Case Scenario for NCM 107

Mrs. Marie, a 27 y/o, G1P1, accompanied by husband had an uncomplicated natural vaginal
birth 10 days ago in a lying in clinic. She delivered a 3.2 kls. healthy baby boy. The nurse who attended
her birth in the lying in clinic checked her and her baby prior to discharged. She has not been to any
health care provider or facility since then and this is her first postpartum visit. Mrs. Marie come to the
OPD because she has a sore, red nipples.

The patient was in the postpartum period upon giving birth to a healthy baby boy
weighing approximately 3.2 kg. Mrs. Marie arrives lying in the clinic and complains about her
sore breast nipples, regardless of the fact no other complications were mentioned in the case
scenario. I will offer the patient a comfortable seat while we discuss her concern prior to
performing the assessment. It is also more certain to learn the patient's information and chief
complaint early, which is crucial to our assessment later on. Every detail provided by the patient
(subjective information) should be documented. This is also the time to inquire on the baby's
health and congratulate the mother on her safe delivery. While interviewing the patient, I will
determine the cause of her complaint, allowing me to devise solutions and provide health
education to the patient.

Because the patient has not had any prenatal checkups and this is her first visit to the
lying-in-clinic for health concerns, the appropriate history taking procedure that will be included
will be the complications during and after the delivery, nutrition and supplements taken after the
delivery to determine the woman's sustained nutrition throughout the recovery process,
breastfeeding method used either through breast milk or pacifier after the delivery( soreness in
the nipple is common for a postpartum mother who are conducting exclusive breastfeeding to
the infant after delivery), history of daily living of the family and other health history from the
family especially if there is a history in breast cancer to give highlight to the patient’s complaint
regarding her nipple and breast. Before I perform the physical assessment, I will first ask the
client whether it is okay if I conduct the examination or if she prefers to have a companion with
her during the while assessment, and I will also ensure that the patient has the privacy she
needs throughout the examination. Inspection of the overall characteristics of the nipple, such
as size and symmetry, color and texture (breast inflammation if any), edema (taking note of a
peau d' orange appearance of the breast is associated with breast cancer), any lesions,
bleeding, dryness, discharges, and retraction and dimpling usually caused by a malignant tumor
are all physical examinations that I will perform. I'll now proceed to palpate the breast, nipple,
and areolas after doing the inspection.

I will completely evaluate and supervise the needs of the client through nursing
interventions, which are nursing diagnosis, formulate a plan, implementation, and evaluation,
based on the information that will most likely be gathered from the physical assessment as to if
there are any signs of complications seen on the patient's breast like tumors or masses.
However, if the physical examination revealed only a sore red nipple, I will provide the client with
health education as well as measures that the patient can use to remedy the problem.
Health Teaching:
Pain from breastfeeding is typically caused by aching, tender nipples, especially once
your milk 'comes in' two to four days after giving birth. Because your baby will be breastfeeding
every couple of hours, the condition can quickly deteriorate, with some mothers experiencing
cracking, bleeding, or blistering of their nipples.
Check to see if your baby is latching on properly. To discover how to get your baby to
latch on, watch a slide video on latching.
Start breastfeeding on the side that is less uncomfortable for the first few minutes to
reduce discomfort, then switch to the other side. The early sucking of the newborn is usually the
most forceful.
Just before a session, express a small amount of milk from your breasts. This can aid
with the let-down reflex and relax the nipples, allowing the infant to latch on more readily and
gently.
With each feeding, shift your baby's posture. The pressure from the baby's mouth is
transferred to a different region of the breast.
After breastfeeding, apply cool compresses to your nipples to relieve pain. Dry nipples
can also be treated with gel pads. If your nipples are inflamed, putting breast shields inside your
bra to prevent clothing from rubbing against your nipples may assist. Make sure your breasts
are properly supported.