2020 ): dicloxacillin 500 mg orally four times daily H e a l t h M e d i c a l

2020 ): dicloxacillin 500 mg orally four times daily H e a l t h M e d i c a l

Elizabeth Varona-Martin

Female Patient Cases 5 and 6

Lactation mastitis is most frequent during the first three months of breastfeeding (Dixon, 2020). The diagnosis of infective mastitis is based on clinical manifestations.Lactational mastitis often manifests as a hard, red, sensitive, swollen region of one breast in a nursing mother with a fever of more than 38.3oC. Myalgia, chills, malaise, and flu-like symptoms are examples of other symptoms. Engorgement begins due to inadequate milk draining, which is most often caused by nipple trauma, resulting in swelling and constriction of one or more milk ducts (Dixon, 2020). 

Culture of the breast milk can be useful to guide selection of antibiotics; it is particularly important in the setting of infection that is severe, hospital acquired, or unresponsive to initial antibiotics. Imaging is useful if lactational mastitis does not respond within 48 to 72 hours to supportive care and antibiotics (Dixon, 2020).

Noninfectious mastitis is most commonly caused by blocked ducts or milk stasis. Infective mastitis can arise due to bacterial invasion by nipple trauma or cracking, stress, exhaustion, milk stasis, and occasionally, without reason (Schuiling & Likis, 2022). 

Staphylococcus aureus is the most frequent bacteria causing infectious mastitis. Escherichia coli, Enterobacteriaceae, Mycobacterium tuberculosis, and Candida albicans are other microorganisms that may cause this disorder (Schuiling & Likis, 2022).

Nonsevere lactational mastitis is first managed with symptomatic therapy to minimize discomfort. Recommendations include Rest, drinking plenty of fluids, and good nourishment.

Patients suffering from mastitis should be urged to empty their breasts and keep a regular feeding schedule through continuous nursing, pumping, or manual expression.  Changing the feeding schedule increases the risk of milk standstill and mastitis. It is not necessary to stop breastfeeding, and good latching will ensure the integrity of the nipple (Schuiling & Likis, 2022).

Empiric treatment for lactational mastitis must include anti- S.aureus effectiveness (Dixon, 2020). Breast milk culture can help guide antibiotic selection, especially when the illness is severe, hospital-acquired, or unresponsive to appropriate treatments.

In the case of a non severe infection and the absence of risk factors for methicillin-resistant S. aureus (MRSA), therapy may begin as follow (Dixon, 2020):

  • Dicloxacillin 500 mg orally four times daily or 
  • Cephalexin 500 mg orally four times daily

For non severe infection with risk for MRSA:

  • Trimethoprim-sulfamethoxazole(TMP-SMX); 1 double-strength tablet orally twice daily,  or 
  • Clindamycin 450 mg orally three times daily.

TMP-SMX is contraindicated in women who are nursing newborn infants (less than one month old)(Dixon, 2020).

Patient education and recommendations.

Lactobacillus probiotic therapy during late pregnancy may significantly reduce the risk of lactational mastitis in pregnant patients with a history of lactational mastitis (Dixon, 2020).

The patient should be encouraged to complete the antibiotic treatment to avoid recurrence. Recurrent mastitis is uncommon; however, it can be caused by insufficient antibiotic medication and inadequate breastfeeding techniques (Dixon, 2020).

Health assessment is an important tool that helps a nurse gain insight into the patient’s condition. Other parameters are important during assessment which includes the medical history of the patient. For instance, her medical history from childhood, previous diagnosis, and treatment are important (Myers-Wright et al., 2018). It helps in connecting the current condition with the previous one. Also, within the medical history, her family medical information is used in the assessment to understand the possible type of infection.

Different family developmental stages include (Khalil Center, 2015):

Stage 1: Coupling for example marriage

Stage 2: Becoming three- for instance bearing a child/children

Stage 3: Entrances, for example, a child starts going to school

Stage 4: Expansion, the last child in the family enters the large community

Stage 5: Exits, where a family member leaves the household and starts another one. An example is a daughter getting married.

Stage 6: Becoming smaller, the last child of the family exits the household

Stage 7: Endings, it occurs when the spouse dies or separate

Family structure refers to a combination of couples, children, and other members whether adopted or by blood relationship living within the same household. Within the family, several relationships exist which include marital relationships, sibling relations, and intergenerational ties (Thomas, Liu,  & Umberson, 2017). The family structure plays an important role in health care. For instance, bedridden patients and aging individuals depend on family members to take care of their needs such as social support, food, cleanliness, and medical support which plays an important role in healthcare.

Fetal screening 

An ultrasound test is done at the first trimester (Edwards, & Hui, 2018). The test allows the detection of abnormalities in the fetal heart. It uses sound waves to create the image. 

Maternal serum indicators are substances and hormones altered if the fetus has specific abnormalities, done in the first trimester. Check Trisomies  13,18, 21. Done at the first trimester, weeks 10-14 (Schuiling & Likis, 2022). 

Noninvasive prenatal testing analyses cell-free fetal DNA in maternal blood and identifies aneuploidy and fetal abnormalities. They are done after ten weeks of gestation (Schuiling & Likis, 2022).

References

Dixon, J. M. (2020, January 15). Lactational mastitis. UpToDate. Retrieved November 29, 2021, from https:// 

Edwards, L., & Hui, L. (2018, April). First and second-trimester screening for fetal structural anomalies. In Seminars in Fetal and Neonatal Medicine (Vol. 23, No. 2, pp. 102-111). WB Saunders.

Khalil Center. (2015, September 4). Family developmental: Stages of the family life cycle. Khalil Center. Retrieved November 29, 2021, from https://khalilcenter.com/family-developmental-stages-of-the-family-life-cycle/. 

Myers-Wright, N., Cheng, B., Tafreshi, S. N., & Lamster, I. B. (2018). A simple self-report health assessment questionnaire to identify oral diseases. International dental journal, 68(6), 428-432.

Schuiling, K. D., & Likis, F. E. (2022). Gynecologic Health Care: With an introduction to prenatal and postpartum care (4th ed.). Jones & Bartlett Learning. 

Thomas, P. A., Liu, H., & Umberson, D. (2017). Family relationships and well-being. Innovation in Aging, 1(3), igx025.