| Course | NU 673 Psychiatric Mental Healthcare I |
|---|---|
| Unit | Unit 1 |
| Paper type | Presenting problem profile |
| Length | About 770 words, 5 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN Psychiatric Mental Health Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NU 673 Unit 1
Presenting Problem Profile for a Covering Colleague: A Mother Five Months Postpartum With Depression and Unwanted Thoughts of Harming Her Baby
Student Name
Department of Nursing, Herzing University
NU 673: Psychiatric Mental Healthcare I
Instructor Name
January 23, 2026
Presenting Problem Profile for a Covering Colleague: A Mother Five Months Postpartum With Depression and Unwanted Thoughts of Harming Her Baby
Why She Came Now
Ms. A. is a composite 34-year-old woman, a bank branch manager, married, with a five-month-old son, her first child, whom she is breastfeeding. She was seen for the first time on January 16 after self-referral. She came now, rather than at any point in the past three months, for two reasons: her maternity leave ends in ten days, and she could not imagine working; and her husband found her crying in the parked car in their garage two weeks ago, which frightened them both. She said she had been waiting for things to get better on their own.
The Story, in Her Sequence
The birth was uncomplicated. She felt tearful and overwhelmed in the first two weeks, which she attributed to lack of sleep. By two months, she was sleeping poorly even when the baby slept, had stopped enjoying anything, including time with her son, and felt she was failing as a mother. At about three months, she began having sudden, unwanted images of dropping the baby down the stairs or of harming him with a kitchen knife. She finds these thoughts horrifying, has never acted on them, and has started avoiding the stairs while carrying him and keeping knives out of sight. She has not told anyone about the thoughts except, at this visit, the nurse practitioner, and only after being asked directly. She denies thoughts of suicide but said, "Sometimes I think he'd be better off with a different mother."
What Has Been Ruled In and Out
Ruled in: a major depressive episode with onset in the postpartum period, supported by her history, an Edinburgh Postnatal Depression Scale score of 19 (Cox et al., 1987), and her examination. Also ruled in: intrusive, unwanted harm-related thoughts, recognized by her as her own and experienced as abhorrent, with avoidance and checking. Unwanted thoughts of harm to a newborn are common among new mothers, including many without a mental disorder, and are not the same as intent (Fairbrother & Woody, 2008).
Ruled out or unlikely: postpartum psychosis, since there are no hallucinations, delusions, confusion, or disorganization, and the thoughts are experienced as foreign rather than believed; bipolar disorder, since screening questions and her husband's account show no history of mania or hypomania; and postpartum thyroid dysfunction, with a normal TSH, 1.9 mIU/L, drawn on January 16. No substance use.
What Remains Uncertain
Whether the intrusive thoughts represent obsessive-compulsive symptoms that will need their own treatment, or will fade as the depression lifts, is not yet clear. Whether the passive thought that her son would be better off with a different mother reflects growing hopelessness is being watched closely; it is not, at present, accompanied by any thought of harming herself or plan.
Current Plan
Sertraline was started at 25 mg daily on January 16, increasing to 50 mg on January 23, chosen partly because it is compatible with breastfeeding. Weekly visits for the first month. Referral to a perinatal therapist for cognitive behavioral therapy, with a first appointment on January 30. A safety plan is in place, reviewed with her and, with her consent, her husband, who is aware of the depression and the intrusive thoughts and was reassured that they are not a sign she will act. Her obstetric clinician has been informed, consistent with current guidance on managing perinatal mental health conditions across care settings (American College of Obstetricians and Gynecologists [ACOG], 2023). Leave: she will ask her employer for a two-week extension; a letter was provided.
What a Covering Colleague Must Know
First, the intrusive harm thoughts are unwanted and distressing to her, she avoids situations to prevent them, and she has no intent. Treating them as evidence of risk to the baby, including an unnecessary report to child protective services, would be a serious error that could end her willingness to disclose them. The features that would change this assessment are thoughts she experiences as justified or commanded, beliefs about the baby that she holds as true, confusion, or any statement of intent; any of these requires same-day evaluation for postpartum psychosis.
Second, she is breastfeeding; any medication change should take this into account.
Third, contacts: her husband, Tom, is her named support and can be reached at the number in the chart; she has agreed that he may be called if she cannot be reached.
Fourth, if she calls in distress, ask directly about thoughts of suicide and about the passive thought regarding her son, since those are the items being watched.
References
American College of Obstetricians and Gynecologists. (2023). Screening and diagnosis of mental health conditions during pregnancy and postpartum (Clinical Practice Guideline No. 4). Obstetrics & Gynecology, 141(6), 1232-1261. https://doi.org/10.1097/AOG.0000000000005200
Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150(6), 782-786. https://doi.org/10.1192/bjp.150.6.782
Fairbrother, N., & Woody, S. R. (2008). New mothers' thoughts of harm related to the newborn. Archives of Women's Mental Health, 11(3), 221-229. https://doi.org/10.1007/s00737-008-0016-7
NU 673 Unit 1 instructions, in plain terms
Unit 1 asks you to write a presenting problem profile that another clinician could use to take over care. Expect to explain why the patient came now, tell the history in a clear sequence, state what has been ruled in and out, name what remains uncertain, summarize the current plan and highlight what a covering colleague must know. Many versions ask whether the profile should commit to a diagnosis; usually it should state a working diagnosis and its uncertainties. Check whether your section allows a patient from your clinical hours, de-identified. Write for a busy reader who needs the most important facts first. Safety-related distinctions, such as intrusive thoughts versus intent, belong near the top so nobody misreads them in a hurry.
Inside the NU 673 Unit 1 example
The profile opens with why she came now, which frames everything after it. The history follows her sequence from birth through the first weeks and the months since, so the reader can see how symptoms developed. The ruled in and out section is brief and evidence-based, citing the Edinburgh score and the interview. The uncertainty section names the open question about obsessive-compulsive symptoms and how it will be watched. The plan section gives medication, dose, start date and the reason for the choice. The final section is the most important for a colleague: it explains that the harm thoughts are ego-dystonic and avoided, which distinguishes them from psychotic or intended harm, and lists who to contact if anything changes.
Where the points sit in the NU 673 Unit 1 rubric
Herzing's rubric for a presenting problem profile usually covers clarity of the reason for presentation, the history, diagnostic reasoning, acknowledgment of uncertainty, the plan and usefulness for handoff. Usefulness for handoff carries a large share, because graders read the profile as a covering colleague would and look for the safety-critical facts first. History points reward a clear sequence with relevant detail. Diagnostic reasoning criteria look for evidence for what is ruled in and out. Uncertainty earns credit when the open question is named with a plan to resolve it. Plan points go to specific medication, dose and rationale. ACOG's 2023 clinical practice guideline and Cox's Edinburgh scale paper belong in the APA 7 list.
Common NU 673 Unit 1 mistakes, and how to avoid them
Presenting problem profiles in Unit 1 tend to lose credit when they bury the safety-critical distinction deep in the history. Another frequent problem is a history told in the order the clinician gathered it rather than the order it happened. Students often state a diagnosis without the evidence behind it. Uncertainty is hidden, which can mislead the covering clinician. The plan lacks doses or dates. Breastfeeding status is left out, though it shapes medication choice. The profile runs long with detail a colleague does not need. Finally, end with what a covering colleague must know, because graders judge the profile by whether someone unfamiliar with the patient could act safely after reading it.
Get a NU 673 Unit 1 example written to your instructions
Send the Unit 1 instructions and the rubric from your NU 673 classroom, and note the setting the profile should sit in. We write a custom example built around the reason for the visit, with history in the person's own order, uncertainty stated openly, and a plan naming who does what before the next appointment. First custom sample free, returned in 24 to 48 hours.
More NU 673 papers and PMHNP samples
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- NU 673 Unit 3: Psychoeducation session outline
- NU 673 Unit 4: Consent and confidentiality brief
- NU 673 Unit 5: Medication and cognition review
- NU 673 Unit 6: Follow-up interval rationale
- NU 673 Unit 7: Interdisciplinary consultation note
- NU 673 Unit 8: Serial encounter record
- NU 672 Unit 1: Therapeutic modality comparison
- NU 674 Unit 1: Service disagreement resolution record
- NU 670 Unit 1: Receptor activity brief
- NU 671 Unit 1: Annotated intake interview
NU 673 Unit 1 questions, answered
Can I write up a patient from my clinical hours?
No, and this matters more here than almost anywhere. Build a composite from features that recur across many people, state in the document that it is composite and de-identified, and keep anything specific to a real encounter inside the setting where it happened. Notes, dates and identifiers from a placement belong in that record system, not in a file you submit or share.
How much detail belongs in the history?
Enough for the reasoning to be followed and no more. A profile is judged on whether a colleague could act on it, so detail that changes nothing tends to bury the detail that changes everything. Where a fact would alter the plan, keep it and say why; where it would not, a phrase is usually sufficient and the rubric rarely rewards volume.
Should the profile commit to a diagnosis?
Say what the encounter supports, what it does not yet support, and what would settle the question, which is what a first clinical course generally expects. A profile stating a firm diagnosis on thin evidence loses more than one admitting uncertainty. Where the referral arrived with a label attached, treat it as information to be tested rather than as a starting point.
Where can I find a free NU 673 Unit 1 sample paper?
The full NU 673 Unit 1 postpartum profile is free on this page, from why she came now to what a covering colleague must know. A profile for a different presentation can be written on request.
Are intrusive thoughts of harming a baby dangerous?
Unwanted, distressing thoughts that a mother avoids acting on are common in postpartum depression and anxiety and differ from intent or psychosis. This sample explains that distinction for a covering clinician and lists signs that would change the assessment.