Pathophysiology
Mastitis is inflammation of the breast tissue, with or without infection, that most often occurs in lactating women due to plugged milk ducts. It is most common 6 – 12 weeks postpartum, but can happen anytime. It may present as a red, swollen, firm area on the breast that is painful.
Etiology
When the milk ducts are not emptied after breastfeeding, the milk collects and sits in the ducts, called milk stasis. This collection of milk then clogs the duct and causes milk to back-up and leads to infection. Cracks and fissures in the skin allow bacteria to enter and infect the clogged duct. This results in painful, swollen areas of breast tissue. Risk factors include a weakened immune system (being tired or stressed can make that worse), using only one position to breastfeed, wearing a tight-fitting bra that restricts milk flow, previous episodes of mastitis, or having sore and cracked nipples.
Desired Outcome
Patient will experience decreased pain, redness and swelling; patient will not exhibit signs of infection; patient will resume breastfeeding with effective emptying of the breast
Mastitis Nursing Care Plan
Subjective Data:
- Unilateral breast pain and tenderness
- General malaise
- Pain during breastfeeding
- Fatigue
- Chills
Objective Data:
- Redness and swelling of breast
- Breast that is warm to touch
- Fever
Nursing Interventions and Rationales
- Assess vitals for signs of systemic infection
Mastitis may or may not be the result of infection. Monitor for fever.
- Assess breasts and note swelling, erythema and tenderness
- Assess for baseline and note location of symptoms. Mastitis generally occurs on only one breast at a time.
- Note skin quality and presence of cracked nipples that may indicate potential for infection. Monitor for signs of potential abscess development
Drinking water helps to promote milk production and flow.
- Apply warm compresses before breastfeeding or milk expression (pumping)
This helps dilate the milk ducts to allow for the expression of breastmilk. Standing in a warm shower may also help.
- Apply cool compresses after breastfeeding or milk expression (pumping)
This helps relieve pain and sooth sore breasts
- Ibuprofen or acetaminophen may help reduce pain, inflammation and fever.
- Antibiotics may be given to treat infection
- Examine patient breastfeeding; observe position and baby’s latch
Improper positioning or bad latch can cause nipple pain and irritation and discourage the patient from fully emptying the breast. Make sure baby has no anatomical cause for bad latching.
- Provide lactation education
- Pump or manually express milk after each feeding
- Alternate breasts when feeding
- Adjust or alternate positions for feedings
Provide education and support for patient and encouragement to continue proper breastfeeding which will help resolve symptoms.
References
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
For more information, visit www.nrsng.com/cornell
