Nursing Care Plan (NCP) for Mastitis
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Outline
Lesson Objective: Mastitis Nursing Care Plan
- Understanding of Mastitis:
- Develop a comprehensive understanding of mastitis, including its causes, risk factors, and symptoms. Recognize the importance of early detection and intervention to prevent complications.
- Knowledge of Breastfeeding Techniques:
- Learn and demonstrate proper breastfeeding techniques, positioning, and latch-on methods to prevent nipple trauma and reduce the risk of mastitis. Understand the significance of maintaining a consistent feeding schedule.
- Recognition of Early Symptoms:
- Recognize the early signs and symptoms of mastitis, such as localized breast pain, redness, and flu-like symptoms. Understand the importance of prompt reporting to healthcare providers for timely intervention.
- Application of Warm Compresses and Massage:
- Learn and practice the application of warm compresses and gentle breast massage to promote milk flow and relieve breast engorgement. Understand how these techniques can aid in preventing mastitis or managing early symptoms.
- Importance of Antibiotic Compliance:
- Understand the significance of completing prescribed antibiotic courses if they are part of the treatment plan. Recognize the role of antibiotics in resolving bacterial infections associated with mastitis.
Pathophysiology of Mastitis
Mastitis is an inflammatory condition of the breast tissue, often caused by bacterial infection. The key factors contributing to mastitis include:
- Bacterial Entry:
- Mastitis often begins when bacteria, commonly Staphylococcus aureus, enter the breast tissue through the nipple, usually through small cracks or fissures.
- Inflammation and Immune Response:
- The presence of bacteria triggers an inflammatory response in the breast tissue. Immune cells are recruited to the site of infection to combat the invading pathogens.
- Obstruction of Milk Ducts:
- Inflammatory changes and the immune response can lead to the obstruction of milk ducts. This obstruction hinders the normal flow of milk, causing it to accumulate in the affected areas.
- Localized Swelling and Pain:
- As milk accumulates and inflammation increases, the affected breast becomes swollen, red, and painful. The inflammation contributes to the characteristic symptoms associated with mastitis.
- Potential Abscess Formation:
- In severe cases or when treatment is delayed, mastitis can progress to abscess formation within the breast tissue. This may require drainage and more aggressive interventions.
Etiology of Mastitis
- Bacterial Infection:
- The primary cause of mastitis is a bacterial infection, commonly Staphylococcus aureus. Bacteria enter the breast tissue through the nipple, often during breastfeeding, and cause an inflammatory response.
- Cracked or Damaged Nipples:
- Damaged nipples, such as those with cracks or fissures, provide an entry point for bacteria. Poor latch during breastfeeding or using improper breastfeeding techniques can contribute to nipple damage.
- Incomplete Breast Emptying:
- Inadequate emptying of the breasts during breastfeeding can lead to milk stasis, creating an environment conducive to bacterial growth. This is more common when there are difficulties with breastfeeding or if the infant is not nursing effectively.
- Compromised Immune System:
- Women with weakened immune systems are at a higher risk of developing mastitis. Conditions such as diabetes, HIV, or other immune-compromising factors can make individuals more susceptible to bacterial infections.
- Engorgement and Blocked Milk Ducts:
- Conditions that result in engorgement or blocked milk ducts, such as abrupt weaning, infrequent breastfeeding, or tight-fitting bras, can contribute to mastitis. These situations hinder the normal flow of milk, creating an environment for bacterial proliferation.
Desired Outcome of Nursing Care for Mastitis
- Resolution of Infection:
- The primary goal is the complete resolution of the bacterial infection causing mastitis. Antibiotic therapy, if prescribed, should effectively eliminate the pathogen.
- Relief of Symptoms:
- Alleviation of symptoms such as pain, swelling, and redness in the affected breast. Pain management strategies, warm compresses, and appropriate medications should contribute to symptom relief.
- Improved Breastfeeding Experience:
- Facilitate a positive breastfeeding experience by addressing any breastfeeding challenges. Encourage proper latch, positioning, and ensure the infant is effectively draining the breast during feeding.
- Prevention of Recurrence:
- Implement measures to prevent the recurrence of mastitis. This includes educating the individual on proper breastfeeding techniques, addressing any underlying issues like cracked nipples, and promoting good breast hygiene.
- Promotion of Overall Breast Health:
- Support and education on maintaining overall breast health. Encourage regular breastfeeding, adequate hydration, and practices that prevent engorgement or blocked milk ducts. Empower individuals to recognize early signs of mastitis for prompt intervention.
Mastitis Nursing Care Plan
Subjective Data:
- Chills
- Fatigue
- Pain/burning during breastfeeding
- General malaise
- Unilateral breast pain and tenderness
Objective Data:
- Redness and swelling of the breast
- Breast that is warm to the touch
- Fever
Nursing Assessment for Mastitis
- Physical Examination:
- Assess the affected breast for signs of inflammation, including redness, swelling, and localized heat. Note any palpable areas of tenderness or lumps.
- Breast Inspection:
- Inspect the nipples for cracks, fissures, or other abnormalities. Check for signs of poor latch during breastfeeding that may contribute to mastitis.
- Temperature Monitoring:
- Monitor the individual’s temperature regularly to detect any fever, a common symptom of mastitis. Elevated body temperature may indicate systemic involvement.
- Pain Assessment:
- Evaluate the intensity and location of pain in the breast. Assess the impact of pain on breastfeeding and daily activities.
- Breastfeeding Assessment:
- Observe breastfeeding sessions for proper latch and positioning. Assess the infant’s ability to effectively drain the breast during feeding.
- Fluid Intake:
- Inquire about the individual’s fluid intake, ensuring they are adequately hydrated, as dehydration can contribute to mastitis.
- Psychosocial Assessment:
- Consider the emotional well-being of the individual. Mastitis can be emotionally challenging, especially for breastfeeding mothers. Assess for signs of stress, anxiety, or postpartum depression.
- Cultural Considerations:
- Be mindful of cultural beliefs and practices related to breastfeeding and health. Respect and integrate cultural preferences into the care plan.
Implementation for Mastitis
- Antibiotic Therapy:
- Administer prescribed antibiotics as directed to target the underlying bacterial infection causing mastitis. Educate the individual on the importance of completing the full course of antibiotics.
- Pain Management:
- Provide pain relief measures, such as over-the-counter pain medications or prescribed analgesics. Encourage warm compresses or cool packs to alleviate discomfort.
- Encourage Breastfeeding:
- Promote frequent breastfeeding or pumping to ensure effective emptying of the affected breast. Emphasize proper latch and positioning to prevent further complications.
- Hydration and Rest:
- Encourage the individual to maintain adequate hydration and get sufficient rest. Proper hydration supports overall health, while rest aids in the body’s recovery.
- Follow-up and Support:
- Schedule follow-up appointments to monitor progress and assess for any complications. Provide ongoing education and emotional support, addressing concerns related to breastfeeding, pain management, and overall well-being.
Nursing Interventions and Rationales
| Nursing Intervention (ADPIE) | Rationale |
| 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 the location of symptoms. Mastitis generally occurs on only one breast at a time.
Note skin quality and the presence of cracked nipples that may indicate the potential for infection. Monitor for signs of potential abscess development |
| Encourage hydration | 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 soothe sore breasts |
| Administer medications | Ibuprofen or acetaminophen may help reduce pain, inflammation, and fever.
Antibiotics may be given to treat the 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 the 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 patients and encouragement to continue proper breastfeeding which will help resolve symptoms. |
Evaluation for Mastitis
- Resolution of Symptoms:
- Assess the individual for the resolution of symptoms such as breast tenderness, redness, and warmth. Improvement in these indicators suggests a positive response to treatment.
- Effectiveness of Antibiotics:
- Evaluate the effectiveness of antibiotic therapy by monitoring any signs of infection. Improvement in white blood cell count or reduction in infectious markers indicates a positive response.
- Breastfeeding Success:
- Assess the individual’s breastfeeding experience, ensuring proper latch and positioning. If breastfeeding was a concern, evaluate whether there is an improvement in the ability to breastfeed without significant pain.
- Pain Management:
- Evaluate the effectiveness of pain management strategies. Reduction in pain scores or reports of improved comfort indicate successful pain management.
- Follow-up Complications:
- Monitor for any complications or recurrence during the follow-up period. Address any lingering issues or concerns and adjust the care plan accordingly.
References
- https://www.mayoclinic.org/diseases-conditions/mastitis/symptoms-causes/syc-20374829
- https://my.clevelandclinic.org/health/diseases/15613-mastitis
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Transcript
Hi everyone, today, we’re going to be creating a nursing care plan for mastitis. So here let’s get started. First, we’re going to go over the pathophysiology. So, mastitis is inflammation of the breast tissue with or without infection that most often occurs in lactating women due to a plugged milk duct. Some nursing considerations: you want to assess vital signs, do a breast exam, use cool, warm compresses, administer medications, and educate on lactation. Desired outcomes: the patient will experience decreased pain, redness, and swelling. The patient will not exhibit signs of infection. The patient will resume breastfeeding with effectiveness of the breast.
So, if we’re going to go ahead and get started on the care plan, we’re going to be writing down some subjective data and we’re going to be writing down some objective data. So, what are we going to see with these patients? They may be complaining of fatigue. They’ll also have unilateral breast pain and tenderness. Some objective data: they’re going to have some redness and some swelling and also fever. Some other things are chills, burning during breastfeeding, general malaise, and a breast that’s warm to touch.
So, interventions, what are we going to do for these mamas? You want to assess the vital signs. So, in assessing vital signs, we’re going to be looking for any sort of systemic infection. Mastitis may or may not be the result of an infection. You want to make sure you’re monitoring for a fever. You want to make sure you’re assessing the breast, noting any sort of swelling and tenderness in the area you want to assess for a baseline note. The location of the symptoms in mastitis generally occurs only on one breast at a time. You want to note the skin quality – the presence of cracked nipples that may indicate the potential for infection. You also want to monitor for signs of potential abscess development. Another intervention we want to do is encourage hydration. So, increase hydration. Drinking water really helps to promote milk production and flow. Another intervention we’re going to do is applying any warm compresses. Warm compresses you want to do before breastfeeding and cold compresses after. So warm compresses before breastfeeding enable milk ducts to express milk. Also, during the day, cool compresses after breastfeeding or milk expression help with relieving pain and soothing the sore breasts. Another invention we’re going to be doing is administering medications. So, medications such as ibuprofen or acetaminophen will help reduce pain and inflammation. And for a fever, antibiotics may also be given to treat infection. Another invention we’re going to be doing is we’re going to examine the patient’s breastfeeding. You want to observe the positioning and the baby’s latch. Improper positioning or a bad latch can cause the nipple pain and irritation, and it can be discouraging for the mom. So, you want to make sure that she’s fully emptying the breast and get a consultation for lactation if needed. So, we’re going to do lactation education including manually expressing milk after each feeding, alternating breasts when she’s feeding, adjust our alternate positions for the feedings, and just making sure that we’re providing any education and support for the mom and encouragement during breastfeeding, which will help resolve any sort of, of anxiety.
All right, we’re going to move on to some of the key points. So, mastitis is inflammation of the breast tissue with or without infection. Most often occurs in lactating women due to the plugged milk ducts. Some subjective and objective data. They may be having some chills, fever, redness, swelling of the breast tissue. It’s warm to touch, unilateral breast pain and tenderness, and some fatigue. You want to make sure we are assessing vital signs. We’re assessing the breast, encouraging hydration, applying a warm or a cool compress, administering medications. And we’re going to make sure we’re providing that lactation education for the mom. Perfect. That is the end of the care plan.
You guys did great. We love you guys. Go out, be your best self today and as always happy nursing.
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