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Mastitis and Engorgement (10 Questions)
1. Mme Tremblay, 3 weeks postpartum, calls the CLSC (community health clinic) in distress. She is exclusively breastfeeding. She reports, "I feel like I've been hit by a truck. My whole body aches, I have chills, and my temperature is 39.5°C." She also mentions that her right breast is very painful and feels hot to the touch.
Question:
Upon physical assessment, which specific finding would confirm the diagnosis of mastitis rather than simple viral influenza?
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Bilateral swelling and hardness of both breasts with a temperature of 37.8°C.
A localized, wedge-shaped area of redness (erythema) and induration on the right breast.
Cracked, bleeding nipples with shooting pain during breastfeeding.
A palpable lump that moves freely and is non-tender.
2. Mme Gagnon has been diagnosed with Infective Mastitis of the left breast. The physician has prescribed Dicloxacillin (an antibiotic) and Ibuprofen. Mme Gagnon is crying and says, "I suppose I have to stop breastfeeding now. I don't want the baby to drink infected milk or get the medicine."
Question:
What is the most appropriate nursing response regarding breastfeeding safety?
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"You must stop breastfeeding on the infected side, but you can continue on the healthy side."
"You should pump and dump the milk from the infected breast until the fever is gone."
"It is safe and essential to continue breastfeeding on both breasts. The antibiotic is safe for the baby, and emptying the breast helps heal the infection."
"Switch to formula for 10 days until you have finished the entire course of antibiotics."
3. Mme Leclerc returns to the clinic 48 hours after starting antibiotics for right-sided mastitis. Despite taking the medication and resting, she reports that her fever has persisted and the pain has increased. Upon palpation of the right breast, you feel a distinct, hard, fluctuant mass that is extremely tender.
Question:
What complication does the nurse suspect, and what is the anticipated intervention?
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A Galactocele (milk cyst); apply warm compresses.
A Breast Abscess; referral for ultrasound-guided aspiration or surgical drainage.
Inflammatory Breast Cancer; immediate oncology referral.
Resistant Mastitis; double the dose of antibiotics.
4. Mme Bedard, 2 weeks postpartum, presents with early signs of mastitis. During the assessment of a breastfeeding session, you notice the infant is latching only onto the nipple, not the areola. Mme Bedard grimaces in pain, and you observe a deep fissure (crack) across the nipple.
Question:
How does the nurse explain the connection between the latch and the infection?
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"The baby's saliva contains bacteria that caused the infection."
"The baby is sucking too hard, which bruised the tissue and caused inflammation."
"The crack indicates you have a yeast infection, which has turned into mastitis."
"The shallow latch caused the crack in your nipple, which acted as a portal of entry for bacteria to enter the breast tissue."
5. Mme Roy is managing mastitis at home. She is taking her antibiotics but asks what else she can do to relieve the pain and help the infection clear up faster. The medical order allows for "supportive care measures."
Question:
Which intervention should the nurse recommend?
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"Apply a warm compress to the affected breast just before feeding to help the milk flow."
"Wear a very tight sports bra to support the heavy breast tissue."
"Limit your fluid intake to reduce the swelling in the breast."
"Avoid feeding from the affected side because it is too painful; just pump."
6. Mme Fortin has just recovered from a bout of mastitis and is terrified of getting it again. She asks, "What can I do to prevent this from coming back?"
Question:
Which instruction is most important for preventing recurrence?
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"Wash your nipples with soap and water before every feed to kill bacteria."
"Ensure you empty your breasts frequently and completely; do not skip feedings or go long periods without milk removal."
"Take a prophylactic antibiotic once a day for the next month."
"Switch to bottle feeding at night to let your breasts rest."
7. Mme Vachon complains of "shooting, burning pain" that radiates deep into her chest during and after feedings. Her nipples appear shiny, bright pink, and flaky. She does not have a fever or a red wedge on the breast.
Question:
Why is this likely not bacterial mastitis?
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Bacterial mastitis is always painless.
Mastitis only occurs in women who are not breastfeeding.
The absence of a fever rules out any type of breast problem.
The symptoms described are classic for Candidiasis (Thrush), a fungal infection, not a bacterial one.
9. Mme Dubé is 4 days postpartum. She calls the nurse stating, "My breasts are huge, hard like rocks, and warm. I have a low fever of 37.6°C. I can't even put my arms down by my sides."
Question:
How should the nurse interpret these findings?
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This is physiological engorgement due to the increase in milk volume and lymphatic fluid; it is a temporary condition.
This is bilateral mastitis requiring immediate antibiotics.
This is a sign of breast cancer and needs a mammogram.
This indicates the mother is producing too much milk and must stop drinking water.
10. Mme Lavoie, 3 days postpartum, is experiencing severe engorgement. Her areolas are so tense and hard that the nipple has flattened out, and her newborn keeps slipping off and cannot latch.
Question:
What is the specific technique the nurse should teach to enable the baby to latch?
*
"Pump for 20 minutes before trying to feed."
"Apply ice packs to the nipples for 10 minutes to numb them."
"Use Reverse Pressure Softening by pressing your fingertips around the base of the nipple to push fluid back and soften the areola."
"Give the baby a bottle of formula until the swelling goes down."