Question: You are the nurse assigned to see Jennifer (she/her), a 28-year-old primiparous woman...

Case Study 1: Jennifer 

You are the nurse assigned to see Jennifer (she/her), a 28-year-old primiparous woman, who delivered a healthy baby boy named Ethan six weeks ago for her postnatal check-up.  

When reviewing the patients’ charts you identify that Ethan weighed 3.22 kg (7lbs, 10 oz) after a 16-hour labour. The labour went well without complications. Jennifer received epidural anesthesia at 6-cm dilatation, and the baby was delivered vaginally. Her partner, John, provided labour support and was present for the delivery. At discharge, the infant was breastfeeding, had normal newborn examination findings, and weighed 3.40 kg (7lbs, 5oz). You note that both parents prepared for the birth by attending childbirth classes and reading several books about infant development and parenting.  Jennifer planned to take a 12-month parental leave from her position as a lawyer in a large practice and had arranged for a childcare provider to come to the family’s home to take care of the infant beginning 2 weeks before the end of her parental leave. John had not planned to take time off from his job because he had recently been promoted to a high-level managerial position in his company that required increased travel and time at work. He was able to postpone a business trip to be present at the delivery.  

You note that during Jennifer’s last visit, she reports she is breastfeeding, and that Ethan is feeding well with a weight of 8lbs 10oz, and without any concerns identified.  Ethan’s circumcision was healing without complications.  

Jennifer and Ethan are in clinic today to complete their postpartum and 6-week well baby visit.  This visit includes an infant assessment discussing feeding, development and care activities, and Jennifer’s adaptation to motherhood including her postpartum recovery.  When discussing Jennifer’s postpartum recovery and coping, Jennifer reports that she is feeling well physically and has mostly resumed normal activity and no longer experiencing any spotting.  Jennifer does state that she is frequently feeling irritated and sad, having difficulty sleeping even when the baby is asleep, feeling fatigued, and being worried about how she would be able juggle everything when she goes back to work.  She reports feeling “overwhelmed” with being a new parent and that her mother has recently been staying with her while John is out of town on business.  Although she reports she enjoys her mother’s company, she does report that she is feeling inadequate “my mother could do everything so easily.  I fumble with every diaper.  It feels like she criticizes how I do things.  When she told me about what she did when she had children, I felt pushed to do things ‘her way’ and not the way that I had planned.  At least Ethan is feeding well and gaining weight making me feel like I’m not a total failure.”  

After weighing Ethan (10lbs 2oz), you discuss Ethan’s development and plan his next visit where he is to receive his first series of vaccinations. Jennifer expresses hesitancy and concerns regarding immunizing her newborn.  She has read various opinions on social media and heard conflicting information from friends and family members.  Jennifer is unsure about the benefits and risks associated with vaccinations and is seeking more information before deciding on a plan of care. 

Case Study 2: Isabella

Isabella (she/her) is a 17-year-old high school student who does well in school, participates on both the basketball and track teams and has an after-school job at a local grocery store.  She is outgoing and likes to spend time hanging out with her friends in her social circle but hesitates to share personal details with them about her relationship with her boyfriend, Justin (he/him).  

About a week ago, Isabella started to experience occasional abdominal discomfort, pain with urination, bleeding between periods, and increased vaginal discharge.  She mentioned her symptoms to her mother, and they discussed that she should visit the sexual health clinic.  Her mother is aware of her sexual health history and has been open and supportive of her.  Isabella asks her mother to drive her to into the sexual health clinic this afternoon.     

Upon assessment with the sexual health nurse, Isabella reports that she has recently become sexually active with her partner after 3 months of dating.  Isabella and her partner occasionally use condoms and when they are not available, they practice the withdrawal method of birth control. She is unsure of her partners past sexual health history and doesn’t know if he is currently having any symptoms.  

Isabella also reports that she isn’t exactly sure when her last known period was but “thinks it was about a week ago?”  Isabelle and her partner haven’t been sexually active since that time.  Isabella tells the nurse that she has no underlying health concerns but does identify that there is a family history of “breast cancer on her mom’s side.”  She discloses that she does vape approximately one 20 mg pod daily and reports occasionally using alcohol and cannabis “on weekends with my friends and Justin.”  She reports that her mom doesn’t know that she vapes and that she isn’t interested in quitting.  She does exercise frequently (participation on the basketball and track team) and eats well (about 2-3 meals a day and regularly snacks).  She tells the nurse that she hasn’t been getting much sleep lately as she has “been staying up late on her phone searching all the symptoms that I’m having.  I am panicking that something is wrong with me.  I haven’t been able to focus on anything else this week including school.  I also called in sick to my job today.” 

1006 Case Study: Middle-Aged Adult

Iris Guzman is a 45-year-old woman who is the Director of Human Resources at a large local hospital. Iris works around 60 hours a week and spends most of her day in meetings or doing work on her computer. Due to the ongoing shortage of hospital staff, Iris reports that her stress levels are high as she tries to support new staff recruitment while also focusing on retaining current staff and ensuring patient care is of high quality. Additionally, as one of the senior leadership members at the hospital, Iris is expected to be “on-call” to management staff in case of emergencies that occur after hours. 

Outside of work, Iris lives at home with her husband Gary, her 13-year-old son named Gus and a 10-year-old daughter named Sarah. Gary is a teacher at a school 30 minutes from their house. Gus and Sarah have just started being able to walk themselves to and from school but have many after-school activities that they need to be driven to by one of their parents. While Gary and Iris’s parents are both alive, they do not live in the same town and do not see each other frequently. Gus and Sarah have historically gotten along very well but lately, have been arguing a lot, creating a tense environment at home.  

Iris reports that she and Gary generally have a good relationship but that their stress levels are quite high whenever one of the kids gets sick because it is hard for either of them to leave work to pick their kids up or work from home on sick days. Iris states she feels guilty about arguing with Gary about who should stay home and look after the kids and is worried that she is a “bad mom” because she is always working so much. 

At her last health checkup, Iris was surprised to learn that her BMI is 25.5 and that her blood pressure was 140/90. Her blood work showed elevated blood sugar levels. Iris has a family history of Type 2 diabetes and cardiovascular disease. Iris states she feels healthy but that with her busy schedule, she often skips breakfast, grabs something quick from the workplace Tim Horton’s for lunch and then throws something frozen from the grocery store (pizza, chicken fingers, etc.) in the oven for dinner. Iris jokingly calls herself a “caffeine monster” and reports drinking 5-6 coffees each day. She has noted that she has been having a harder time falling asleep at night and then once she is asleep, wakes up one- or two-times each night to urinate. Iris estimates she gets about 6 hours of sleep each night. 

As part of her New Year’s resolution to get healthier, Iris was thinking about joining a neighborhood walking group but feels intimidated that all the other walkers seem to look “very fit” and know each other quite well. Iris admits she is too tired to exercise after a long day at work and just wants to lay on the couch and watch Netflix to decompress. 

Case Study 4

Patient Profile: Name: Mr. Harold Johnson 

Age: 78 

Medical History: Hypertension, Type 2 Diabetes (controlled with medication), Osteoarthritis (affecting knees and hands) 

Recent Loss: Mrs. Johnson (wife) passed away three months ago after a two-year battle with pancreatic cancer.

Presenting Issues: Mr. Johnson has been struggling to cope with the recent loss of his wife, who was his primary caregiver. They lived in a modest two-story house, and Mrs. Johnson managed most of the household duties. Since her passing, Mr. Johnson has been managing poorly at home.

Mr. Johnson and his wife were married for 54 years, and her death has left him with profound grief and a sense of emptiness. The couple did not have children, and Mr. Johnson's limited social circle has further isolated him. Most of his social activities included his wife’s friends and he now feels uncomfortable reaching out to these groups. He has been having trouble sleeping, often waking up in the middle of the night and feeling overwhelmed by loneliness.

Hypertension and Type 2 Diabetes have been relatively well-controlled, but the recent emotional stress has led to fluctuations in blood pressure and occasional forgetfulness in taking medications. Osteoarthritis has significantly impacted his mobility, making it challenging for him to climb stairs and perform basic tasks like cooking and cleaning.

Mild cognitive impairment is evident, as Mr. Johnson has difficulty concentrating and tends to forget recent events or conversations.

He has not been managing the household bills effectively, leading to overdue payments and increased financial stress.

The house has become increasingly difficult for Mr. Johnson to navigate, especially the stairs, which pose a fall risk. He has fallen a few times in the last few weeks, but has been able to get up on this own.

The lack of emotional support at home exacerbates feelings of loneliness and despair.

The home environment lacks adaptive equipment to assist with mobility and safety, such as handrails and ramps.

Mr. Johnson is experiencing difficulties in properly maintaining his diet due to physical limitations, leading to weight loss and nutritional concerns. He has lost 20lbs in the last 3 months (current weight is 135lbs and his height is 5’11’). He says that he misses his wife’s cooking and that it is very discouraging to cook for only one person.