Question

Patient Profile: Candace is a 23-year-old, G1P1, MWF, who delivered a 7 pound 8 ounce baby boy three weeks ago at the local birth center. She is very happy about the birth and is adjusting well to motherhood. She breastfed her baby a few minutes after the birth and has continued to exclusively breastfeed him. She intends to breastfeed for at least a year probably starting him on solid foods around six months. Prior to the pregnancy, Candace was a busy office executive in a local shipping firm. She is on a six-week leave of absence. She plans to pump her breast milk for the baby when she returns to work. She is hoping that her mother-in-law who will be caring for the baby, will be able to bring the baby to her workplace at least once a day at noon to breastfeed and then give the baby the breast milk she has left from a bottle for the other feedings. Her mother-in-law will be arriving from out of state in two weeks. Candace is a very “in control person.” She plans everything in her life, and up to this point the world has respected her wishes.

Case Study: Candace called the birth center this morning crying. Her breast on the left side is so sore she cannot stand to have the baby nurse on that side, and to make matters worse, that is the only side the baby will take. For the last 12 hours the baby seems to want to nurse all the time or just cries and sucks his fist. She feels sick, cannot get anything done at home and at 2 p.m. is still in her pajamas with last night’s dinner and this morning’s breakfast dishes still in the sink. She and her husband had an argument this morning and he left for work angry and overtired after getting no sleep all night from the baby crying. He just wants her to stop being so stubborn, since she obviously doesn’t have enough milk, and give the baby some formula. Her car has broken down and she has no other source of transportation. The nurse working at the birth center offers to make a home visit.

Questions:

1. Prior to arriving at the home, what problems does the nurse anticipate at this visit?

2. Make a list of the quesitons that the nruse will ask Candace at the home visit.

3. Make a list of the observations that need to be made at the home visit.

4. Explain the process of supply and demand as it aplies to breastfeeding and milk supply.

5. Why does it appear to Candace’s husband that Candace has lost her milk?

6. On arrival the nruse find that Candac’s left breast mipple is cracked and bleeding slightly. The nurse also notes that Candace has a fever of 101.2, seems lethargic, and has an area the size of a quarter on the underside of her right breast that is firm, red, and warm. Candace tells the nruse that she feels like she has the flu. What is Candace’s problem, what probably caused it and what is the nurs’es next action?

7. The CNM at the birth center calls in a prescription for ampicillin 500 mg po qid for 10 days. Candace starts crying and asks if this means she can no longer breastfeed. What is the nruse’s best response?

8. Outline a teaching plan to reduce the possibility of Candace having another mastitis infection.

9. Why did the baby only want to nurse on the left side?

10. How can the nurse help Candace get him to also nurse on the right side?

11. Where can the nurse refer Candace for support with her breastfeeding?

12. Candace plans to return to work in two weeks. Make a list of decisions and possible problems that she will have to work through during these next two weeks, and after she returns to work, to prepare her and the baby for this transition. Provide alternative suggestions for her to consider.

13. Identify three priority concepts for Candace and three goals for each concept.

Answer 1

In this case study,Ms.Candase 23 years old, breast feeding mother ,suffers with breast sore indicative of mastitis,due to the infection she could not breast feed her baby sufficiently, A nurse at birth center vists her home,

1.before arivining home,the nurse aticipate,to collect adequate histoy regarding the Candase conition,and provide adequate management strategies including pain managemeent,meaures to reduce infammation and prevent further infection.

moniter the health status of the baby,and frovide formula feed if inicated

2.Questions ;

• How you feeling now?
• Describe your pain status( mild,moderate or severe using pain rating scale 1-10
• how pain  affect your daily lfe?
• what are the are athe associated signs and symptoms
• how many times you feed baby?
• how many times baby uinate?
• what is the current weight and immunization stus of the baby
• do you chhose any formula feed for your baby

3.list of observations

• General condition and mental ststus of the patient
• vital signs,physical examination,pain scale ratinng
• the family;s current living status
• observe how the disease affect the normal functining of family
• Babys health status and feefing habits
• measurement of the physical growth of baby

4,.Breast feeding is a suppy and demand system.The more demand on the system through breast feeding the baby, the more milk the bidy makes.

exprssing milk by pumbinginstead of nursing, reduce the amount of milk a mother is able to produce while breast feeding.

5.the baby does'nt get adequate milk becone hungry and crying though out the night .that make the husband think so.

6.on observing signs and symptoms ,it is the indicative pf mastitis secondary to cracked nipple

the nurse next action shoud be .reduce the pain and limit ifammation by proper analgesics,antibiotics and anti infammatory drugs ,encourage breast feedinh

7.ampicilline is accepible for breast feeding mothers.that does not cause adverse affect on baby

8.further infection can be prevented by drinking more fluids,getting more rest,using warm and cold pack on the affectd breast

• Before breast feeding place warm wet wash clth over affected breast about15 min,3 times/day
• massaging breast increase the milk flow
• iBreast feeding from affected breast safe for the baby,if cracked nipple present use a breast pumb to empty the breast milk.

9. left side is the only sise .the baby ussually used to feed.

10.the nurse can refer her to a lactation consultant.This person usually nurse-specializes in helping women in lactation.

11,the nurse can assist the patient in feeding provide comfortbla position to the baby in feeding right side. make a habit of feeding both breasr in a single sitting

12.Candate can feed the baby before going and after return from work place. expreese mik also preferable ,formula feed can preffer only if sufficient amound of breast milk not avalably

13,priority concepts

• adequate higiene -to prevent infection to both mother and baby
• proper nutrition and hydration
• routine breast self examination