Can't answer all these questions - but on the meds - unless you take blood from the cord within a couple of minutes or less of administration, it is gone from the blood stream and into the brain.
-----Original Message-----
From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Shannon Theiss
Sent: Friday, July 24, 2009 11:45 AM
Subject: Re: exam practice L. Smith
I am so glad you posted this. I too am about ready to pull my hair out with this book. I have found several text questions that I do not agree with and can find supporting rational for my "wrong" answer in other breast feeding books. I am mainly using Jan Riordan's "Breastfeeding and Human Lactation 3rd Ed" and Barbara Wilson-Clay & Kay Hoover's "The Breastfeeding Atlas 3rd Ed"
and have but not using as much "Breastfeeding A guide For the Medical Professional" by Ruth and Robert Lawrence. I am at the point that I don't know which text to believe and follow? They all have slight variances from each other. I am getting questions wrong in the L. Smith practice exam book, and I don't completely understand her rational.
In Riordan on pg 202 it suggests hypoglycemia from birth to day 1 to be under 30mg/dl and under 40mg/dl, but I get the answer wrong for the 6 hour old with a BS of 36mg/dl that needs immediate feeding. So what is the number I should go by?
For the questions about no traces of pain killers being found in the infant or cord blood after the mother was given high doses before delivery. I don't understand why at least a trace wouldn't be found in blood if when the answer is because it is concentrated in the infant's brain. My level of thinking leads me to think there has to at least be a trace in order for it to get to the brain to concentrate anyway?
Another questions says bf has no benefit to cardiovascular health, but I can find in Riordan as well as several Nutritional articles that bf is now being thought to decrease the risk of later cardiovascular disease with the thought that higher cholesterol levels in breast milk being a contributing, protective factor. AND I get another question wrong because according to L. Smith, there is absolutely no cholesterol in formula; however, even though it is a small amount, there is a small amount of cholesterol in at least cow- milk based infant formula. Even if small, it is still there. Also, according to L. Smith, the swallowing reflex develops at 26 weeks gestation, where B.WC, K.H, and Riordan all say this reflex is seen first seen developing between 10-14 weeks.
I DON'T KNOW WHO TO BELIEVE or what to study anymore. I also agree, some of the pictures are also unfair. How many of you think POISON IVY as their first thought for a nipple rash (with no other information)? Also, why is flicking the feet of a newborn to arouse it worse than placing a cool cloth on the infants face? Maybe I am just thinking too much in terms of being a pediatric nurse where this practice (cold to the face) could trigger a vagal response which could slow the heart rate? And why is vit D supplements for a dark skin toned bf baby, located in an area with little sunlight always the wrong answer for treatment to prevent Rickets? How does "exposing the mothers face to at least 20 min of sunlight daily" have any measurable effect on the infant?
Working in a pediatric clinic and reading in texts, this (Vit D supplement) is the common and recommended practice per the AAP.
Please someone help me out here? I have had several people say " give the answer they want." The thing is, I don't know what "they" want anymore when there are so many inconsistencies between sources. How does this method help a person out in this career path?
Shannon Theiss, BSN,RN
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