Notebook Working Through COMMON Pregnancy Case Studies and Other Issues in Advanced Nursing Practice
Obstetrics
Teresa is a 34‑year‑old Hispanic woman, G2P2002, presenting for her 6‑week postpartum evaluation at 10 weeks following cesarean delivery. Her postpartum course has been complicated by persistent right breast pain, erythema, and swelling, accompanied by fever and occasional chills. She reports difficulty breastfeeding despite prior lactation support, emotional distress, and family pressure to continue despite severe discomfort. Teresa expresses guilt and feelings of maternal inadequacy, contrasting her current struggles with her previous successful breastfeeding experience. The purpose of this case study is to systematically analyze Teresa’s postpartum presentation using a structured clinical framework: Subjective Data, Objective Findings, Diagnostic Tests, Differential Diagnoses, Medications/Treatments, Social Determinants of Health, and Collaborative Care & Patient Education. Each section will integrate evidence‑based reasoning and scholarly references. As Schuiling and Likis (2022) emphasize, comprehensive gynecologic health care requires attention to both physiologic recovery and psychosocial well‑being across the life span.
| Outline Subjective data.
Identify data provided in your chosen case and any additional data needed. |
Outline
Objective findings.
Identify findings provided in your chosen case and any additional data needed. |
Identify diagnostic tests, procedures, and laboratory work indicated.
Describe the rationale for each test or intervention with supporting references. |
Distinguish at least three differential diagnoses.
Describe the rationales for your choice of each diagnosis with supporting references. |
Identify the appropriate medications, treatments, or other interventions for each differential diagnosis.
Describe rationales and supporting references for each.
|
Explain key
Social Determinants of Health (SDoH) for your chosen case. |
Describe collaborative care referrals and patient education needs for your chosen case.
Describe rationales and supporting references for each.
|
| Teresa reports severe right breast pain since hospital discharge, describing it as constant, erythematous, and interfering with breastfeeding. She notes occasional chills but has not measured her temperature at home. Teresa expresses frustration and emotional distress, stating that “nothing is working” despite lactation consultant support. She fears using formula due to her mother-in-law’s insistence on breastfeeding and feels she has failed her son, contrasting her current struggles with her previous successful breastfeeding experience. She perceives her husband views her as a “bad mother,” reflecting significant psychosocial strain and diminished self-confidence. Teresa denies abnormal vaginal bleeding, urinary symptoms, or wound complications. She has not resumed sexual activity postpartum. Additional subjective data needed include pain severity using a standardized scale, breastfeeding frequency and duration, infant feeding adequacy, milk production, nipple trauma, sleep patterns, appetite, mood screening for postpartum depression, anxiety symptoms, home support systems, coping strategies, medication use, allergies, and previous history of mastitis. As Ricci (2024) emphasizes, postpartum care must address both physical recovery and maternal emotional well-being. | On examination, Teresa’s vital signs reveal a blood pressure of 110/70, a pulse of 90, a respiratory rate of 18, and a temperature of 38.4°C, consistent with a febrile illness. Her weight is 132 lbs, appropriate for postpartum recovery. The cesarean incision is healing well, with no erythema, drainage, or tenderness, excluding wound infection. Pelvic exam findings are normal: uterus is firm, involuted, and non‑tender; no vaginal discharge or cervical motion tenderness is noted. The most significant abnormality is localized erythema, swelling, and tenderness of the right breast, strongly suggestive of mastitis, with possible progression to abscess. No axillary lymphadenopathy is reported. Additional objective data required include a complete blood count to assess leukocytosis, a breast milk culture to identify causative organisms, and a breast ultrasound if abscess formation is suspected. Psychosocial evaluation tools, such as the Edinburgh Postnatal Depression Scale, should be administered to assess emotional distress objectively. Comprehensive postpartum care integrates physical findings with psychosocial assessment to ensure maternal recovery and infant well‑being (Gregory et al., 2024) | For Teresa, several diagnostic tests are indicated to confirm the suspected mastitis diagnosis and to exclude complications, such as abscess formation. A complete blood count (CBC) should be obtained to evaluate leukocytosis, which would support the diagnosis of infection. A breast milk culture is recommended to identify the causative organism, most commonly Staphylococcus aureus, and guide antibiotic therapy. If an abscess is suspected based on persistent pain or localized swelling, a breast ultrasound should be performed to detect a fluid collection requiring drainage. Given her fever and chills, blood cultures may be warranted to rule out systemic infection. Routine postpartum labs, including urinalysis and a basic metabolic panel, can provide baseline data and help exclude other causes of fever. Additionally, psychosocial screening tools such as the Edinburgh Postnatal Depression Scale should be administered to assess Teresa’s emotional distress objectively. Integrating diagnostic evaluation with attention to social determinants of health ensures comprehensive care that addresses both physiologic recovery and maternal well‑being (Nattell, 2024). | Teresa’s postpartum presentation of fever, breast pain, and emotional distress warrants consideration of three major diagnoses: mastitis, breast abscess, and postpartum depression.
Mastitis: Her fever, chills, and localized erythema and tenderness of the right breast are most consistent with mastitis. This condition often results from bacterial invasion during lactation, commonly Staphylococcus aureus. Ricci (2024) highlights mastitis as a frequent postpartum complication requiring antibiotics and supportive care to prevent worsening infection. Breast abscess: If mastitis is untreated or inadequately managed, abscess formation may occur, presenting with persistent pain, fluctuant swelling, and systemic illness. Oladapo & Nihlén (2024) emphasize the role of ultrasound in confirming abscess and guiding drainage, making this a critical differential for Teresa’s severe symptoms. Postpartum depression: Teresa’s guilt, perceived maternal failure, and psychosocial strain reflect risk for postpartum depression. Puri and Sharma (2026) stress that maternal well‑being programs must address emotional health, as untreated depression negatively impacts both mother and infant outcomes. |
Teresa’s clinical presentation is most consistent with mastitis, requiring prompt pharmacologic and supportive management. First-line therapy includes oral antibiotics targeting Staphylococcus aureus, such as dicloxacillin or cephalexin, and is prescribed for 10–14 days. If methicillin‑resistant strains are suspected, clindamycin may be considered. Analgesics such as acetaminophen or ibuprofen should be provided to reduce fever and pain. Continued breastfeeding or pumping is encouraged to maintain milk flow, unless abscess formation is confirmed. If a breast abscess is identified, ultrasound‑guided drainage combined with antibiotics is indicated. Supportive measures include warm compresses, hydration, and rest. In addition, Teresa should receive psychosocial support and counseling to address feelings of guilt and maternal inadequacy. Screening for postpartum depression is essential, with referral to mental health services if indicated. Comprehensive reproductive health management requires both medical treatment and surveillance, ensuring that complications are promptly addressed while supporting maternal emotional well-being (Darling et al., 2022). This integrated approach optimizes recovery and promotes successful infant feeding outcomes. | Teresa’s postpartum recovery is influenced by several social determinants of health that directly affect her well‑being and infant care. She lives with her husband, mother-in-law, and children, creating a household dynamic in which cultural expectations strongly shape feeding decisions. Her mother‑in‑law’s insistence on exclusive breastfeeding despite Teresa’s pain contributes to guilt and emotional distress, highlighting the impact of family pressure on maternal autonomy. Financial strain is not explicitly reported, but as a stay‑at‑home mother, Teresa may face limited access to independent resources, increasing reliance on family support. Language is not a barrier, as she is fluent in English, though her family primarily speaks Spanish at home, which may influence communication preferences in healthcare settings. Access to lactation support was provided in the hospital, but ongoing difficulties suggest gaps in continuity of care. Wood et al. (2024) note that barriers such as cultural expectations, household dynamics, and healthcare accessibility significantly affect women’s ability to engage in reproductive health services, underscoring the need for tailored interventions. | Teresa’s management requires a collaborative, multidisciplinary approach to address both physical and psychosocial needs. Coordination with her primary care provider and obstetrician ensures appropriate antibiotic therapy and monitoring for mastitis or abscess. A lactation consultant should provide ongoing support, teaching effective positioning, pumping techniques, and strategies to reduce discomfort. If abscess is suspected, referral to radiology and surgical services for ultrasound and drainage may be necessary. Given her emotional distress, collaboration with mental health professionals is essential for screening and intervention in postpartum depression. Family involvement, particularly her husband and mother‑in‑law, should be encouraged to foster supportive communication and reduce cultural pressure around feeding choices. Patient education must emphasize the importance of completing antibiotic therapy, maintaining adequate hydration, resting, and continuing breastfeeding or pumping to prevent milk stasis. Holistic reproductive health care requires integrating infection management with psychosocial support to ensure maternal recovery and infant well‑being (Şahin et al., 2022). This collaborative model empowers Teresa to regain confidence and autonomy in her postpartum journey. |
References
Darling, A. J., Albright, B. B., Strickland, K. C., & Davidson, B. A. (2022). Molar pregnancy: Epidemiology, diagnosis, management, surveillance. Current Obstetrics and Gynecology Reports, 11(2), 133–141. https://doi.org/10.1007/s13669-022-00327-6
Gregory, K. D., Ramos, D. E., & Steegers-Theunissen, R. P. M. (2024). Preconception and prenatal care (9th ed.). Obstetrics: Normal and Problem Pregnancies E-Book, 86.
Nattell, N. (2024). Addressing social and structural determinants of health in the delivery of reproductive health care. Obstetrics and Gynecology, 144(5), e113-e120. https://doi.org/10.1097/AOG.0000000000005721
Oladapo, O. T., & Nihlén, Å. (2024). Maternal health in a dramatically different world: Tailoring actions to achieve targets for 2030 and beyond. The Lancet Global Health, 12(2), e185-e187. https://doi.org/10.1016/S2214-109X(23)00545-4
Puri, S., & Sharma, A. (2026). Programmes and policies promoting maternal well-being during pregnancy. Child Health and Nutrition from Conception to Age Two: Policies and Practices in Public Health (1st ed.), 165. https://doi.org/10.1007/978-981-95-7868-9
Ricci, S. (2024). Essentials of maternity, newborn, and women’s health nursing (6th ed.). Lippincott Williams & Wilkins.
Şahin, B., Şahin, B., & Şahin, G. C. (2022). Sexually transmitted infections in pregnancy, screening and treatment. Current Obstetrics and Gynecology Reports, 11(1), 34–43. https://doi.org/10.1007/s13669-021-00318-z
Schuiling, K. D., & Likis, F. E. (2022). Women’s growth and development across the life spans. In Gynecologic Health Care (4th ed.). Jones and Bartlett Learning.
Wood, S. M., Alston, L., Chapman, A., Lenehan, J., & Versace, V. L. (2024). Barriers and facilitators to women’s access to sexual and reproductive health services in rural Australia: a systematic review. BMC Health Services Research, 24(1), 1221. https://doi.org/10.1186/s12913-024-11710-9
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The Assignment for this week is to provide you an opportunity to analyze one of five case studies provided. These case studies involve common pregnancy and psychosocial issues encountered in advanced nursing primary care practice. You will use the case study template under weekly resources to develop your assignment.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To prepare:
- Review the 5 case studies in this week’s Learning Resources. Select one of the cases to prepare your written assignment.
- Review the Learning Resources for this week.
Assignment Instructions:
- Use the Case Study Template from the Learning Resources to complete the assignment. Your submission must include a brief case write-up, followed by the fully completed template, which must be integrated into the document rather than submitted separately.
- Include a title page, a case summary in your own words, the completed template, and a reference page formatted in APA style.
- Ensure your submission meets all criteria outlined in the template and rubric for completeness and accuracy.
By Day 7 of Week 9
Submit your case study assignment by Day 7 of Week 9.
Learning Resources
Required Readings
- Schuiling, K. D., & Likis, F. E. (2022). Gynecologic health care (4th ed.). Jones and Bartlett Learning.
- Chapter 3,” Women’s Growth and Development Across the Life Spans) pp. 39–49)
- Chapter 13, “Contraception” (pp. 236–266)
- Morreim, H., Antiel, R. M., Zacharias, D. G., & Hall, D. E. (2014). Should age be a basis for rationing health care?Links to an external site. The Virtual Mentor: VM, 16 (5), 339–347. https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1001/virtualmentor.2014.16.05.ecas2-1405
- World Health Organization. (2020). Ageing and life courseLinks to an external site.. https://www.who.int/ageing/en
- Committee on Gynecologic Practice American Society for Reproductive Medicine. (2019). ACOG committee opinion No. 762: Prepregnancy counselingLinks to an external site.. (2019). Obstetrics and Gynecology, 133(1), e78–e89. https://doi.org/10.1097/AOG.0000000000003013
- Committee on Health Care for Underserved Women. (2018). ACOG committee opinion No. 729: Importance of social determinants of health and cultural awareness in the delivery of reproductive health careLinks to an external site.. Obstetrics and Gynecology, 131(1), e43–e48. https://doi.org/10.1097/AOG.0000000000002459
- Davidson, K. W., Terry, M. B., Braveman, P., Reis, P. J., Timmermans, S., & Epling Jr., J. W. (2024). Maternal mortality: A National Institutes of Health Pathways to prevention panel reportLinks to an external site.. Obstetrics and Gynecology, 143(3), e78–e85. https://doi.org/10.1097/AOG.0000000000005488
- Endres, K. H. (2024). Improving women’s health: How nurse practitioners can support reproductive healthLinks to an external site.. The Journal for Nurse Practitioners, 20(1).
- Verbiest, S., McClain, E., & Hernandez, N. (2022, December 1). A roadmap toward equitable, coordinated, quality reproductive care for women with chronic conditionsLinks to an external site.. Health Services Research, 57(6), 1379. https://doi.org/10.1111/1475-6773.14081
- Document: Week 9 Case Studies Download Week 9 Case Studies (PDF)
- Document: Week 9 Case Study TemplateDownload Week 9 Case Study Template (Word document)
- Document: Preconception Counseling ChecklistDownload Preconception Counseling Checklist (PDF)
Adult Gerontology Resources
- Harrison, B. J., Hilton, T. N., Rivière, R. N., Ferraro, Z. M., Deonandan, R., & Walker, M. C. (2017). Advanced maternal age: Ethical and medical considerations for assisted reproductive technologyLinks to an external site.. International Journal of Women’s Health, 9, 561–570.
Clinical Guideline Resources
As you review the following resources, you may want to include a topic in the search area to gather detailed information (e.g., breast cancer screening guidelines; CDC – for zika in pregnancy, etc.).
- American College of Obstetricians and Gynecologists (ACOG).Links to an external site. (2020). https://www.acog.org/
- American Cancer Society, Inc. (ACS). (2020). Information and Resources about Cancer: Breast, Colon, Lung, Prostate, Skin. Links to an external site. https://www.cancer.org/
- American Nurses Association (ANA). (n.d.). Lead the profession to share the future of nursing and health careLinks to an external site.. https://www.nursingworld.org/
- Centers for Disease Control and Prevention. (CDC). (n.d.). CDC in actionLinks to an external site.. https://www.cdc.gov/
- HealthyPeople 2030. (2020). Healthy People 2030 Framework Links to an external site.. https://www.healthypeople.gov/2020/About-Healthy-People/Development-Healthy-People-2030/Framework
- The American Association of Nurse Practitioners (AANP). (2020). What’s Happening at your associationLinks to an external site.. https://www.aanp.org/
Required Media
- Unfolding Case Study 1 – Issues in Advanced Nursing PracticeLinks to an external site.
In this interactive media program, you will be presented with various case studies with a variety of decision paths to take as an Advanced Nurse Practitioner. - Unfolding Case Study 2 – Ethical Dilemmas in Advance Nursing PracticeLinks to an external site.
In this interactive media program, you will be presented with various case studies with a variety of decision paths to take as an Advanced Nurse Practitioner. - Association of Professors of Gynecology and Obstetrics (APGO). (2015, September 3). Topic 9: Preconception careLinks to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=k9GJEvPnmlQ
Note: This media program is approximately 8 minutes.
Optional Resources
Note: In Weeks 1-10, these resources are optional for your review. In Week 11, you will be required to review each of the PowerPoint slides from the text Gynecologic Health Care (4th ed.).
- Chapter 3, “Women’s Growth and Development Across the Life Spans”Download “Women’s Growth and Development Across the Life Spans”
- Chapter 13, “Contraception”Download “Contraception”
- NRNP_6552_Week9_Case_Study_Assignment_Rubric
| NRNP_6552_Week9_Case_Study_Assignment_Rubric | ||
| Criteria | Ratings | Pts |
| This criterion is linked to a Learning Outcome Analyzes subjective and objective data and outlines applicable diagnostic tests related to case studies. | 30 to >26.7 pts Excellent The response provides clear, complete, and comprehensive descriptions of subjective and objective case data, appropriately outlining all diagnostic tests, clinical procedures and pharmacological interventions.
26.7 to >23.7 pts Good The response provides clear, complete partial descriptions of the components of the subjective and objective case data, appropriately outlining most of the diagnostic tests, clinical procedures and pharmacological interventions. 23.7 to >20.7 pts Fair The response provides some components of the subjective and objective case data, but they are incomplete, vague or inaccurate, outlining some of the diagnostic tests, clinical procedures and pharmacological interventions. 20.7 to >0 pts Poor The response provides unclear or incomplete components of subjective and objective case data. The diagnostic tests, clinical procedures and pharmacological interventions are missing, incorrect, or inappropriately applied. |
30 pts |
| This criterion is linked to a Learning Outcome Identifies differential diagnoses related to case studies. | 30 to >26.76 pts Excellent The response contains at least 3 differential diagnoses relevant and applicable to the case.
26.76 to >23.7 pts Good The response contains at least 2 differential diagnoses relevant and applicable to the case. 23.7 to >20.7 pts Fair The response contains at least 1 differential diagnosis relevant and applicable to the case. 20.7 to >0 pts Poor The response contains few or no differential diagnoses and/or diagnoses are not relevant and applicable to the case. |
30 pts |
| This criterion is linked to a Learning Outcome Formulates a treatment plan related to case studies based on scientific rationale, evidence- based standards of care, and practice guidelines. Integrates ethical, psychological, physical, financial issues and Social Determinants of Health in plan. | 30 to >26.76 pts Excellent Formulates a thorough treatment plan including explanations of appropriate diagnostic tests and treatment options. Fully incorporates syntheses representative of knowledge gained from the resources for the module and current credible sources, with no less than 75% of the treatment plan having exceptional depth and breadth. Supported by at least 3 current peer- reviewed, references or professional practice guidelines.
26.76 to >23.7 pts Good Formulates a partially complete treatment plan including partial explanations of appropriate diagnostic tests and treatment options. Somewhat incorporates syntheses representative of knowledge gained from the resources for the module and current credible sources with no less than 50% of the treatment plan having exceptional depth and breadth. Supported by at least 3 current peer- reviewed, references or professional practice guidelines. 23.7 to >20.7 pts Fair Formulates a minimally complete treatment plan including incomplete or vague explanations of appropriate diagnostic tests and treatment options. Lacking in synthesis of knowledge gained from the resources for the module and current credible sources. Supported by at least 2 current peer- reviewed, references or professional practice guidelines. 20.7 to >0 pts Poor Formulates a treatment plan that contains incomplete explanations of appropriate diagnostic tests and treatment options and/ or explanations are missing. Lacks synthesis gained from the resources for the module and current credible sources. Supported by 1 or no current peer- reviewed, references or professional practice guidelines. |
30 pts |
| This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation |
5 to >4.45 pts Excellent Uses correct grammar, spelling, and punctuation with no errors.
4.45 to >3.95 pts Good Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3.95 to >3.45 pts Fair Contains several (3 or 4) grammar, spelling, and punctuation errors. 3.45 to >0 pts Poor Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. |
5 pts |
| This criterion is linked to a Learning Outcome Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. | 5 to >4.45 pts Excellent Uses correct APA format with no errors.
4.45 to >3.95 pts Good Contains a few (1 or 2) APA format errors. 3.95 to >3.45 pts Fair Contains several (3 or 4) APA format errors. 3.45 to >0 pts Poor Contains many (≥ 5) APA format errors. |
5 pts |
- Total Points: 100
