Maternity Nursing: Postpartum Q 8
A nurse is providing instructions to a mother who has been diagnosed with mastitis. Which of the following statements, if made by the mother, indicates a need for further teaching?
A. “I need to take antibiotics, and I should begin to feel better in 24-48 hours.”
B. “I can use analgesics to assist in alleviating some of the discomfort.”
C. “I need to wear a supportive bra to relieve the discomfort.”
D. “I need to stop breastfeeding until this condition resolves.”
Correct Answer: D. “I need to stop breastfeeding until this condition resolves.”
In most cases, the mother can continue to breastfeed with both breasts. If the affected breast is too sore, the mother can pump the breast gently. Regular emptying of the breast is important to prevent abscess formation. Continuing to fully empty the breasts has shown to decrease the duration of symptoms in patients treated both with and without antibiotics. Patients should be encouraged to continue to breastfeed, pump, or hand express. If the patient stops draining the milk, further stasis occurs, and the infection will progress.
Option A: Antibiotic therapy assists in resolving the mastitis within 24-48 hours. If the symptoms of lactational mastitis persist beyond 12 to 24 hours, antibiotics should be administered. Because S. aureus is the most common cause, antibiotic therapy should be tailored accordingly. In the setting of mild infection without MRSA risk factors, outpatient treatment can be initiated with dicloxacillin or cephalexin.
Option B: The doctor may recommend an over-the-counter pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others). Lactational mastitis occurs due to a combination of inadequate drainage of milk, and the introduction of bacteria. Common scenarios leading to poor milk drainage include infrequent feeding, an oversupply of milk, rapid weaning, illness in mother or child, and a clogged duct. The inadequately drained milk stagnates, and organisms grow, leading to infection. It is thought that bacteria (usually from the infant’s mouth, or mother’s skin) gain entry to the milk via cracks in the nipple.
Option C: Additional supportive measures include ice packs, breast supports, and analgesics. Non-steroidal anti-inflammatory drugs (NSAIDs) can be used for pain control. Heat applied to the breast just before emptying can help increase milk letdown and facilitate emptying. Cold packs applied to the breast after emptying can help reduce edema and pain.