Dong-Pan Fan,Hong Chen＊

1Second Breast Surgery Department,Dongfang Hospital Beijing University of Chinese Medicine,Beijing 100078,China.

Abstract Objective:To discuss the prevention of acute mastitis during lactation and the nursing after its formation.Methods:The diet is light and easy to digest,keep the mood at ease,massage and drain the milk.After the occurrence of acute mastitis during lactation,prompt symptomatic treatment and care.Results:As a result after careful treatment and care acute mastitis during lactation healed.Conclusion:Effective prevention and care are the key to the treatment of acute mastitis during lactation.

Keywords:Pain,Breast carbuncle,Nursing,Milk deposition,Manipulation massage breast discharge

Background

Lactation acute mastitis is just an acute suppurative infection of the mammary gland,which is an inflammation of the connective tissue in and around the mammary duct.More in postpartum lactation women,especially primipara more common.It usually takes place in the third or fourth week after giving birth.The main clinical manifestations are local breast hardening,skin temperature rising,tenderness,skin redness and other symptoms[1].Sometimes can also be coupled with chills,fever,chills and other systemic bacteremia symptoms.Patients usually present with enlarged axillary lymph nodes,as well as an increased proportion of white blood cells and neutrophils on blood tests.This paper talks about case of lactation acute mastitis prevention and nursing care after the formation.The patient because the fetus is too large,resulting in dystocia,postpartum Qi and blood deficiency(Qi deficiency:such as air,essence,vitality,etc.Blood deficiency:blood deficiency,viscera,meridians,body loss of nourishment),insufficient milk,excessive consumption of greasy soup to promote milk production,resulting in lactation acute mastitis.Acute mastitis in lactation period was cured by manual massage and breast drainage.

The patient,Liu Weina,female,29 years old,a primipara,one month after delivery,reported that the fetus was too big,resulting in dystocia.The patient complained of distension and pain in the left breast,and declined to touch it.At the same time accompanied by chills,fever,thirst symptoms,self-reported anxiety.That is to measure temperature 38.5 °C,blood pressure 120/80 mmHg,pulse 80 times/min,respiration 18 times/min,the chief complaint was untreated with distension and pain in the left breast one day earlier.She reported that it slightly improves after breastfeeding.Now she has come to the Mammary Department Outpatient Department of Dongfang Hospital of Beijing University of Chinese Medicine for treatment due to aggravation of pain at 9:00 am.Visually,there is a cord-like protuberance in the left breast.The local area was red and swollen,and the size of the red and swollen area was about 4×4 cm(Figure1).According to the doctor's advice,the patient was given manual massage and breast drainage treatment,and signed the informed consent.White blood cell:1.5×109/L,neutrophils:0.8×109/L.

Nursing

Dialectical nursing:acute mastitis with pattern of Qi stagnation and heat congestion

Symptoms.Milk stasis D causes lumps,reddening skin color,slightly hot skin,swelling and pain,accompanied by fear of cold and fever,thirst and rapid pulse.

Symptoms analysis.Emotional anxiety,unsmooth liver or stomach heat,Qi stagnation and blood coagulation,blocked channels and collages,obstructing obstruction and carbuncle.Therefore,it can be seen that the boundary is not obvious in the breast,Qi and blood and milk stagnation lead to poor drainage of milk,swelling and pain.Evil heat inside Sheng,loss of harmony between nutritive Qi and defensive Qi(nutritive Qi:the Qi that moves in the veins with the blood,defensive Qi:the Qi that moves outside the veins),there is a fear of cold fever.Thirst and rapid pulse is thermal signs.

TCM diagnosis.Breast carbuncle[2].

Western medicine diagnoses.Lactation acute mastitis.

Nursing diagnosis

Pain.Obstruction of the milk collateral,not general pain.

High body temperature.With milk deposition,long heat,or liver depression stomach heat,or feel evil,long heat related.

Anxiety.Associated with the fear of not being able to continue breastfeeding.

Lack of knowledge.Related to lack of knowledge of breast health during lactation.

Potential complications.Cystic breast carbuncle,associated with the spread of pus to other breasts.

Nursing scale

Numerical Rating Scale(NRS)pain score criteria[3]are shown in Figure 2.The patient was admitted to the hospital with breast swelling and pain,and was given a score of 6.

Figure 2 Numerical Rating Scale pain score criteria

Self-rating Anxiety Scale(SAS)[4](Table 1)was compiled by Professor Zhuang,Duke University,USA in 1971.Using a 4-level score,from“no or very little time”to“most or all of the time”,the scores ranged from 1 to 4,respectively.Of the 20 items,15 are negative word statements,graded in order 1–4 above,and 5(with a*)are positive word statements,graded in order 4–1 above.The total score is 20 to 100 points,the higher the standard score,the more severe the symptoms.The score for the 20 items is added up to give a course score(X).After the formula conversion,that is,after multiplying the rough score by 1.25 and taking the integer part,the standard score(Y)is obtained[5].The full score of the Self-Rating Anxiety Scale is 100.According to the Chinese grading standards,the cutoff value of the standard score of the Self-Rating Anxiety Scale is 50 points,in which 50–59 is considered mild anxiety,60–69 is considered moderate anxiety,and 70 or above is considered severe anxiety.

According to the Self-Rating Anxiety Scale,the anxiety score of the patient was 60 points,when he came to the hospital,which was moderate anxiety.

Nursing measures

Diet nursing.Patients were given a light,low-fat,easily digestible,nutrient-rich diet.Such as porridge,noodle soup and so on.Encourage patients to drink more water and eat more fruit and vegetables.Patients should avoid spicy and greasy and fishy things,such as fat meat,tobacco and wine,fish and shrimp,so as not to cause obstruction of the mammary gland duct and induce acute mastitis.Keeping warm,prevent colds,breastfeed regularly and keep your nipples clean.

Emotional nursing.Nursing staff encouraged family members to communicate with the patient at least once a day,such as chatting,hugging,and listening to soothing music,so as to divert attention and relax the mood.

Psychological nursing.Because it is difficult for primipara to adapt to the role change after delivery,they may suffer from depression,anxiety and other negative psychology.Inflammatory reaction and pain stimulation will lead to poor rest,unable to cooperate well with treatment,resulting in poor treatment and nursing compliance.In addition,because the puerpera is in the lactation period,the puerpera worry that the clinical treatment will have an impact on lactation or the baby,which further aggravates the negative psychology such as nervousness,anxiety,depression and so on.Therefore,nursing staff should combine the mother’s cultural background and other conditions to carry out targeted psychological intervention.Use easy to understand language to comfort and encourage mothers to actively face the disease,so as to reduce the patient’s anxiety,tension and depression and other psychological burden,so that they actively cooperate with the treatment and nursing work.

Pain care.Breast pain is the main characteristic of acute mastitis.At the beginning,the breast is swollen,painful,the skin is not red or slightly red,and the local induration gradually increases,the pain is aggravated,accompanied by fever.Nursing staff should respect patients’response to pain,comfort,encourage and support patients,so as to enhance their pain tolerance with a good attitude[6].

Evaluation of nursing intervention effect

Cure.After intervention,the tumor disappeared,the milk was discharged undoubtedly,the skin was free of redness and pain,and the body temperature was below 37.5°C.

Significant effect.After intervention,the mass of the patient was reduced but not disappeared,with slight pain,smooth milk discharge,and body temperature below 37.5°C.

Effective.After intervention,the mass of the patient was reduced,the pain was relieved,the milk was not completely smooth,and the body temperature was 37.5–38°C;

No effect.After intervention,the patient had poor milk discharge,no improvement in redness and pain,no reduction in mass or local abscess[7].

Characteristics of cases

In this case,the fetus is too large,resulting in dystocia,postpartum Qi and blood deficiency,insufficient milk,excessive consumption of fat soup to promote milk production,resulting in lactation acute mastitis.When the patient came to the hospital,there was a large area of the left breast swelling and obvious cable-like swelling.It was preliminaries judged that the milk plug blocked the internal milk duct,and the milk plug was discharged through manipulation massage,which was confirmed.

Nursing effective telephones follow-up

At 19:00 on the chief complaint day,the patient’s breast pain was significantly alleviated.Numerical Rating Scale(pain measurement)pain score was 2 points.The left breast cord like protrusion disappeared,and the local redness and swelling area of the breast were significantly reduced.The self-measured body temperature was 36.5 °C,she could continue breastfeeding,and the evaluation result was cured.The self-reported anxiety condition was significantly improved,and the telephone anxiety score was 50 points.The effect after treatment was shown in Figure 3.

Figure 3 Breast condition after treatment

Discussion

Acute mastitis is the acute suppurative inflammation of the mammary gland,the peak incidence is 3–4 weeks after delivery,with one side of the breast redness,swelling,heat,pain and rigid mass as the main clinical manifestations,if not timely treatment can form abscess,bring great pain to the patient,serious and even affected the postpartum nursing quality and the maternal and infant health[8–10].

This paper describes a case of lactation acute mastitis cured by manual massage after breast discharge,and it is known that effective prevention and nursing are the key to the treatment of lactation acute mastitis.

Through effective assessment,develop and improve care based on the patient’s condition,nursing staff should take the patient at the center,plus love heart,patience,responsibility,everything from the patient’s reality.Emphasize the“personalized”nursing,that is,according to different cases,different etiology,objectively treat the risk factors of lactation acute mastitis,fully understand its harm,and make efforts to study,in different lactation acute mastitis medical records,check the omissions and fill the gaps,take the short to make up the long,try to do perfect.In this way,the prevention and nursing of lactation acute mastitis can achieve breakthrough progress,and can make nursing work more detailed.