Mastitis Flashcards
Situation
Eliza is 7 days postnatal following universal midwifery care and a Kiellands rotational forceps. She has been breastfeeding her baby Ario since he was born. You are the community midwife who is routinely visiting her at home today.
Demonstrate your initial introduction and assessment
Hi im Carly the student midwife in to do you postnatal visit
Explain what im going to do
Gain consent
Apple PPE
Ask how she is
Ask how her breastfeeding is going
Eliza tells you I thought i was doing well so far breastfeeding but today feels very different. My left breast is really painful and i’m getting so hot and bothered. I thought i was imagining it but i think i felt a breast lump. You palpate Elizas breast and notice a hard lump that is hot to touch.
What may be the problem
From what you describe and what i can feel i think you may have Mastitis
Can you explain what Mastitis is and some signs and symptoms
Mastitis is inflammation of the breast tissue, that can occur when a block duct does not clear or when the build up causes swelling and inflammation.
Signs and Symptoms
Redness or swelling and warm
Pain that is often localised to one area
Lump in the area
Fever over 38.5c
Malaise
Can you explain the causes of mastitis
Engorgement- Excessive milk build up, causing milk stasis that can lead to blocking of the milk ducts resulting in mastitis
Ineffective attachment- If attachment in ineffective the milk will not be removed effective- causing the milk build up and milk stasis
Bacteria - bacteria can enter into the crack so the nipples from clothing or babies mouth leading to inflammation of the milk ducts. The inflammation in turn restrict the milk flow leading to them being blocked causes milk stasis. Bacteria being present also increases the risk of infection to grow and develop
Pressure- Tight fitting clothing (bras or a finger pressure) can create milk stasis. This leads to blocked ducts
Eliza tells you- This is a bit scary, i had never heard of mastitis before. I missed all of my antenatal classes because i was too busy to go”
Educate Eliza on the anatomy and physiology of breastfeeding
External structure of the breast
- Fatty adipose tissue- creates the size and shape of the breast
- areola- darker central area of the breast that helps guild baby to correct part of the breast
- montgomery tubercles- raised part on the areola that release rebus to keep nipple moisturised and creates a small for baby to look for
-nipple- the centre of the breast that the milk is expelled from
Internal structures of the breast
- ribs- creates the structure of the body
-Alveolar clusters- contain multiple alveoli
-Alveoli- lined with lactoytes
-Lactoctes- milk producing cells
-Myoepithelial cells- Contractile cells
-Lactiferous ducts- transport milk to exit the nipple
Hormones
Oxytocin- Feel good hormone and stimulated the let down reflex, allowing the milk to flow to the baby
When baby is suckling it send a signal and release oxytocin from the posterior pituitary gland. It allows the myopithial cells to contract and push the milk to the exit. Oxytocin creates an emotional bond with baby and can be stimulated by touch, sight, smell, sound and taste from baby
Prolactin- is the milk producing hormone. After the delivery of the placenta progesterone levels fall. This stimulates proclamation receptors. When baby suckles prolactin is released from anterior pituitary gland. The hormones acts on lactoyes promoting production of milk. Prolactin is at its highest during baby suckling and during the night when sleeping.
FIL- Helps regulate and control milk production. It is a whey protein. As the breast fills FIL signals the lactoytes to slow down. This is an example of negative feedback mechanism. When milk is emptied FIL decreases and allows more production of milk and prevent overproduction
What management strategies to support Eliza
Postnatal daily check to assess condition of breast- maybe though woman’s explanation you suspect mastitis
With consent inspect breasts, palpate to help diagnosis
Enquire about feeding history and observe a feed
Offer methods of support to ease and prevent from reoccurring
Provide worsening advice and consider treatment options
Support methods to discuss with Eliza
Encourage to continue breastfeeding and pumping to help relive engorgement
Explain feeding cues, effective attachment and hand expression
Show different potions that might help target milk ducts that are clogged
Breast massage and compression
Warm therapy ( pre and in between feeds)
Cold therapy (post feed)
Loose clothing
Rest and hydration
Eliza tell you- I am worried that i haven’t got the knowledge to continue with feeding Ario. I want to keep breastfeeding but i have no idea what im doing. My confidence is completely gone.
Explain positioning and attachment to support Eliza
The cradle and cross cradle hold- Baby lies across the woman body being support by opposite hard.
Rugby Ball hold- baby is tucked under mother’s arm with the same arm support back and head. This can be effective is blocked milk duct is round to the outer side of the breast
Upright- when baby is upright on mother lap. Helps baby with reflux as they are sitting more upright
Side lying- Mum and baby are lying side ways looking at each other. Allows mum to be more comfortable and can relive some pressure
Koala
Biological nurturing
Attachment
Used to describe how baby latches onto breast. There needs to be a large amount of breast in babies mouth to have an effective feed.
Wide mouth, chin leading, asymmetrical attachment
C- close in to mother
H- head free to allow baby to find its way to breast and latch effectively
I- The body should be in line to allow baby to swallow
N- nose to nipple allows baby to make a wide mouth and fit the breast into the mouth
S- sustainable for mother and baby to be in a position to stay for a while
Ways to know effective attachment;
More are also above than below
Mouth wide open
Cheeks are full
Rhythmic sucking
Shouldn’t be painful
Treatment option to relieve Eliza discomfort and safety precautions
Before administering medication check;
Name and DOB
Name band
Drug kardex and notes
Up to date weight
Known allergies
Drug is prescribed and signed
Drug dose and route is correct
Consent is gained
Watch while patient takes medication
Paracetamol
For pain orally
<50kg 500mg every 4 hours, up to 6 times in 24 hours with a maximum of 3 grams in 24 hours
or
1 gram 3 times in 24 hrs with a maximum of 3 grams in 24 hours
>50kgs 1 gram every 4 hours up to 4 times in 24 hours- max 4g in 24hrs
Contraindications- allergies
Ibuprofen
For pain and inflammation orally
Dose- 400mg 3 times intervals of 6 hrs max 1.2g in 24hrs
Contraindications- Allergy and Asthma
Antibiotics
These need to be medically prescribed
Oral ABX
-Flucloxacilin 500mg 4 times a day up to 14 days
-If a woman is allergic to penicillin- Erythromucin 250-500mg 4x a day or clarithromycin 500mg 2x a day up to 14 days
If Symptoms persist for more than 24hrs commence IV ABX
Eliza partner Sam is also there and wants to know how she can support Eliza.
How would you manage this situation
Active listening
Verbal and non verbal cues
Clear communications
Encourage questions
personal centered approch
Empathy
Educate family members
Conclude visit with Eliza
Arrange follow up visit
Give relevant phone numbers
Worsening advice
Highlight a GP appointment should be made if after 12-24 hrs there is no improvement as can develop into infective mastitis and lead to breast abscesses .
If painful lump or swelling develops call 111 or urgent same date GP appointment
Advice urgent medical attention is woman becomes seriously unwell as these can be signs of sepsis
Ask if any other questions
Document findings and visit
Sign, date and time all documentation
