Case Study #2
The client is a 28-year-old transmasculine client who prefers the pronouns he/him/his.
He is 1 month post-delivery. The client presents to the community health clinic with a
swollen and shiny right chest that is tender and warm to touch. He has sore nipples,
with no milk able to be expressed from right chest. Client states he’s fatigued, but he
thought that was normal with a newborn, and complains of chills and aches. Left chest
continues to produce milk and he has been able to feed his infant off that chest while
also supplementing with formula. Infant is noted to be healthy in appearance. Small
milia noted on face. Infant weight 3700 g, feeding without issue, normal bowel
movements, minimal jaundice noted at 1 week check-up which resolved with increased
feeds and bowel movements. Client reported expected associated pregnancy changes
related to chest size with ability to express colostrum during hospital stay. When client
returned home post-delivery, chest feeding became difficult after well child visit at 1
week post discharge. Due to a negative hospital experience, he did not seek out
additional chest feeding support and began binding his chest regularly 2 weeks after
discharge although he wishes to continue chest feeding.
Subjective Data
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Fatigue, chills, aches
Difficult postpartum experience in hospital.
States several staff nurses were disrespectful towards him and unaccepting of
transmasculine status and parenthood.
Reports overhearing the night nurses laughing at his desire to chest feed his
newborn despite a successful latch at delivery.
Due to negative experience, unable to share his fears of not having enough milk
and could not ask when he could start lightly chest binding after delivery.
Objective Data
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Vital signs: T: 38.6o C; BP: 120/77; P: 97; RR: 14; sp02: 99% on room air
Left chest noted to have several white pearls x 3 noted on the tip of the nipple
Erythema and swelling noted on left chest.
Left chest remains tender to touch.
Obstetrical History
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No chest masculinization surgery
Discontinued testosterone 6 months prior to conceiving.
BSCN 2506 Summer 2023
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G1P1A0 discharged home after uneventful spontaneous vaginal delivery
Minimal tears noted
No episiotomy required
Newborn had documented APGARS of 7 and 9, weighing 3500g at delivery and
3425 g at discharge.
Newborn nursed well after delivery with no issues noted during postpartum
period.
Partner present during throughout and for client education.
Client planned to continue to chest feed as he indicated this for his birth and
postpartum plan.
Discussion Questions for Your Consideration
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What are the main issues in this case study? How are they related to nursing care
and the health of the young family?
What is the impact of the issue(s) in terms of its significance related to the health
of this client/family?
What developmental issues, ethical considerations and relevant determinants of
health apply in this case?
Which findings require immediate follow-up by the nurse?
What priority actions should the nurse take?
What approach and nursing care would be appropriate for this patient and
family?
What health teaching and anticipatory guidance is important for the nurse to
provide?
BSCN 2506 Summer 2023