Patient Presentation
C.G., a 28 y/o female presents to the CNM/WHNP office complaining of
throbbing breast pain, breast swelling, and redness on her left breast for
3 days along with fever, fatigue, and chills since yesterday morning. Pt
HX is significant for a spontaneous vaginal delivery 3 weeks ago to a
full-term 8lb 6oz female infant. Pt has been breastfeeding her baby since
birth and expressed no difficulty with feeding until now. Pt temp is
100.6F with a heart rate of 95 and a BP of 122/86. Pt rates her breast
pain as a 5/10 at rest, but a 8/10 when breastfeeding. Pt explains that
because of the pain while breastfeeding on the left side she was mostly
feeding on the right side. Pt found some relief by placing warm compresses
on the left breast, but took 2 ibuprofen yesterday afternoon when the warm
compresses no longer helped the pain. Pt reports cracks on the nipples of
the left breast beginning 1 week ago.
Differential List
Diagnosis
Examination of both breasts showed a hot, painful, and erythematous lobule
in the upper left outer quadrant of the left breast. Small amounts of
purulent discharge was noted. Subscapular and brachial lymph nodes on the
left side were inflamed, palpable, mobile and non-tender.
The final Dx was mastitis of the left breast. A culture of the nipple
discharge was taken which revealed the presence of Staphylococcus aureus.
Pt is expected to feel reduced symptoms within 2-3 days with a course of
antibiotics and full recovery is expected. Pt will also receive teaching
regarding methods to prevent recurrence.
Treatment
Dicloxacillin 250mg q 6 hr for 10 days. Administer on an empty stomach and
with a full glass of water. Pt must finish complete dosage of medication.
Acetaminophen PRN for pain and fever reduction
Apply warm compresses to the affected breast PRN especially before
breastfeeding. If possible, continue breastfeeding on both sides,
especially on the affected side. Pumping of both breasts is encouraged to
avoid engorgement and maintain lactation. Pt was encouraged to get
adequate rest and increase hydration.
Patient teaching included personal hygiene – washing hands before
breastfeeding, letting breasts air dry, wearing a supportive bra,
beginning breastfeeding on the affected side, and feeding the infant
frequently to empty the breast. Mother was told the early signs of
potential infection: nipple redness and cracked nipples and to help avoid
them by keeping the nipples moist with lanolin. Mother was reassured that
feeding her infant from this breast will not harm the infant and is
encouraged.
Outcome
Patient fully recovered and experienced reduced symptoms within 2 days. Pt
reported continued breastfeeding without problems.