DNP 645 Module 4 Heavy Menstrual Bleeding Case Study Example

Course	DNP 645 Management of Common Problems in Pediatric Primary Care
Module	Module 4
Paper type	Hosted case study thread (host case, differential table and management plan)
Length	About 528 words
Format	Discussion post with APA 7 citations
School	Arizona State University
Program	Doctor of Nursing Practice
Updated	October 2026

Free sample paper for DNP 645 Module 4

Case Study 4: Soaking Through at School

Soaking Through at School: A Hosted Case Study on Heavy Menstrual Bleeding and a Possible Bleeding Disorder in a 14-Year-Old

Host Post: The Case

K., a 14-year-old, comes with her mother because her periods are "too heavy." Menarche was at 12. Periods come every 24 to 35 days and last 8 days; on the first three days she changes a pad every hour, sometimes doubles up at night and has missed school twice this year. She is tired climbing stairs. She is pale, with a heart rate of 96 and normal blood pressure.

Subjective Questions and Host Answers

Asked privately: sexually active? No. Nosebleeds lasting more than 10 minutes, easy bruising or bleeding after dental work? Frequent nosebleeds and long bleeding after a tooth extraction. Family history? Her mother also has heavy periods and needed a transfusion after childbirth. Medications? Occasional ibuprofen. Weight change, acne or excess hair? No.

Differential Diagnosis Table

Diagnosis weighed	Present in this case	Absent from this case
von Willebrand disease	Heavy periods since menarche, nosebleeds, dental bleeding, mother with heavy periods and postpartum hemorrhage	Laboratory confirmation pending
Anovulatory bleeding (immature axis)	Two years after menarche	Cycles are fairly regular; bleeding history points elsewhere
Polycystic ovary syndrome	Adolescent with bleeding concern	Irregular cycles, acne, hirsutism, weight gain
Platelet function disorder	Mucocutaneous bleeding, family pattern	Testing pending; less common than von Willebrand disease
Pregnancy-related bleeding	Adolescent with bleeding	Not sexually active; pregnancy test to confirm

What this page is doingThe table puts a bleeding disorder first because of the bleeding history and family pattern, the details that the confidential subjective questions brought out.

Management Plan

Most probable diagnosis: heavy menstrual bleeding with suspected von Willebrand disease and likely iron deficiency.

Testing: Anovulatory cycles are common in the first years after menarche (Kliegman et al., 2024), but her bleeding history calls for more than reassurance. Order a complete blood count, ferritin and a urine pregnancy test. Initial screening for von Willebrand disease includes von Willebrand factor antigen, activity and factor VIII levels, ideally drawn before hormonal treatment begins, since estrogen raises these levels; refer to hematology for interpretation (James et al., 2021). Adolescents with heavy bleeding since menarche should be screened for a bleeding disorder (American College of Obstetricians and Gynecologists, 2019).

Treatment: For acute heavy days, tranexamic acid during menstruation reduces blood loss and does not contain hormones. Combined hormonal contraception or a levonorgestrel intrauterine device also reduces bleeding and can be used once testing is drawn. Avoid ibuprofen until a bleeding disorder is excluded. Start oral iron if ferritin is low, taken every other day or daily with vitamin C.

Supporting article: The ASH, ISTH, NHF and WFH guideline on the diagnosis of von Willebrand disease reviews the evidence for testing and supports specialist evaluation when the bleeding score or history is abnormal (James et al., 2021).

Anticipatory guidance: Track periods with an app or calendar that records pad changes. Explain that heavy periods are not normal and are treatable. Provide a school plan for bathroom access and supplies.

Family websites: Center for Young Women's Health at Boston Children's Hospital and the National Bleeding Disorders Foundation patient pages.

Follow-up: Review results within one week; recheck hemoglobin and ferritin in 6 to 8 weeks. Go to the emergency department for soaking more than one pad an hour for several hours, dizziness or fainting.

What this page is doingThe plan orders testing before hormones, names a nonhormonal option, removes an NSAID that could worsen bleeding and treats the iron deficiency, which reflects the care sequence the ACOG opinion recommends for adolescents.

References

American College of Obstetricians and Gynecologists. (2019). Screening and management of bleeding disorders in adolescents with heavy menstrual bleeding: ACOG committee opinion, number 785. Obstetrics & Gynecology, 134(3), e71-e83. https://doi.org/10.1097/AOG.0000000000003411

James, P. D., Connell, N. T., Ameer, B., Di Paola, J., Eikenboom, J., Giraud, N., Haberichter, S., Jacobs-Pratt, V., Konkle, B., McLintock, C., McRae, S., Montgomery, R. R., O'Donnell, J. S., Scappe, N., Sidonio, R., Flood, V. H., Husainat, N., Kalot, M. A., & Mustafa, R. A. (2021). ASH ISTH NHF WFH 2021 guidelines on the diagnosis of von Willebrand disease. Blood Advances, 5(1), 280-300. https://doi.org/10.1182/bloodadvances.2020003265

Kliegman, R. M., St. Geme, J. W., Blum, N. J., Tasker, R. C., Wilson, K. M., Schuh, A. M., & Mack, C. L. (Eds.). (2024). Nelson textbook of pediatrics (22nd ed.). Elsevier.

DNP 645 Module 4 instructions, in plain terms

Week 10 of DNP 645 covers reproductive disorders, and the fourth hosted case runs all week. Each pair has one job: the hosts present the case and field questions, the question askers fill in the history in the first two days, the differential pair builds its table of five possibilities around which details each explains, and the plan pair posts testing, treatment, a high-level article as a PDF, guidance, websites and follow-up. Discussion then continues toward a confirmed diagnosis. Adolescent reproductive cases add two features to watch: questions about sexual activity belong in a confidential conversation, and some tests must be drawn before treatment starts or they lose their value.

Inside the DNP 645 Module 4 example

In thread order, the sample opens with the host's case: cycle length, duration, pad changes, missed school and signs of anemia. The subjective section shows questions asked privately and the answers that reveal a bleeding history and a family pattern. The differential table weighs von Willebrand disease against anovulatory bleeding, polycystic ovary syndrome, a platelet function disorder and pregnancy, marking what each has and lacks. The management plan orders testing in the right sequence, before hormones, offers hormonal and nonhormonal treatment, stops ibuprofen, treats iron deficiency, cites the international von Willebrand guideline and ACOG's opinion and adds tracking, a school plan, websites and follow-up with emergency criteria.

Reading the DNP 645 Module 4 grading rubric

Case Study 4 earns up to 10 points under the Canvas rubric. In adolescent reproductive cases, faculty generally look for a confidential approach to the history, a differential that includes a bleeding disorder or endocrine cause alongside common explanations, testing sequenced so results stay interpretable, a plan with both hormonal and nonhormonal options, treatment of complications such as anemia and follow-up with clear emergency criteria. Recommending a medication that could worsen bleeding before a disorder is excluded is a common deduction. The supporting article should match the decision the plan makes. Engagement through the week matters too, so check back after your role post and answer questions about it.

DNP 645 Module 4 help: mistakes that cost marks

Many plans for heavy menstrual bleeding start hormones at the first visit, which can mask the very condition the history suggests. Draw the tests first and say so. Another weakness is overlooking iron deficiency, which often explains the fatigue and needs its own treatment and recheck. Ask about bleeding beyond the menses, such as nosebleeds and dental bleeding, and about family history. Give a nonhormonal option for families who prefer one. Write the iron instructions so a parent could follow them at home. Ask the sexual history privately. For a second review of your role post, send the desk the case as the host posted it. In the table, use the family history and the timing of onset as case details, since they separate a bleeding disorder from anovulation.

Write yours, or have the desk draft it

This paper is an original model document written by our desk, not a submitted student paper and not an official Arizona State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.

More DNP 645 and Doctor of Nursing Practice sample papers

DNP 645 Module 4 questions, answered

Where can I find a free DNP 645 Module 4 sample paper?

A complete DNP 645 Module 4 sample is posted here: a hosted reproductive case study on heavy menstrual bleeding and possible von Willebrand disease in a 14-year-old.

When should a teen with heavy periods be tested for a bleeding disorder?

When heavy bleeding started at menarche or comes with nosebleeds, easy bruising, bleeding after procedures or a family history of bleeding.

Why draw von Willebrand tests before starting birth control?

Estrogen raises von Willebrand factor and factor VIII levels, which can make the tests look normal in someone who has the disorder.

What treats heavy periods without hormones?

Tranexamic acid taken during menstruation reduces blood loss and can be used alone or with hormonal treatment.

What does Week 10 of DNP 645 cover?

Reproductive disorders, with Case Study 4 running all week and Quiz 9 due.

DNP 645 Module 4 Case Study 4: Reproductive Disorders (Heavy Menstrual Bleeding in an Adolescent) Example