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Multiple Choice Questions 4-1 for Effective breast pump use and management of breast pump-induced trauma

Learning Objectives

  1. Describe the effects of “hands-on” pumping on milk volume and composition and breast health
  2. Describe how to use a double electric hospital-grade breast pump
  3. Propose solutions for  injuries to the nipple-areolar complex acquired from breast pump use
  4. Describe the importance of hand expression as a strategy for breast milk provision to a hospitalized infant born preterm

Question 1

A 23 year-old female, G1P0, presents to the hospital in labor at 32 weeks gestation. She delivers an 1100 g male infant who is admitted to the NICU. The mother is sent to the maternity ward to recover and undergo observation for infectious complications for 48 hours. She has a strong desire to breastfeed. The nursing staff have taught her hand expression of colostrum. After 48 hours, she is cleared for discharge and instructed to return at least daily to the NICU to provide her infant with her breast milk.

Before she leaves, you discuss how to effectively use the breast pump. Which of the following describes the reason why pumping mothers should practice ‘hands-on’ pumping?

 

Question 2

A 23 year-old female, G1P0, presents to the hospital in labor at 32 weeks gestation. She delivers an 1100 g male infant who is admitted to the NICU. The mother is sent to the maternity ward to recover and undergo observation for infectious complications for 48 hours. She has a strong desire to breastfeed. The nursing staff have taught her hand expression of colostrum. After 48 hours, she is cleared for discharge and instructed to return at least daily to the NICU to provide her infant with her breast milk.

You want to discuss proper positioning and fitting of the flange with the patient. Which of the following sets of images shows an appropriate setup?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Question 3

A 23 year-old female, G1P0, presents to the hospital in labor at 32 weeks gestation. She delivers an 1100 g male infant who is admitted to the NICU. The mother is sent to the maternity ward to recover and undergo observation for infectious complications for 48 hours. She has a strong desire to breastfeed. The nursing staff have taught her hand expression of colostrum. After 48 hours, she is cleared for discharge and instructed to return at least daily to the NICU to provide her infant with her breast milk.

On day 4 postpartum, approximately 36 h following discharge, the patient asks about new irritation to her areola that appeared after a pumping session. She describes the irritation as ‘burning,’ but not really painful. She has been using a double-electric pump with silicone cushion inserts and lanolin for lubrication. Physical examination of the right nipple and areola shows a new area of erythema with a striated, vesicular rash in a periareolar distribution from about 1- to 5-o’clock. A brief review of her chart demonstrates no prior breast complaints, no rashes or skin conditions during either childhood or adulthood, and an up-to-date immunization record. Which of the following is the most likely mechanism underlying the patient’s new physical exam findings?

 

Question 4

A 23 year-old female, G1P0, presents to the hospital in labor at 32 weeks gestation. She delivers an 1100 g male infant who is admitted to the NICU. The mother is sent to the maternity ward to recover and undergo observation for infectious complications for 48 hours. She has a strong desire to breastfeed. The nursing staff have taught her hand expression of colostrum. After 48 hours, she is cleared for discharge and instructed to return at least daily to the NICU to provide her infant with her breast milk. You discussed ‘hands-on pumping’ and flange fitting prior to discharge. On day 4 postpartum, approximately 36 h following discharge, the patient asks about new irritation to her areola caused while pumping. Physical examination of the right nipple and areola shows a new area of erythema with a striated, vesicular rash in a periareolar distribution from about 1- to 5-o’clock. A brief review of her chart demonstrates no prior breast complaints, no rashes or skin conditions during either childhood or adulthood, and an up-to-date immunization record.

The patient asks what she should do to prevent this rash from appearing again. Which of the following is the best advice for this patient?

 

 

Question 5

A 23 year-old female, G1P0, presents to the hospital in labor at 32 weeks gestation. She delivers an 1100 g male infant who is admitted to the NICU. The mother is sent to the maternity ward to recover and undergo observation for infectious complications for 48 hours. She has a strong desire to breastfeed. The nursing staff have taught her hand expression of colostrum. After 48 hours, she is cleared for discharge and instructed to return at least daily to the NICU to provide her infant with her breast milk. You discussed ‘hands-on pumping’ and flange fitting prior to discharge. On day 4 postpartum, approximately 36 h following discharge, the patient asks about new irritation to her areola caused while pumping. Physical examination of the right nipple and areola shows a new area of erythema with a striated, vesicular rash in a periareolar distribution from about 1- to 5-o’clock. A brief review of her chart demonstrates no prior breast complaints, no rashes or skin conditions during either childhood or adulthood, and an up-to-date immunization record.  

The patient returns two days later with pain in her nipples bilaterally. She has been practicing hands-on pumping for most of the sessions and reports that her milk came in yesterday on day 5 postpartum.  She reports feeling exhausted and is looking forward to bringing her baby home with her to practice breastfeeding. Physical examination reveals an afebrile patient in no apparent distress. The base of both nipples is erythematous and a circumferential, non-bleeding fissure is present around the base of each nipple. The areolar rash from two days ago has resolved. Breasts are engorged bilaterally with multiple nontender, mobile masses. Which of the following describes the best recommendation for this patient?

Multiple Choice Questions 4-2 for Effective breast pump use and management of breast pump-induced trauma

Learning Objectives:

  1. Assess a lactating person’s infant feeding goals
  2. Discuss proper assembly and use of a wearable breast pump
  3. Troubleshoot breast pump difficulties following  injury to the nipple-areolar complex
  4. Discuss appropriate breast milk storage conditions
  5. Propose a schedule for breast pump use when away from the infant

Question 1

A 28 year-old G1P1 comes to the clinic to discuss the use of a breast pump. She is planning to return to work in two weeks and wants to be able to pump and store breast milk. She has no other concerns.  Her pregnancy, labor and delivery, and postnatal course were uncomplicated. She delivered a healthy, term male infant (3.5 kg) via normal spontaneous vaginal delivery. Her infant is 6 weeks old today. He regained birth weight by 2 weeks postpartum and has since gained an additional 2 pounds. The pediatrician has no concerns.  She has been exclusively breastfeeding him since birth and would like to breastfeed him for as long he is interested.

Which of the following information would be useful in providing guidance regarding breast pump use for this patient?

 

Question 2

A 28 year-old G1P1 comes to the clinic to discuss the use of a breast pump. She is planning to return to work in two weeks and wants to be able to pump and store breast milk. She has no other concerns.  Her pregnancy, labor and delivery, and postnatal course were uncomplicated. She delivered a healthy, term male infant (3.5 kg) via NSVD. Her infant is 6 weeks old today. He regained birth weight by 2 weeks postpartum and has since gained an additional 2 pounds. The pediatrician has no concerns.  She has been exclusively breastfeeding him since birth and would like to breastfeed him for as long he is interested.

The patient plans to be away for 8.5 hours a day, 5 days a week. She thinks she will leave the house around 8 AM and come back by 5:30 PM. She is worried about having enough milk to feed her baby on her first day away so she’d like to start pumping now. The patient has never used her wearable pump before and asks about how it should be set up. Which of the following best describes the proper approach to setting up a wearable breast pump?

“Wear a loose fitting bra. Lean back and place the pumps into the bra in line with the nipple. Turn the pump on.”

 

Question 3

A 28 year-old G1P1 comes to the clinic to discuss the use of a breast pump. She is planning to return to work in two weeks and wants to be able to pump and store breast milk. She has no other concerns.  Her pregnancy, labor and delivery, and postnatal course were uncomplicated. She delivered a healthy, term male infant (3.5 kg) via NSVD. Her infant is 6 weeks old today. He regained birth weight by 2 weeks postpartum and has since gained an additional 2 pounds. The pediatrician has no concerns.  She has been exclusively breastfeeding him since birth and would like to breastfeed him for as long he is interested.

The patient plans to be away for 8.5 hours a day, 5 days a week. She thinks she will leave the house around 8 AM and come back by 5:30 PM. She is worried about having enough milk to feed her baby on her first day away so she’d like to start pumping now. The patient has never used her pump before and asks about how it should be set up.

You go over the pump setup with the patient and ask her to practice pumping for ten minutes while you discuss breast milk storage with her. After ten minutes of pumping she winces in pain and you observe the following on her right breast.

 

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Which of the following recommendations is least likely to prevent this injury from happening again? 

 “Make sure the nipple is centered.”

 

Question 4

A 28 year-old G1P1 comes to the clinic to discuss the use of a breast pump. She is planning to return to work in two weeks and wants to be able to pump and store breast milk. She has no other concerns.  Her pregnancy, labor and delivery, and postnatal course were uncomplicated. She delivered a healthy, term male infant (3.5 kg) via NSVD. Her infant is 6 weeks old today. He regained birth weight by 2 weeks postpartum and has since gained an additional 2 pounds. The pediatrician has no concerns.  She has been exclusively breastfeeding him since birth and would like to breastfeed him for as long he is interested.

The patient plans to be away for 8.5 hours a day, 5 days a week. She thinks she will leave the house around 8 AM and come back by 5:30 PM. She is worried about having enough milk to feed her baby on her first day away so she’d like to start pumping now. The patient has never used her pump before and asks about how it should be set up.

You go over the pump setup with the patient and ask her to practice pumping for ten minutes while you discuss breast milk storage with her. After ten minutes of pumping she winces in pain and you observe a blister on her nipple.

Which of the following is the best recommendation in the short term to promote healing of the blister?

 

Question 5

A 28 year-old G1P1 comes to the clinic to discuss the use of a breast pump. She is planning to return to work in two weeks and wants to be able to pump and store breast milk. She has no other concerns.  Her pregnancy, labor and delivery, and postnatal course were uncomplicated. She delivered a healthy, term male infant (3.5 kg) via NSVD. Her infant is 6 weeks old today. He regained birth weight by 2 weeks postpartum and has since gained an additional 2 pounds. The pediatrician has no concerns.  She has been exclusively breastfeeding him since birth and would like to breastfeed him for as long he is interested.

The patient plans to be away for 8.5 hours a day, 5 days a week. She thinks she will leave the house around 8 AM and come back by 5:30 PM. She is worried about having enough milk to feed her baby on her first day away so she’d like to start pumping now. The patient has never used her pump before and asks about how it should be set up.

You go over the pump setup with the patient and ask her to practice pumping for ten minutes while you discuss breast milk storage with her. After ten minutes of pumping she winces in pain and you observed a blister form on her nipple. You’ve discussed with the patient that she needs no more than 8 oz. of breast milk stored for her first day back to work.

The patient mentions that she is worried about her milk going bad in the fridge if she starts to express now in preparation for going back to work in 2 weeks. Which of the following is the best advice for this patient concerning milk storage?

“Milk should not be stored in the fridge for more than 24 hours, so you should freeze it if you think that it will not be used within that time. Be careful when microwaving the frozen breast milk as there could be some areas of the milk that are very hot.”