UNIVERSITY of the ASSUMPTION

Unisite Subdivision, Del Pilar, City of San Fernando, 2000 Pampanga, Philippines

COLLEGE OF NURSING
LEVEL II
RELATED NURSING EXPERIENCE 109
CARE OF MOTHER, CHILD AT RISK OR WITH PROBLEMS (ACUTE AND CHRONIC)

Case Analysis
Background of the study:
 Mastitis is a common condition that causes a woman's breast tissue to become painful and inflamed. It is most common in
breastfeeding women, although women who aren't breastfeeding can develop it. Nearly 1 in 5 breastfeeding women are affected
by mastitis in the first 6 months after giving birth. The incidence of mastitis requiring hospitalization is low; in one cohort
including 136,459 new mothers, 127 women were hospitalized for mastitis, an incidence of 9 per 10,000 deliveries.

Brief discussion:
 What is mastitis?
- Mastitis is an inflammation of breast tissue that sometimes involves an infection. It is a type of benign (noncancerous) breast
disease. Breast pain, swelling, warmth, and redness are all symptoms of inflammation. Mastitis can also be accompanied by
fever and chills. In rare cases, it affects both breasts.
 Who might get mastitis?
- Mastitis most commonly affects women who are breast-feeding (lactation mastitis). It most commonly occurs during the first
six to 12 weeks of breastfeeding. However, men, as well as women who aren’t breastfeeding, also get mastitis. You’re more
likely to get mastitis if you have:
o Breast implants.
o Diabetes or other autoimmune disease.
o Eczema or similar skin condition.
o Nicks in skin from plucking or shaving chest hairs.
o Nipple piercing.
o Tobacco or nicotine addiction (smoking).

What are the types of mastitis?

 1. Lactation: This infection type affects breastfeeding women. Also called puerperal mastitis, it's the most common. Lactation
mastitis can cause you to feel run down, making it difficult to care for your baby. Sometimes mastitis leads a mother to wean her
baby before she intends to. But continuing to breast-feed, even while taking an antibiotic to treat mastitis, is better for you and
your baby.
2. Periductal: Menopausal and postmenopausal women and smokers are more prone to periductal mastitis. Also called mammary
duct ectasia, this condition occurs when milk ducts thicken. The nipple on the affected breast may turn inward (inverted nipple)
and produce a milky discharge.
Risk factors:
 Previous bout of mastitis while breast-feeding- more chances of developing mastitis if the mother already experienced it in the
past pregnancy.
 Sore or cracked nipples- although mastitis can develop without broken skin, higher chance for bacteria to enter.
 Wearing a tightfitting bra or putting pressure on your breast when using a seat belt or carrying a heavy bag, which may restrict
milk flow
 Improper nursing technique- increase chance of having crack and sore nipple thus, making it at risk of having mastitis.
 Becoming overly tired or stressed- when a mother skip feedings and breasts stay engorged, it causes extreme pressure in the
breast tissue. Milk starts to leak out of the milk compartments into the surrounding tissues that where not meant to hold milk and
they become inflamed.
 Poor nutrition- does not cause mastitis, but poor nutrition can make it easier for bacteria to become established in the mammary
gland, resulting in increased rates of mastitis.
 Smoking- mothers who smoke have an increased risk of periductal mastitis because substances in cigarette smoke can damage the
ducts behind the nipple.
 Nipple piercings- increase the chances of infection and may make periductal mastitis more difficult to treat.
 Breast implants- the surgery may damage the milk-producing ducts.
 Use only one position to breastfeed- using different positions helps make sure you completely drain the breast.

Expected findings:
 Breast tenderness or warmth to the touch
 Breast swelling
 Thickening of breast tissue, or a breast lump
 Pain or a burning sensation continuously or while breast-feeding
 Skin redness, often in a wedge-shaped pattern
 Generally feeling ill
 Fever of 101 F (38.3 C) or greater
  Anxiety and feeling stressed
 Chills and shivering
 Fatigue
 General aches and pains
 A feeling of malaise

Treatment:
 Antibiotics (dicloxacillin or cephalosporin) - antibiotics such as dicloxacillin and cephalosporin are effective against penicillin-
resistant staphylococci, and, because symptoms often appears after a hospital discharge, it is treated on a outpatient basis. The
antibiotics will have no effect on the infant. If therapy fails, your physician may send a sample of your breast milk to a lab to help
identify the type of bacteria causing the infection.
 Breastfeeding- should be continued if possible because keeping the breast emptied of milk can prevent the growth of bacteria.
Some women find an infected too painful to allow their infant to suck.
 Cold or ice compresses and a good supportive bra- can help with pain relief until the process improves.
 Warm or wet compresses- can also help because it reduces inflammation and edema.
 Therapy- delaying therapy may result in a breast abscess, which is more difficult to treat.

Pathophysiology:

 Bacteria (typically from the infant's mouth) are likely to acquire entrance through cracks or fissures in the nipple surface in
lactational mastitis. Once the major defenses are compromised, organisms have a perfect culture environment in nutrient-rich
 mother milk, resulting in fast reproduction. This can be worsened by milk stasis and overproduction, which can lead to mastitis.
Transient breast swelling caused by maternal hormones in newborns can make them susceptible to mastitis.
 Mastitis, inflammation of the breast in women or of the udder in sheep, swine, and cattle.
 Acute mastitis in women is a sudden infectious inflammation caused usually by the bacterium Staphylococcus aureus, or
sometimes by streptococcus organisms. It begins almost exclusively during the first three weeks of nursing and is limited to the
period of lactation (milk production).
 The bacterial organisms invade the breast through cracks in the nipples, the exposed lymphatic ducts, or the milk ducts. Irregular
nursing, which leads to overfilling of the breasts, increases the effects of infections. The breasts become swollen, painful,
reddened, hardened, and tender. The infection may be in one or both breasts; it can be localized or spread over an area.
 Purulent discharges may occur; frequently the discharge indicates abscess formation. Abscesses may remain internal, or they may
involve the skin.
 The lymphatic system’s nodes and vessels are commonly enlarged and tender also.
 Acute mastitis accompanied by abscesses is often mistaken for acute inflammatory carcinoma (cancer) of the breasts. In a female
child, after birth and during puberty, there may be brief episodes of breast inflammation; these are usually hormone induced and
are not caused by bacterial infection.
 Chronic mastitis is usually a secondary effect of systemic diseases such as tuberculosis, fungal infections, yeast infections, or
syphilis. A relatively uncommon type of mastitis, called plasma cell mastitis, occurs most frequently in older women who have had
a number of children and have a history of difficulty in nursing. It is sometimes difficult to distinguish from cancer of the breast. In
this disease lymphatic fluids stagnate in the breast, and the stagnated fluids are treated by the body as foreign objects. Plasma
cells, white blood cells, and fatty acid crystals accumulate, and fatty tissue suffers degeneration.
 A hard lump form under part of the nipple; there may be distortion of the nipple because of the lesion. The nipple area is painful,
tender, and inflamed and may exude a cloudy discharge.
 The milk ducts and lymph nodes are commonly thickened and enlarged. As the condition progresses, small areas of the breast
become hardened as the original tissue is destroyed and replaced by fibrous or granular tissue.
 Injury to the breast tissue is sometimes followed by inflammation and necrosis (death) of the fatty tissue resulting in a hard fixed
lump with no skin discoloration. The symptoms of mastitis may be present for many years or may arise after a disease of the
breast that involves purulent discharges and abscesses.

Case Progress #1
In the clinical setting, the nurse obtained the V/S of Florence and noted her right breast has cracked skin, hard, tender, warm to touch, red
spots, and pain on the right outer area (pain scale of 8/10). It was found that the body temperature of Florence was 38.5C, BP was
130/90mmHg, pulse and respiration rate was 89bpm and 19cpm, and O2 saturation of 97%.

Breastmilk culture and sensitivity testing were performed: prior to collection, nipples were cleansed to further reduce skin contamination
and false-positive culture results. Breastmilk was obtained by a collection of a hand-expressed midstream clean-catch sample into a
sterile container. On the basis of history and clinical signs, it was diagnosed as mastitis caused by Staphylococcus aureus. Medical
management will be performed to rule out mastitis.

Questions:
A. Explain the assessment findings the nurse-midwife would be alert for to indicate whether Florence is experiencing
mastitis.
 V/S
o BT: 38.5 °C
o BP: 130/90mmHg
 Physical Assessment
o Cracked skin
o Hard, Red spot
o Pain on the right breast
o Tenderness
o Swelling
o Thickening of breast tissue

Laboratory test:
 Breast Examination
 Breast Milk Testing

B. A medical diagnosis of mastitis of Florence’s right breast is made. State two nursing diagnoses appropriate for this
situation.
 Acute pain related to inflammation of breast tissue as evidence by reporting pain in the right breast.
 Risk for ineffective breastfeeding related to interruption secondary to inflammation as evidence by patient reporting pain in right
breast.

C. Describe the treatment measures and health teaching that Florence needs regarding her infection and breastfeeding,
because she wishes to continue to breastfeed.
 Mastitis treatment might involve:
o Antibiotics - If you have an infection, a 10-day course of antibiotics is usually needed. It's important to take all of the
medication to minimize your chance of recurrence. If your mastitis doesn't clear up after taking antibiotics, follow up with
your doctor.
o Pain relievers - Your doctor may recommend an over-the-counter pain reliever, such as acetaminophen (Tylenol, others)
or ibuprofen (Advil, Motrin IB, others).
  For the Health Teaching:
o Avoid overfilling the breast with milk before breastfeeding
o Ensure that the infant latches correctly
o Massaging the breast while breast-feeding or pumping from the affected area of the nipple.
o Teach breast-feeding positions

D. Identify several behaviors that Florence should learn to prevent recurrence of mastitis.
 Fully drain the milk from your breasts while breast-feeding.
 Allow your baby to completely empty one breast before switching to the other breast during feeding.
 Change the position you use to breast-feed from one feeding to the next.
 Make sure your baby latches on properly during feedings.
 Avoid wearing tight-fitting bras or tops
 If you smoke, ask your doctor about smoking cessation.

E. Prepare a nursing care plan to address the need of the patient.

NURSING CARE PLAN

Patient: Mrs. Florence Gender: Female Age: 26 years old

Date of Admission: February 20, 2022

Case: Florence, a primiparous breastfeeding mother at 2 weeks postpartum, calls her nurse-midwife to tell her that her right breast is
painful and she’s not feeling well.

CUES NURSING SCIENTIFIC PLANNING NURSING RATIONALE EXPECTED

DIAGNOSIS EXPLANATION INTERVENTIONS OUTCOME

Subjective Cues: Interrupted Mastitis is caused by Short Term: Independent: Independent: Short Term:
breastfeeding the pathogens
“Dalawang araw ko related to Escherichia coli (E. After 8 hours of Establish rapport and Rapport promotes After 8 hours of
nang hindi discomfort coli), Streptococcus nursing provide a therapeutic emotional comfort and nursing
napapadede ng secondary to uberis and intervention the environment with the security, which enhances intervention the
maayos yung anak ko mastitis. Staphylococcus Pt will: patient. open communication. Pt shall :
sobrang sakit kasi ng aureus. Therapeutic
suso ko tapos napansin environment provides a
ko din na namumula at ● Verbalize suitable and calm ● Verbalized
medyo mainit kapag feelings of surrounding that may feelings of
hinahawakan ko.” as The bacteria are comfort as help minimize the comfort as
verbalized by the most often carried on evidenced by patient’s pain. evidenced by
client. the skin of the reduced pain reduced pain
mother or in the from 8/10 to Use open-ended To explore the patient’s from 8/10 to
Pt. verbalizes the mouth or the nose of 2/10. questions to assess knowledge and personal 2/10.
following: the newborn. the mother’s feelings on her current
● Explain knowledge, thoughts, situation as this ● Explained
● Pain scale of benefits of and feelings about intervention will benefits of
8/10 continuing breastfeeding in encourage her to continuing
The organism gains breastfeeding relation to having verbalize her feelings breastfeeding
Objective Cues: entry via cracks or (e.g.enhanced mastitis. may urge patients to (e.g.enhanced
fissures of the nipple immunity and openly express and immunity and
● Hyperthermia surface. nutrition) ventilate her feelings, nutrition)
AEB a fears, discomfort, and
temperature of ● Demonstrate anxieties and may ● Demonstrated
38.5 °C adequate therefore help relieve adequate
● Restlessness Leading to soreness emptying of the tension she is feeling. emptying of
● Discomfort and pain of the breasts as breasts as
● Facial grimace nipple. evidenced by Offer emotional The patient who is in evidenced by
● Chills stating and support. pain may be stating and
● Redness of the performing discouraged, performing
skin around ways of disappointed, or feel that ways of
the right Discomfort of the effective she has failed as a effective
breast in a mother caused by emptying such mother. Reassuring her emptying such
wedge-shaped the pain and us proper that she did nothing to us proper
pattern inflammation. position, latch, cause this condition and position, latch,
● Breast use of breast that it is temporary may use of breast
tenderness pump help her cope with pump
and warm to constitute. treatments and pain constitute.
touch Interrupted until the condition
● Swollen right breastfeeding. resolves.
breast ● Demonstrate ● Demonstrated
 ● Cracked nipple Reference: effective Discourage weaning Some women will decide effective
methods of due to discomfort. to stop breastfeeding methods of
V/S as follows: https:// breast milk due to pain. Cessation of breast milk
my.clevelandcli collection and breastfeeding while collection and
BP: 130/90 mmHg nic.org/health/disea storage (e.g. mastitis is present may storage (e.g.
Temp: 38.5°C se s/15613-mastitis use of breast contribute to pain use of breast
PR: 89 bpm pump because of increased pump
RR: 19 bpm constitute) breast engorgement. As constitute)
O2 Sat: 97% a result, stasis of milk
● Be able to and reduced expression ● Been able to
continue of milk will occur, all of continue
breastfeeding which contribute to breastfeeding
as evidenced abscess formation. The as evidenced
by regular woman who by regular
breastfeeding understands the effects breastfeeding
every 2 to 3 of weaning will most every 2 to 3
hours within likely continue hours within
20 to 30 breastfeeding. 20 to 30
minutes. minutes.
Teach the need for Handwashing is known
Long Term: hand washing prior to to be the most effective Long Term:
feeding or touching means of removing
After 5 days of breasts. microorganisms and After 5 days of
nursing preventing nursing
intervention the contamination of the intervention the
Pt will: breasts. Touching the Pt shall:
breasts or infant,
● Be free from especially around the ● Been free from
the signs and mouth, prior to the signs and
symptoms of breastfeeding can be a symptoms of
Mastitis. source of contamination Mastitis.
(e.g.Breast if hands are not (e.g.Breast
tenderness thoroughly washed. tenderness and
and warm to warm to touch,
touch, Swollen Apply warm compress To reduce inflammation, Swollen breast,
 breast, or ice packs on the relieve pain and provide Cracked
Cracked affected breast. Advise comfort to the mother. nipple)
nipple) the mother to do this This can also help to
every 2 to 4 hours. empty the milk ducts ● Achieved
● Achieve gently while effective
effective breastfeeding. breastfeeding
breastfeeding or satisfaction
or satisfaction Perform a tepid To stabilize the body with the
with the sponge bath to the temperature of the breastfeeding
breastfeeding mother. patient within normal experience as
experience as levels. evidenced by
evidenced by adequate milk
adequate milk production.
production. Reassure the woman Patient’s with mastitis
regarding the safety of should be informed that
breastfeeding. it is not necessary to
discontinue
breastfeeding and that
breastfeeding is actually
beneficial. The infant is
not affected by sucking
on the involved breast
and will not require
antibiotic treatment.

Provide teachings on Incorrect positions can

breastfeeding, such as: cause crackling of the
emptying her breasts skin. Varying positions
with each feeding by can help infants to latch
breastfeeding or properly and can aid the
pump, proper let-down of milk.
positioning and Continued emptying of
ensuring that the the breast by
infant latches breastfeeding or breast
correctly. pump constitute the first
 line of treatment. This
prevents stasis of milk,
which contributes to
abscess formation.
Breastfeeding should
occur every two to three
hours. If the woman is
too sore to breastfeed,
she should express the
milk or use a pump to
completely empty her
breasts to ensure
adequate milk
production, prevent milk
suppression and
facilitate healing.

Explain benefits of Patients who experience

breastfeeding. pain and discomfort may
decide to terminate
breastfeeding, but if they
understand the benefits
of breastfeeding
including enhanced
immunity and nutrition,
they may be more
inclined to continue
breastfeeding.

Instruct the patient Feeding on the

to initiate feeding on unaffected side initiates
the side without milk ejection on the
soreness. affected side, which
facilitates complete
emptying of the affected
 breast, prevents milk
stasis and promotes
faster healing.

Encourage the patient Comfortable supportive

to wear a good bra reduces the pain and
supportive bra. discomfort because it
decreases the pressure
on the skin of the patient
that causes pain and
tenderness in the
affected area.

Discuss the During lactation , there

importance of is an increased need for
adequate nutritional energy and
fluid intake of 3,000 supplementation of
ml per day, vitamins protein, vitamins,
and mineral minerals along with
supplements such as extra fluid intake to
vitamin c, as indicated. provide nourishment to
the infant and to protect
mother’s stores.

Discuss the Completing the entire

importance of course of antibiotics is
completing antibiotic important to prevent
therapy. recurrence or a breast
abscess. Antibiotics
should be continued for
a full 7 days, depending
upon the prescription of
the physician.

Plan with the woman When a woman caring

what will be an for a newborn is busy,
effective reminder forgetting to take
system for her to use, medicine is easy to do.
such as a chart on her
refrigerator door or
reminder signal on
her smartphone.

Encourage frequent To limit fatigue and

rest periods, sharing facilitate relaxation at
household/ childcare feeding times.
duties.

Identify maternal The infant’s father and

support systems or maternal grandmother
presence and (in addition to caring
response of significant healthcare providers)
others,extended are important factors to
family,and friends. contribute to successful
breastfeeding.
Dependent:

Administer and assess Antibiotics inhibit

effectiveness of pathogenic growth and
antibiotic therapy as prevent development of
prescribed by the systemic infection. They
physician, prior to work by killing bacteria
breastfeeding. or preventing them from
reproducing and
spreading. Infective
mastitis should begin to
resolve within 48 hours
following initiation of
antimicrobial therapy
and other therapeutic
 treatments.

Administer analgesics Analgesics may be

as prescribed by the required to relieve
physician. discomfort and pain.

Collaborative:

Refer the patient to a An acute infection like

lactation consultant as mastitis can affect a
feasible. woman’s ability and
desire to breastfeed.
Thus, a lactation
consultant may be
helpful to her if she
desires to breastfeed but
is experiencing pain and
fatigue.

F. Create a drug study of 1 of the drugs given in medical treatment measures?

Drug Name Classification Mechanism of Action Therapeutics Effects Nursing Considerations

Generic Name: Therapeutic Class: MOA: Indications: Side Effects: Assessment and Drug Effects:
Dicloxacillin
Brand Name: Pharmacologic Class: Dicloxacillin exerts a Contraindications: ● Diarrhea ● Take care to establish
Appearance: bactericidal action ● Nausea previous exposure and
against penicillin- ● Vomiting sensitivity to penicillins and
susceptible ● Mouth Irritation cephalosporins as well as
Shape: microorganisms during ● Swollen Joints other allergic reactions of
Color: the state of active ● Black tongue any kind before initiating
Form: multiplication. All ● Heartburn therapy.
Dosage: penicillins inhibit the ● Blisters or ● Obtain C&S prior to
biosynthesis of the ulcers in your initiation of therapy to
Route: bacterial cell wall. By mouth determine susceptibility of
 binding to specific causative organisms.
Frequency: penicillin-binding Adverse Effects: Therapy may begin pending
proteins (PBPs) located test results.
inside the bacterial cell NS: ● Nurses must monitor
wall, dicloxacillin ● Seizures patients and watch for
inhibits the third and GI: seizures; notify physicians
last stage of bacterial ● Diarrhea immediately if a patient
cell wall synthesis. Cell ● Epigastric develops or increases
lysis is then mediated distress seizure activity.
by bacterial cell wall ● Nausea ● Nurses must monitor signs
autolytic enzymes such ● Vomiting of allergic reactions and
as autolysins; it is ● Pseudomembra anaphylaxis, including
possible that nous colitis pulmonary symptoms
dicloxacillin interferes ● ↑ liver enzymes (tightness in the throat and
with an autolysin GU: chest, wheezing, cough
inhibitor. ● Interstitial dyspnea) or skin reactions
nephritis (rash, pruritus, urticaria).
Derm: ● Assess for muscle aches and
● Rash joint pain (arthralgia) that
● Urticaria may be caused by serum
Hemat: sickness. Notify physicians if
● Eosinophilia these symptoms seem to be
● leukopenia. drug-related rather than
Misc: caused by musculoskeletal
● Anaphylaxis injury, or if muscle and joint
● Serum Sickness pain are accompanied by
● Superinfection allergy-like reactions (fever,
rashes, etc.)
● Monitor signs of
eosinophilia (fatigue,
weakness, myalgia) or
leukopenia (fever, sore
throat, signs of infection);
report these signs to the
physician.
● Monitor periodic
monitoring of CBC,
urinalysis, BUN, serum
creatinine, and liver
enzymes during prolonged
therapy.

Patient and Family Education:

● Advise the patient to take

medication around the
clock. Do not miss a dose
and continue taking
medication until it is all
gone, unless otherwise
directed by a physician.
● Instruct the patient to notify
the physician immediately if
signs of the following occur:
Pseudomembranous colitis
(diarrhea, abdominal pain,
fever, pus or mucus in
stools) or other severe or
prolonged GI problems
(nausea, vomiting,
heartburn), Superinfection
(black, furry overgrowth on
tongue; vaginal itching or
discharge; loose or foul-
smelling stools), Interstitial
nephritis (blood in urine,
decreased urine output,
weight gain from fluid
retention).
● Instruct the patient and
 family/caregivers to report
other troublesome side
effects such as severe or
prolonged skin problems
(rash, itching) or GI
problems (nausea, vomiting,
diarrhea, heartburn).

Pregnancy and Lactation

● Dicloxacillin can pass into

breast milk and may harm a
nursing baby. Consult first
with a doctor if you are
breast-feeding a baby,
before taking this
medication.

Significance of the study:

- This study is made to have an in depth understanding about high-risk postpartum complication which is mastitis. For that reason,
this analysis of the said complication presents the ways on how to deal or minimize the risk of having the above mention
complication. Therefore, through this study the following will benefit the case that is presented above: Students (Especially
Nursing Students), Professionals, and people of the community that are curious about Mastitis.

Current trends:

Prevention:
- To get your breast-feeding relationship with your infant off to its best start — and to avoid complications such as mastitis —
consider meeting with a lactation consultant. A lactation consultant can give you tips and provide invaluable advice for proper
breast-feeding techniques.
Minimize your chances of getting mastitis by following these tips:
 Fully drain the milk from your breasts while breast-feeding.
 Allow your baby to completely empty one breast before switching to the other breast during feeding.
  Change the position you use to breast-feed from one feeding to the next.
 Make sure your baby latches on properly during feedings.
 If you smoke, ask your doctor about smoking cessation.

Objective of the study:

- This study aims to scrutinize the correct procedures for treating mastitis. The objective of this study is to provide detailed
information about the necessary treatments to avoid undesirable circumstances. Furthermore, this study provides the risks,
preventions, treatments, and medications regarding mastitis.

Assessment:
 The right outer area of the patient’s breast is noted to have cracked skin, hard, tender, warm to touch, red spots, and also
experiences pain.
 Temperature is 38.5°C.
 Blood pressure is 130/90mmHg.
 Normal pulse & respiratory rate of 89bpm/19cpm.
 Normal O2 saturation of 97%.
 Observe for the swelling/redness of the breasts.
 Physical Examination - Breast examination - Palpation of the Breasts.
 Breast Milk Testing (determines whether there is bacterial infection).

Laboratory:
 Ultrasound- reveals features of subcutaneous edema with skin thickening with increase in echogenicity of subcutaneous tissue.
Fluid is observed as intervening hypoechoic lines in subcutaneous tissue.
 Somatic Cell Count- Milk consists of somatic cells that are 75% leukocytes, i.e., neutrophils, erythrocytes, macrophages,
lymphocytes and 25% epithelial cells. During intra-mammary infection, a significant increase in total SCC is observed where
mostly epithelial cells and white blood cells are present in large numbers. It is also observed that the cell count increases
whenever the mammary glands are injured.

Diagnostic test:
 Mammogram- bacterial (puerperal or non-puerperal) mastitis will usually feature ill-defined regions of increased density and skin
thickening.
  Breast Ultrasound-ultrasound is a valuable method for the diagnosis of mastitis, especially when an abscess is suspected and
established a correct diagnosis in most cases; the abscesses appear as inhomogeneous fluid collections, with poorly defined
margins.
 MRI- used to diagnose mastitis if multiple regional and separated enhancements or contiguous clustered rim-like enhancements
appear on MRI.
 Biopsy- A tissue sample, Inflammatory breast cancer has symptoms that are a lot like mastitis and can be mistaken for an infection
so you might need a skin biopsy to make sure it’s not cancerous.
 Culture- Culture is rarely used to confirm bacterial infection of the milk because positive cultures can result from normal bacterial
colonization, and negative cultures do not rule out mastitis. Culture has been recommended when the infection is severe, unusual,
or hospital acquired. To culture the milk, the mother should cleanse her nipples, hand express a small amount of milk, and discard
it. She should then express a milk sample into a sterile container, taking care to avoid touching the nipple to the container.
 Physical examination- Your doctor will ask you about your symptoms and examine the affected breast. He or she will check for
swelling, tenderness and a painful, wedge-shaped area on the breast that is a sign of mastitis.

Interpretation of the laboratory test:

Test Client’s Reason for Order Interpretation Nursing Consideration

Result

Ultrasoun Positive Doctor’s Order -Confirmation of mastitis -Explain the procedure to the patient.
d Result for after Breast -Early stage of mastitis shows -Ask the patient to lie on their back on the
Mastitis Examination various features that are presented examination table with their hands at their sides.
with thickness of skin and -Tell the patient that a warm gel will be applied
subcutaneous layer. to their  breast. The gel will help the sound waves
to travel from the machine into their breast.
-A transducer, a small device similar to a
microphone, will be placed over their breast. This
will be painless, although they may feel mild
pressure from the transducer.

Case progress #2
Hospital and routine and treatment prescribed to Florence were properly carried out, that includes proper administration of antibiotics,
continuation of breastfeeding to empty the breast, cold or warm compress, and wearing of supportive bra, and therapy. After 48-72 hours
of medical management and nursing interventions, Florence was re-examine for the signs and symptoms of mastitis; she reported reduce
in pain on the right side of the breast, manifested decreased signs and symptoms of mastitis, and was also able to breastfeed and empty
the breast without further complications.

Conclusion:
- Mastitis is an inflammation of the breast tissue that can occasionally be associated with an infection. Breast discomfort, swelling,
warmth, and redness are all symptoms of inflammation. You may also get a fever and chills. Breast-feeding mothers are the most
usually affected by mastitis (lactation mastitis). Signs and symptoms of mastitis can appear suddenly and examples of this are
Breast tenderness or warmth to the touch, Breast swelling. Mastitis is caused mostly by retained milk in the breast. A milk duct
that is clogged. One of your milk ducts might get plugged if a breast does not entirely drain at feedings. The obstruction causes
milk to back up, which might lead to a breast infection. Bacteria infiltrating your breast. Bacteria from the surface of your skin and
your baby's mouth can enter the milk ducts through a fissure in the skin of your nipple or a milk duct hole. Stagnant milk in an
unemptied breast provides a fertile habitat for the germs. For the complications, Mastitis that is not appropriately treated or is
caused by a blocked duct might result in a collection of pus (abscess) in your breast. Surgical drainage of an abscess is typically
required. Reduce your risks of having mastitis by following these tips: While breast-feeding, fully drain the milk from your breasts.
Allow your infant to finish emptying one breast before switching to the other during feeding.

Learning derived:
- This case analysis served as a foundation for us student nurses to know the background of mastitis as a nursing student. Having
knowledge about pathophysiology, assessment, health education, risk factors, treatment for mastitis, prevention, and the
importance of hospital care when it comes to handling the needs of the patient is a big factor in providing care to the patient. This
study was designed to provide an in-depth understanding of mastitis, a high-risk postpartum complication. Breastfeeding is also
useful for nursing mothers. As a result, it is critical to assist the mother in overcoming challenges such as mastitis and continuing
to breastfeed. The selection of an appropriate therapy and the supply of therapeutic instructions to the patient are critical for a
cure, a successful length of breastfeeding, and the prevention of difficulties for both mother and infant. In interpretation, poorly
managed mastitis may result in the early end of breastfeeding, causing pain and suffering to both mother and infant. Adequate
treatment and instructions to the mother are thus critical.

References:
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