Exhibits

The nurse reviews the client's history and physical, the nurses' notes, and the flow sheet.

Select the findings that will help the nurse determine what is causing the client's symptoms.

• Plugged duct: A plugged duct occurs when milk is not effectively drained from the breast, leading to milk stasis and inflammation. If untreated, it can progress to mastitis, an infection caused by bacterial overgrowth in stagnant milk. The client's history of missing a feeding while shopping increases the likelihood of milk stasis, making a plugged duct the most likely cause of mastitis.
• Breast abscess: A breast abscess is a collection of pus that forms when mastitis is left untreated or does not respond to antibiotics. Unlike mastitis, an abscess is typically fluctuant (soft and fluid-filled), extremely tender, and may require drainage. Since the client’s mastitis symptoms have just begun, an abscess is unlikely at this stage.
• Engorgement : Breast engorgement occurs when the breasts overfill with milk, causing swelling and discomfort. While engorgement can increase the risk of mastitis, it is not an infection itself and does not directly cause mastitis unless milk stasis leads to bacterial overgrowth. Engorgement is bilateral, whereas mastitis is usually unilateral with localized redness, warmth, and fever.
• Nipple trauma with cracked skin: Cracked nipples can allow bacteria to enter the breast, increasing the risk of infection. However, mastitis is primarily caused by milk stasis, not just nipple trauma. In this client, there is no mention of nipple cracks or bleeding, making this a less likely cause.
• Firm, red, warm area on the right breast: A firm, red, warm, and tender area on the breast is a hallmark symptom of mastitis, indicating localized inflammation and infection. The presence of systemic symptoms (fever, chills, fatigue) further supports mastitis rather than another breast condition.
• Pus draining from the nipple: Pus or fluctuance (fluid-filled swelling) suggests a breast abscess, not mastitis. While untreated mastitis can lead to an abscess, this client’s symptoms do not indicate a severe or advanced infection requiring drainage.
• Generalized swelling of the entire breast: Severe engorgement can cause generalized swelling, but mastitis typically presents as a localized, inflamed area rather than affecting the entire breast. Engorgement also does not cause fever or systemic illness, which are present in mastitis.
• Pain that worsens with cold compresses: Cold compresses reduce inflammation and discomfort in mastitis. If cold worsens pain, it may suggest Raynaud’s phenomenon of the nipple, which is not related to mastitis. Mastitis pain is relieved with warmth, massage, and frequent breastfeeding.

A. Begin prescribed intravenous antibiotic administration. While IV antibiotics are essential for treating bacterial infections such as epiglottitis, securing the airway is the priority in this child with severe respiratory distress. Antibiotic therapy should be initiated after airway stabilization to prevent further deterioration.
B. Schedule the child for a STAT magnetic resonance imaging (MRI) of the neck. An MRI is not appropriate in an emergency airway situation, as it requires the child to remain still and may delay critical interventions. A clinical diagnosis of epiglottitis is based on symptoms, and confirmation is typically done with lateral neck X-rays only if the airway is stable.
C. Obtain bedside trays for intubation or tracheotomy by the healthcare provider. The child’s symptoms—high fever, drooling, anxiety, and a tripod sitting position—are classic signs of epiglottitis, a life-threatening condition caused by Haemophilus influenzae type B (Hib). Immediate airway management is critical, as swelling of the epiglottis can rapidly lead to complete airway obstruction. Equipment for emergency intubation or tracheotomy must be readily available.
D. Provide a nebulizer treatment with bronchodilators. Nebulized bronchodilators are used for conditions like asthma or croup but are ineffective in epiglottitis, which is caused by inflammation and swelling of the supraglottic structures. Administering nebulized treatments may further distress the child and increase the risk of airway obstruction.