Engorgement Flashcards
Introduction to OSCE and identifying the problem
Introduce myself
Explain here for a routine postnatal check
Ask how sophia is feeling and how she is getting on with breastfeeding
She explains breasts are heavy, swollen and uncomfortable
Ask with consent to observe her breasts
Diagnose engorgement
Definition- When there is an excessive build up of milk in the breast .
It can occur at any point postnatally
If not treated can lead to mastitis
Explain sings and symptoms to sophia and partner
Breast can be:
Swollen and hard
tights and shiny
The skin will be warm around the breasts
Nipples will be flattened
Fever can occur
Causes: Oversupply
WHAT; Excessive amount of milk building typically between day 3-5 postnatal
WHY; An increase in prolactin to increase milk supply- the body needs type to regulate how much milk baby requires
WHAT HAPPENS; An over production of milk occurring at any point
WHY; overstimulation of the breast through pumps or frequent feeding, triggering a boost in prolactin release.
Missed or Delayed Feeding
WHAT HAPPENS; feeds that are delayed and missed means there is a build up of milk in the breast. that continues to fill.
WHY; As breastfeeding continues the body anticipates the amount of milk required for each feed however if this is not emptied the body needs to recalculate the amount of milk needing which can lead to an oversupply and will happen till FIL is triggered.
Causes; ineffective Attachment
What happens; if the latch is ineffective edition can cause painful and short feeds and therefore inadequate milk transfer
Why; Milk is left in the breast due to short feeds and then more milk is produced from next feed cause it the build up
Causes; Abrupt weaning
What; if breastfeeding comes to a stop suddenly it is no longer getting emptied however the body hasn’t been alerted feeding is stopping so will buildup the milk in the breast until it realises it is no loner required.
Why; the body doesn’t have time to suddenly adjust and FIL wont activate until it realises which in the mean time can cause excessive milk in breasts
explain management strategies
Routine postnatal checks to assess condition of breast- vocal or visual (Gain consent to look at. breasts ad signs of engorgement
Observing feeds to establish cause of issue
Support offering methods of support to ease engorgement
Consider the treatment options and if required for individual case
Encourage to continue pumping and breastfeeding- ensuring appropriate attachment, length and emptying in breast- revisit condition once support has been given
Explain feeding cues, positioning and attachment and when breast are emptied again
Explain hand expression again to help relive some pain
Breast massages
Breast compression during feeds
Cold therapy
Loose clothing
Plan follow up visit in 2-3 days to review breasts
Give worsening advice and give contact details for the days in between if condition is worse
Treatment:
Before giving medications check;
Name and DOB
Name band is correct
Drug Kardex and notes match and are correct
Up to date weight
Allergies
Correct dose and route
prescribed by the correct person
Consent is obtained
Watch person taking tablet
Paracetamol
For pain management
Taken oral
<50kgs 500mg every 4hrs, up to 6 times in 24 hours with a maximum of 3 grams in 24 hours grams
or
1 grams 3 times in 24 hours, with maximum of 3 grams in 24 hours.
>50kgs 1 grams every 4 hours up to 4 times in 24 hours with a maximum of 4 grams in 24 hours
Contraindications: Allergies to paracetamol
Ibuprofen
For pain and inflammation orally
Dose- 400mg 3 times a day intervals of 6 hrs with a max of 1.2 g in 24 hrs
Contraindications; Allergies or Asthma
Cabergoline
For prevention of lactation
Dose; 1mg as a single dose of first day postpartum
or
250 mcg every 12 hrs for 2 days
Support Martin in how he can spurt sophia- explain leadership skills
Conclude the visit with sophia
Allow an oppertunity for sophia to ask any questions
Ensure she has worsening advice
Has contact numbers if symptoms deteriorate
Plan a visit 12-24hrs after to ensure symptoms are getting better
Document all findings from visit
Date time and sign documentation
Say goodbye
