Mastitis Nursing Diagnosis and Nursing Care Plan

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Mastitis Nursing Care Plans Diagnosis and Interventions

Mastitis NCLEX Review and Nursing Care Plans

Mastitis is the localized inflammation of the breast tissue, sometimes involving the nipple and areola.

It is characterized by redness and swelling, and usually affects only one breast. It is mostly seen in lactating women but can also occur in men and non-breastfeeding women.

About 80% of reported cases are women. It is commonly associated with breastfeeding but can also be caused by an infection.

Lactation mastitis specifically refers to mastitis seen in breastfeeding women.

The discomfort associated with it is said to be a contributing factor for women to wean their babies from breastfeeding earlier than as planned.  

Signs and Symptoms of Mastitis

Mastitis has a quick onset especially in breastfeeding women. It manifests as follows:

  • Breast that is warm to touch
  • Swelling of the breast
  • Presence of breast lump or thickened breast tissue
  • Continuous burning pain or pain when breastfeeding
  • Skin redness that is mostly wedge shape in appearance
  • Generally feeling unwell
  • Hyperthermia of 38.3⁰C or higher

Causes and Risk Factors of Mastitis

Mastitis is often associated with breastfeeding because of the following pathophysiology:

  1. Build-up of milk in the breast can cause clogged milk duct. In some cases, the breast is not completely emptied of milk when breastfeeding. The remaining milk can clump and block the milk ducts. It then causes stasis of milk in the ducts, making the breast prone to infection.
  2. Cracking of the nipple skin often happens to breastfeeding women. These cracks can act as entry points for bacteria to invade the breast tissues, leading to mastitis.

In non-breastfeeding women and in men, the following may lead to mastitis:

  • Smoking. Toxins that are present in cigarettes and tobacco are known to damage breast tissues.
  • Piercing of the skin such as in the nipple. A break in the skin is always a good way for bacteria to enter the breast tissues. Skin condition like eczema can also cause mastitis.
  • Breast implants
  • Conditions related to having weak immune system
  • Shaving or plucking of hair on or near the breast

The following are the predisposing risk factors that increase the chance of developing mastitis:

  • Previous mastitis – mastitis can recur particularly in breastfeeding women
  • Having sore or cracked nipples
  • Wearing tight-fitting garments that can put pressure on the breast as it can restrict flow of breastmilk in lactating women
  • Incorrect breastfeeding position
  • Stress
  • Poor nutrition
  • Smoking

Complications of Mastitis

The main complication stemming from mastitis is the collection of abscesses in the breast if the inflammation is unresolved or inadequately treated.

Abscess or pus formation may require surgical drainage.

Diagnosis of Mastitis

Diagnosing mastitis is usually dependent on the patient’s signs and symptoms.

A thorough history taking and physical examination will be performed by the patient’s clinician.

In most cases, the signs and symptoms, and the physical assessment results are enough to make the diagnosis, however, the following procedures may also be required:

  • Breast milk culture -to determine the bacteria causing the infection. It will then help the clinician decide on what antibiotic to use in the treatment.
  • Imaging – breast imaging, like ultrasound and mammogram, is sometimes required to rule out inflammatory breast cancer. It is a form of breast cancer that has the same manifestations as mastitis.
  • Breast biopsy – commonly performed to rule out breast cancer in the presence of lumps or microcalcifications in the breast.

Treatment for Mastitis

  1. Antibiotic therapy. A complete course of antibiotic treatment is prescribed to resolve mastitis. It is important that the full course of treatment is followed to minimize the possibility of recurrence. If the signs and symptoms persist after the treatment, it is important to report back to the prescribing clinician for further assessment. It is safe for lactating women to carry on breastfeeding. A small amount can be passed on to the infant. It is proven to not cause any harm; however, the infant may be noted to be irritable.
  2. Pain relief. Burning pain is one of the most common symptoms associated with mastitis. Pain relieving medication may be prescribed by the clinician not to treat mastitis, but to help ease the symptoms associated with it. Also, some pain killers have anti-inflammatory effects.
  3. Aside from medication therapy, there are helpful advice that can help with the discomfort:
    • Continue to breastfeed as weaning will cause milk to pool in the breast making it even sore.
    • Avoid overfilling of breasts with milk by emptying breasts regularly.
    • Making sure that the infant latches correctly when breastfeeding is key. Incorrect positions can cause cracking of skin and inadequate emptying of the breasts.
    • Application of warm cloth over the breast may help with proper emptying of milk when breastfeeding.
    • Breast massage while breastfeeding can also help.
    • Breast feed on the affected side first as the infant tend to suck stronger when hungry.
    • Varying breastfeeding position can also help infant to latch properly and can aid the let-down of milk.

Mastitis Nursing Diagnosis

Nursing Care Plan for Mastitis 1

Nursing Diagnosis: Risk for Ineffective Breastfeeding related to pain and inflammation secondary to mastitis

Desired Outcome: The mother will be able to demonstrate effective breastfeeding to nourish the baby properly.

Mastitis Nursing InterventionsRationale
Use open-ended questions to assess the mother’s knowledge, thoughts, and feelings about breastfeeding in relation of having mastitis.To explore the mother’s knowledge and personal feelings on her current situation. This can also enable the nurse to establish rapport with the mother.
Apply warm compress on the affected breast. Advise the mother to do this every 2 to 4 hours. Breast massage while breastfeeding can also help.  To reduce inflammation, relieve pain and provide comfort to the mother. This can also help to empty the milk ducts gently while breastfeeding.
Observe the mother when breastfeeding the infant.To assess any latching problems and provide realistic solutions.
Help the mother to create a plan for proper latching methods in relation to having mastitis.To involve the mother in making a plan to perform breastfeeding while battling the symptoms of mastitis.
Provide proper advice on breastfeeding, such as:Empty breasts by regular breastfeeding. Make sure that the infant latches correctly when breastfeeding.Breast feed on the affected side first as the infant tend to suck stronger when hungry.Varying breastfeeding position    Incorrect positions can cause cracking of skin and inadequate emptying of the breasts. Varying positions can help infant to latch properly and can aid the let-down of milk.    
Advise the mother to take the prescribed antibiotics and anti-inflammatory medication on the recommended times of the day.Antibiotic therapy is prescribed to fight the infection that causes mastitis. Anti-inflammatory medications reduce inflammation, relieve pain and provide comfort to the mother.

Nursing Care Plan for Mastitis 2

Nursing Diagnosis: Hyperthermia related to mastitis as evidenced by temperature of 38.5 degrees Celsius, rapid and shallow breathing, flushed skin, profuse sweating, and weak pulse.

Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.

Mastitis Nursing InterventionsRationales
Assess the patient’s vital signs at least every 4 hours.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs administered.
Remove excessive clothing, blankets and linens. Adjust the room temperature.To regulate the temperature of the environment and make it more comfortable for the patient.
Administer the prescribed antibiotic and anti-pyretic medications.Use the antibiotic to treat bacterial infection, which is the underlying cause of the patient’s hyperthermia. Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.
Offer a tepid sponge bath.To facilitate the body in cooling down and to provide comfort.
Elevate the head of the bed.Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.

Nursing Care Plan for Mastitis 3

Nursing Diagnosis: Alteration in comfort related to hyperthermia.

Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range and will verbalize feeling more comfortable.

Mastitis Nursing InterventionsRationales
Remove excessive clothing, blankets and linens. Adjust the room temperature.To regulate the temperature of the environment and make it more comfortable for the patient.
Administer the prescribed antibiotic/ antiviral or antiparasitic and anti-pyretic medications.Use the antibiotic drug to treat the infection, which is the underlying cause of the patient’s hyperthermia. Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.
Offer a tepid sponge bath.To facilitate the body in cooling down and to provide comfort.
Elevate the head of the bed.Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.
Offer a cooling blanket to the patient.To facilitate the body in cooling down and to provide comfort.

Nursing Care Plan for Mastitis 4

Nursing Diagnosis: Acute Pain related to breast inflammation, as evidenced by pain score of 10 out of 10, guarding sign on the affected breast, and irritability

Desired Outcome: The patient will report a pain score of 0 out of 10.

Mastitis Nursing InterventionsRationales
Assess the patient’s vital signs. Ask the patient to rate the pain from 0 to 10, and describe the pain he/she is experiencing.To create a baseline set of observations for the patient. The 10-point pain scale is a globally recognized pain rating tool that is both accurate and effective.
Administer analgesics and anti-inflammatory medications as prescribed.To provide pain relief to the patient.
Ask the patient to re-rate her acute pain 30 minutes to an hour after administering the analgesic.To assess the effectiveness of treatment.
Provide more analgesics at recommended/prescribed intervals.To promote pain relief and patient comfort without the risk of overdose.
Ask the mother to reposition herself in a more comfortable position. Encourage pursed lip breathing and deep breathing exercises.To promote optimal patient comfort and reduce anxiety/ restlessness.
Apply warm compress on the affected breast. Advise the mother to do this every 2 to 4 hours. Breast massage while breastfeeding can also help.To reduce inflammation, relieve pain and provide comfort to the mother. This can also help to empty the milk ducts gently while breastfeeding.

More Mastitis Nursing Diagnosis

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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