NCLEX Review Guide: Postpartum Complications - Mastitis

Definition and Pathophysiology

• Mastitis is an inflammatory condition of the breast tissue that commonly occurs during breastfeeding, typically within the first 2-3 weeks postpartum. It results from bacterial invasion through cracked nipples or milk stasis in the ducts.
• The most common causative organism is Staphylococcus aureus, which enters through damaged nipple tissue or spreads from the infant's nose or throat.

Signs and Symptoms

• Localized breast symptoms: Redness, warmth, swelling, and tenderness in a wedge-shaped area of the breast. The affected area feels firm and may have red streaking.
• Systemic symptoms: Fever >38.5°C (101.3°F), chills, malaise, body aches, and flu-like symptoms that develop rapidly.

Priority Nursing Actions

1. Assess vital signs, particularly temperature and pain level using 0-10 scale
2. Inspect both breasts for asymmetry, redness, swelling, and palpate for areas of induration
3. Evaluate breastfeeding technique and frequency of feeding/pumping
4. Assess for risk factors: cracked nipples, engorgement, missed feedings, stress, fatigue

• Encourage frequent breastfeeding starting with the unaffected breast, then the affected breast to promote milk flow and prevent stasis.
• Apply warm compresses before feeding and cold compresses after feeding to reduce inflammation and provide comfort.
• Teach proper positioning and latch techniques to prevent nipple trauma and ensure effective milk removal.

Pharmacological Treatment

• Antibiotic therapy: First-line treatment is typically dicloxacillin 500mg PO every 6 hours for 10-14 days, or cephalexin for penicillin-allergic patients.
• Pain management: Ibuprofen 600-800mg every 6 hours provides both anti-inflammatory and analgesic effects while being safe during breastfeeding.

Prevention Strategies

• Proper breastfeeding technique: Ensure correct latch and positioning to prevent nipple trauma and ensure complete breast emptying.
• Regular feeding schedule: Feed every 2-3 hours and avoid skipping feedings to prevent milk stasis.
• Maintain good hygiene, get adequate rest, manage stress, and ensure proper nutrition and hydration.

Potential Complications

• Breast abscess: May develop if mastitis is untreated or inadequately treated, requiring surgical drainage.
• Sepsis: Rare but serious complication requiring immediate medical attention if fever persists or worsens despite treatment.