Mastitis Practice Exam

EXPLANATION

✔Correct answer:

Diffuse breast tenderness and warmth. While mastitis does involve breast tenderness and warmth, these symptoms are usually focal, meaning they are localized to a specific area of the breast. Mastitis typically presents with focal tenderness, warmth, and redness in one part of the breast where the infection is most concentrated. Diffuse breast tenderness and warmth (affecting the entire breast) are less specific to mastitis and could indicate other conditions such as engorgement or generalized inflammation, but not the localized infection typical of mastitis.

Nurse Sarah should be aware that the most characteristic symptoms of mastitis are localized (focal) to one area of the breast. She should look for other signs such as redness in a specific area, the presence of a hard lump, and systemic symptoms like fever and elevated white blood count (WBC), which confirm the presence of infection.

Think of mastitis like a small, localized fire in one room of a house (the breast). You would feel the heat (tenderness and warmth) mainly in that one area. If the whole house felt warm, it might indicate a different problem, like the furnace (engorgement) overheating the entire house.

✘Incorrect answer options:

Fever: Fever is a common systemic symptom associated with mastitis, indicating that the body is fighting off an infection.

Elevated white blood count: An elevated WBC is typical in mastitis as it reflects the body's immune response to a bacterial infection.

Focal breast tenderness and warmth: Focal tenderness and warmth in a specific area of the breast are classic signs of mastitis, where the infection is most concentrated.

EXPLANATION

✔Correct answer:

"I need to stop breastfeeding until this condition resolves." This statement indicates that the mother may need additional teaching. Contrary to the belief that breastfeeding should be stopped during mastitis, continuing to breastfeed is actually encouraged. Breastfeeding helps to drain the affected breast, which can reduce milk stasis, one of the contributing factors to mastitis. Ceasing breastfeeding can exacerbate the condition by leading to further milk stasis and engorgement, which can worsen the infection and prolong recovery. Therefore, it is important that mothers understand the significance of continuing breastfeeding or pumping during treatment for mastitis.

Nurse Emily should reassure the mother that breastfeeding is safe and beneficial during mastitis. She should instruct the mother to ensure that the baby is latching properly and feeding frequently to help clear the infection. If the pain is significant, the mother can try breastfeeding on the unaffected breast first and then switch to the affected side once the milk starts flowing.

Imagine a clogged drain (milk duct). If you stop using the drain (stop breastfeeding), the clog gets worse. But if you keep the water flowing (continue breastfeeding), it helps to clear the blockage (resolve the mastitis).

✘Incorrect answer options:

"I need to take antibiotics, and I should begin to feel better in 24-48 hours." This statement is correct. Antibiotics are typically prescribed to treat the bacterial infection causing mastitis. Most patients begin to feel better within 24-48 hours of starting antibiotic therapy, but it is important to complete the entire course of antibiotics to prevent recurrence.

"I can use analgesics to help alleviate some of the discomfort." This statement is also correct. Analgesics, such as acetaminophen or ibuprofen, can be used to manage the pain and inflammation associated with mastitis. These medications are generally safe to use while breastfeeding.

"I need to wear a supportive bra to relieve the discomfort." This statement is correct as well. Wearing a supportive, well-fitting bra can help alleviate discomfort and provide support to the breasts during mastitis. However, it is important that the bra is not too tight, as this could exacerbate milk stasis.

EXPLANATION

✔Correct answer:

Continue breastfeeding or pumping to maintain milk flow. One of the most important self-care instructions for a client with mastitis is to continue breastfeeding or pumping. This helps to maintain milk flow and prevent further milk stasis, which is a key factor in both the development and worsening of mastitis. Regularly emptying the breast through breastfeeding or pumping can alleviate symptoms and promote healing. It also reduces the risk of abscess formation, which can occur if the infection is left untreated or if milk stasis continues.

Nurse Carla should emphasize the importance of breastfeeding or pumping every 2 to 3 hours to keep milk flowing. She should also teach Sarah to ensure proper latch and positioning during breastfeeding to minimize further nipple trauma and help relieve pain. If breastfeeding is too painful, Sarah could start breastfeeding on the unaffected side or use a breast pump.

Think of milk flow in the breast as water flowing through a pipe. If you stop the flow (by not breastfeeding or pumping), the pipe can clog (milk stasis), leading to a buildup of pressure and worsening the problem. Keeping the water flowing helps to clear the pipe and prevent further issues.

✘Incorrect answer options:

Discontinue breastfeeding from the affected breast until the infection resolves. This is incorrect because discontinuing breastfeeding from the affected breast can worsen milk stasis and exacerbate the condition. Instead, continued breastfeeding or pumping is recommended to help resolve the infection and prevent further complications.

Apply cold compresses to the affected breast to reduce swelling. While cold compresses might provide temporary relief from swelling, they are not typically recommended in the treatment of mastitis. Instead, warm compresses are often suggested to help improve milk flow and reduce discomfort. Warmth can help in dilating the milk ducts and facilitating milk drainage, which is crucial for resolving mastitis.

Stop taking antibiotics once symptoms improve. This is incorrect because it is important to complete the full course of antibiotics prescribed by the healthcare provider, even if symptoms improve before the medication is finished. Stopping antibiotics early can lead to a resurgence of the infection and increase the risk of antibiotic resistance.

EXPLANATION

✔Correct answer:

Breast injury from overdistention, milk stasis, and cracked nipples. Mastitis is a common breast infection that typically occurs in lactating women, especially in the early weeks of breastfeeding. The primary predisposing factor for mastitis is breast injury, which often results from milk stasis (where milk is not adequately removed from the breast), overdistention of the breast, or cracked nipples. These conditions create an environment conducive to bacterial growth, as milk provides a rich medium for bacterial proliferation. When milk is not effectively drained, it can cause inflammation and infection of the breast tissue, leading to mastitis.

Mastitis usually occurs when bacteria (most commonly Staphylococcus aureus) enter the breast tissue through cracks or breaks in the nipple or through milk ducts. Milk stasis provides a breeding ground for bacteria, leading to localized infection. If not managed promptly, this infection can become systemic, causing symptoms like fever, chills, and malaise, in addition to the localized breast pain, redness, and swelling.

Think of the breast like a sponge filled with water (milk). If the sponge is not squeezed out regularly, water (milk) collects, making it heavy and prone to tearing (cracks in the nipple), allowing bacteria to enter and cause an infection (mastitis).

Nurses should educate mothers on the importance of proper breastfeeding techniques to prevent milk stasis and ensure complete emptying of the breasts during feeding. They should also encourage mothers to monitor for signs of cracked nipples and seek prompt care if symptoms of mastitis develop.

• Advise frequent breastfeeding or pumping to ensure complete emptying of the breast.
• Teach proper latch techniques to minimize nipple trauma and cracking.
• Encourage wearing a well-fitting bra to avoid unnecessary pressure on the breasts.
• Recommend the use of lanolin-based creams to protect and heal cracked nipples.
• Instruct mothers to seek medical attention at the first signs of infection, such as redness, warmth, or fever.

✘Incorrect answer options:

Infection spread from hospital sources, affecting the lactiferous glands and ducts. While it is possible for infections to be transmitted in a hospital setting, this is not a common cause of mastitis. Mastitis typically results from bacteria that are already present on the skin or in the baby's mouth, not from hospital-acquired infections.

Randomly occurring infection that targets the connective tissue around the glands. Mastitis is not typically a random infection but is associated with specific risk factors like milk stasis, breast overdistention, and nipple trauma. The infection is more localized to the ducts and glandular tissue rather than the connective tissue around the glands.

Temporary urinary retention due to reduced awareness of the urge to void. This option is unrelated to mastitis. Temporary urinary retention is not a recognized factor in the development of mastitis and is more likely associated with postpartum recovery or anesthesia effects rather than breastfeeding complications.

EXPLANATION

✔Correct answer:

False. The statement is false. It is generally recommended that mothers continue breastfeeding or pumping during an episode of mastitis. Continuing to breastfeed helps to maintain milk flow, reduce milk stasis, and alleviate the symptoms of mastitis. Ceasing breastfeeding can lead to further milk stasis, worsening the infection, and potentially increasing the risk of developing a breast abscess.

Nurse Jenna should instruct the mother to continue breastfeeding on both breasts, starting with the unaffected breast to stimulate milk let-down and then switching to the affected breast. Proper latch and breastfeeding techniques should be emphasized to prevent nipple trauma, and the mother should be advised to empty the breasts regularly, either by feeding or pumping.

Imagine a clogged sink. If you stop using the sink (stop breastfeeding), the clog could get worse, leading to more problems. But if you keep the water running (continue breastfeeding), you can help clear the clog and fix the problem.

EXPLANATION

✔Correct answer:

Dicloxacillin. Dicloxacillin is the drug of choice for treating mastitis, particularly when the infection is suspected to be caused by Staphylococcus aureus, which is the most common pathogen in mastitis. Dicloxacillin is a penicillinase-resistant penicillin, meaning it is effective against bacteria that produce the enzyme penicillinase, which can otherwise deactivate penicillin antibiotics. This makes it highly effective for treating infections caused by penicillin-resistant Staphylococcus aureus strains.

Nurse Adams should ensure that the patient understands the importance of completing the full course of dicloxacillin, even if symptoms improve before the medication is finished. She should also monitor the patient for any potential allergic reactions to penicillin and educate the patient on common side effects, such as gastrointestinal upset.

Think of dicloxacillin as a specialized lockpick designed to open a particular type of lock (penicillin-resistant bacteria). While other lockpicks (antibiotics) might work on some locks, dicloxacillin is particularly effective for this specific job.

✘Incorrect answer options:

Amoxicillin: Amoxicillin is a broad-spectrum penicillin antibiotic, but it is not penicillinase-resistant. Many strains of Staphylococcus aureus that cause mastitis can produce penicillinase, rendering amoxicillin ineffective against them. Therefore, amoxicillin is not the first-line treatment for mastitis.

Clindamycin: Clindamycin can be used to treat mastitis, especially in patients who are allergic to penicillins or when the infection is caused by methicillin-resistant Staphylococcus aureus (MRSA). However, it is not the first-line treatment and is typically reserved for cases where dicloxacillin or other penicillin-based antibiotics are contraindicated.

Doxycycline: Doxycycline is a tetracycline antibiotic and is not typically used to treat mastitis. It is more commonly used for infections like acne, respiratory infections, and certain types of sexually transmitted infections. It is not as effective as dicloxacillin against the common pathogens that cause mastitis.