Lactation Mastitis (Nursing)

by Jacquelyn McMillian-Bohler, PhD, CNM

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      Slides Postpartum Complications Nursing.pdf
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      Slides Postpartum Complications Lactation Mastitis Nursing.pdf
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      Reference List Maternity Nursing Care of the Childbearing Family.pdf
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    00:01 The next complications is mastitis.

    00:04 Mastitis is an inflammation of breast tissue caused by a blocked milk duct or bacteria that makes its way into the breast tissue.

    00:12 Clinical features include pain, lots of pain.

    00:16 This is one of those characteristic tell-tell sign of mastitis.

    00:20 Redness, heat from the area, temperature, and we're speaking of maternal temperature at this point; a palpable mass, and engorgement.

    00:29 What may help differentiate mastitis from typical engorgement? Maybe, the unilateral nature of its presentation.

    00:37 So in engorgement, most of the time, both breasts are enlarged; with mastitis, all of these clinical features are limited to one breast and that lets you know, that it's likely an infection that's the culprit.

    00:49 Risk factors, milk stasis.

    00:52 So any time there's an imbalance between the demand for milk and the supply of the milk, there's a possibility of milk just sitting around and that milk stasis can lead, will leave a perfect place for bacteria to find its way and have a party right there.

    01:08 Poor latch. So if the baby is not really latched on very well, then one of the things that can happen is damage to the breast tissue and that creates cracks and openings for the bacteria to make its way into the breast.

    01:21 Nipple trauma is exactly what I'm talking about.

    01:24 A history of mastitis, so someone who has previously had mastitis during this postpartum period is at risk for developing mastitis again.

    01:33 An ill-fitting bra, and an ill fitting bra actually contributes to mastitis because you might get spots where the breast is not able to adequately emptied or you have milk stasis because of the way that the bra sort of catches the breast tissue.

    01:48 And then, poor nutrition, because poor nutrition can lead to infection of almost anything.

    01:54 It decreases your ability to fight off infection and so that might be the culprit, as well.

    01:59 When mastitis is diagnosed, it's typically done by assessment.

    02:04 So we use our wonderful palpation and observations skills to actually see the changes in the breast.

    02:09 We also want to listen to the mother, because they will tell us about the pain and the discomfort, that's there as well.

    02:16 We also want to go back to signs of infection which includes temperature.

    02:20 So having a slight elevation in temperature like a 100.4 or less, that might be normal.

    02:27 With mastitis, however, the temperature goes way up, 102, might be more typical of a mastitis infection.

    02:35 And, also, an elevated white blood cell count indicating that there's an infectious process in order.

    02:41 So what does the nurse do to help alleviate mastitis? First of all, we want to encourage more frequent, feedings.

    02:49 Now it may seem counterintuitive to suggest that someone actually breastfeed from a breast that's full of bacteria.

    02:56 Well, that bacteria probably either came from the baby's mouth or somewhere else and it's perfectly fine for them to drink it.

    03:04 Actually, there are enzymes and acids on the stomach that will break down that bacteria, so make sure you talk to the patient about that so they won't be scared to breastfeed.

    03:13 We've got to get the milk out in order to begin to cure the mastitis.

    03:18 The patient will likely receive an order for antibiotics.

    03:21 They need to complete the entire course to make sure that the infection is gone.

    03:26 Next, since we know that one of the reasons why mastitis happens is because of poor latch.

    03:32 We need to ensure that the client has received good instruction about proper positioning, and how to be supported during the breastfeeding process.

    03:40 Washing hands cures all infections, mastitis is no exception, so make sure that the client knows they need to wash their hands before every episode of breastfeeding.

    03:52 We may also monitor for signs of worsening infection by checking the white blood cell count, so if that's ordered, look up those results.

    04:00 And also, we know that mastitis can actually transition into an abscess which can actually transition to sepsis, really quickly.

    04:08 So if the client is not getting better despite doing all those other things, then we need to have them come back in.

    About the Lecture

    The lecture Lactation Mastitis (Nursing) by Jacquelyn McMillian-Bohler, PhD, CNM is from the course Postpartum Complications (Nursing).

    Included Quiz Questions

    1. Milk stasis is a risk factor.
    2. Increased maternal temperature
    3. Palpable mass
    4. Bilateral breast engorgement
    5. Breastfeeding multiple babies is a risk factor.
    1. Monitor for possible abscess formation.
    2. Educate the client to not nurse out of the affected breast.
    3. Educate the client on antifungal therapy.
    4. Educate the client to wash their hands after each breastfeeding.

    Author of lecture Lactation Mastitis (Nursing)

     Jacquelyn McMillian-Bohler, PhD, CNM

    Jacquelyn McMillian-Bohler, PhD, CNM

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