CASE study ON breast engorgement

Guide - ……………………
Name - …………………….
Group - M.Sc. Nursing 1st year student
Subject - Obstetrics &gynaecology

Date - ,…………………
Time - 2:00 to 3:00 pm
Method of teaching - lecture,discussion
A V AIDS - poster ,ohp,blackboard

General objectives - At the end of the class the student will be able

To gain knowledge about breast engorgement

And they will be able to apply this
Knowledge in their clinical and teaching area

Specific objectives -
All he of the class the student will be able to:-
 To introduce about breast engorgement
 To know about definition of engorgement
 To know about etiology of engorgement
 To know about sign and symptom of engorgement
 niosTo know about medical and nsg management of engorgement
 to know about complication of engorgement
 Biodata of my patient

POSTNATAL CASE

BIODATA OF THE PATIENT

Name Mrs Geeta

Age /Sex 29 yrs/F

Date Of Admission 07-01-13

Date Of Discharge 14-01-13

Weeks Of Gestation 32weeks

Address MR 10 , Indore

Religion Hindu

Diagnosis breast engorgement

Consulted Dr Dr.Ratna Thakur .

Obstetric Score G1p1l0A0

PRENATAL HISTORY
Date of booking :-

LMP:- 12-04-12

EDD:- 19-01-13

Gestation at first week:- 32weeks

MEDICAL HISTORY
Chronic illness :-No history of chronic illness

Allergy:- No history any allergies

Surgery:No past history of surgery

Communicable disease :No history of communicable disease such as malaria ,chiken pox, TB
etc
FAMILY HISTORY
Type of family : Joint

No. of person: 12

DISEASE:
Chronic illness: no past history of hypertension and diabetes

Genetic disorder : no history of genetic disorder like thalassemia colour blindness

Psychiatric disorder: no history of psychiatric disorders

SOCIO ECONOMIC BACKGROUND

Religion : Hindu

Family Income : 15000/Month

Education Wife B.Sc

Educational Status Husband B.A

Occupation Status Husband railway

Occupation Status Wife House Wife

MENSTRUAL HISTORY
Menarchy:- 14thyr

Duration :- 4 days

Interval :- 30 day

Flow :-normal flow

MARITAL HISTORY
Age of marriage : 22 yrs

Years married : 2yrs

Consanguineous : no
 DIETARY PATTERN
Vegetarian : yes

Habbits : the patient is not having having any bad habits which like tobacco, alcohol, cigrratte
,smoking

PAST OBSTETRICAL HISTORY

SN YEA FUL PRE ABORTI TYPE BABY RE
O RS L TER ON OF MA
TER M DELIVE RK
M RY
SE ALIV STILLB WEIGH
X E ORN T
1

P R I M I G R AV I D A
2

3
4

PRESENT PREGNANCY
Admission note

Admitted on 07/01/13 at 9:30 .am

Contraction commenced

PRENATAL HISTORY
DA HEI WEI U BP F GESTA HT AB PRESENT POSITI TREAT
TE GH GHT RI H TION OF D ATION ON MENT
T NE R FUN GIR AND
DUS TH REMAK
S

10- 150 52 kg A- 11 12 12cm 60 Iron tab

09- cm nil 0/7 weeks cm Calcium
12 S- 0 tab
nil T.T 1st
dose
10- 150 53 kg A- 11 16 16 cm 63 Iron tab
10 - cm nil 0/7 weeks cm Calcium
12 S- 0 tab
nil T.T 2 nd
dose
ADMISSION NOTES
Date of admission : 7-01-13

Diagnosis Breast Engorgement

General condition : fair

OBSTETRICAL EXAMINATION
Period of gestation: 12weeks

Presentation: cephalic

Position : LOA

Height of fundus:

Engaged : not engaged

Fetal heart rate : 140

Abdominal girth : 76cm

INVESTIGATION :
Blood group: ‘O’ positive

Rh : positive

Hb : 12.2 gm/dl

VDRL:

HIV: negative

Ultrasound : single live intrauterine fetus in cephalic presentation having an estimated

gestational abe about 33weeks ,4 days +/ - 2 weeks
Medication :
 Cap. Ampoxin 500mg BD
 Tab.Metro 400mg TDS
 Tab.aciloc 150mg OD

PHYSICAL EXAMINATION
Height : 157 cm

Weight: 58kg

Vital signs : temperature :1020F

Plus : 88/min

Respiration: 26/min

Blood pressure : 110/70

Head

Scalp: normal

Hair : normal black hair

Cranium: symmetrical

Face : face is clear no wrinkles present

Eyes :

visual activity : normal

Visual field; normal

Lids: normal

Sclera: normal

Conjunctiva normal

Ears:

External structure: normal

Canal: normal

Hearing activity normals

Nose :

External structure normal

Mucous membrane pink in colour

Oral activity

Lips : pink in colour

Teeth normal proper arranged

Neck

General structure normal

Trachea normal

Respiratory system : normal with tachycardia

Breast : abnormalities present on palapation

Hardness present

Breast enlarged

Nipple enlarged

Abdomen :

Round in shape

Linea nigra present

Straegravidum present

Abdgirth -30cm

Fundal height : 7cm

Muculoskeletal :- result

Upper extremities:- normal

Lower extremities :-edema present

Nervous system :

Mental status : conscious

Language she speaks :-Hindi

Place : oriented

Time : oriented

Person : oriented

INVESTIGATIONS:
BLOOD GROUP AB +VE
HIV, AUSTRALIAN ANTIGEN  NEGATIVE
Hb 12.6 gm%
T&D 12,400 per cum
PTT  28.4 SEC
PLATELET COUNT 2.63
RBS  120mg%

URINE ROUTINE
ALBUMIN ABSENT
PC 0/HPF
EC  0/HPF
RBC NIL
Specific gravity- 1.025
Acetone- nil
Sugar nil

BLOOD TEST-
Blood glucose[random/post prandial]- 107 [normal value-70-140 mg/dl]
Blood urea nitrogen - 12 [8-25 mg/dl]
 BREAST ENGORGEMENT

Introduction-
Breast engorgement occurs in the mammary glands due to expansion and pressure exerted by the
synthesis and storage of breast milk.
Engorgement usually happens when the breasts switch from colostrums to mature milk (often
referred to as when the milk "comes in"). However, engorgement can also happen later if
lactating women miss several nursing and not enough milk is expressed from the breasts. It can
be exacerbated by insufficient breastfeeding and/or blocked milk ducts. When engorged the
breasts may swell, throb, and cause mild to extreme pain.
Engorgement may lead to mastitis (inflammation of the breast) and untreated engorgement puts
pressure on the milk ducts, often causing a plugged duct. The woman will often feel a lump in
one part of the breast, and the skin in that area may be red and/or warm. If it continues
unchecked, the plugged duct can become a breast infection, at which point she may have fever
or flu-like symptoms.

ANATOMY AND PHYSIOLOGY OF BREAST

The breast are bilateral glandular structures and in females constitute accessory reproductive
organs as the glands are connected with lactation following child birth .

The shape of the breast varies in women and also in different period of life .but the size of the
base of the breast is fairly constant. it usually extended from the second to sixth ribs in the
midclavicular line .it lies in the subcutaneous tissue over the facia covering the pectoralis major
or even beyond that to lie over the serratus anterior and external oblique . an axillary
prolongation , if present ,lies in axillary fossa some time deep to deep fascia .

STRUCTURE
The areola is placed about the center of the breast and is pigmented.

It is about 2,5 cm in diameter . there are numerous sebaceous glands over it . it contains few
involuntary muscles

The nipples is a muscular projection covered by pigmented skin .it is vascular and surround ed
by unstriped muscles which makes it erectile . it accommodates about 15 – 20 lactiferous ductus
and their openings. The whole breast is embedded in the subcutaneous fat .the fat is however
,absent the nipple and areola . the breast tissue consist of the following
Each breast is divided into 15-20 lobes by fibrous tissue septa which radiate from the centre
.each lobe consist mainly of fibro fatty tissue .

The glandular tissue consists mainly of duct system in non lactating breast .one lactiferous duct
a drains a lobe . the lining epithelium of the duct is cubical , becomes stratified squamous near
the openings . each duct divides and ultimately ends in alveoli ,the total number being 10-100.
Each alveolus is is lined by columnar where milk secretion occurs .a network of branching
longitudinal striated cell called myoepithelial cell surround the alveoli and the smaller ducts .
there is a dense network of capillaries surrounding the alveoli . these are situated between the
basement membrane and epithelial lining . contraction of these cells squeezes the aveoli and
eject the milk into the larger duct . behind the nipple , the main duct (lactiferous ) dilate to form
ampulla where the milk is stored . at place the fibrofatty connective tissue extend from the skin
down to the deep fascia in between the lobes . these bands are called suspensory ligaments of
cooper

Blood supply:
Arterial supply

 Lateral thoracic – branches of the axillary artery

 Internal mammary
 Inter costal arteries

Veins – the veins follow the course of the arteries

Nerve supply : the nerve supply is from , fourth, fifth and sixth intercostals nerves

Development : the parenchyma of the breast is developed from the ectoderm . the connective
tissue stroma is from the mesoderm .

ETIOLOGY

IN GENERAL IN MY PATIENT

 that mothers stop breast-feeding

  a suddenly increased milk production

that is common during the first days

after the baby is delivered or when the

baby

 the mother does not nurse or pump the 

breast as much as usual.

CLINICAL MANIFESTATION

IN GENERAL IN MY PATIENT

 Patients who suffer from breast 

engorgement may experience a
gradually raising body temperature

 pain 

 tenderness in one of both breasts 

 general malaise 

 engorged breast feels tense and heavy 

 acutely painful on movement. 
 swollen, firm and painful breasts 

 In more severe cases, the affected 

breast becomes very swollen, hard,
shiny, warm, and slightly lumpy when
touched

 Breast engorgement also causes slightly

swollen and tender lymph nodes in the
armpits

 flushed nipples

 In cases when the breast is greatly

engorged, the nipple is likely to retract
 into the areola.

 Commonly, patients experience loss of

appetite, fatigues, weakness and chills.

MEDICAL MANAGEMENT

 As women are naturally prone to suffer from some degree of breast engorgement, the
main part of treatment is prevention.
 This means breastfeeding the baby whenever he or she seems hungry and making sure
that the baby is latching on and feeding well. In cases when the baby is not hungry
enough to empty the breasts, the breast should be nursed or pumped.
 Avoiding caffeine and chocolate as well as wearing a well fitting maternity bra with wide
straps that do not scratch and with a cup that comfortably holds the entire breast usually
help in easing the discomfort and other symptoms
 If the symptoms persist and tend to worsen, the patient is advised to seek a doctor.
Depending on the severity of the condition, the doctor may recommend pain killers such
as ibuprofen, cool water compresses, massaging and nursing the breasts.
 If the cause is not due to pregnancy then the best remedy is self therapy (milking of the
breast)

NURSING MANAGEMENT

 Try a warm compress before nursing and a cold compress afterwards.

 Use your hand or a pump to express a little milk and relieve a bit of pressure. Don't
express too much, though, because that will only make matters worse. (The more you
express, the more milk is made — and if it's more than baby's ready to take, you'll wear
the rest in engorgement.)
 Massage your breasts gently while nursing to help get the milk flowing.
 Alter the position of your baby (try the cradle hold one time, the football hold at the next
feeding) to ensure all milk ducts are being emptied.
 Make sure your bra fits well — not too tight, but snug and supportive.
 Most important: Feed your baby frequently.
 For severe pain, consider taking acetaminophen (take it after a feeding) or asking your
practitioner for another mild pain reliever.
 In order to minimize pain and tenderness and discourage future milk production:
  Wear a snug-fitting bra.
 Avoid any kind of nipple stimulation or milk expression.
 Use ice packs to help soothe discomfort.

HEALTH EDUCATION:

SNO TOPIC CONTENT

1 PERSONAL  Explained the importance of maintaining good personal hygiene.
HYGIENE  Keep perineum clean, dry.
 Told the patient to take regular bath & change cloth.

2 DIET  Explained the importance of high caloric diet & protein rich diet.
 Also explained iron rich diet & calcium diet.
 Advice to take green leafy vegetables.
 Take plenty of oral fluid.

3 REST & SAFETY  Explained the importance of bed rest.

 To decrease anxiety by providing accurate information.
 Monitor breathing patter
 Monitor accurate intake & output.
4 MEDICATIONS  Explained the importance of medication.
 Instruct to take regular medicine
 Educated regarding side effects of medication.
Prognosis:-
In my patient having some anxiety about there condition.She feel some time sad because of their
problem .In my patient the prognosis was good; she recovered and developed no complication
till date of discharge

Summary and conclusion:

My patient Mrs.geeta admitted under Dr. Ratna thakur with the complaint with breast
engorgement Patient was fine at the time of discharge and developed no complication.
Bibliography

 Cooper, A, Margaret &Fraser, M, Daine. (2005).Myles Textbook for midwives. (14th

edition).London.Elsevier.
 Pilliteri, Adere. (1999).Maternal & child health nursing. (3rd
edition).Philadelphia.Lippincott.P-P 199-202.
 Wong,l,Donna&Peery,E,Shannon.(1998).Maternal child nursing
care.Philadelphia.Mosby.p-p234-256.
 D.c.Dutta, text book of obstetrics, sixth edition 2004, 221-240

 NeelamKumari, midwifery and gynacological nursing, first edition 2010, 332-342

 Annnamajacob,text book of obtetrics,second edition,319-326

 Myles, text book for midwives, 14th edition, 338-348

 C.s. Dawn, text book of obstetrics, sixteenth edition, 2004, 256-265

 www.wikipedia.com

 www.google .com