Question

It was the first pregnancy for Barbara Ann, 29 years old, and it was normal. During pregnancy, she reported a "small" breast enlargement. Your child is breastfed for the first time within 2 hours after delivery. The infant latches on well and sucks vigorously. Also, eat every 2 hours for the first 3 to 4 days. Barbara Ann's breasts become noticeably full on the third day postpartum and by the fourth day she experiences congestion pain. In addition, it manifests pain, burning and cracking in the nipples. Congestion makes it difficult for the baby to attach to the breast. The infant becomes irritable and Barbara experiences a significant degree of pain. A lactation consultant instructs you to control congestion. By day 5, the congestion still causes discomfort. You experience more pain and cracking in the nipples. The lactation consultant notes that the infant's attachment is shallow and tight, perhaps due to an attempt to control the flow of milk. However, the little one shows all the signs of adequate intake, such as 10 very wet diapers and 5 bowel movements during the 24 hours prior to the consultation. By day 7, Barbara Ann has mastitis. You are treated with a seven-day dose of dicloxacillin. A lactation consultant helps you achieve the proper mating of the child. By day 14, Barbara is feeling better. Mastitis disappears and her nipples are relieved. You still experience tenderness when breastfeeding and scarred cracking on the right side. Her breasts are still full, causing her discomfort, and she sometimes experiences swelling and tenderness. At three weeks postpartum, an inflamed area develops in the right breast, which continues red despite applying heat and massage to the area. The lactation consultant helps you find a placement for the child that allows the swollen area to drain and recommends that you pump the affected side to relieve discomfort. The cracking of the right nipple improves, but is not fully healed.

There are still signs of overproduction, such as full breasts that cause discomfort (even after breastfeeding) and excessive milk leakage between each feed. The lactation consultant helps you by suggesting techniques to decrease overproduction. After 10 days of persistent burning pain in the nipple area, Barbara Ann is treated with fluconazole due to a yeast infection. Seven days after starting fluconazole, a topical nystatin ointment is prescribed to apply to your nipples and oral suspension for your child. Seven weeks after delivery, Barbara Ann calls the lactation consultant to report another outbreak of bacterial mastitis. Her healthcare provider prescribes a 10-day course of dicloxacillin and she continues to treat her nipples with nystatin ointment. At eight weeks postpartum, mastitis disappears; nipple pain is still present, but improves. Breastfeed the infant only on one side for each feeding and reports that the infant engages better when she adopts a more inclined position

Questions
1. Mention the causes of congestion.
2. List at least two feasible nutrition diagnoses for this case.
3. Identify at least one nutritional intervention for each diagnosis mentioned.
4. Name potential indicators for each intervention listed.

Answer 1

1.Causes of congestion :-

Incomplete and/or inefficient milk emptying from baby or pump.

2. Nutrional diagnosis :-

Breastfeeding difficulty related to incomplete emptying of the breast via baby orpump.

Breastfeeding difficulty related to engorgement, mastitis, and possible nipple damage.

3.Nutrition intervention :-

Frequent nursing or pumping to resolve the mastitis, staying properly hydrated, and eating a well-balanced meal. Massage over the affected area before and during the feeding to help ensure complete emptying, and take analgesics for pain.

4.Potential indicators for each intervention listed. Nipple pain and positioning of the nursing infant.