Nursing Care Plan (NCP) for Mastitis

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Outline

Pathophysiology

Mastitis is inflammation of the breast tissue, with or without infection, that most often occurs in lactating women due to plugged milk ducts.   It is most common 6 – 12 weeks postpartum but can happen anytime. It may present as a red, swollen, firm area on the breast that is painful.

Etiology

When the milk ducts are not emptied after breastfeeding, the milk collects and sits in the ducts, called milk stasis. This collection of milk then clogs the duct and causes milk to back-up and leads to infection. Cracks and fissures in the skin allow bacteria to enter and infect the clogged duct. This results in painful, swollen areas of breast tissue. Risk factors include a weakened immune system (being tired or stressed can make that worse), using only one position to breastfeed, wearing a tight-fitting bra that restricts milk flow, previous episodes of mastitis, or having sore and cracked nipples.

Desired Outcome

The patient will experience decreased pain, redness and swelling; the patient will not exhibit signs of infection; the patient will resume breastfeeding with effective emptying of the breast.

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 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. 

Writing a Nursing Care Plan (NCP) for Mastitis

A Nursing Care Plan (NCP) for Mastitis starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


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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