Case Presentation Postnatal Acute Mastitis
Case Presentation Postnatal Acute Mastitis
Case Presentation Postnatal Acute Mastitis
SUBMITTED TO SUBMITTED BY
MAAM KH. MEMITA DEVI THOLEH LALRAMDINI JONGTE
PROFESSOR ROLL NO.-18
OBSTETRICS & GYNAECOLOGY NURSING M.Sc (N) 2nd YEAR
CPMS COLLEGE OF NURSING CPMS COLLEGE OF NURSING
INTRODUCTION:
As a part of our clinical posting. I was posted in postnatal ward and I was assigned to present
a case. So I choose a patient by the name Asmina Khatun, 23 years old. She was diagnosed
with Acute mastitis. At the time of collecting history, I introduced myself to the patient and
ask her to cooperate with me while collecting her history and other required information.
IDENTIFICATION DATA:
AGE: 23 years
RELIGION: Islam
BED: 443
LMP 07/10/21
EDD 14/07/22
CHIEF COMPLAINTS:
Patient Asmina Khatun is admitted GMCH Hospital with the diagnosis of full term
pregnancy but after delivery she complaint of redness, swelling and pain in the right breast
and having difficulty to feed her baby.
FAMILY HISTORY:
There is no history of any disease like TB, HTN, DM & hereditary disease, twin pregnancy in
her family.
FAMILY IDENTIFICATION:
GENOGRAM:
Key:
- Male
- Female
- Patient.
There is a PHC in her village at a distance of about 2 km. transportation facility available like
bicycle, motorcycle, Car.
HOUSING:
Personal history:
Personal hygiene: She is maintaining her personal hygiene like oral hygiene by brushing
daily and taking bath once daily with soap and normal water.
Diet: she takes vegetarian and non-vegetarian diet and she takes meals 3 times a day. She
don’t have any addiction of alcohol and tobacco. She drinks about 2-3 lts. of water per day.
She takes rest of about 2 hrs at day time and 8 hours during night time. She takes no drugs for
sleep.
Menstrual history:
She got menarche at 12 years old age with regular cycles of 28-30 days interval & 3-4 days
duration with average amount of bleeding.
She has been married to Mr. Inzamul Hussain since a year and has satisfactory relationship
with her spouse. General health of her spouse is good.
Obstetrical history:
FIRST VISIT:
She missed her menstrual period and went to nearby clinic & tested her urine for pregnancy
& become confirm of her pregnancy. On her examination her weight 48kg, BP=120/70
mmHg, pulse=74/minute. At that time she suffered from minor ailments like nausea &
vomiting.
SECOND VISIT:
She attended OPD of GMCH hospital for further antenatal check-up and 1 st dose of Inj. TT
0.5ml was given.
THIRD VISIT:
She attended OPD of GMCH hospital for further antenatal check-up and 2 nd dose of Inj. TT
0.5ml was given.
FOURTH VISIT:
POSTNATAL ASSESSMENT
GENERAL APPEARANCE
Anthropometric measurements
Height - 153cm
Weight – 46 kg
VITAL SIGNS
Temperature - 98.20F
Pulse - 76 beats/min
Respiration - 16 breaths/min
B.P - 120/80 mm of Hg
HEAD-
EYES-
Sclera - normal
Vision - normal
EARS:
Pinna - no infection
Discharge - absent
NOSE:
MOUTH:
Lips - dry
NECK:
CHEST:
INSPECTION:
Shape - normal
PALPATION
PERCUSSION
AUSCULTATION
S1 and S2 heard
Inspection-
Shape - normal
Umbilicus - flattened
Palpation
BACK-
GENITOURINARY SYSTEM-
No of pads - 4 pads/day
Bowel -regular
R- Redness is absent
E- Edema is absent
E- Ecchymosis is absent
D- Discharge
EXTREMITIES-
UPPER EXTREMITIES
Numbness - absent
Pallor - absent
LOWER EXTREMITIES-
Varicosity - absent
Clubbing - absent
NEWBORN ASSESSMENT:
IDENTIFICATION DATA-
Gender - Male
Anthropometric measurement
Sl no Parameters Result of the Normal Remarks
child value
1 Weight 3.1 kg 2.9 – 3.5 kg Baby has
normal body
weight
2 Length 48 cm 46-50 cm Baby has
normal length
3 Head circumference 33 cm 33 - 35 cm Normal
4 Chest circumference 32 cm 31 – 33 cm Normal
5 Mid arm Baby has
circumference 14cm 12- 17.5 cm normal mid
arm
circumference.
VITAL SIGNS
PHYSICAL EXAMINATION
Immunization Status:
Posture :Flexed
Skin Condition
Skin Color :No cyanosis
Temperature :Warm
Texture :Smooth
Turgor and elasticity :Normal, good skin turgor
Edema/ Puffiness :No edema
Vernix caseosa :Present
Lanugo :Present
Telangiedtatic nevi :Absent
Mangolian spots :Present
Milia :present on the nose
HEAD
FACE
Symmetry- symmetrical
EYES
NOSE
Placement - medial
Discharge/stuffiness - absent
EARS
Position - normal
Pinna - flexible
Uvula - present
NECK
Clavicle - no fracture
CHEST
Chest circumference - 33 cm
LUNGS
Respiration - 42 breaths/min
Rhythm - regular
HEART
ABDOMEN
Shape - cylindrical
Movement - synchronized
Liver - palpable
GENITALIA
No abnormalities present.
Meconium - passed
EXTREMITIES
NEUROMUSCULAR SYSTEM
Cry - good
NEURO MUSCULAR:
CORNEAL REFLEX When cornea is touched Baby closed his eyes when
with a wisp of cotton, cornea was touched with a
newborn will close his eyes cotton
GLABELLAR BLINK Newborn will blink with Baby blinked his eyes when
first 4 or 5 taps to bridge of tapped on his glabellar
nose when eyes are open
PALMAR GRASP Newborn’s finger will curl Baby tightly closed his
around object and hold on finger when examiner
momentarily when finger is places finger in the palmar
placed in palms of hand region
PLANTAR GRASP Newborn’s toes will curl Baby curled her toes when
downward when a finger is his base of the foot is
placed against the base of touched with examiner’s
the toes fingers
STEPPING/ DANCING Newborn will step with one Holded the baby in straight
REFLEX foot and then the other in position by touching flat
walking motion when one surface then he stepped with
foot is touched to flat one foot and then the other
surface
PARACHUTE REFLEX Place the hand under the Baby flexed the arms and
chest of baby in prone legs and then extended his
position arms and legs will back and head
be flexed and then try to
extend his back and head
TRACTION REFLEX Hold the baby with both the Baby’s head lagged behind
hands, lift him and then his when lifted with both the
head will lag behind hands
STARTLE REFLEX Newborn abducts and flexes Baby abducts and then
all extremities and may flexed his all extremities
begin to cry when exposed when exposed to sudden
to sudden movement or movement
loud noise
CROSSED EXTENSION Newborn’s opposite leg will Baby flexed and extended
flex and then extend rapidly opposite leg rapidly when
as if trying to deflect other foot was touched
stimulus to other foot when
placed in supine
position :newborn will
extend one leg in response
to stimulus on bottom of
foot
DELIVERY NOTES
Duration
On PV
Mode of delivery
Gender - Male
Time - at 7:30am
Weight - 3.2 kg
At 5th min - 10
Condition - alive
Placenta
Delivered at 7: 45 am
Weight- 500 gm
Length of cord- 50 cm
ACUTE MASTITIS
Introduction:
Mastitis is inflammation of the breast tissue and can be broken down into lactational and non-
lactational mastitis. Lactational mastitis is the most common form of mastitis. Two types of
non-lactational mastitis include periductal mastitis, and idiopathic granulomatous mastitis
(IGM).
Definition:
Mastitis is an infection that develops in breast tissue. The painful condition causes one breast
to become swollen, red and inflamed. In rare cases, it affects both breasts. Mastitis is a type
of benign (noncancerous) breast disease.
Noninfective mastitis may be due to milk stasis. Feeding from the affected breast
solves the problem.
Etiology:
Lactational mastitis is most commonly caused by bacteria that colonize the skin,
with Staphylococcus aureus being the most common. Methicillin-resistant S. aureus (MRSA)
has become an increasingly common cause of mastitis, and risk factors for MRSA should be
considered. Other causative organisms include Streptococcus pyogenes, Escherichia
coli, Bacteroides species, and Coagulase-negative staphylococci.
There are two different types of mastitis depending upon the site of infection-
1. Infection that involves the breast parenchymal tissues leading to cellulitis. The
lacteal system remains unaffected.
2. Infection gains access through the lactiferous duct leading to development of
primary mammary adenitis. The source of organisms is the infant’s nose and
throat.
Onset:
In superficial cellulitis, the onset is acute during first 2-4 weeks postpartum. However, acute
astitis may occur even several weeks after delivery.
Clinical Features:
Symptoms include-
BOOK PICTURE PATIENT PICTURE
a) Generalized malaise and headache, Headache was present.
nausea, vomiting.
b) Fever (102ºF or more) with chills. Fever was 100ºF.
c) Severe pain and tender swelling in Present.
one quadrant of the breast.
Signs include-
BOOK PICTURE PATIENT PICTURE
a) Presence of toxic features. Absent.
b) Presence of a swelling on the breast. Swelling was present. Redness and
The overlying skin is red, hot and tenderness was present.
flushed and feels tense and tender.
Diagnostic evaluation:
BOOK PICTURE PATIENT PICTURE
1. Complete history Done.
collection of the mother.
2. If there is concern that Not done.
the patient may have a breast abscess, a
breast ultrasound can be obtained.
3. If an abscess is Not done.
present, hypoechoic areas of purulent
material will be seen.
4. For patients with a Not done.
severe infection that is unresponsive to
initial antibiotic therapy, a culture of
breast milk can be useful to guide
appropriate antibiotic selection.
5. If there is a concern Not done.
for bacteremia in a patient with severe
mastitis, blood cultures should be
obtained.
6. Because the clinical Not done.
features of IGM overlap with those of
breast cancer, a biopsy must be done to
make this diagnosis.
- Core needle biopsy or
excisional biopsy are both
viable options.
Treatment:
If the symptoms of lactational mastitis persist beyond 12 to 24 hours, antibiotics should be
administered. Because S. aureus is the most common cause, antibiotic therapy should be
tailored accordingly. In the setting of mild infection without MRSA risk factors, outpatient
treatment can be initiated with dicloxacillin or cephalexin. If the patient has a penicillin
allergy, erythromycin can be used. If the patient has risk factors for MRSA infection,
treatment options include trimethoprim-sulfamethoxazole (TMP-SMX) or clindamycin.
TMP-SMX should be avoided in women who are breastfeeding infants less than 1-month-old,
and in infants who are jaundiced or premature. If a patient requires hospitalization, empiric
treatment with vancomycin should be initiated until cultures and sensitivities return.
Management:
a) Breast support.
b) Plenty of oral fluids.
c) Breastfeeding is continued with good attachment. Nursing is initiated on the
uninfected side first to establish letdown.
d) The infected side is emptied manually with each feed.
e) Dicloxacillin (penicillinase-resistant penicillin) is the drug of choice. A dose of 500
mg every 6 hours orally is started till the sensitivity report available. Erythromycin is
an alternative to patients who are allergic to penicillin. Antibiotic therapy is continued
for atleast 7 days.
f) Analgesics (ibuprofen) are given for pain.
g) Milk flow is maintained by breastfeeding the infant. This prevents proliferation of
Staphyococcus in the stagnant milk. The ingested Staphylococcus will be digested
without any harm.
Complications:
One of the most common complications of lactational mastitis is early termination of
breastfeeding. The disease of the breast and associated pain are some of the most commonly
cited reasons for early cessation of breastfeeding. A breast abscess is another complication of
lactational mastitis and occurs in 3% to 11% of patients. The development of a breast abscess
is more common if mastitis is not treated early.
Periductal mastitis and IGM can both be complicated by abscess or fistula formation. Both
forms of non-lactational mastitis are associated with recurrence and can lead to scarring and
deformity of the breast tissue.
Prognosis:
The majority of patients with mastitis will recover with appropriate treatment. The recurrence
rate for each type of mastitis varies as follows:
One study reported that 38% of patients with IGM reported significant scarring, and 29%
reported long term pain.
NURSING MANAGEMENT:
ASSESSMENT:-
NURSING DIAGNOSIS:-
Pain related to tenderness in the breast.
Ineffective breastfeeding related to pain or difficulty with breastfeeding process.
Anxiety related to pain and tenderness.
Knowledge deficit related to breastfeeding process.
Risk for infection related to complication of the breast engorgement.
NURSING CARE PLAN:
Patient is stable, breast pain and tenderness is relieved. Now, patient is able to breastfeed her
baby normally. Vital signs are normal but she is having mild pain in the breast. Proper
medication and complete bed rest is taken by patient.
HEALTH EDUCATION:
Diet-
Advice regarding fat free diet.
Advice patient to take protein rich diet.
Advice to take 3 meals a day and in between snacks.
Advice patient to take more fluids per orally.
Advice regarding intake of haematinic and calcium supplement
Exercise-
Avoid heavy exercises after taking meal.
Educate the patient for postnatal exercises.
Hygiene-
Teach the patient about maintaining proper personal hygiene.
Educate the mother for handwashing before each feed and to clean the nipples before
and after each feed and keeping them dry.
Educate the patient to clean her perineal area properly after each urination and
defecation.
Educate the patient to change her pad every 8 hourly.
Medication-
Educate the patient about medication regimen, route, dose, frequency and adverse
effects.
Rest and sleep
Advice the patient to take proper rest and sleep at least 6 hours in night and 2 hours in
a day.
Immunization
Educate the parents of the newborn about immunization according to the age.
Breast feeding
Educate the mother about proper breastfeeding technique and its importance.
Educate the mother to breastfeed her baby every one hourly.
Ensues that the neonate is awake and alert during feeding.
Follow-up care
Advise the patient for regular medical check-up so that if any complication occurs can be
detected at right time.
Advice the family for follow-up care and its importance and to report immediately if
there is any signs of complication.
BIBLIOGRAPHY