Breast Nursing

When these drugs are given to the female patient with inoperable breast carcinoma, tire nurse evaluates the patient s current status (physical, emotional, and nutritional) carefully and records tire finding in tire patient s chart. Problem areas, such as pain, any limitation of motion, and the ability to participate in tire activities of daily living, are carefully evaluated and recorded in tiie patient s record. The nurse takes and records vital signs and weight. Baseline laboratory tests may include a complete blood count, hepatic function tests, serum electrolytes, and serum and urinary calcium levels. The nurse reviews these tests and notes any abnormalities. 

The nurse weighs the patient with inoperable breast carcinoma daily or as ordered by the primary health care provider. If the patient is on complete bed rest, the nurse may take weights every 3 to 4 days (or as ordered) using a bed scale The nurse notifies the primary health care provider if there is a significant (> 5 lb) increase or decrease in the weight. The nurse checks the lower extremities daily for signs of edema. 

In patients with breast carcinoma or prostatic carcinoma, the nurse observes for and evaluates signs indicating a response to therapy, for example, a relief of pain, an increase in appetite, a feeling of well-being. In prostatic carcinoma, the response to therapy may be rapid, but in breast carcinoma the response is usually slow. 

When administering oxytocin intranasally to facilitate the letdown of milk, the nurse places the patient in an upright position, and with the squeeze bottle held upright, administers the prescribed number of sprays to one or both nostrils. The patient then waits 2 to 3 minutes before breastfeeding the infant or pumping the breasts. If a breast pump is being used, the nurse records the amount of milk pumped from the breasts. 

The nurse notifies the primary health care provider if milk drips from the breast before or after breastfeeding or if milk drips from the opposite breast during breastfeeding because there would be no need to continue drug therapy. The primary health care provider is notified if nasal irritation, palpations, or uterine cramping occurs. 

Children are expected to be exposed to methyl parathion by the same routes that affect adults. Small children are more likely to come into contact with methyl parathion residues that may be present in soil and dust both outside and inside the home, due to increased hand-to-mouth activity and playing habits. Methyl parathion has been detected in a few samples of breast milk, indicating potential for exposure of nursing infants. However, available data are not adequate for determination of the importance of this route of child exposure. 

Infliximab is FDA category B and also appears to carry minimal risk in pregnant patients. Little is known about excretion of infliximab in breast milk, so benefit versus risk should be considered if it is used during nursing. 

No adequate studies have been conducted using diethyl-propion in pregnant women therefore, the drug should be used only if the benefit outweighs potential fetal risk. Use with caution in nursing mothers because the drug is excreted in breast milk.40... 

Russell, L. C., Caffeine restriction as initial treatment for breast pain, Nurse Pract., 14, 36, 1989. 

Bullough, B., Hindi-Alexander, M., Fetopuh, S., Methylxanthines and fibrocystic breast disease study of correlations, Nurse Pract, 15, 43, 1990. 

In a review of data on occupational chemicals that may contaminate breast milk (Byczkowski et al. 1994), it is stated that lead may be excreted in milk in amounts lethal to the infant and that the metal may be mobilized from bone stores to milk during the lactation period. Even when the concentration of lead in mother s milk is low, the absorption of metals into the systemic circulation of infants is generally high when they are on a milk diet. To better understand the sensitivity of the nursing infant to chemicals, epidemiological studies, chemical monitoring, and model development and application are needed. 

Serum concentrations in the nursing infant are 10% to 50% of the mother s serum concentration, thus breast-feeding is usually discouraged for women taking lithium. 

There is no experimental evidence available to assess whether the toxicokinetics of -hexane differ between children and adults. Experiments in the rat model comparing kinetic parameters in weanling and mature animals after exposure to -hexane would be useful. These experiments should be designed to determine the concentration-time dependence (area under the curve) for blood levels of the neurotoxic /7-hcxane metabolite 2,5-hexanedione. w-Hcxanc and its metabolites cross the placenta in the rat (Bus et al. 1979) however, no preferential distribution to the fetus was observed. -Hexane has been detected, but not quantified, in human breast milk (Pellizzari et al. 1982), and a milk/blood partition coefficient of 2.10 has been determined experimentally in humans (Fisher et al. 1997). However, no pharmacokinetic experiments are available to confirm that -hexane or its metabolites are actually transferred to breast milk. Based on studies in humans, it appears unlikely that significant amounts of -hexane would be stored in human tissues at likely levels of exposure, so it is unlikely that maternal stores would be released upon pregnancy or lactation. A PBPK model is available for the transfer of M-hcxanc from milk to a nursing infant (Fisher et al. 1997) the model predicted that -hcxane intake by a nursing infant whose mother was exposed to 50 ppm at work would be well below the EPA advisory level for a 10-kg infant. However, this model cannot be validated without data on -hexane content in milk under known exposure conditions. 

Endrin has been detected in human breast milk (0.02-6.24 milligrams endrin in each kilogram milk fat [mg/kg]) this may be a route of exposure for nursing infants. However, no studies of endrin in breast milk in United States or Canadian populations have been conducted. 

Studies in animals show that mirex can be taken into your bloodstream when you breathe in cigarette smoke containing mirex or eat food contaminated with mirex. We do not know if mirex can pass through your skin and enter your body after you touch it. Mirex passes from the stomach and intestines of animals into their blood. We do not know how much passes from the stomach and intestines of people into the bloodstream. Once in the bloodstream, mirex is carried to many parts of the body where it is stored, mainly in fat. Mirex is not broken down in the body. Mirex that is not stored leaves the body unchanged mainly in the faces. Very little leaves the body in the urine. Most of the mirex that is swallowed leaves the body in feces within two days. However, the mirex that enters the bloodstream and is stored in fat leaves the body very slowly. This process can take from several weeks to months. Mirex can also enter breast milk from the bloodstream of nursing mothers who have been exposed. Refer to Chapter 2 for more information on this subject. 

Mirex was detected (mean detection limit 3 pg/g [ppt])in 62% of 412 breast milk samples collected from women in all Canadian provinces (Mes et al. 1993). The mean, median, and maximum mirex concentrations detected in whole milk were 0.14, 0.08, and 6.56 ng/g (ppb), respectively, and for milk fat were 4.2, 2.3, and 124.5 ng/g, respectively. In previous studies, mirex residues were not detected. None of the 1,436 human milk samples collected in the United States in the late 1970s as part of the National Human Milk Study contained identifiable levels of mirex (Savage et al. 1981). A similar national study of nursing mothers in Canada (Mes et al. 1986) also failed to detect mirex in any human milk samples. The high rate of detection in the Mes et al. (1993) study was a result of improved analytical procedures and lower limits of detection. 

There have been no measurements of the levels of 1,4-dichlorobenzene or its metabolites in amniotic fluid, meconium, cord blood, or neonatal blood to investigate prenatal exposure. Consumption of breast milk can potentially expose nursing infants to 1,4-dichlorobenzene. Dichlorobenzene (all isomers) was detected in 100% of 42 samples of human breast milk collected in 5 urban areas of the United States at concentrations ranging from 0.04-68 ppb however, concentrations of 1,4-dichlorobenzene were not specified (Erickson et al. 1980). Dichlorobenzene (all isomers) was also identified in human breast milk in 8 of 12 women who were residents of Bayonne, New Jersey (6 women) Jersey City, New Jersey (2 women) Bridgeville, Pennsylvania (2 women) and Baton Rouge, Louisiana (2 women) however, concentrations of... 

I conclude this section with a science fiction idea. If nursing an infant (instead of bottle-feeding) fosters olfactory discrimination (Cernoch and Porter, 1985), would it be desirable and possible to train noses early on Should babies be breast-fed to give them a chance to become gourmets, sophisticates, wine or tea testers or would we be doing them a favour by bottle-feeding them to render them less sensitive to unpleasant odors such as pollution in our air ... 

Lactation Warfarin appears in breast milk in an inactive form. Infants nursed by warfarin-treated mothers had no change in PT. 

Lactation It is not known whether lepirudin is excreted in breast milk. Because of the potential for serious adverse reactions in nursing infants, decide whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother. 

Lactation It is not known whether bivalirudin is excreted in breast milk. Exercise caution when bivalirudin is administered to a nursing woman. 

Ectopic as well as intrauterine pregnancy may occur in contraceptive failures. Lactation Hormonal contraceptives may interfere with lactation, decreasing both the quantity and the quality of breast milk. A small amount of OC steroids is excreted in breast milk. A few adverse effects on the nursing infant have been reported, including jaundice and breast enlargement. 

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