CASE STUDY ON BREAST ENGORGEMENT

Patient A and her son K, 6 days of age, were seen in the lactation clinic for sore nipples.

History of Presenting Concern

Baby K was initially ABM-fed in the nursery. First nursing was at 26 hours of age. Nipple pain began
with the first breastfeeding. Patient A experienced moderate engorgement on postpartum day 4.
Following engorgement, her nipples began to crack. Nipples now "seem to hurt all the time." Patient
A reports that severe nipple pain occurs with latch-on. Nipple cracks began bleeding bilaterally
yesterday. The infant vomited blood after this morning's feeding.

Subjective
Patient A is 28 years of age, gravida 2 para 2. Pregnancy was uneventful except for a herpes
outbreak at 36 weeks. Patient A reports breast changes accompanied pregnancy. The infant was
born by elective cesarean section at 39 and 3/7 weeks for active genital herpes. The cesarean was
done under epidural anesthesia. K's birth weight was 8 pounds, 7.5 ounces. Hospital discharge
weight at 3 days of age was 7 pounds, 15 ounces. Bilirubin level was 10 mg/dL. Patient A has a
daughter, 3 years of age, at home whom she attempted to nurse for three weeks but quit because of
severely sore nipples. Family history is noncontributory except for a tendency toward allergies.
Father is allergic to milk, wheat, and pollen. Patient A is allergic to codeine, penicillin, and sulfa.
Three-year-old sibling has asthma. Patient A desires to nurse this child as long as possible to help
prevent asthma and other allergies. Father was present during the consultation and appears very
supportive. The couple did not attend breastfeeding classes.
During the last 24 hours, K has nursed every 2.5 hours; mother is switching breasts every 10
minutes. Feedings take 20 to 40 minutes. Patient A reports eight damp diapers and two semi-runny,
yellow stools since this time yesterday.

Objective

Maternal breast examination revealed moderately engorged breasts. Nipples are everted,
approximately 1 cm in size with a linear fissure diagonally from 2 to 8 o'clock on the left side and 10
to 4 o'clock on the right. Areolae, approximately 3.5 cm, appear moist and intact.

Observation of a Nursing Session

Patient A positioned K on his back in cradle hold. Breast support technique was C-hold; however,
mother pinched the nipple between the thumb and forefinger and placed the nipple into the baby's
mouth before any evidence of a rooting response. K latched on to nipple only. The latch was
immediately broken by the consultant.

GUIDE QUESTIONS:
1. Briefly describe the disease / condition of the patient.
2. What are the etiologic factors or causes of this disease/ condition?
3. What are the signs and symptoms or manifestations of the disease condition?
4. What are the possible complications?
5. What are the needed laboratories and diagnostic tests needed for the
confirmation of condition or disease?
• Definition
• Indication or reason
• Results
• Interpretation
6. As a nurse, how do you manage the client? What are the nursing independent
interventions needed for this client?
7. What are the possible medical management? Surgical management?
• Definition
• Indication or reason
• Medications: Brand name, Generic Name, Mechanism of Action,
Classification, Indication, Dosage, Route, Frequency,
contraindication, Side effects, adverse effects and Nursing
responsibilities.
8. What are the 3 priority nursing diagnoses for the disease condition and provide
reason each nursing diagnosis on why you choose this problem and their nursing
responsibilities?
9. Reference: APA FORMAT
• Books
• Electronics