Initial STARES: Intervention

Situation: Pt presented with nipple trauma day 4 post natal. Discharged from hospital day before. Was Rx’ed with LASER Rx day before on ward. Baby not getting good attachment, expressing milk for 24 hrs before seeing the lactation/breast feeding clinic next day. Also has 2 yr old, expressed for 3 months with that child. Wants to breast feed this child. Hx of post natal depression, currently being managed

Task: On Subjective Ax patient complained that (L) nipple was the problem and that LASER treatment on the ward the previous day had helped extremely. On Physical Examination, (L) nipple had horizontal crease, with small scab. Desired outcome is to decrease pain and increase healing in preparation for breast feeding and lactation clinic

Action: Laser treatment to the (L) nipple, along the crease line and over the scab. Explanation of treatment, contraindications and risks given. Glasses put on, warning sign on door and all reflective material removed. Machine set up and turned on. Patient is seated in chair, I was in a half kneel position. Turn on the LASER and treat the area

Result: Patient happy with treatment, no redness cited

Evaluation: I was happy with the way I delivered the treatment, especially it being the first time in using LASER. Just before the treatment started the patients partner called in distress with the baby in emergency awaiting test results and the 2 yr old chucking a tantrum. This meant that the patient wanted to get to him to help him out quickly, so we only treated the 2 worst points on the crease. If I was to do again I would like to have more time with the patient.

Strategies: The LASER has to be perpendicular to the treating area and you must stay very still. I was happy with my position, however after the treatment when the machine was turned off, I got to practice in different positions and I found that if I held it as a pen I was more stable, so if given the opportunity again I would try that hand grip