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.

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

5.Candace has severe pain in her breast and not able to feed the baby. she is not interested in giving formula feed and the baby is crying contuisoly.Candace husband thinks that she has no milk that is the reason why baby is crying.

6. Candace is having mastitis. Through craked or sore nipple bacteria can enter and cause mastitis. The nurse informs the doctor and with the prescription start antibiotics.

7.Nurse reassure Candace that it is safe to breast fed her baby even from the affected nipple. If she has severe pain the nurse told her to start feeding from the unaffected breast and then from the affected breast. If the pain is severe then express breast milk manually or using a breast pump from the affected breast.

8. Health education regarding prevention of further mastitis was given by the nurse. Do not delay or skip breast feeding or pumping out the milk. Poor latching on or breast feeding positon can cause sore or craked nipple. The nurse also remained her that she had the risk for developing mastitis again till the baby becomes 2 months of age. Also encouraged her to take drink before feeding.

9. It is due to breast preference. The baby gets enough milk from the left side itself.

10.First allow the baby to start feeding from the left breast. Then once let-down starts slowly slide the baby to the other side without changing the position.

11 The nurse can refer her to the lactation consultant.

12.Before going to work Candace must practice expressing milk by hand or breast pump. Store expressed milk in a a container in the refrigrator and also supplement formula can be given to the baby. During off days give unrestricted ,demand feeding.

13. Candace which to contuine breast feeding for her baby till 1 year. She wish to start weaning at 6 months of age. she wish to feed her baby at the work place during the afternoon. These are her priorities for feeding her child.

She can acheive her goal by proper feeding. she has to express her milk and store the milk in air tight container and keep in the refrigrator. At the age of 6 months she can start weening.She can acheive her goal when her mother-in law joins her. At the workplace she can breast feed her baby with the support from her mother- in law.