Hi all,
I have a client that I am seeing for a third time tomorrow and could use some
input!
Mom is 40yo multip, 2nd child-older is 15 yrs old, healthy FT pregnancy after
several miscarriages.
Initial consult at 2.5wks of age, contact d/t ?? plugged ducts, positioning
issues. Baby appeared slightly scrawny and mildly-moderately jaundiced, stools
were small-"stains" per Mom, weight at 2 wk ped visit down 3oz from D/C wt but
followup visit scheduled in 1mth (!) breasts were soft-sl full, right greater
than left, firm, ropelike texture noted on sore left breast, superficial at
12n position, nipples were sl pink and sore. Assist w/positioning led to
painfree latch, swallows were inconsistent w/ breast fullness, ie. should have been
more frequent based on available milk but were increased with compression. I
continued to compress deeply and firmly over "clogged" area with fair-good
result ie. firmness diminished but didn't disappear completely, swallowing picked
up w/ compression, baby appeared sated following feed. pre and post weights
were not done but reports from Mom over following days revealed much improved
stooling pattern. Mom experienced intermittent return of clogged ducts over next
2 weeks which she reportedly "worked out" on her own w/ massage. I returned
again at 4-5 wks of age (d/t unremitting clog) to find baby gaining, approx
1/2-1oz/day (closer to 1/2). At this point I palpated larger "mass" deep in
left breast, compression attempted again w/ some affect per Mom- "much more
comfortable" but difficult to assess from my end as mass was so deep. Latch had
deteriorated slighty, nipples sore again- corrected w/ positioning. Mom taking
lecithin since 1st consult, feeling demoralized and depressed but w/o
further s/s mastitis. telephone call a few days later reported flu llike
symptoms-instructed to call Ob-dicloxacillin -therapeutic dose x 7days, with little
effect at 1 week, treatment extended to 3 wks.
consult tomorrow will be 2+wks into treatment, "clogs" continue (although Mom
can't ID mass that I palpated) and she wants to quit, wants my help to
"massage out" clogs in interim. I did discuss abscess possibility/need for u/s-with
her for first time. After searching archives it appears quite possible
although transient nature of clogs seems inconsistent. Interestingly, one other
poster mentions cyst like areas (lumps) on areola in conjunction w/abscess which my
Mom also mentioned with last telephone conversation-any correlation do you
think?
IF an abscess, does anyone have experience with the ultrasound guided needle
aspiration of abscesses? (an article on it's use was in the archives)
I have seen only 5 private patients since moving to Florida and not one has
been straightforward! ARGHH!
Lynn Shea Rn,Bsn,Ibclc
Lakewood Ranch, Fl
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