AIIMS CRE 2025
Obstetrics & Gynaecology
Hard
A 3rd day postpartum woman has a 100°F temperature and breast engorgement. Which nursing action would be appropriate?
Appeared in: AIIMS CRE 2025
Explanation
- The patient's symptoms are characteristic of physiological breast engorgement, which typically occurs 3-5 days postpartum as mature milk replaces colostrum.
- The low-grade fever (100°F) is a common associated finding known as 'milk fever,' which is a transient inflammatory response to milk coming in and does not usually signify infection.
- Expressing breast milk is the appropriate action as it relieves the painful pressure and fullness associated with engorgement.
- Softening the breast by expressing a small amount of milk before feeding makes it easier for the infant to latch on correctly, which promotes effective milk removal and resolves the engorgement.
Why Other Options Were Wrong
- Option A: Antibiotics are not indicated. The patient's low-grade fever is a physiological response to engorgement ('milk fever'), not a sign of a bacterial infection.
- Option C: Stopping breastfeeding is contraindicated as it would cause milk to accumulate, worsening the engorgement, increasing pain, and raising the risk of mastitis.
- Option D: This advice is the opposite of the recommended treatment. Frequent and effective emptying of the breasts is the primary strategy to manage and resolve engorgement.
Related Visual
- Visual 1: Infographic - Illustrating the signs of breast engorgement versus mastitis, highlighting differences in fever, pain location (generalized vs. localized), and skin appearance.
- Visual 2: Diagram - Showing proper vs. improper infant latch to demonstrate how a good latch helps empty the breast effectively and prevents nipple trauma.
Clinical Relevance
- Nursing practice connection: Knowing Management of postpartum breast engorgement helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
- Nurses play a crucial role in educating new mothers to differentiate between normal engorgement and mastitis, which prevents unnecessary antibiotic use, reduces anxiety, and supports breastfeeding continuation.
- Proper management of engorgement is key to preventing complications like plugged ducts, mastitis, breast abscess, and premature cessation of breastfeeding.
- What if? If the patient's temperature was 102°F and she reported a painful, red, wedge-shaped area on one breast, the priority would shift. The nurse should suspect mastitis and advise the patient to contact her healthcare provider for evaluation and probable antibiotic therapy, while still encouraging continued emptying of the affected breast through feeding or pumping.
How to Approach the Question
- First, identify the patient's status: a 3rd-day postpartum woman.
- Next, analyze the key clinical findings: breast engorgement and a 100°F temperature.
- Correlate these findings with the expected physiological changes of the puerperium. Day 3 is the classic time for mature milk to 'come in,' which often leads to physiological engorgement.
- Differentiate between a normal process (engorgement with 'milk fever') and a complication (mastitis). The low-grade fever without other systemic or localized signs of infection strongly points to engorgement.
- Evaluate the options based on the underlying pathophysiology. Engorgement is caused by temporary milk stasis and increased vascularity. Therefore, the solution must involve removing the milk.
- Select the option that promotes milk removal and relieves pressure. Eliminate options that would worsen the condition (stopping feeding) or are inappropriate for the diagnosis (antibiotics).
Concept Tested & Keywords
- Concept Tested: Management of postpartum breast engorgement
- Stem keywords: 3rd day postpartum, 100°F temperature, breast engorgement
- Lead-in keywords: appropriate
- Clinical cues: 3rd day postpartum: Classic timing for primary breast engorgement as mature milk production begins.
- Clinical cues: 100°F temperature: Consistent with physiological 'milk fever,' not typically indicative of an infection like mastitis.
Question ID
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Practise the full AIIMS CRE 2025
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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