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Nutrition Through the Life Cycle (...

6th Edition
Judith E. Brown
ISBN: 9781305628007

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Nutrition Through the Life Cycle (...

6th Edition
Judith E. Brown
ISBN: 9781305628007
Textbook Problem

Chronic Mastitis

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This was an unremarkable first pregnancy for 29-year-old Barbara Ann. Barbara Ann has reported experiencing “a little” breast enlargement during her pregnancy.

Her infant is first put to the breast at 2 hours postpartum, and the infant latches well according to mom, and suckles vigorously. The infant nurses every 2 hours over the first 3–4 days postpartum. Barbara Ann’s breasts became noticeably fuller during the third postpartum day, and by the fourth postpartum day they are painfully engorged. In addition, Barbara Ann reports painful, burning, cracked nipples. The engorgement makes it difficult for her baby to latch at the breast. The baby becomes irritable, and Barbara Ann experiences a significant amount of pain. A lactation consultant gives Barbara Ann guidelines for engorgement management.

On day 5, the engorgement is still causing discomfort. Barbara Ann’s nipples have become more cracked and painful. The lactation consultant notes that the infant’s latch has become shallow and tight, probably in an attempt to control the flow of milk. However, the infant shows all the signs of adequate intake, including 10 very wet and 5 soiled diapers during the 24 hours prior to the consultation.

By day 7 postpartum, Barbara Ann has mastitis. She is treated with a 7-day course of dicloxacillin. A lactation consultant assists her in achieving a proper infant latch.

By day 14, Barbara Ann is feeling much better. The mastitis has resolved, and her nipples are healing. She still has tenderness during infant feedings and a healing crack on the right side. Her breasts are still uncomfortably full and are occasionally swollen and tender.

At 3 weeks postpartum, Barbara Ann develops an inflamed area on the right breast that remains red and tender despite applying warmth and massage to the area. The lactation consultant helps Barbara Ann to position the infant in a way that allows drainage of the inflamed area and recommends she pump the affected side to relieve the discomfort. The crack on the right nipple has improved, but is still not completely healed. Barbara Ann continues to show signs of oversupply, such as breasts feeling uncomfortably full, even after feeding, and excessive milk leakage between feedings. The lactation consultant provides Barbara Ann with techniques to decrease her overproduction.

After 10 days of persistent burning pain in the nipple area, Barbara Ann is treated with fluconazole for a yeast infection. Seven days after starting the fluconazole, a topical nystatin ointment is prescribed for her nipples and an oral suspension for her infant.

At 7 weeks postpartum, Barbara Ann calls the lactation consultant to report another flare-up of mastitis. Her health care provider prescribes a 10-day course of dicloxacillin. Barbara Ann is still treating her nipples with nystatin ointment. At 8 weeks postpartum her mastitis resolved; her nipple pain is still present, but improving. Barbara Ann is nursing the infant on one side only per feeding and reports that the infant latches better when she is in a more reclined position.

Questions

Name the causes of engorgement.

Summary Introduction

To mention: Various causes of engorgement.

Introduction: Chronic mastitis is a breast disease that leads to prolonged inflammation. This disease occurs in the case of a mother who avoids breastfeeding. Breastfeeding is the most important and natural way to feed a newborn baby. Mother’s milk provides all the nutrition and immunity to the baby, which is needed during the first six months. Breastfeeding satisfies their hunger and thirst, and provides the proper amount of proteins, minerals, and immunity to the child, which helps to deal with the environment.

Explanation

Person B was pregnant at the age of 29 and during her pregnancy she had reported experiencing breast enlargement. After two hours of postpartum, her newborn was put to the breast and the infant latched well according to the mother. The infant was nursed over the initial 3-4 days of postpartum in every two hours. Person B was noticed with heavy breast during the third day of postpartum and gradually, she felt painful engorgement by the fourth day of postpartum. During this time, she also reports painful, burning sensation and cracks in her nipples. Due to breast engorgement, the infant is unable to latch properly to the breast. This makes the infant irritable. Person B consulted a lactation consultant and follows engorgement management. On the fifth day, the engorgement caused discomfort. The nipples of Person B became more cracked and painful because the vigorous latching of the infant. In the case of the infant, all the symptoms show about the adequate intake of nutrition. By the seventh day of postpartum, Person B had mastitis and consulted a lactation consultant for treatment. By the fourteenth day, her symptoms became very less and she felt much better. During the third week, while feeding the infant, she still had inflammation, a healing crack, and still some symptoms of chronic mastitis were present.

Again, she consulted the lactation consultant who helped Person B to position the infant in a comfortable way that mostly allows the drainage of the inflamed area and recommends her to pump the affected side to relieve the discomfort during breastfeeding. Then, Person B continued to show the signs of oversupply like breast feeling full after feeding and excess leakage of milk between feedings. Her lactation consultant provided techniques to decrease the overproduction of milk. After 10 days of burning pain in the nipples, Person B is treated with fluconazole for a yeast infection. Again after the seventh week of postpartum, Person B consulted the lactation consultant to report about another mastitis condition. Her consultant prescribed dicloxacillin for treatment. During the eighth week of postpartum, her mastitis condition resolved but the pain was still present in her nipples. Also, she is improving from mastitis condition.

In this case study, the causes of engorgement in breasts of Person B are as follows:

  • Instability between the demand and the supply of breast milk
  • Excess production of breast milk
  • Improper breastfeeding techniques
  • Infrequent or ineffective removal of milk from the breast

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