidneys to handle Magnesium calcium iron and zinc are highly available to the infant Trace Minerals in breast milk not altered by maternal diet or supplements Osmolality a measure of the concentration of particles in solution Monovalent Ion an atom with an electrical charge of 1 or 1 Macrophages a white blood cell that acts mainly through phagocytosis Neutrophils Class of white blood cells that are involved in the protection against infection T ymphocyte a white blood cell that is active in fighting infection May also be called tcellthe t in tcell stands for thymus these cells coordinate the immune system by secreting hormones that act on other cells Blymphocytes White blood cells that are responsible for producing immunoglobulins Epithelial Cells Cells that line the surface of the body Secretory lmmunoglobin A a protein found in secretions that protect the body s mucosal surfaces from infections the mode of action may be by reducing the binding of a microorganism with cells lining the digestive tract It is present in human colostrum but not transferred across the placenta Morbidity the rate of illnesses in a population Mortality rate of death Cognitive Function the process of thinking Breast Milk Supply and Demand 1st month 600 ml daily 20 oz 45th month 750800 ml daily 2428 oz Ranges from 4501200 m daily 1540 oz Supply is related to demand or amount consumed emptying of breast RecommendationNurse or pump early and often to build a good milk supply The Breastfeeding Infant Optimal Duration AAP 1 year or longer past introduction of solids Healthy term babies have reflexes to enable nourishment Sucking gag reflex oral search reflex rooting reflex The Breastfeeding Infant cont Identifying Hunger and Satiety Recognize early hunger behaviors Nurse at one breast as long as possible Foremilk higher lactose vs hindmilk higher fat Feeding Frequency Stomach emptying within 112 hours so 1012 feedings per day for newborns Breastfeeding Infant Issues Identifying Malnutrition Normal weight loss of up to 7 in first week postpartum Greater than 10 weight loss needs evaluation Malnourished infants FTT become sleepy non responsive weak cry few wet diapers infrequent stools Normal 6 wet diapers 34 soft yellowish stools What about supplements Vitamin D 400 IU for exclusively breastfed infants No Fluoride until 6 months of age add if water has not been treated Breastfed infants rarely have iron deficiency Baby Bottle Tooth Decay May occur with frequent night nursing after 1 year The Maternal Diet Follow the Dietary Guidelines with 4 servings from the dairy group DRls 500 kcal per day for 1st 6 mos 400 kcalday 6 12 mos Minimum energy intake 1800 Kcal per day for the first 6 weeks Modest kcalorie restriction exercise may help loss of weight but not reduce milk volume Other Maternal Issues Diet Supplements MVl Vitamin D Assess mom s dietary intake and sun exposure Fluids 13 802 glasses per day oDHA 200300 mgday Vegetarian Diets May need Vit B12 supplement Herbals Fenugreek Important Most women do not experience significant problems with breastfeeding Prevention is key Prenatal breastfeeding education Positive supportive breastfeeding environmen Summary of the components of the four steps of the nutrition care Process for breastfeeding Women ADA Step 1 Nutrition Assessment for Breastfeeding Women oFood and nutrient intake oDiet history oKnowledgeattitudesbeliefs oFoods that may increase risk of infant colic oAdequate energy intake for return to prepregnant weight oMedications herbs and supplements oCheck for safety and compatibility with breastfeeding see more on herbs and medications in Chapter 7 oNeed for supplements based on inadequate intake missing food groups or vegan dietary pattern a Nutritionrelated behaviors oExcessive dieting or calorie restriction oPhysical activity oReturn to physical activity after adequate recovery from delivery oBiochemical data medical tests and procedures oGradual return to non pregnant non lactating values oAnthropometric measures oBMl to return to pre pregnant or ideal levels oClient history oMedical history treatments beast surgeries use of alternativecomplementary medicine social history Step 2 Common Nutrition Diagnoses for Breastfeeding Women oAltered maternal BMI oObesity underweight or related to rate of weight loss oNutrient inadequacy or excess oVegan oLactose intolerance oPerceived or real inadequate milk production oBehavioralenvironmental oKnowledge deficit oNeedqualify for WIC services Step 3 Common Nutrition Interventions for Breastfeeding Women oAlter energy intake to achieve ideal weight or weight goal oReinforce principles of milk production early signs of infant hunger and signs of adequate infant milk intake oRecommend vitamin B12 for vegans or other supplements if intake is inadequate Step 4 Common Nutrition Monitoring and Evaluation Plan Components oWeight changeBMI olnfant growth oB12 status CrossSectional Study a study that measures the current disease and exposure status of all individuals in a sample at a single time point Le a study that measures the prevalence of breastfeeding at 6 months of age Common Breastfeeding Conditions Sore Nipples Poor positioning maternal infection poor suck Letdown Failure Usually resolved with environmental changes Oxytocin nasal spray for shortterm use Overactive Letdown Volume overwhelms infant More common problems Engorgement Breasts overfilled Plugged Duct Caused by milk stasis Bacterial Infection Mastitis Symptoms are flulike with fever Infected area on breast becomes red and hot Other maternal factors Alcohol Level in breast milk matches maternal blood levels at time of feeding Level in milk peaks within 1 hr consumption Nicotine Children of smoking mothers breastfed Marijuana Affects DNA and RNA metabolism Caffeine Moderate intake usually not a problem Do consider timing of consumption Hyperbilirubinemia and Jaundice Elevated levels of bilirubin cause yellow discoloring of the skin occurs in 60 of newborns within first week of life Bilirubin is a cell toxin can result in permanent brain damage byproduct of heme breakdown Jaundice caused by disease condition Treatment phototherapy Intravenous immunoglobulin lVlg results in the baby carrying antibodies from the mother that contribute to the breakdown of blood cells in the baby Exchange transfusion this involves repeatedly withdrawing small amounts of blood diluting the bilirubin and maternal antibodies and then transferring blood back into the baby a procedure that39s performed in a newborn intensive care unit Doula an individual who surrounds interacts with and aids the mother at any time within the period that includes pregnancy birth and lactation may be a relative friend or neighbor and is usually but not necessarily female One who gives psychological encouragement and physical assistance to a new mother 10 Lactogenesis 1 the first stage of milk production which extends into the first few postpartum days when suckling is not needed for milk production Lactose and protein content of milk increases Lactogenesis ll begins 25 days postpartum and continues to about 10 days of postpartum This is when milk comes in the lactose and fat composition are increasing the protein content decreases and the volume of milk produced is increasing Lactogenesis lll begins about 10 days postpartum and milk composition becomes stable 11 Correct answers include o The balance of nutrients in human milk matches human infant requirements for growth and development closely no other animal milk or HMS meets infant needs as well Human milk is isosmotic of similar ion concentration in this case human milk and plasma are of similar ion concentration and therefore meets the requirements for infants without other forms of food or water The relatively low protein content of breast milk compared to cow s milk meets the infant s needs without overloading the immature kidneys with nitrogen


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