UNIVERSITY OF GHANA,

LEGON
NURS 348 Gynecological nursing & Obstetrics

GROUP 5
PATIENT CARE PLAN ON
MASTITIS

(GROUP 5)

Lecturers:

Mrs Ernestina Asiedua

Mrs. Samira Ablordey

i
 SCENARIO

Mrs. Adomah, a 35-year-old trader with Gravida 3, Para 3 visited the post-natal clinic with

her spouse. She presented with a history of left breast pain and tenderness, increased body

temperature, inability to breastfeed and generalized body weakness for the past three days.

On examination, the left breast was swollen and felt warm to touch. The obstetrician on duty

assessed her and she was diagnosed of mastitis. She was admitted to the medical ward for

further management.

QUESTION

Envisage patient problems using the clinical manifestations of the condition and develop a

care plan for Mrs Adomah.

PATIENT’S PROBLEMS

• Patient has elevated body temperature (38.2 oC)

• Patient complains of left breast pain

• Patient complains of generalized body weakness

• Patient has less knowledge about condition

PATIENT’S STRENGTHS

• Patient can assume a particular position during tepid sponging

• Patient can verbalize the presence of pain

• Patient is willing to be cooperative during period of hospitalization

• Patient is willing to gain insight into disease condition

ii
 ALLERGIES

No known allergies

ROUTINE CARE

• TPR: 4 hourly

• B.P: 4 hourly

• Diet: Normal diet

• Fluid: Oral and intravenous fluid

• Intake and output: Monitored

• Oral hygiene: Twice daily with toothbrush and paste

• Bath: Twice daily with sponge, soap and water

• Urine testing: done on admission

• Body weight: 75kg

• Activity: Less restricted

NURSING DIAGNOSIS

• Hyperthermia (38.2 oC) related to microorganism invasion into the body

• Acute pain (left breast) related to inflammatory process

• Impaired mobility related to generalized body weakness

• Deficient knowledge related to lack of exposure/recall and information

misinterpretation

iii
 LITERATURE

Mastitis, an inflammation or infection of breast tissue, occurs most commonly in women who

are breast-feeding, although it may also occur in women who are nonlactating (Smeltzer, S.,

C., Bare, B., G., Hinkle, J., L. & Cheever K., H., 2018)

Mastitis is an inflammatory process in the breast producing localized tenderness, redness, and

heat, together with systematic reactions of fever, malaise. Literature suggests that mastitis

represents just one of several pathologic states from which breastfeeding mothers may suffer.

Medical problems linked to breastfeeding comprise a continuous spectrum of pathologic

states ranging from breast engorgement due to reduced milk flow (stasis) to clinical mastitis

(De Allegri, M., Sarker, M., Hofmann, J., Sanon, M., & Böhler, T., 2007).

The infection may result from a transfer of microorganisms to the breast by the patient’s

hands or from a breast-fed infant with an oral, eye, or skin infection. It may also be caused by

bloodborne organisms. As inflammation progresses, the breast texture becomes tough or

doughy, and the patient complains of dull to severe pain in the infected region (Smeltzer, S.,

C., Bare, B., G., Hinkle, J., L. & Cheever K., H., 2018)

Mastitis is quite common among breastfeeding women. The WHO estimates that although

incidences vary between 2.6% and 33%, the prevalence globally is approximately 10% of

breastfeeding women. Most mothers who develop mastitis usually do so within the first few

weeks after delivery. Most breast infections occur within the first or second month after

delivery or at the time of weaning. However, in rare cases it affects women who are not

breastfeeding (Truoin S. R. & Stoppler M. C., 2020)

iv
 TABLE OF CONTENTS

SCENARIO ......................................................................................................................... ii

QUESTION ......................................................................................................................... ii

PATIENT’S PROBLEMS .................................................................................................. ii

PATIENT’S STRENGTHS ................................................................................................ ii

ALLERGIES ...................................................................................................................... iii

ROUTINE CARE ............................................................................................................... iii

NURSING DIAGNOSIS .................................................................................................... iii

LITERATURE ................................................................................................................... iv

TABLE OF CONTENTS .................................................................................................... v

NURSING CARE PLAN .................................................................................................... 1

REFERENCES .................................................................................................................... 5

GROUP MEMBERS ........................................................................................................... 7

v
 NURSING CARE PLAN

DIAGNOSIS OUTCOME CRITERIA NURSING ORDERS

Acute pain (left breast) Patient pain will be • Introduce yourself to patient to establish rapport
related to inflammatory reduced within 48hours • Reassure patient of competent staff t to allay anxiety
as evidenced by:
process • Assess for pain and the source of pain; noting the location, duration and the
• Patient
verbalizing a intensity of the pain for the necessary action to be taken
reduction in the • Discuss the normality of phantom breast sensations to provide reassurance that,
pain sensations are not imaginary and that relief can be obtained
• Nurse observing • Verbalize and demonstrate to patient how to apply warm compresses to the
patient showing a affected breast every 2hrs after breastfeeding or milk expression to help reduce
good facial pain
expression.
• Provide basic comfort measures and diversional activities as well as comforting
• Patient resuming
breastfeeding of objects such as small pillows and cabbage leaves to help reduce pain
the baby with no • Provide lactation education to mother by teaching mother the right position to
further assume when breastfeeding to avoid nipple pain and irritation
complications • Provide woman with diversional therapy such as music to take her mind off the
pain
• Encourage patient to assume a comfortable position to help relieve pain
• Encourage intake of fluid to help flush the body of infection
• Assist patient to take warm shower to relieve pain
• Administer prescribed analgesic like ibuprofen 200mg to help relieve pain
• Monitor patient for the therapeutic and side effects of the administered drug to
determine the effectiveness of the administered drug and for the necessary action
to be taken
• Apply warm compresses on the affected breast to help reduce the inflammation

1
 • Encourage patient to rest to help relieve pain.
• Restrict visitors to aid in adequate rest
• Monitor vital signs such as temperature, pulse, respiration and blood pressure to
serve as a baseline data
• Administer prescribed antibiotics to help reduce inflammation and fight
infection.
Hyperthermia (38.2 oC) Patient body temperature • Reassure patient of competent staff to allay anxiety
related to microorganism will be reduced by 1 oC • Give patient copious amount of fluids for rehydration
within 24hours as
invasion into the body. • Open nearby windows to help reduce body temperature
evidenced by:
• patient body • Remove extra bed clothing from patient to help reduce temperature
feeling warm to • Provide cooling to aid in reduction of temperature
touch • Encourage bed rest to aid in recovery
• Nurse observing • Raise side rails to help protect patient from falling
thermometer • Administer prescribed antipyretics like acetaminophen to reduce the temperature
recording a
decrease in body • Monitor patient for the side effect and therapeutic effect of administered drug to
temperature determine the effectiveness of the drug and for the necessary action to be taken
• Educate patient and family members on signs and symptoms of hyperthermia so
they can gain insight in the condition of the patient
• Monitor vital signs such as temperature, pulse, respiration and blood pressure to
serve as a baseline data
• Serve patient with cold drinks to help reduce the temperature.
• Administer prescribed antibiotics like dicloxacillin (Dycil) to reduce
inflammation and fight infection.

2
Deficient knowledge Patient will gain insight into
related to lack of condition within 2 hours as
evidenced by:
exposure/ recall and
information • Client verbalizing
understanding of disease
misinterpretation process and potential
complications.
• Client performing
necessary procedures
correctly and explain
reasons for actions.
• Client initiating
necessary lifestyle
changes and
participating in the
treatment regimen.
• Reassure client of competent staff to allay anxiety
• Introduce yourself to patient to establish rapport
• Educate patient to protect hand and arm and avoid lifting heavy objects to
prevent complications
• Teach patient how to hold affected arm appropriately to prevent complication.
• Teach patient how to self-examine the unaffected breast for changes
• Educate patient on the need for medical review to prevent complications
• Educate patient to check out for signs and symptoms that need medical
evaluation
• Discuss necessity for well-balanced, nutritious meals and adequate fluid intake to
aid in recovery.
• Suggest alternating schedule of frequent rest and activity periods, especially in
situations when sitting or standing is prolonged to aid in recovery.
• Instruct patient to protect hands and arms by wearing long sleeves and gloves
when gardening; use thimble when sewing; use potholders when handling hot
items; use plastic gloves when doing dishes; avoid lifting or moving heavy
objects; and do not carry a purse or wear jewelry and wristwatch on the affected
side to prevent complications.
• Demonstrate holding affected arm appropriately by not dangling the arm,
swinging arms with elbows bent when walking, placing arm above heart level
when sitting or lying down to prevent complications.
• Encourage regular self-examination of remaining breast to determine the
recommended schedule for mammography.
• Stress importance of regular medical follow-up for the necessary action to be
taken.
• Identify signs and symptoms requiring medical evaluation (breast or arm red,
warm, and swollen; edema, purulent wound drainage; fever or chills) for the
3
 necessary action to be taken.
Impaired comfort Patient will have a feeling of • Reassure patient of competent staff to allay anxiety
related to generalized comfort within 24 hours as • Encourage patient to assume a comfortable position to aid in comfort
evidenced by:
body weakness. • Allow patient to assume comfortable position on the unaffected side with pillows
• Patient verbalizing a
feeling of comfort. to ease discomfort.
• Patient having the • Assist patient to take her bath by accompanying her to the bathroom to keep her
strength to breastfeed active and her body warm.
and be able to empty • Encourage patient to sit up in bed and also stretch herself to keep her active.
both breasts • Frozen bags of peas are applied as a cold compress after breastfeeding to soothe
• Nurse observing patient discomfort.
feeling comfortable in
bed • Ensure ward is free from noise to aid in comfort
• Patient performing daily • Prepare a bed free from creases and crumbs to aid in comfort
activities. • Monitor patient's diet to ensure that she eats a balanced diet to aid in recovery
• Restrict visitors to the ward to aid in comfort.
• Monitor vital signs such as temperature, pulse, respiration and blood pressure to
serve as a baseline data
• Position patient appropriately to prevent lying on the affected breast to avoid
discomfort.
• Assist patient to take her bath as it will help regain some strength.
• Involve patient in passive exercise to keep her active.
• Apply warm compresses before and cold compress after breastfeeding to aid in
comfort
• Educate patient to take healthy diets to regain strength.

4
 REFERENCES

De Allegri, M., Sarker, M., Hofmann, J., Sanon, M., & Böhler, T. (2007). A qualitative

investigation into knowledge, beliefs, and practices surrounding mastitis in

sub-Saharan Africa: what implications for vertical transmission of HIV? BMC

Public Health, 7(1), 22–29. https://ezproxy.ug.edu.gh:2057/10.1186/1471-

2458-7-22

Lemone, P. & Burke, K.(2000). Medical-surgical nursing. 2nd Ed. Prentice Hall, USA.

NANDA Nursing Diagnosis 2018-2020. 11th edition.

Nettina, S. M. & Mills, E. (2006). Lippincott manual of nursing practice. 8th ed. Lippincott

Williams and Williams, Philadelphia

Notes on Masectomy nursing care plan retrieved from https://nurseslabs.com/mastectomy-

nursing-care-plans/6/ on 20th May, 2020

Notes on Mastitis care plan and management retrieved from

https://www.rnpedia.com/nursing-notes/maternal-and-child-nursing-

notes/mastitis on 20th May 2020.

Notes on Mastitis retrieved from https:// www. health line. com/health/mastitis on 21 st May,

2020

Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2012) Brunner & Saddath's

textbook of medical- surgical nursing. 12 th Ed. Lippincott Williams &

Wilkins, Philadelphia

Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2012) Brunner & Saddath's

textbook of medical- surgical nursing. 12 th Ed. Lippincott Williams &

Wilkins, Philadelphia

5
Smeltzer, S., C., Bare, B., G., Hinkle, J., L. & Cheever K.,H. (2018). Brunner & Suddarth’s

Textbook of Medical Surgical Nursing, 14th Ed. Lippincott Williams &

Wilkins, Philadelphia.

Spencer,Jeanne.(2008).Managementofmastitisinbreastfeedingwomen.Americanfamily

physician.78.727-31.

Truoin S. R. & Stoppler M. C., 2020. Notes on Breast Infection causes retrived from

https://www.emedicinehealth.com/breast_infection/article_em.htm#Breast%20

Infection%20Causes on 21st May, 2020.

6
 GROUP MEMBERS

1. Asamoah Chris Boateng 10670802

2. Akpakli Afua Rejoice 10673320

3. Ampong Bridget 10681521

4. Antwi Nana Yaa Aboagye 10672919

5. Appiah Emily Akua 10670467

6. Asante Dorcas 10704859

7. Felix Andoh Nuamah 10667296

8. Owusu Michael Barfi 10661191

9. Tetteh Ashiatey Korleki Emmanuella 10661973

10. Welbeck Bridget 10666150

11. Yeboah Edna Kyerewaa 10658095