CPMS COLLEGE OF NURSING

POSTNATAL CASE PRESENTATION

ON
ACUTE MASTITIS

SUBJECT: OBSTETRICS & GYNAECOLOGY NURSING

DATE OF PRESENTATION:
DATE OF SUBMISSION:

SUBMITTED TO SUBMITTED BY
MAAM KH. MEMITA DEVI THOLEH LALRAMDINI JONGTE
PROFESSOR ROLL NO.-18
OBSTETRICS & GYNAECOLOGY NURSING M.Sc (N) 2nd YEAR
CPMS COLLEGE OF NURSING CPMS COLLEGE OF NURSING
INTRODUCTION:
As a part of our clinical posting. I was posted in postnatal ward and I was assigned to present
a case. So I choose a patient by the name Asmina Khatun, 23 years old. She was diagnosed
with Acute mastitis. At the time of collecting history, I introduced myself to the patient and
ask her to cooperate with me while collecting her history and other required information.

IDENTIFICATION DATA:

PATIENT NAME: Asmina Khatun

NAME OF THE HUSBAND: Inzamul Hussain

AGE: 23 years

ADDRESS: Jalukbari, Assam

MARITAL STATUS: Married

RELIGION: Islam

WARD: Postnatal ward

BED: 443

HOSPITAL NO: 217536/22

MRD No: 45021

EDUCATION: HSSLC passed

OCCUPATION: House wife

DIAGNOSIS: G1P1L1 with Acute Mastitis

DATE OF ADMISSION: 13/07/22.

LMP 07/10/21

EDD 14/07/22
CHIEF COMPLAINTS:

 Redness in the right breast since 2 days.

 Swelling in the right breast since 2 days.
 Pain in the right breast since 2 days.

HISTORY OF PRESENT ILLNESS:

Patient Asmina Khatun is admitted GMCH Hospital with the diagnosis of full term
pregnancy but after delivery she complaint of redness, swelling and pain in the right breast
and having difficulty to feed her baby.

PAST MEDICAL AND SURGICAL HISTORY:

 There is no past medical history of TB, HTN, DM.

 She has not undergone any surgical procedure.

FAMILY HISTORY:

She belongs to a nuclear family having four members

FAMILY HISTORY OF ILLNESS:

There is no history of any disease like TB, HTN, DM & hereditary disease, twin pregnancy in
her family.

FAMILY IDENTIFICATION:

Sl.No Name of Age Relationshi educatio Occupation Marita Health

. the and p n l status status
family sex
member
s
1 Asmina 23 Patient HSSLC House wife Marrie Hospitalize
Khatun years, passed d d
Femal
e
2 Inzamul 31 Husband B.A Employee Marrie Healthy
Hussain years, passed d
Male
3 Abdul 65 Father in Class X Businessme Marrie Healthy
Hussain years, law passed n d
 Femal
e
4 Narjina 55 Mother in Class Vlll House wife Marrie Healthy
Ahmed years, law d
Femal
e

GENOGRAM:

Key:

- Male

- Female

- Patient.

HEALTH FACILITY NEAR HOME:

There is a PHC in her village at a distance of about 2 km. transportation facility available like
bicycle, motorcycle, Car.

HOUSING:

 She lives in a pucca house.

  Having 2 rooms with adequate ventilation.
 Present sanitary latrine for toileting.
 Electricity supply is available.
 They use municipality water supply taps for drinking,

Personal history:

Personal hygiene: She is maintaining her personal hygiene like oral hygiene by brushing
daily and taking bath once daily with soap and normal water.

Diet: she takes vegetarian and non-vegetarian diet and she takes meals 3 times a day. She
don’t have any addiction of alcohol and tobacco. She drinks about 2-3 lts. of water per day.
She takes rest of about 2 hrs at day time and 8 hours during night time. She takes no drugs for
sleep.

Elimination: She has a regular bowel and bladder habits.

Menstrual history:

She got menarche at 12 years old age with regular cycles of 28-30 days interval & 3-4 days
duration with average amount of bleeding.

Sexual and marital history:

She has been married to Mr. Inzamul Hussain since a year and has satisfactory relationship
with her spouse. General health of her spouse is good.

Obstetrical history:

Present obstetric history:

She is a registered case. She had attended antenatal clinic 4 times.

Her LMP is 07/10/21 and EDD 14/07/21.

FIRST VISIT:

She missed her menstrual period and went to nearby clinic & tested her urine for pregnancy
& become confirm of her pregnancy. On her examination her weight 48kg, BP=120/70
mmHg, pulse=74/minute. At that time she suffered from minor ailments like nausea &
vomiting.
SECOND VISIT:

She attended OPD of GMCH hospital for further antenatal check-up and 1 st dose of Inj. TT
0.5ml was given.

THIRD VISIT:

She attended OPD of GMCH hospital for further antenatal check-up and 2 nd dose of Inj. TT
0.5ml was given.

FOURTH VISIT:

She attended OPD of GMCH hospital for further antenatal check-up.

Observation and assessment:

 Her general appearance is good.

 Patient is conscious and anxious.
 She has no foul body odour & foul breath.

POSTNATAL ASSESSMENT

GENERAL APPEARANCE

Anthropometric measurements

Height - 153cm

Weight – 46 kg

VITAL SIGNS

Temperature - 98.20F

Pulse - 76 beats/min

Respiration - 16 breaths/min

B.P - 120/80 mm of Hg

HEAD-

Hair - equally distributed, black in color, healthy

Scalp - clean, no dandruff, no infection, no lesion and scar

Face - pleasant look, no puffiness

EYES-

Eye brows - equally distributed

Eye lids - no infection

Eye lashes - present

Eye balls - not sunken, normal

Conjunctiva - white in color, normal and clear

Sclera - normal

Pupils - equal in size and reacting to light

Vision - normal

EARS:

External ear - no infection

Gross hearing - normal

Pinna - no infection

Discharge - absent

NOSE:

Nasal septum - no deviation

Nostril - not inflamed

External ears - no discharge

Placement - normal and symmetrical in face

MOUTH:

Lips - dry

Teeth - alignment is good, discoloration is present

Tongue - normal, not coated

Odour - no halitosis

NECK:

Range of motion - possible

Thyroid gland - not enlarged

Lymph nodes – not palpable

Distended neck veins- absent

CHEST:

INSPECTION:

Shape - normal

Symmetry of expansion- equal

Respiratory rate - 20 beats/min

No cracked nipple, Montgomery tubercle present

Primary and secondary areola present

PALPATION

Palpation done by circular method

No lymph node enlargement

Nipple - is erected, Secretion present

No pain, redness, tenderness

PERCUSSION

No abnormal sounds of fluid collection heard

AUSCULTATION

Normal heart sounds heard

S1 and S2 heard

No abnormal breath sounds heard

ABDOMEN-

Inspection-

Size - normal size

Shape - normal

Linea nigra - present

Striae gravidarum - present

Umbilicus - flattened

Condition of bladder- emptied

Palpation

On palpation uterus is hard and no distension

Fundal height- 13.5cm

BACK-

Lesion/ scar/infection/scoliosis/kyphosis/lordosis – not present

GENITOURINARY SYSTEM-

Lochia rubra - present

No of pads - 4 pads/day

Bladder- passed urine after 2 hour following delivery

Bowel -regular

Episiotomy sutures are normal

R- Redness is absent

E- Edema is absent

E- Ecchymosis is absent

D- Discharge

L- lochia rubra; red in colour

A-Approximation normal

EXTREMITIES-

UPPER EXTREMITIES

Capillary refill - 2 sec

Carpel tunnel syndrome - absent

Numbness - absent

Range of motion - possible

Nails - no clubbing of nail

Pallor - absent

LOWER EXTREMITIES-

Range of motion - possible

Edema - not evidenced

Varicosity - absent

Homan’s sign - negative on both legs

Clubbing - absent

NEWBORN ASSESSMENT:

IDENTIFICATION DATA-

Baby of - Parishmita Deka

Age in days - 6 days.

Gender - Male

Gestational age - 39th weeks

Type of delivery - normal vaginal delivery with right mediolateral episiotomy

Date and time of delivery- 14/07/22 at 7:30 pm

Date of assessment - 20/07/22

APGAR SCORE

COMPONENT 0 1 2 FIRST FIFTH

MINUTE MINUTE
HEART RATE Absent Less than More than 1 2
100 100
RESPIRATORY Absent Slow Good crying 1 2
RATE irregular
MUSCLE Flaccid Some Action 1 1
TONE flexion of motion
extremities
REFLEXES No response Weak cry or Vigorous 2 2
grimace cry
COLOR Blue pale Body pink Complete 1 2
extremities pink
blue
TOTAL - 7 10
SCORE

Anthropometric measurement
Sl no Parameters Result of the Normal Remarks
child value
1 Weight 3.1 kg 2.9 – 3.5 kg Baby has
normal body
weight
2 Length 48 cm 46-50 cm Baby has
normal length
3 Head circumference 33 cm 33 - 35 cm Normal
4 Chest circumference 32 cm 31 – 33 cm Normal
5 Mid arm Baby has
circumference 14cm 12- 17.5 cm normal mid
arm
circumference.
VITAL SIGNS

Characteristics Normal value Baby value Remarks

Temperature 370 C or 98.6 0F 990 F Normal
Heart rate 120-160 b/min 151 b/min Normal
Respiration 30-60 breaths/min 42breaths/min Normal

PHYSICAL EXAMINATION
Immunization Status:

BCG 0 dose was given on the first day.

GENERAL ASSESSMENT - no external congenital anomalies present, baby is active and

sucking the breast milk well

Posture :Flexed

Skin Condition
Skin Color :No cyanosis
Temperature :Warm
Texture :Smooth
Turgor and elasticity :Normal, good skin turgor
Edema/ Puffiness :No edema
Vernix caseosa :Present
Lanugo :Present
Telangiedtatic nevi :Absent
Mangolian spots :Present
Milia :present on the nose
HEAD

Head circumference - 33cm

Anterior fontanelle - Diamond shape, palpable, it measures approximately 3cm each, no

depression and no bulging

Posterior fontanelle- Triangular shape palpable and measures about 1.2×1.2cm,

no depression and no bulging
Sutures - Present, not distended

FACE

Symmetry- symmetrical

No congenital anomaly is present

EYES

Eye lids - equally distributed

Colour - sclera is white

Tears - not formed

Corneal reflex - present

Pupillary reflex - present

Blink reflex - present

NOSE

Nasal patency - good

Placement - medial

Discharge/stuffiness - absent

Septum - no septal deviation

Sneezing reflex - present

EARS

Position - normal

Startle reflex - present

Pinna - flexible

Cartilage - well developed

MOUTH AND THROAT:

 Palate - intact, no cleft palate

Uvula - present

Frenulum of tongue - present

Sucking reflex - present

Rooting reflex -present

Gag reflex - present

Epstein pearls - present

NECK

Lymph nodes - no enlargement

Clavicle - no fracture

Skin folds - present

Tonic neck reflex - present

CHEST

Anterior and lateral diameters - equal, equal expansion of chest

Breast engorgement - absent and no witch milk

Chest circumference - 33 cm

LUNGS

Respiration - 42 breaths/min

Rhythm - regular

Cough reflex - present

Breath sounds - normal bronchovesicular breath sounds

HEART

Heart rate - 151 beats/min

Heard sounds - S1 and S2 heard

 Cyanosis - absent

ABDOMEN

Shape - cylindrical

Movement - synchronized

Auscultation - bowel sounds heard

Liver - palpable

Spleen - not palpable

Femoral pulse - felt in groin region

Umbilical cord - two arteries and one vein is present, no infection

GENITALIA

No abnormalities present.

BACK AND RECTUM

Spine - intact, no abnormal findings

Meconium - passed

Anal opening - patent

EXTREMITIES

Fingers - no syndactyly and no polydactyly

Range of motion - possible

Nail beds - pink in colour, no cyanosis

Muscle tone - good

Brachial pulses - palpable

NEUROMUSCULAR SYSTEM

Cry - good

Flexion of extremities - present

 Extension of extremities - present

Head lag while sitting - present

Turns head from side to side – yes

NEURO MUSCULAR:

RELEXES (0-6 MONTHS):-

REFLEXES BOOK PICTURE BABY PICTURE

LOCALISED Newborn turns head in Baby turned head in the

REFLEXES direction of stimulus opens direction of stimulus and
mouth and begins to suck opened his mouth and
ROOTING AND
when cheek lip or corner of begins to suck when corner
SUCKING
mouth is touched with of mouth touched with
finger or nipple finger

EXTRUSION Newborn pushes tongue Baby pushed his tongue

outward when tip of tongue outward when tip is touched
is touched with finger or with a finger
nipple

CORNEAL REFLEX When cornea is touched Baby closed his eyes when
with a wisp of cotton, cornea was touched with a
newborn will close his eyes cotton

SWALLOWING Newborn swallows in co- Baby swallowed milk

ordination with sucking followed by sucking
when fluid is placed on
back of tongue

GLABELLAR BLINK Newborn will blink with Baby blinked his eyes when
first 4 or 5 taps to bridge of tapped on his glabellar
nose when eyes are open

PALMAR GRASP Newborn’s finger will curl Baby tightly closed his
around object and hold on finger when examiner
 momentarily when finger is places finger in the palmar
placed in palms of hand region

PLANTAR GRASP Newborn’s toes will curl Baby curled her toes when
downward when a finger is his base of the foot is
placed against the base of touched with examiner’s
the toes fingers

BABINSKI SIGN Newborn’s toes will Baby hyperextended and

hyperextend and fan apart fanned her fingers with
from dorsi flexion of big toe dorsiflexion of the big toe
when one side of foot is
stroked upward from heel
and across ball of foot

MASS REFLEXES Bilateral symmetrical Symmetrical abduction and

extension and abduction of extension of the arms and
MORO REFLEXES
all extremities with thumb legs with fanning by
and forefinger forming abduction and flexion of
characteristic ‘C’ are arms and legs
followed by abduction of
extremities and return to
relaxed flexion when
newborn’s position changes
suddenly or when newborn
is placed on back or flat

STEPPING/ DANCING Newborn will step with one Holded the baby in straight
REFLEX foot and then the other in position by touching flat
walking motion when one surface then he stepped with
foot is touched to flat one foot and then the other
surface

PARACHUTE REFLEX Place the hand under the Baby flexed the arms and
chest of baby in prone legs and then extended his
position arms and legs will back and head
 be flexed and then try to
extend his back and head

PRONE CRAWL Newborn will attempt to Baby tried to crawl forward

crawl forward with both with both arms and legs
arms and legs when placed
on abdomen on flat surface

GALANT REFLEX If baby is on his stomach Baby made a ‘C’ shape to

and you stroke neck to the the side which is stroked
spinal cord [paravertebral
area] on his middle to lower
back to curve towards the
slide that you are stroking.
This reflex is present at
birth and disappears by 3-6
months

TRACTION REFLEX Hold the baby with both the Baby’s head lagged behind
hands, lift him and then his when lifted with both the
head will lag behind hands

TONIC NECK OR Extremities on side to Baby’s extremities are

FENCING which head is turned will extended and flexed
extend and opposite
extremities will flex when
newborn’s head is turned to
one side while resting,
response may be absent or
incomplete immediately
after birth

STARTLE REFLEX Newborn abducts and flexes Baby abducts and then
all extremities and may flexed his all extremities
begin to cry when exposed when exposed to sudden
to sudden movement or movement
 loud noise

CROSSED EXTENSION Newborn’s opposite leg will Baby flexed and extended
flex and then extend rapidly opposite leg rapidly when
as if trying to deflect other foot was touched
stimulus to other foot when
placed in supine
position :newborn will
extend one leg in response
to stimulus on bottom of
foot

DELIVERY NOTES

Date and time of delivery- 14/09/22 at 7:30am

Duration

First stage –12 hours

Second stage –4 hours

Third stage–15 minutes.

On PV

Mode of delivery

Gender - Male

Time - at 7:30am

Weight - 3.2 kg

Apgar scoreat 1st min -7

At 5th min - 10

Condition - alive
Placenta

 Delivered at 7: 45 am

 Weight- 500 gm

 Length of cord- 50 cm

 Mode of delivery- expressed

 Estimation of placenta and membranes- complete

 Vaginal bleeding- within normal limits

 Medication:

Sl. Name of Dose Route Frequency Action Side effects Nursing

no the drugs responsibilities
1. Injection 1 gm IV BD Its exerts Headache  Assess
Monocef bactericidal Diarrhea the vital
activity by Change in signs of
inhibiting test. patient.
septum
 Provide
formation and
hydratio
cell wall
n
synthesis of
therapy
susceptible
to
IV OD bacteria.
patient.
Vomiting,
2. Inj Pantop 40mg
 Maintain
Suppress the constipation,
I/O chart
final step in Rash,
of
gastric acid headaches,
patient
production, by stomach
covalently pain,  About
binding to the Gastritis, over

ATP phase Joint pain, dose of

enzyme Dizziness. drug.

system at the  Educate

secretory about
surface ofthe side
gastric parietal effects.
IV BD -Vomiting,
3. Infusion 100ml cell.  Continu
Constipation,
Ciplox ous
Rash,
It inhibits monitori
headaches.
DNA ng of
replication by client.
inhibiting  Provide
bacterial DNA
fiber rich
 topoisomerase diet to
and DNA- the
IV BD gyrase. Nausea, client.
4. Inj. 100ml stomach
Metrogyl It works by upset,
stopping the metallic taste
growth of in the mouth.
parasite
IV BD
causing the Nausea,
5. Injection 80mg
infection. vomiting,
Gentamicin
diarrhea,
Gentamicin decreased
belongs to a appetite,
class of drugs headache.
known as
aminoglycosid
e antibiotics.
It works by
IV BD stopping the
Edema,
growth of
6. Injection 25mg nausea,
bacteria.
Voveron headache,
dizziness,
It works by
vomiting,
blocking the
constipation.
release of
certain
chemical
messengers
that causes
pain and
inflammation.
ROUTINE INVESTIGATIONS

S.No. TEST PATIENT’S NORMAL REMARKS

VALUE VALUES
1. Hemoglobin 10 gm/dl 12-15 gm/dl Decreased
2. TLC 7700/cumm 4000-11000/cumm Normal
3. DLC; N 55% 40-70% Normal
4. Lympho 32% 20-40% Normal
5. Mono 02% 1-6% Normal
6. Eiosino 06% 2-10% Normal
7. BT 4.2 min. 3-7 min. Normal
8. CT 6.8 min. 4-10 min. Normal
9. Blood Sugar 102 mg/dl 70-110 mg/dl Normal
10. HIV -ve --------- Normal
11. VDRL -ve --------- Normal
12. Blood O +ve --------- ----------
Group
 DISEASE CONDITION

ACUTE MASTITIS

Introduction:

Mastitis is inflammation of the breast tissue and can be broken down into lactational and non-
lactational mastitis. Lactational mastitis is the most common form of mastitis. Two types of
non-lactational mastitis include periductal mastitis, and idiopathic granulomatous mastitis
(IGM).

Lactational mastitis, also known as puerperal mastitis, is typically due to prolonged

engorgement of milk ducts, with infectious components from the entry of bacteria through
skin breaks. Patients can develop a focal area of erythema, pain, and swelling, and can have
associated systemic symptoms, including fever. This occurs most commonly in the first six
weeks of breastfeeding but can occur at any time during lactation, with most cases falling off
after 3 months.

Definition:

Mastitis is an infection that develops in breast tissue. The painful condition causes one breast
to become swollen, red and inflamed. In rare cases, it affects both breasts. Mastitis is a type
of benign (noncancerous) breast disease.

Puerperal mastitis (Lactational nastitis) is the inflammation of the breast in connection

with breastfeeding.

Noninfective mastitis may be due to milk stasis. Feeding from the affected breast
solves the problem.

Etiology:

Lactational mastitis is most commonly caused by bacteria that colonize the skin,
with Staphylococcus aureus being the most common. Methicillin-resistant S. aureus (MRSA)
has become an increasingly common cause of mastitis, and risk factors for MRSA should be
considered. Other causative organisms include Streptococcus pyogenes, Escherichia
coli, Bacteroides species, and Coagulase-negative staphylococci.

The etiology of idiopathic granulomatous mastitis (IGM) remains unclear. Autoimmune

disease, trauma, lactation, oral contraceptive pill use, and hyperprolactinemia have all been
implicated as possible causes. There may also be an association with Corynebacterium,
especially in patients with the histological findings of cystic neutrophilic granulomatous
mastitis (CNGM).

There are two different types of mastitis depending upon the site of infection-

1. Infection that involves the breast parenchymal tissues leading to cellulitis. The
lacteal system remains unaffected.
2. Infection gains access through the lactiferous duct leading to development of
primary mammary adenitis. The source of organisms is the infant’s nose and
throat.

Onset:

In superficial cellulitis, the onset is acute during first 2-4 weeks postpartum. However, acute
astitis may occur even several weeks after delivery.

Clinical Features:

Symptoms include-
BOOK PICTURE PATIENT PICTURE
a) Generalized malaise and headache, Headache was present.
nausea, vomiting.
b) Fever (102ºF or more) with chills. Fever was 100ºF.
c) Severe pain and tender swelling in Present.
one quadrant of the breast.

Signs include-
BOOK PICTURE PATIENT PICTURE
a) Presence of toxic features. Absent.
b) Presence of a swelling on the breast. Swelling was present. Redness and
The overlying skin is red, hot and tenderness was present.
flushed and feels tense and tender.
Diagnostic evaluation:
BOOK PICTURE PATIENT PICTURE
1. Complete history Done.
collection of the mother.
2.  If there is concern that Not done.
the patient may have a breast abscess, a
breast ultrasound can be obtained.
3. If an abscess is Not done.
present, hypoechoic areas of purulent
material will be seen. 
4. For patients with a Not done.
severe infection that is unresponsive to
initial antibiotic therapy, a culture of
breast milk can be useful to guide
appropriate antibiotic selection. 
5. If there is a concern Not done.
for bacteremia in a patient with severe
mastitis, blood cultures should be
obtained.
6. Because the clinical Not done.
features of IGM overlap with those of
breast cancer, a biopsy must be done to
make this diagnosis.
- Core needle biopsy or
excisional biopsy are both
viable options.

Treatment:

The initial management of lactational mastitis is symptomatic treatment. Continuing to fully

empty the breasts has shown to decrease the duration of symptoms in patients treated both
with and without antibiotics. Patients should be encouraged to continue to breastfeed, pump,
or hand express. If the patient stops draining the milk, further stasis occurs, and the infection
will progress. Non-steroidal anti-inflammatory drugs (NSAIDs) can be used for pain control.
Heat applied to the breast just before emptying can help increase milk letdown and facilitate
with emptying. Cold packs applied to the breast after emptying can help reduce edema and
pain.

If the symptoms of lactational mastitis persist beyond 12 to 24 hours, antibiotics should be
administered. Because S. aureus is the most common cause, antibiotic therapy should be
tailored accordingly. In the setting of mild infection without MRSA risk factors, outpatient
treatment can be initiated with dicloxacillin or cephalexin. If the patient has a penicillin
allergy, erythromycin can be used. If the patient has risk factors for MRSA infection,
treatment options include trimethoprim-sulfamethoxazole (TMP-SMX) or clindamycin.
TMP-SMX should be avoided in women who are breastfeeding infants less than 1-month-old,
and in infants who are jaundiced or premature. If a patient requires hospitalization, empiric
treatment with vancomycin should be initiated until cultures and sensitivities return.

Management:

Puerperal mastitis may be managed by the following-

a) Breast support.
b) Plenty of oral fluids.
c) Breastfeeding is continued with good attachment. Nursing is initiated on the
uninfected side first to establish letdown.
d) The infected side is emptied manually with each feed.
e) Dicloxacillin (penicillinase-resistant penicillin) is the drug of choice. A dose of 500
mg every 6 hours orally is started till the sensitivity report available. Erythromycin is
an alternative to patients who are allergic to penicillin. Antibiotic therapy is continued
for atleast 7 days.
f) Analgesics (ibuprofen) are given for pain.
g) Milk flow is maintained by breastfeeding the infant. This prevents proliferation of
Staphyococcus in the stagnant milk. The ingested Staphylococcus will be digested
without any harm.

Complications:
One of the most common complications of lactational mastitis is early termination of
breastfeeding. The disease of the breast and associated pain are some of the most commonly
cited reasons for early cessation of breastfeeding. A breast abscess is another complication of
lactational mastitis and occurs in 3% to 11% of patients. The development of a breast abscess
is more common if mastitis is not treated early.

Periductal mastitis and IGM can both be complicated by abscess or fistula formation. Both
forms of non-lactational mastitis are associated with recurrence and can lead to scarring and
deformity of the breast tissue.

Prognosis:

The majority of patients with mastitis will recover with appropriate treatment. The recurrence
rate for each type of mastitis varies as follows: 

 Lactational mastitis: 8%-30%.

 Periductal mastitis: 4%-28%.
 Idiopathic granulomatous mastitis: 20%-78%.

One study reported that 38% of patients with IGM reported significant scarring, and 29%
reported long term pain.
NURSING MANAGEMENT:

ASSESSMENT:-

1. Assess the general condition of the mother and baby.

2. Assess the vital signs of the mother.
3. Assess the blood pressure of the mother.
4. Assess the breast for any infections and complications.
5. Assess the episiotomy wound for sepsis.
6. Assess the bowel and bladder pattern of the mother.
7. Assess the breastfeeding pattern of the mother.

NURSING DIAGNOSIS:-
 Pain related to tenderness in the breast.
 Ineffective breastfeeding related to pain or difficulty with breastfeeding process.
 Anxiety related to pain and tenderness.
 Knowledge deficit related to breastfeeding process.
 Risk for infection related to complication of the breast engorgement.
 NURSING CARE PLAN:

Sl. Assessment Nursing Goal Planning Rational Implementation Evaluation

No Diagnosis
.
1. Subjective Acute pain To relieve -Assess the level of  Assessment of pain -Level of pain is assessed Pain of the patient
data: related to the pain of the pain with the help is important with the help of pain is relieved
tenderness in the patient. of pain scale. because scale.
Patient the breast as -Provide diversional -Diversional therapy is
restlessness
complaints of evidenced by therapy to the patient, provided to the patient
increases the body
breast pain discomfort, e.g. T.V and e.g. T.V and newspaper.
metabolism.
since 2 days. tiredness. newspaper. -Patient is advised to
-Advice the patient to  To know the how apply hot or cold
apply hot or cold much pain patient compressions on the
compressions on the is suffering from. breast that helps to reduce
breast that helps to  Reduce and help in the tenderness.
Objective reduce the pain relief. -Patient is advised for
data: tenderness.  Reduce discomfort manual expression of
-Advice the patient of breast. remaining milk after each
Patient is
for manual  To relieve pain feed.
feeling
expression of -Analgesics such as
discomfort
remaining milk after injection voveran are
and tired.
each feed. administered to the
-Administer patient as prescribed by
analgesics to the the physician.
patient as prescribed
by the physician such
as Injection voveran.

2. Subjective Ineffective To -Assess the - To know -Breastfeeding pattern Effective breast

 data: breastfeeding establish breastfeeding pattern knowledge and mother’s knowledge feeding is
related to an and mother’s regarding regarding breastfeeding established.
Patient pain or effective knowledge regarding breast feeding. are assessed.
complaints of difficulty breast breastfeeding. -Mother is educated
difficulty in with feeding. -Educate the mother regarding breast care and
breast feeding breastfeeding regarding breast care breastfeeding techniques.
process as and breastfeeding - Help to know -Mother is educated to
evidenced by techniques. about feed her baby every one
worried, -Educate the mother breastfeeding hourly or demand feed
unhappy to feed her baby and care of also.
Objective every one hourly or breast. -Stay with mother during
data: demand feed also. - To fullfill the feeding and position of
-Stay with mother baby’s the mother and baby is
Patient is demand.
during feeding and evaluated during feeding.
feeling
evaluate the position -Ensued that the neonate
worried and
of the mother and is awake and alert during
unhappy. - Position will
baby during feeding. feeding.
-Ensues that the help to give -Positive reinforcement is
neonate is awake and good feeding. provided to the mother in
alert during feeding. order to increase her
-Provide positive confidence and self-
reinforcement to the esteem.
mother in order to
increase her
3. confidence and self-
To reduce esteem. Anxiety level of
Anxiety  To know the the patient is
Subjective related to the anxiety -Anxiety level of the
level of the -Assess the anxiety anxiety level of reduced.
data: pain and level of the patient patient is assessed with
patient. patient.
Patient tenderness as with the help of the help of anxiety scale.
complaints evidence anxiety scale. -Procedures are explained
that she is frequent -Explain the  To feel the to the patient.
feeling scared question, -Psychological support is
 of breast pain scared. procedures to the comfort to the provided to the patient.
and patient. patient. -Feelings of the patient
tenderness. -Provide the are explored.
psychological  To help in feel -All the doubts of the
support to the patient. mind relaxed. patient are cleared.
Objective -Explore the feelings -Counselling is provided
data: of the patient.  To help in to the patient regarding
On -Clear all the doubts knowing about complications of breast.
observation of the patient. the breast
patient is -Provide the engorgement.
asking counselling to the
4. frequent patient regarding
question. complications of Knowledge of the
Knowledge To breast patient is
deficit enhance enhanced
Subjective the -To know the patient-Knowledge of the
related to
data: knowledge -Assess the knowledge regarding patient regarding disease
breastfeeding
The patient process of the knowledge of the condition is assessed.
the disease condition.
complaints of patient. patient regarding -Patient is advised to
less disease condition. support her breast with
knowledge -To provide support to binders.
-Advice the patient to
regarding the the breast. -Patient is advised to put
support her breast
breast with binders. her baby on the breast
engorge. -Advice the patient to To make the bond regularly.
put her baby on the -Patient is advised for
properly. manual expression of
breast regularly.
Objective -Advice the patient remaining milk after each
data: for manual feed.
On expression of -Patient is advised for the
To prevent from
observation remaining milk after breast engorgement. use of breast pump may
patient is each feed. help to reduce the tension
asking -Advice the patient in the breast.
frequent -Patient is advised for
 question for the use of breast regular follow-up visits
regarding pump may help to
breast reduce the tension in
5. engorgement the breast.
-Educate the patient Risk of infection
Risk for To reduce for regular follow-up is reduced.
infection the risk of visits.
related to infection.
Subjective complication - To know the -Breast of the patient is
data: of the breast condition of assessed for tenderness,
The patient is engorgement. -Assess the breast for breast. redness and pain.
complain tenderness, redness -Vital signs of the patient
about - To know vital are checked.
and pain.
unhygienic signs of the Temperature: 98.2ºF
-Check the vital signs
condition. patient. Pulse: 80 per minutes.
of the patient
especially Respiration: 16 per
- To maintain minutes.
temperature. the
Objective -Educate the patient
data: cleanliness. -Patient is advised to
to clean her breast
On before and after each clean her breast before
observation - To maintain and after each
breastfeeding. the
patient is not - Educate the patient breastfeeding.
feeling cleanliness. -Patient is advised to
to maintain her
comfortable personal hygiene. maintain her personal
- To fullfill the hygiene.
of hospital -Educate the mother baby’s -Mother is educated to
atmosphere. to feed her baby demand. feed her baby every one
every one hourly or
demand feed also. hourly or demand feed
- To reduce the also.
-Advice the patient to tenderness.
apply hot or cold -Patient is advised to
compressions on the apply hot or cold
breast. - To prevent compressions on the
breast that helps to reduce
-Advice the patient from the tenderness.
for manual engorgement. -Patient is advised for
expression of manual expression of
remaining milk after - To reduce the remaining milk after each
each feed. tension in the feed.
-Educate the patient breast. -Patient is advised for use
for use of breast of breast pump helps to
pump helps to reduce - To prevent reduce the tension in the
the tension in the from infection breast.
breast. -Antibiotics are
-Administer administered to the
antibiotics to the patient as prescribed by
patient as prescribed the physician such as
by the physician such Gentamycin.
as Gentamycin.
PROGRESS NOTES:

Patient is stable, breast pain and tenderness is relieved. Now, patient is able to breastfeed her
baby normally. Vital signs are normal but she is having mild pain in the breast. Proper
medication and complete bed rest is taken by patient.

HEALTH EDUCATION:

Diet-
 Advice regarding fat free diet.
 Advice patient to take protein rich diet.
 Advice to take 3 meals a day and in between snacks.
 Advice patient to take more fluids per orally.
 Advice regarding intake of haematinic and calcium supplement
Exercise-
 Avoid heavy exercises after taking meal.
 Educate the patient for postnatal exercises.
Hygiene-
 Teach the patient about maintaining proper personal hygiene.
 Educate the mother for handwashing before each feed and to clean the nipples before
and after each feed and keeping them dry.
 Educate the patient to clean her perineal area properly after each urination and
defecation.
 Educate the patient to change her pad every 8 hourly.
Medication-
 Educate the patient about medication regimen, route, dose, frequency and adverse
effects.
Rest and sleep
 Advice the patient to take proper rest and sleep at least 6 hours in night and 2 hours in
a day.
Immunization

 Educate the parents of the newborn about immunization according to the age.
Breast feeding

 Educate the mother about proper breastfeeding technique and its importance.
 Educate the mother to breastfeed her baby every one hourly.
 Ensues that the neonate is awake and alert during feeding.

Follow-up care
Advise the patient for regular medical check-up so that if any complication occurs can be
detected at right time.
 Advice the family for follow-up care and its importance and to report immediately if
there is any signs of complication.

BIBLIOGRAPHY

 Dutta DC. Textbook of obstetrics; Central publisher, 6th ed. 2004.

 Jacob annamma. A comprehensive textbook of midwifery and gynaecological
nursing; Jaypee publisher, 3rd ed. 2012.