NRNP 6552 Week 9 case study answers – History of Present Illness (HPI): Teresa is a 34-year-old Hispanic G2P2002. She presents to your office today at 10-weeks post-partum (PP) for her 6-week PP check
College of Nursing, Walden University
Advanced Nurse Practice in Reproductive Health Care – 6552-C
Gynecologic Health – Week 9 Case Study
Case 1: Teresa
Case Write-Up
Teresa is a 34-year-old Hispanic female of G2P2002 who has come to visit at 10 weeks postpartum with a delay of 6 weeks of postpartum care following a cesarean section as a result of failure to progress after prolonged labor. She reports having serious problems with breastfeeding since discharge, and she reports pain in the right breast, localized swelling, and pain at the incision site. She also complains of chills, though no recorded fever at home. Teresa reports a psychosocial concern of inadequacy, guilt, and being judged by her husband and mother-in-law over breastfeeding. Physical examination shows fever (38.4°C) and an erythematous, swollen, and tender field of the right breast, which is indicative of an infectious process. Her cesarean wound is healing well, and her pelvic examination is normal. The case raises concerns of postpartum complications such as lactational mastitis and potential postpartum mood disorder, which have to be further examined and treated.
PLACE YOUR ORDER HERE
Outline Subjective data.
Identify the 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 appropriate medications, treatments, or other interventions associated with 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.
Subjective Data Provided
Teresa presents with severe pain in her right breast, inability to breastfeed, and emotional instability with a sense of failure and perceived judgment. She also complains of chills, failure to breastfeed despite lactation consultation, and fear of using formula because of family pressure. She denies substance use and has no notable past medical history.
Additional Subjective Data Needed
Additional subjective data required will involve severity and duration of breast symptoms, nipple cracking or discharge, frequency of breastfeeding or pumping, sleep pattern, appetite alteration, and formal postpartum depression screening using questionnaires like the Edinburgh Postnatal Depression Scale (EPDS). Additional investigations on support mechanisms, cultural beliefs about breastfeeding, and marital relations are also necessary.
Objective Data
Vital signs reveal that the patient has a fever (38.4°C) with otherwise stable hemodynamics. Physical examination reveals a localized erythematous, swollen, and tender locality of the right breast, which is indicative of inflammation or infection. The cesarean section is healing without any indication of infection. Pelvic examination is normal.
Additional Objective Data Needed
Other objective information that should be obtained includes laboratory confirmation of infection (CBC), a potential breast ultrasound to evaluate the establishment of an abscess, and mental health screening outcomes. Observation of breastfeeding technique may also provide useful clinical information.
To determine infection, a complete blood count (CBC) is recommended to investigate the presence of leukocytosis (Mank & Brown, 2024).
In case of a suspected abscess, a breast ultrasound is advised, especially when no response is obtained to the initial treatment (Toomey & Le, 2023).
Where the recurrent or severe cases are involved, milk culture can be taken to determine the causative organisms (Blackmon et al., 2024).
Postpartum depression screening with EPDS is necessary due to her emotional distress (ACOG, 2025) NRNP 6552 Week 9 case study answers – History of Present Illness (HPI): Teresa is a 34-year-old Hispanic G2P2002. She presents to your office today at 10-weeks post-partum (PP) for her 6-week PP check
The primary diagnosis is lactational mastitis, and it is supplemented by local pain, erythema, swelling, and fever. This disorder is prevalent among breastfeeding women because of milk stasis and the introduction of bacteria by nipple trauma (Blackmon et al., 2024).
Breast abscess is a second differential that can occur as a complication of untreated mastitis and is characterized by persistent pain, fever, and a palpable, fluctuating mass (Toomey & Le, 2023).
A third differential is postpartum depression, evidenced by Teresa’s feelings of failure, guilt, and perceived inadequacy. It is more likely to occur in cases of hormonal changes, lack of sleep, and psychosocial stressors (ACOG, 2025).
In the case of mastitis, antibiotics like dicloxacillin or cephalexin against the Staphylococcus aureus and ongoing breastfeeding or pumping to clear the milk stasis should be used as the first-line treatment (Blackmon et al., 2024). Ibuprofen and other analgesics are advised to be used for pain and inflammation.
In case a breast abscess has been confirmed, it must be treated with incision and drainage or ultrasound-guided aspiration along with antibiotics.
In the case of postpartum depression, treatment can involve psychotherapy, including cognitive behavioral therapy, and in more severe cases, pharmacologic therapy using selective serotonin reuptake inhibitors (SSRI) like sertraline, which is safe in breastfeeding (ACOG, 2025).
Lactation support, reassurance, and education are among the supportive interventions that can be used to decrease anxiety and enhance the success of breastfeeding.
The cultural and family demands on breastfeeding, especially the pressure of her mother-in-law, are a major factor in her health. This can add to emotional distress and unwillingness to use formula supplementation.
Also, her status as a stay-at-home mother might be a contributing factor to social isolation and poor access to external support networks (Bord et al., 2025). The influence of language in the house and cultural practices can also affect healthcare communications and decision-making. She is also emotionally stressed and feels that she is not supported by her partner, which further worsens her condition.
It is necessary to refer to a lactation consultant to resolve the problems with breastfeeding and avoid complications. Referral to a mental health professional is required to assess and treat postpartum depression.
In case of aggravation of the infection or in case of an abscess, a referral to a breast specialist or surgeon could be necessary. Referral to social work can be used to intervene in family situations and offer support.
Education of patients should cover correct breastfeeding, the need for continued milk expression during infection, the signs of worsening infection, and an explanation that formula supplementation is not wrong when necessary (Wilde, 2021).
Postpartum mental health education and promotion of health-seeking behavior due to emotional symptoms are essential to enhance the outcomes (ACOG, 2023).
References
ACOG. (2025).
Patient screening
. Www.acog.org.
https://www.acog.org/programs/perinatal-mental-health/patient-screening
Blackmon, M. M., Nguyen, H., & Mukherji, P. (2024, December 11).
Acute mastitis
. PubMed; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK557782/
Bord, S., Inchi, L., Paldi, Y., Baruch, R., Schwartz Shpiro, M., Ronen, S., Eizenberg, L., Gens, I., & Yaari, M. (2025). The pivotal role of social support, self-compassion, and self-care in predicting physical and mental health among mothers of young children.
Healthcare
,
13
(15), 1889.
https://doi.org/10.3390/healthcare13151889
Mank, V., & Brown, K. (2024, April 21).
Leukocytosis
. PubMed; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK560882/
Pileri, P., Sartani, A., Mazzocco, M. I., Giani, S., Rimoldi, S., Pietropaolo, G., Pertusati, A., Vella, A., Bazzi, L., & Cetin, I. (2022). Management of breast abscess during breastfeeding.
International Journal of Environmental Research and Public Health
,
19
(9), 5762.
https://doi.org/10.3390/ijerph19095762
Toomey, A., & Le, J. K. (2023, January 11).
Abscess, breast
. Nih.gov; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK459122/
Wilde, V. K. (2021). Breastfeeding insufficiencies: Common and preventable harm to neonates.
Cureus
,
13
(10).
https://doi.org/10.7759/cureus.18478
Case #1. Teresa.
History of Present Illness (HPI): Teresa is a 34-year-old Hispanic G2P2002. She presents to your office today at 10-weeks post-partum (PP) for her 6-week PP check. She underwent a C-section for failure to progress following a 20-hour labor with Pitocin augmentation. She was discharged from the hospital on day 2 post-partum without complications. Teresa has had difficulty with breast feeding due to discomfort in her suture line and terrible pain in her right breast since her discharge from the hospital. She reports occasional chills- she has not measured her temperature at home. Teresa was seen by the lactation consultant while in the hospital but “nothing is working” and her son “cries all the time”. She is afraid to feed her son formula as her mother-in-law wants her to “keep trying to breastfeed”. Teresa
tells you she feels as if she has failed her son- “it was so easy with my first baby, I know my husband thinks I am a bad mother”.
Prior medical history: None. Prior surgical history: Appendectomy (2000)
Current medications: Prenatal vitamins, stool softener. Allergies: None
OB- GYN History: NSVD (2019) healthy female 7lb 10oz; C-section healthy male 8 lbs. 8 oz as per HPI.
Menarche age 12, cycle length- 5 days- frequency every 28 days- 4-5 tampons per day. No history of
sexually transmitted infections (STDs). History of abnormal pap smear in 2019 which was followed by a
normal colposcopy. Last pap (during recent prenatal care) reported normal. HIV negative.
LMP: First PP menstrual cycle last week. Has not resumed sexual activity PP. Contraception history:
Oral contraceptives, condoms.
Social history: Lives with husband, mother- in- law, and children. Stay at home mom. Denies EtOH or
recreational drug use, never smoker. Her family speaks Spanish at home; she is fluent in English.
Family history: Unremarkable.
Review of Systems (ROS): Negative except as noted in HPI.
Physical Exam (PE)
VS: BP: 110/70, P: 90, RR: 18, T: 38.4, Weight: 132 lbs.
Teresa’s C-section suture line is healing well without erythema or tenderness. No vaginal discharge or
lesions, no cervical motion tenderness (CMT), uterus normal size firm and non-tender. On breast exam,
you do note an erythematous, swollen, and painful area to the right breast. Her physical exam is
otherwise unremarkable.
NRNP 6552 Week 9 case study answers – History of Present Illness (HPI): Teresa is a 34-year-old Hispanic G2P2002. She presents to your office today at 10-weeks post-partum (PP) for her 6-week PP check
Allowed Attempts
2
Back to Week at a Glance
Working Through COMMON Pregnancy Case Studies and Other Issues in Advanced Nursing Practice
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
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Rubric
NRNP_6552_Week9_Case_Study_Assignment_Rubric
NRNP_6552_Week9_Case_Study_Assignment_Rubric
Criteria
Ratings
Pts
This criterion is linked to a Learning OutcomeAnalyzes subjective and objective data and outlines applicable diagnostic tests related to case studies.
30 to >26.7 ptsExcellent
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 ptsGood
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 ptsFair
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 ptsPoor
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 OutcomeIdentifies differential diagnoses related to case studies.
30 to >26.76 ptsExcellent
The response contains at least 3 differential diagnoses relevant and applicable to the case.
26.76 to >23.7 ptsGood
The response contains at least 2 differential diagnoses relevant and applicable to the case.
23.7 to >20.7 ptsFair
The response contains at least 1 differential diagnosis relevant and applicable to the case.
20.7 to >0 ptsPoor
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 OutcomeFormulates 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 ptsExcellent
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 ptsGood
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 ptsFair
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 ptsPoor
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 OutcomeWritten Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation
5 to >4.45 ptsExcellent
Uses correct grammar, spelling, and punctuation with no errors.
4.45 to >3.95 ptsGood
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
3.95 to >3.45 ptsFair
Contains several (3 or 4) grammar, spelling, and punctuation errors.
3.45 to >0 ptsPoor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
5 pts
This criterion is linked to a Learning OutcomeWritten 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 ptsExcellent
Uses correct APA format with no errors.
4.45 to >3.95 ptsGood
Contains a few (1 or 2) APA format errors.
3.95 to >3.45 ptsFair
Contains several (3 or 4) APA format errors.
3.45 to >0 ptsPoor
Contains many (≥ 5) APA format errors.
5 pts
Total Points: 100 NRNP 6552 Week 9 case study answers – History of Present Illness (HPI): Teresa is a 34-year-old Hispanic G2P2002. She presents to your office today at 10-weeks post-partum (PP) for her 6-week PP check
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