#1
My patient is M.P., a 27 year old female who delivered her first baby at 35.2 weeks gestation due to complications from pre-eclampsia. She delivered vaginally after an induction of labor, with no complications. In her postpartum period she experienced swelling and engorgement of the breast. M.P. is an exclusive pumper and was diagnosed with mastitis. Mastitis is an inflammatory condition of the breast tissue, commonly occurring in lactating women but can affect anyone. The pathophysiology typically involves a combination of factors leading to infection and inflammation.1. Infection: These cases of mastitis are caused by bacterial infection, often due to Staphylococcus aureus. Bacteria can enter the breast tissue through cracked nipples or milk stasis due to inadequate drainage during breastfeeding. The body mounts an inflammatory response, leading to edema, erythema, and pain in the affected breast. Accumulation of pus may occur, resulting in a breast abscess if left untreated. 2. Inflammation: This type of mastitis can occur with, or without, bacterial infection. Inflammatory mastitis can occur when the breast is not being emptied effectively or consistently, causing inflammation to occur around the milk duct, narrowing that ductal passageway. The narrowed passage, causes a block from milk products being accumulated. 3. Immune Response: The immune system responds by sending white blood cells to the site of infection, leading to the characteristic symptoms of mastitis, including swelling, warmth, and tenderness. (WHO, 2000)Factors Related to Mastitis1. Cultural Implications: Cultural beliefs about breastfeeding can impact the prevalence and management of mastitis. For instance, some cultures may discourage breastfeeding due to stigma or lack of support, potentially leading to milk stasis and increased risk of mastitis.2. Financial Implications: Access to healthcare services for treatment can vary based on socioeconomic status. Those with limited financial resources may delay seeking care, increasing the risk of complications, such as abscess formation.3. Environmental Implications: Living in an environment with limited access to healthcare facilities or support services can exacerbate the risks associated with mastitis. Women in rural areas may face barriers to timely treatment and support for breastfeeding. (Pevzner & Dahan, 2020)Priority Nursing Interventions for Home Monitoring1. Education on Breastfeeding Techniques: Teach proper latch techniques and breastfeeding positions to minimize nipple trauma and promote effective milk drainage. 2. Pain Management: Provide recommendations for pain relief, including the use of warm compresses and over-the-counter analgesics.3. Monitoring Symptoms: Instruct the client to monitor for symptoms of worsening infection, such as increased redness, swelling, or fever.4. Support for Milk Expression: Encourage frequent breastfeeding or pumping to reduce milk stasis and facilitate drainage.5. Follow-Up Care: Schedule regular follow-up visits to monitor progress and ensure resolution of symptoms.Labs and Diagnostic Testing
Blood Tests: Complete blood count (CBC) to check for elevated white blood cell counts indicative of infection.
Culture of Milk or Abscess Fluid: If there is significant drainage or abscess formation, cultures can help identify the causative organism for targeted antibiotic therapy.
Client EducationEducate M.P. to report the following symptoms to the healthcare team:- Increasing breast pain or swelling.- Fever or chills, indicating systemic infection.- Purulent discharge from the nipple.- Signs of an abscess, such as a firm, painful lump in the breast. (Mitchell, et al., 2022)Interdisciplinary Team MembersThis interdisciplinary approach ensures comprehensive care, addressing not only the medical but also the social and psychological aspects of the client’s experience with mastitis. To provide holistic, patient-centered care for mastitis, the following members should be included:
Lactation Consultant: For breastfeeding support and education.
Primary Care Physician: To manage treatment and any complications.
Nutritionist: To offer dietary recommendations that support healing.
Social Worker: To address any financial or social barriers to care.
Nurse Educator: To provide ongoing education and support for self-management.(Mitchell, et al., 2022)
#2
Pathophysiology: There are two types of cells in the thyroid, the follicular cells and the parafollicular or C-cells. In my patient, the follicular cells are affected as she has papillary thyroid cancer. One cell mutated and kept multiplying, eventually leading to her cancer. Papillary thyroid cancer is the most common kind and is the most invasive when it comes to the lymphatic structures around the gland. Prognosis is usually good in most patients with this type of thyroid cancer. (Limaeim et al., 2023)
Cultural implications: One thing culturally that would be a risk factor for thyroid cancer is if there is a history in the family of thyroid cancer. Her also being white and a female put her at higher risk for developing thyroid cancer as well. (Limaeim et al., 2023)
Financial implications: Thyroid cancer tends to affect younger people who are unable to qualify for many of the government programs that older people with cancer can obtain help from (Mongell et al., 2020). 43% of patients who have survived thyroid cancer reported financial troubles after the fact as well. My patient, fortunately, was still on her mom’s insurance when she was diagnosed at 20. This has significantly decreased her financial burden during her cancer, and will hopefully decrease her burden afterwards as well.
Environmental implications: Some enviromental risk factors for thyroid cancer are exposure to pesticides, organochlorines, and radiation. Radiation is the highest risk factor, however (Limaiem, 2024). My patient’s doctors have stated that her living near power lines could’ve been a risk factor but she is the only one in her family to develop thyroid cancer, therefore they believe she just got unlucky with a genetic mutation.
Priority nursing interventions: Regular outpatient lab collections as ordered by the doctor to monitor thyroid levels and ensure the correct dose of levothyroxine is being prescribed.
Provide the patient with psychosocial resources such as support groups and local therapists who specialize in treating young patients with cancer.
After surgeries, perform outpatient wound care as ordered and check on the healing of the wound through either phone calls to the patient or visually observing it.
Ensure the patient is scheduling all routine follow ups and neck ultrasounds.
While receiving radiation treatment, educate the patient on following a low-iodine diet at home to make the thyroid cells “hungry” for iodine. This will ensure as much radiation is absorbed into the cancerous cells as possible (American Thyroid Association, n.d.).
Labs and routine testing: Thyroid stimulating hormone to ensure levothyroxine prescription is the correct amount.
Neck ultrasounds to see if the cancer is spreading to other lymph nodes and areas of the neck.
CBC and CMP to make sure the patient’s overall health is good. This can also show some signs of depression as if the patient is eating poorly or not drinking much, it can show through low electrolytes and high kidney function.
Interdisciplinary team:
Endocrinologist since the thyroid is a hormone gland in the body. An endocrinologist will ensure that the patient’s thyroid hormone levels are kept within healthy range. A surgeon that specializes in thyroid cancer. Most patients have to have their thyroid removed and continue to have lymph node involvement issues, like my patient does. A pathologist to test the pathology of suspected cancerous areas. A radiologist to interpret neck ultrasounds and any imaging performed of the patients throat and neck. A therapist to help the patient manage her feelings and talk through the struggles that come with having cancer.
(Lee et al., 2024)