NRNP 6552 Week 8 Case studies – A 32-year-old African American woman presents to the clinic for her 24-week check-up.
Case # 4
A 32-year-old African American woman at 24 weeks gestation presents with persistent daily sadness, fatigue, decreased energy, and difficulty completing daily tasks and maintaining work attendance. Although she expresses happiness about her pregnancy, she reports an inability to explain her ongoing sadness. Symptoms began one week prior to presentation. Her family history is significant for paternal chronic depression and diet-controlled diabetes, while her mother has no known medical conditions. The patient currently takes a daily prenatal vitamin and denies allergies.
Outline Subjective data.
The patient reports daily depressed mood, persistent fatigue, anhedonia, inability to perform usual daily chores, and difficulty attending work. She tried going to bed earlier without improvement. She denies understanding why she feels sad. Additional subjective data required includes a formal validated depression screening score using the Edinburgh Postnatal Depression Scale (EPDS) or Patient Health Questionnaire-9 (PHQ-9), full psychiatric and prior depressive episode history, suicidal ideation assessment, relationship quality and social support evaluation, history of adverse childhood experiences, sleep pattern changes, appetite changes, and current financial or occupational stressors.
Outline
Objective findings.
Vital signs include height 5’4”, weight 147 lbs, BMI 25.2, blood pressure 132/78 mmHg, and heart rate 88 bpm. The patient appears well-nourished but demonstrates a flat affect and mildly disheveled appearance, suggesting decreased self-care. HEENT examination is normal. The neck is supple without thyromegaly. Lung auscultation is clear bilaterally. Cardiovascular exam reveals a regular rate and rhythm with a soft grade II/VI systolic murmur, likely physiologic in pregnancy. Peripheral pulses are normal without edema. Breast and genitourinary exams are consistent with normal pregnancy at 24 weeks, and fetal heart tones are present.
Additional objective data should include a documented PHQ-9 or EPDS score. Laboratory evaluation should include thyroid-stimulating hormone (TSH), complete blood count (CBC), and a one-hour glucose challenge test, as this aligns with routine gestational diabetes screening at 24–28 weeks. A validated suicide risk assessment tool should also be completed.
Identify diagnostic tests, procedures, laboratory work indicated.
The American College of Obstetricians and Gynecologists recommends systematic screening and diagnosis of mental health conditions during pregnancy, including depression, anxiety, and bipolar disorder, with formal validated instruments at a minimum of twice during gestation (American College of Obstetricians and Gynecologists [ACOG], 2023a). The PHQ-9 or EPDS must be administered immediately, as these are validated, brief, and widely available instruments appropriate for perinatal populations (Kendall-Tackett, 2024). A TSH level is indicated because hypothyroidism shares overlapping symptoms of fatigue and depressed mood with antenatal depression; levothyroxine is the recommended treatment when TSH exceeds 2.5 mIU/L in pregnancy (Nguyen, 2022). A complete blood count is indicated to evaluate for iron-deficiency anemia, a common pregnancy complication contributing to fatigue and low energy. A one-hour glucose challenge test is necessary given the patient’s strong bilateral family history of diabetes. A structured suicide risk assessment using the Patient Safety Screener is mandated whenever depressive symptoms are identified, as untreated perinatal depression carries risk of maternal mortality (MS & Kay Roussos-Ross, 2023).
Distinguish at least three differential diagnoses.
Antenatal Depression: This is the most likely diagnosis given persistent sadness, anhedonia, fatigue, and impaired functioning. Family history increases susceptibility. ACOG identifies perinatal depression as a leading contributor to maternal morbidity and emphasizes early screening and treatment (ACOG, 2023a).
Adjustment Disorder with Depressed Mood: The recent onset of symptoms suggests a possible stress-related response to pregnancy-related life changes. However, symptom severity and functional impairment raise concern for progression to major depression if persistent (MS & Kay Roussos-Ross, 2023).
Hypothyroidism in Pregnancy: Overlapping symptoms such as fatigue and low mood necessitate exclusion of thyroid dysfunction. Pregnancy increases thyroid hormone demand, and untreated disease carries significant maternal-fetal risks (Nguyen, 2022) NRNP 6552 Week 8 Case studies – A 32-year-old African American woman presents to the clinic for her 24-week check-up..
Identify appropriate medications, treatments or other interventions associated with each differential diagnosis.
For antenatal depression, cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are evidence-based, first-line interventions for mild-to-moderate symptoms during pregnancy, avoiding fetal pharmacological exposure. When symptoms are moderate-to-severe or unresponsive to psychotherapy, sertraline is the preferred pharmacological agent given the broadest perinatal safety data among SSRIs (MS & Kay Roussos-Ross, 2023). Suicide as a leading preventable contributor to maternal mortality exceeding hemorrhage underscores the ethical imperative of timely pharmacological intervention when clinically indicated (MS & Kay Roussos-Ross, 2023).
For adjustment disorder, supportive psychotherapy, social work referral, and stress reduction strategies are appropriate initial interventions.
For confirmed hypothyroidism, levothyroxine is the sole recommended thyroid hormone replacement therapy during pregnancy, with monthly TSH monitoring until the target of below 2.5 mIU/L is achieved (Nguyen, 2022). Prenatal vitamins and iron supplementation should be maintained throughout regardless of confirmed diagnosis.
Explain key
Social Determinants of Heath (SDoH) for your chosen case.
This patient faces several intersecting social determinants that elevate her risk. As an African American woman, she is subject to structural racism in healthcare systems, contributing to underdiagnosis and undertreatment of perinatal mental health conditions (Blebu et al., 2024). Employment demands and the challenge of attending work while experiencing depression and fatigue signal financial vulnerability and occupational stress, creating an ethical obligation to discuss workplace accommodations. Poor social support and partner relationship quality are among the most consistently identified determinants of antenatal depression and must be explicitly assessed (Insan et al., 2022). The physical burden of untreated depression on fetal outcomes, including low birth weight and preterm birth, reinforces the urgency of intervention. Psychologically, the patient’s flat affect and disorganized appearance suggest moderate functional decline requiring immediate attention.
Describe collaborative care referrals and patient education needs for your chosen case.
Referral to a perinatal psychiatrist or licensed clinical social worker specializing in maternal mental health is strongly indicated. Integrated collaborative care models combining obstetric and psychiatric expertise demonstrate significantly improved screening utilization and treatment rates for perinatal depression (Blebu et al., 2024). The patient must be educated on the clinical distinction between normal pregnancy fatigue and clinical depression, the safety of both psychotherapy and carefully selected pharmacological agents during pregnancy, and the importance of consistent prenatal attendance and validated screening at every visit. She should be counseled on available community mental health resources, crisis hotlines, and employer accommodation rights to address financial and occupational stressors. Ethically, she must be informed of her right to participate in treatment decisions using shared decision-making. A documented safety plan addressing suicidal ideation warning signs must be established and placed in her medical record at this visit (ACOG, 2023a).
References
American College of Obstetricians and Gynecologists. (2023a). Screening and diagnosis of mental health conditions during pregnancy and postpartum: ACOG Clinical Practice Guideline No. 4.
Obstetrics & Gynecology, 141
(6), 1232–1261.
https://doi.org/10.1097/aog.0000000000005200
Blebu, B., Jackson, A., Reina, A., Dossett, E. C., & Saleeby, E. (2024). Social determinants among pregnant clients with perinatal depression, anxiety, or serious mental illness.
Health Affairs
,
43
(4), 532-539.
https://doi.org/10.1377/hlthaff.2023.01456
Insan, N., Weke, A., Forrest, S., & Rankin, J. (2022). Social determinants of antenatal depression and anxiety among women in South Asia: A systematic review & meta-analysis.
PLOS ONE
,
17
(2), e0263760.
https://doi.org/10.1371/journal.pone.0263760
Kendall-Tackett, K. A. (2024). Screening for perinatal depression: Barriers, guidelines, and measurement scales.
Journal of Clinical Medicine
,
13
(21), 6511.
https://doi.org/10.3390/jcm13216511
MS, M., & Kay Roussos–Ross, M. D. (2023). Treatment and management of mental health conditions during pregnancy and postpartum.
American College of Obstetricians and Gynecologists, 141
(6), 1262–1288.
https://doi.org/10.1097/aog.0000000000005202
Nguyen, C. T. (2022). Postpartum thyroiditis: Diagnosis and management.
Thyroid Diseases in Pregnancy
, 211-222.
https://doi.org/10.1007/978-3-030-98777-0_14
NRNP 6552 Week 8 Case studies – A 32-year-old African American woman presents to the clinic for her 24-week check-up.
Back to Week at a Glance
Common Health Conditions with Implications for Women
Case studies provide the opportunity to simulate realistic scenarios involving patients presenting with various health problems or symptoms. Such case studies enable nurse learners to apply concepts, lessons, and critical thinking to interviewing, screening, and diagnostic approaches, as well as to the development of treatment plans.
For this Case Study Assignment, you will chose from four case studies to identify common health implications for women. You will then explore the chosen case study to determine the diagnosis, diagnostic tests, and treatment options for the patient.
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 4 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 8
Submit
your case study assignment by
Day 7 of Week 8
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submission information
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Rubric
NRNP_6552_Week8_Case_Study_Assignment_Rubric
NRNP_6552_Week8_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 NRNP 6552 Week 8 Case studies – A 32-year-old African American woman presents to the clinic for her 24-week check-up..
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 8 Case studies
Case 1
A 48-year-old Asian American woman is concerned about thin bones. Her mother was diagnosed with osteoporosis at the age of 50 and fell at the age of 68 and fractured her hip and spent months in Rehab before being able to return home. The patient has no history of fractures. The patient presents to the office to have her bones checked to see if she has “thin bones” Patient has no history of previous fractures: Patient states she went through Menopause at the age of 43-44 with no major problems. Patient was diagnosed with hypothyroid at at age 40. Patient does not drink. Smokes 1ppd for 20 yrs. Husband has been out of work for 9 months due to downsizing at his job. Pt works as an administrative assistant for a publisher but does not have health insurance at this time.
Pt had a melanoma removed from her left cheek in 2018; No hospitalizations except for childbirth x2
Family history: Paternal Grandmother died at age 78 due to heart disease. Paternal Grandfather died at age 83 due to heart attack. Maternal Grandmother died at age 82 cause unknown; Maternal Grandfather died from farm accident at age of 56. Mother is 75 alive with Osteoporosis diagnosed at age 50 and HTN diagnosed at age 63. Father is 77 alive with HTN diagnosed at age 45. Pt has two daughters alive and well with no medical problems.
Objective Info
Height 5’2’ Wt 105 lbs; BMI 19.2; 128/78; HR-72/min
•
HEENT: Normocephalic, no lumps/lesions
•
Neck: supple without adenopathy , no thyromegaly.
•
Lungs: Eupneic, CTA
•
CV: RRR, no murmurs, rubs or extra sounds noted; 2+ peripheral pulses, no edema noted
•
Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge
•
Abd: soft, +BS, no tenderness
•
MS: Full ROM in spine and shoulders. No tenderness, no spasms
•
T-Score is -1.2
Case 2
A 46-year-old Caucasian woman presents to the clinic complaining of breast pain. The patient state the pain is intermittent, in the right breast, the pain is sharp and has a burning sensation. She rates the pain as 7/10 at it worst. The patient states the pain sometimes interferes with her sexual activity. She has tried warm compresses, ibuprofen, and support bras with little improvement. Pt is on oral birth control pills and takes a daily vitamin.
Soc hx: Pt reports she sometimes eats nutritious meals, but due to her job and family obligations she does eat fast food frequently. Pt states she is an assistant accountant at a local accounting firm, which
adds to her stress especially at the end of each month and during tax season. She exercises 1-2 times/week by walking around the block. Sometimes the walking causes more pain in her breast. She drinks socially once or twice a month and has 1-2 glasses of wine at that time. She smokes 2 packs/day for last 22 yrs. She has tried to quit but has not been successful. Family history non-contributory.
Objective Info
Height 5’6” Wt 155 lbs; BMI 25; 140/78; HR-72/min
•
HEENT: Normocephalic, no lumps/lesions
•
Neck: supple without adenopathy , no thyromegaly.
•
Lungs: Eupneic, CTA-bilaterally
•
CV: RRR, no murmurs, rubs or extra sounds noted; 2+ peripheral pulses, no edema noted
•
Breast: Macromastia breasts are soft, fibrocystic changes bilaterally noted without masses, dimpling or discharge, no redness or inflammation noted.
Case 3
A 36-year-old Hispanic woman presents to the OB clinic for her Week 24 check-up, gravida 2 para 1. Patient is a full-time homemaker. Pt states she is doing well but is worried about her weight gain. Obstetric history includes a normal spontaneous vaginal delivery (NSVD) 31/2 yrs ago with a viable 9 lb male infant after a 10-hour labor. No complications during pregnancy, delivery or postpartum period. She denies allergies to food, drugs or the environment. Current meds include Prenatal vitamins 1/day and Fe 90 mg/day. Family history significant only for diet-controlled DM in paternal grandfather and an aunt and obesity in both mother and father.
Objective Info
Height 5’2” Wt 170 lbs; BMI 31.1; 140/84 (sitting); HR-92/min
•
HEENT: Normocephalic, no lumps/lesions
•
Neck: supple without adenopathy , no thyromegaly.
•
Lungs: Eupneic, CTA-bilaterally
•
CV: RRR, soft systolic murmur Grade II/VI, no rubs noted; 2+ peripheral pulses, no edema noted
•
Breast: Soft, fibrocystic changes bilaterally noted without masses, dimpling or discharge, no redness or inflammation noted. Breast self-exam reviewed
•
GU: Uterus at umbilicus-approximately 24 wks size and non-tender. FHT present with Doppler
Case 4
A 32-year-old African American woman presents to the clinic for her 24-week check-up. Pt states her morning sickness has resolved. However, she states she seems sad often and does not understand why, as she is happy about the pregnancy.
HPI: Pt is 24 weeks gestation. The patient is having sad moods at least once a day. She also states she is tired all the time, but figures that is just part of being pregnant, but has no energy and does not feel like doing her usual daily chores. She finds it difficult to go to work every day. This moodiness started about a week ago. She tried going to bed earlier but it did not seem to help. Taking 1 prenatal vitamin every day, No known drug, food, or environmental allergies. Family history is significant only for diet-controlled DM in paternal grandfather with onset in mid 40’s, Mother 58 yrs old is healthy; Father 60 yrs old with hx of DM with onset at age 45 and chronic depression which began in early 20s.
Objective Info
Height 5’4” Wt 147 lbs; BMI 25.2; 132/78 (sitting); HR-88/min
•
General: Appears well nourished, hair is in disarray, with flat affect
•
HEENT: Normocephalic, no lumps/lesions
•
Neck: supple without adenopathy , no thyromegaly.
•
Lungs: Eupneic, CTA-bilaterally
•
CV: RRR, soft systolic murmur Grade II/VI, no rubs noted; 2+ peripheral pulses, no edema noted
•
Breast: Soft, enlarged, fibrocystic changes bilaterally noted without masses, dimpling or discharge, no redness or inflammation noted. Breast self-exam reviewed
•
GU: Uterus at umbilicus- approximately 24 wks size and non-tender. FHT present with Doppler
NRNP 6552 Week 8 Case studies – A 32-year-old African American woman presents to the clinic for her 24-week check-up.
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