Table 2 Items and indicators to quantify the nursing knowledge outcome: breastfeeding (1800)

Indicator 180003: composition of breast milk, milk outlet process, and initial vs late milk

 1. Occurs between 5 and 10 days after delivery

 2. Contains less sugar, fats, and vitamins of B complex and vitamin C

 3. Contains proteins, sugar, fats, minerals such as sodium, calcium, iron, selenium, zinc, and B complex vitamins and vitamins such as C, A, E, K.

 4. Its composition contains between 88% and 90% water

 5. Occurs in the first 3 to 4 days after delivery

 6. It is yellow, thick and of little amount

 7. Contains more sugar, fats, calories, and B Complex vitamins and vitamin C

 8. It occurs progressively up to about 100 ml a day

 9. Contains fewer proteins, antibodies, and vitamins A, E, K

 10. It occurs in an amount of 400 to 600 ml per day

 11. Occurs from the tenth day after delivery

 12. Contains more protein, minerals such as sodium, iron, selenium, zinc, and vitamins such as A, E, K

 13. Its composition contains 87% water

 14. It is produced in an amount of 700 to 800 ml per day

Indicator 180001: benefits of breastfeeding

 15. Prevents breast, uterine, and ovarian cancer

 16. Prevents respiratory diseases such as bronchitis, pneumonia, and gastrointestinal diseases such as diarrhea and dehydration

 17. Prevents the onset of diseases such as allergies, obesity, high blood sugar, high blood pressure, and cancer

 18. Prevents postpartum depression states (mood affecting women after giving birth, characterized by feelings of extreme sadness and anxiety)

 19. Prevents constipation and cramping

 20. Prevents child malnutrition

 21. Facilitates the affective bond between mother and child

 22. Strengthens self-appreciation, self-confidence, and emotional satisfaction

 23. Contributes to postpartum weight loss

 24. Lowers the risk of osteoporosis (a disease that thins and weakens bones, causing them to break easily)

 25. Promotes better growth and development of physical, language, and social capacities

 26. Reduces risk of postpartum hemorrhaging or bleeding

 27. Lowers the risk of heart disease

 28. Improves intelligence

 29. Delays the return of ovulation and menstruation

Indicator 180005: proper technique for breastfeeding the baby

 30. The mother should select the most comfortable position

 31. The baby's body must be attached to the mother's body

 32. The baby's head and body are in the same direction

 33. The mother should grab the breast with her C-shaped hand (placing her thumb above the breast and the other four fingers below the nipple and behind the areola (ring of pigmented skin around the breast)

 34. The mother should bring the child closer to the breast and not the breast to the child

 35. The mother should stimulate the baby to have a search reflex, bringing the nipple closer to the baby's lip and when it opens its mouth to insert the nipple and the areola

 36. The baby's lips should remain outside like the mouth of a fish

 37. The baby's mouth should coat the entire areola (dark area of the breast)

 38. The baby's chin must touch or almost be touching the mother's chest

Indicator 180006: adequate position of the infant during breastfeeding

 39. Stretched or cradle position (classic or traditional)

 40. Cross-cradle position

 41. Parallel stretched position (side lying down)

 42. Rugby ball or football position (inverted)

 43. Sitting or horse position

 44. Face-up position

 45. Vertical or standing position

Indicator 180014: signs of mastitis, duct obstruction, and nipple trauma

 46. Breast skin is shiny, red, tense, and warm

 47. Formation of a mass or lump in the breast that is palpable and painful, often with redness of the skin in that area

 48. Painful cracks or wounds on the nipple

 49. Uncontrolled fever, chills, general discomfort, nausea, vomiting, headache

 50. Formation of a mass or lump in the breast, severe pain, swollen and hardened sinus, obstruction at the milk outlet (milk does not flow), pus secretion

 51. Inflammation or swelling in the breast with a feeling of warmth

 52. Nipple pain

 53. Cracks or nipple wounds that may bleed

 54. Decreased milk flow

 55. No fever or symptoms of general discomfort

Indicator 180015: appropriate techniques for the extraction and storage of breast milk

 56. Massage into the breast before breast milk extraction

 57. At room temperature: breast milk is preserved for up to 4 h, it is advisable to leave it in a dry place, protected from sunlight and heat.

 58. In the freezer: breast milk is kept frozen for up to 15 days, so it is recommended not to constantly open and close the freezer. If the refrigerator is two doors, breast milk can be stored for up to 3 months.

 59. With your hand in the shape of a C, place it on the breast (placing your thumb above the breast and the other four fingers below the nipple and behind the areola (dark area of the breast)

 60. In a refrigerator or refrigerator: breast milk is stored for up to 12 h, it is advisable not to place it in the refrigerator door to avoid temperature changes every time the door is opened or closed.

 61. Lean the body forward, squeeze the breast without swiping your fingers, and gently push against the ribs

 62. Then move your fingers forward and repeat the procedure as many times as necessary simultaneously and smoothly

Indicator 180020: need for fluid intake by the mother

 63. It is advisable to increase the consumption of liquids, preferably water, as it is the largest component of breast milk

 64. Water intake during lactation should be sufficient to compensate for the loss of water through milk

 65. Vitamin C-rich juices are recommended

 66. The most recommended liquids for women during breastfeeding are water, fruit juices, and milk

 67. Avoid drinking alcoholic beverages, excessive coffee, and tea (more than 2 cups a day, during the term of breastfeeding)