Mastitis can be defined as an infection of the breast characterized by oedematous swelling of the breast, hard mass and painful breast.
Causes of Mastitis
Maternal Causes
Poor Breast Hygiene: if the breast are not properly cared for, they could be infected and once infection set in, it leads too inflammation of the breast tissues.
Breastfeeding Restrictions/contra-indications: in case of HIV/AIDS patient and patient taking cytoxic drugs, breast feeding may be contraindicated leading to breast engorgement. If this breast milk is infected, it will lead to inflammation of breast tissues and ductal blockage.
Mother’s illness: if the mother is severely sick, she may not be able to establish breast feeding on time leading to breast engorgement and the associated complications if prolonged and infected.
Ductal Thrush Infection: this condition could cause ductal blockage and milk stasis.
Neonatal Causes
Ill baby: if the baby is very ill he may not be able to suck breast due to fatigue, hence predisposing the breast to engorgement and other associated breast complication.
Prematurity: premature babies find it difficult to breast feed since they don’t have well developed suckling reflexes. This condition will then render the breast with engorgement and swelling which may lead to mastitis if not taking care of.
Cleft palates/lips: these conditions make breast feeding difficult for the new born hence breast complication may set in.
Hyper-prolactinaemia: if this condition is found in a new born, the baby will not be breastfed hence predisposing the mother to mastitis.
Other causes may include;
- Delay in establishment of breast feeding.
- Breast engorgement that gets infected.
- Cracked nipple.
- Milk stasis.
- Ductal thrush infection.
- Raised intra ductal pressure caused by inefficient milk removal.
- Poor attachment of baby to the breast.
- Incomplete emptying of the breast.
- Sore nipple.
- Blockage of duct.
Read Also: What is Bad Obstetric History
Possible Nursing Diagnosis of a Patient with Mastitis
- Acute pain related to oedamatous breast evidenced by her facial expression.
- Hyperthermia related to inflammation of breast tissue evidenced by high body temperature.
- Impaired tissue integrity related to inflammation associated with breast engorgement evidenced by hard oedamatous breast.
- Deficient knowledge related to mastitis evidenced by her numerous questions.
- Anxiety related to unknown outcome of her breast condition evidenced by her tensed facial expression.
- Breast feeding interrupted related to breast pain evidenced by breast engorgement.
How To Prevent Mastitis
Antenatally
- Proper breast hygiene during pregnancy; daily washing and mild rubbing of the nipple and the areolar with a flannel and soap.
- Regular breast massage and pulling of the nipples to stimulates the circulation which leads to better development of mammary gland and lessens the tendency to engorgement during puerperium.
- Expressing colostrum at ten weeks of pregnancy.
- Adequate nutrition in pregnancy.
- Prevention of breast injuries during pregnancy.
- Wearing of well sized brassiere.
- Avoidance of breast or systemic infection.
Post-natally
- Put baby to breast immediately after delivery or within thirty minutes of delivery.
- Ensure that the baby empties each breast well before putting it to the other.
- Encourage exclusive breast feeding.
- Express the breast if baby cannot empty them.
- Teach her how the baby can properly attach to the breast.
- Prevention of breast injuries after delivery.
- Maintain adequate nutrition and moderate exercise.
Ten Components of Baby Friendly Hospital Initiative
- Have a written breastfeeding policy that is routinely communicated to all health care staff.
- Train all health care staff in skills necessary to implement this policy.
- Inform all pregnant women about the benefit and management of breast feeding.
- Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants.
- Give newborn infants no food or drink other than breast milk, unless medically indicated.
- Practice rooming in. allow mother and infants to remain together for twenty-four hours a day (also bedding in – both should sleep in the same bed all nights)
- Give no artificial teats or dummies to breastfeeding infants.
- Foster the establishment of breast-feeding support groups and refer mothers to them on discharge from hospital or clinic.
Steps in Self Breast Examination
Examine the breast immediately after menstruation (day to five to day seven) and subsequently.
Looking;
- Stand in front of a mirror with hands at sides and observe any change in the shape colour and size of each breast.
- Check for discharge from the nipple, puckering, dimpling on points in a different, creasing and scaling of the skin.
- Clasp your hands behind your head and press your hands forward or hands over head, watch closely in the mirror, check front and side view for symmetry.
- Press your hands firmly on your hips and bow slightly towards the mirror.
Feeling;
This can be done either in the bath or shower with soapy hand, or lying on the bed using talcum powder.
- In the bath or shower: raise your left arm while standing.
- With a soapy hand, use the pads of the tree fingers of your right hand to feel your left breast firmly, carefully and thoroughly.
- Starting at the outer edge (12 o’clock position) move the fingers pressing gently down and around the outer circumference of the breast, making sure that all areas of the breast have been examined.
- Gradually move towards the nipple.
- Play special attention to the area between the breast and the axilla.
- Repeat the examination on your right breast.
Lying down:
- Lie flat on your back with your left arm over your head and pillow or folded towel under your left shoulder.
- Repeat as above (while standing)
- Report to your doctor if any abnormally is found.
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