NRNP 6645: Psychopathology and Diagnostic Reasoning Essay
NRNP 6645: Psychopathology and Diagnostic Reasoning Essay
NRNP 6645: Psychopathology and Diagnostic Reasoning Essay
Week 2: Family Assessment
NRNP/PRAC 6645 Comprehensive Psychiatric
Evaluation Note Template
Medical professionals use health assessments as part of a comprehensive treatment strategy to pinpoint and prioritize a patient’s unique requirements. Before providing care, it is important to evaluate the patient thoroughly. Family therapy, often known as family counseling, is a type of talk therapy with the goal of improving family relationships and communication (McGoldrick & Hardy, 2019). As a result, it is crucial to listen to and weigh every member’s opinion while solving challenges. Examining the patient’s current symptoms can help doctors determine if family dynamics are affecting the patient’s health. In this paper, I will talk about family therapy and mental examination.
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Demographic data
Sharleen, Patti’s daughter, accompanied her mother on their visit to the clinic. The Iranian family relocated to the United States so that one of their daughters might receive treatment. Originally, Patti and her husband had moved to Iran without their three daughters. However, they eventually moved back to be with their family after Patti separated from him and he remarried. She is now crippled after two botched foot surgery.
CC (chief complaint): “My children are abandoning me.”
HPI: Patti, a patient referred for mental evaluation, arrived at the clinic with her daughter Sharleen. She has been complaining that she has no authority over her kids, that they are out of reach, that she is powerless to help them, and that they no longer need her. Patti and her daughters had a history of painful events, including their immigration from Iran to the United States, their experience with beating and family issues in Iran, and the sexual assault of Patti’s 3rd daughter by her father, who stayed behind. Since her daughter, who had been left, rejoined them again two years ago, she has told all of them about her experiences and how she blames Patti for the problems that have arisen in the family as a result. Both of Patti’s previous foot surgeries were unsuccessful, making her unable to work and adding to the stress and strain already present in the family. According to the family therapist, Patti was still adhering to her traditional ways, which worried her even more, given that in her culture, it is the younger generation’s responsibility to care for their elderly parents. Her offspring reported that this caused tension between them because they felt she should strike out on her own to make her own life, just as they are doing. Sharleen, Patti’s daughter, says that she attempts to visit her mother about six days a week, but Patti is either on the cell phone or in front of the TV, so they do not get to spend much quality time together. According to Patti, she only spends minimal time with her, which is disappointing.
A Review of the Psychiatric Past
Her psychological background is unknown.
Her past medical history should be noted but has not been explored.
Substance Current Use and History: No records exist of this kind.
Family psychiatric history: Patti and her family went to treatment for a total of two sessions before stopping, but Patti and Sharleen have been receiving treatment for the last year and a half.
Psychosocial History: Patti, a mother of five, was born and reared in Iran but moved to the United States so that her youngest kid might receive medical care. Her documented level of education is unknown; however, she identifies as Muslim and does not participate in religious activities because of her disabilities. She says that she enjoys playing phone games and hearing religious lectures. Her youngest son is 15, and he and she share a home, while her other children all live far away but pay frequent visits.
Her third child was left when the family immigrated, and her father later sexually molested her. The family has a long record of being battered and assaulted.
Medical History: A record of her previous medical history would be helpful, but it has not been mentioned.
ROS:
- GENERAL: She says she is not experiencing any symptoms, including a decreased appetite, headache, lethargy, weight fluctuations, chills, exhaustion, or sensitivity to heat or cold.
- HEENT: head- Refutes having suffered a concussion, dizziness, or a headache. Vision: Claims they have not experienced any problems with their eyes, including discharge, severe tears, blurred or double vision, or complete blindness. Hearing, balance, and tinnitus are all things she insists she does not have. Negates symptoms of stuffy nose, nosebleed, and rhinorrhea. Throat: She claims she has no trouble swallowing or that it hurts.
- SKIN: She claims she has not experienced any visible symptoms like rashes or itching.
- CARDIOVASCULAR: She claims she has no problems breathing, has no heart palpitations, and has no swelling or chest pain.
- RESPIRATORY: She insists she has no respiratory issues and has not been producing any phlegm.
- GASTROINTESTINAL: She claims she has not experienced any gastrointestinal issues, including sickness, diminished appetite, stomach pain, indigestion, throwing up, or irregular bowel movements.
- GENITOURINARY: She says she does not have any issues with micturition, including that it does not hurt or that it is too often or inconvenient, and she does not leak or have any vaginal discharge either.
- NEUROLOGICAL: She claims she is not experiencing any of the symptoms of blackouts, tingling, confusion, numbness, headaches, or ataxia, despite the fact that she has a handicap in both lower limbs.
- MUSCULOSKELETAL: She complains of discomfort in both of her feet but claims she has no other aches or pains.
- HEMATOLOGIC: She complains of discomfort in both feet but claims she has no other aches or pains.
- She claims she does not have anemia, bruise easily, or bleed easily.
- LYMPHATICS: She claims she does not have lymphadenopathy or that she had her spleen removed.
- ENDOCRINOLOGIC: She also claims she has not recently gained or lost weight or had any other unusual symptoms like polyuria, polyphagia, or hyperhidrosis (excessive sweating).
Physical exam: if applicable
In this case, a physical examination is unnecessary.
Diagnostic results:
Assessment
Mental Status Examination: Patti is a healthy, attractive woman with a strong figure and good hygiene. She is aware of her surroundings and can tell you the time and names of people. She has complete and fluent communication in the appropriate tone and volume, and she requires a mobility device since she is impaired in both lower limbs. She is attentive and makes appropriate eye contact during the evaluation, and her affect and mood are both typical. Her intelligence leaves an international impression, and her short- and long-term memories are both intact.
Differential Diagnoses:
Problems in Parent-Child Relationships
Problems in parent-child relationships, as defined by Phillips & Mychailyszyn. (2021) can arise at any stage of childhood development and are characterized by communication issues and difficulties resolving conflicts. Overprotection and parental pressure are the most common parental behaviors, and they can lead to disputes and even physical violence. Because of their parent’s actions, the youngster avoids them and may develop negative emotions like anger, sadness, or apathy.
Family Breakdown Caused by Divorce and Separation
Changes in family responsibilities brought on by divorce and separation can make children hostile and distant (Damota et al., 2019). This causes higher emotional instability and disturbance in the family’s mental health. Most of the patient’s family members were emotionally unstable, and her children had a history of withdrawing.
The Challenges of Acculturation
According to Bagasra & Mackinem (2019), acculturation issue is the struggle or incapacity to adjust to a new cultural or environmental context. Relocation and social transplantation can cause a number of problems, some of which are bias, prejudice, and discrimination. Patti, the case study patient, and her family emigrated to the United States from Iran, yet Patti has maintained many of her cultural practices and beliefs.
Case Formulation
Family problems have forced Patti and her daughter Sharleen into therapy for the past year and a half. Patti has been experiencing feelings of helplessness and hopelessness as well as a sense that her children are beyond her ability to influence, leading her and her family to seek treatment in family therapy. Her children, she says, should be able to help her because she is disabled and cannot work because that is what her society demands. Patti is sad because her kids are growing apart from her and want to strike out on their own.
Treatment Plan:
This family will be urged to keep doing their family counseling sessions, and other family members will be urged to participate in them as well in order to facilitate their healing. They will undergo counseling once a week. In addition, the third child will be reached and persuaded to attend counseling, given that she was the victim of sexual assault.
Reflections:
It is essential to take into account the perspectives of all people in a group or household when providing care. Healthcare providers should use the data gathered during family counseling to make an accurate diagnosis and formulate an effective treatment strategy. Having a family member with a mental disorder can cause tension and animosity between relatives. The goal of family counseling is to make sure that everyone in the family is happy and fulfilled. In order to deliver effective family therapy, medical professionals must first thoroughly evaluate the family unit as a whole, identifying its problematic and functional aspects.
References
Bagasra, A., & Mackinem, M. (2019). Assessing aspects of acculturation in an American Muslim sample: development and testing of the acculturation scale for Muslim Americans. Religions, 10(1), 26. https://doi.org/10.3390/rel10010026
Damota, M. D. (2019). The effect of divorce on family’s life. Academia Edu, 46. https://doi.org/10.7176/JCSD
Phillips, S., & Mychailyszyn, M. (2021). A review of Parent-Child Interaction Therapy (PCIT): Applications for youth anxiety. Children and Youth Services Review, 125, 105986. https://doi.org/10.1016/j.childyouth.2021.105986
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FAMILY ASSESSMENT
Assessment is as essential to family therapy as it is to individual therapy. Although families often present with one person identified as the “problem,” the assessment process will help you better understand family roles and determine whether the identified problem client is in fact the root of the family’s issues.
RESOURCES
Gehart, D. R. (2013, August 29). Progress noteLinks to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=CEB1vBObUqc
Masterswork Productions. (2003). Mother and daughter: A cultural taleLinks to an external site. [Video/DVD]. https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/watch/mother-and-daughter-a-cultural-tale
Sommers-Flanagan, J., & Sommers-Flanagan, R. (2013). Counseling and psychotherapy theories in context and practiceLinks to an external site. [Video]. https://waldenu.kanopy.com/video/counseling-and-psychotherapy-theories-contex
Family Systems Therapy (starts at 4 hours)
To prepare:
Review this week’s Learning Resources and reflect on the insights they provide on family assessment. Be sure to review the resource on psychotherapy genograms.
Download the Comprehensive Psychiatric Evaluation Note Template and review the requirements of the documentation. There is also an exemplar provided with detailed guidance and examples.
View the Mother and Daughter: A Cultural Tale video in the Learning Resources and consider how you might assess the family in the case study.
THE ASSIGNMENT
Document the following for the family in the video, using the Comprehensive Evaluation Note Template:
Masterswork Productions. (2003). Mother and daughter: A cultural taleLinks to an external site. [Video/DVD].
Chief complaint
History of present illness
Past psychiatric history
Substance use history
Family psychiatric/substance use history
Psychosocial history/Developmental history
Medical history
Review of systems (ROS)
Physical assessment (if applicable)
Mental status exam
Differential diagnosis—Include a minimum of three differential diagnoses and include how you derived each diagnosis in accordance with DSM-5-TR diagnostic criteria
Case formulation and treatment plan
Include a psychotherapy genogram for the family
Note: For any item you are unable to address from the video, explain how you would gather this information and why it is important for diagnosis and treatment planning.
