Sample Answer for NRNP 6645 Family Assessment Included After Question
Document the following for the family in the video, using the Comprehensive Evaluation Note Template:
- 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.
A Sample Answer For the Assignment: NRNP 6645 Family Assessment
Title: NRNP 6645 Family Assessment
CC (chief complaint): We are here for family therapy
HPI: Mother and daughter who are Iranian have come in for a therapy consultation due to various conflicts.The parent is a 40 years old a mother of five that consists of three daughters and two sons. The mother is an immigrant from Iran and she come only with four of her children and left the youngest girl in Iran at that time. The mother has come in with her 23 year old daughter for evaluation of trauma related issues that could have been caused by the husband the children’s father.
The mother is at the time struggling with trauma related issues due to her marriage and also she struggles with adjusting to the new culture of the United States (US) and the various involved norms of the country. The daughter reports that her struggles involve being raped by her father which has affected her and also the family in their relations with their father. Additionally, the mother wants to spend more time with her children while her children seek independence from her (Masterwork Productions, 2003).
Past Psychiatric History:
- General Statement: The mother has complaints of lonliness as well as depression and would like more time with her children who are at the time adults. However, the children would like to be more independent from their mother.
- Caregivers (if applicable): None as they are both adults and live indipendently
- Hospitalizations: The mother reports she has had several surgeries that included surgery on her feet. She has not been hospitalized for psychiatric reasons
- Medication trials: The mother and daughter have not engaged at any time in medication trials
- Psychotherapy or Previous Psychiatric Diagnosis: None that have been previously described (Masterwork Productions, 2003).
Substance Current Use and History: Mother and daughter do not report any previous or current use of substances (Masterwork Productions, 2003).
Family Psychiatric/Substance Use History: Mother and daughter also do not report any previous use of substances in the family or occurrence of psychiatric conditions (Masterwork Productions, 2003).
Psychosocial History: The involved patients are a mother and daughter who are Iranian whereby the daughter is 23 while the mother is 40 though without an educational history. This could be due to the mother being married at an early age of 16 which was arranged as the husband was chosen for her by the family. The mother reports that she has had 5 children with the man and that the husband has been physically and verbally abusive towards her. She currently lives at home with 2 of her youngest children. She reporsts complaints of depression though she is not aware if she has been officially diagnosed. She no longer lives with her abusive husband though he still tries to control her despite that (Masterwork Productions, 2003).
- Current Medications: No medications were reported in the therapy session.
- Allergies:No known food or drug allergies reported.
- Reproductive Hx:The mother has five children that consist of three girls aged 24,23 and 21 repectively as well as two boys aged 18 and 15. For the children it’s not yet determenide if they have their own. The mother at the time separated from her husband. The daughter who accompanied her for the session is married (Masterwork Productions, 2003).
- GENERAL: The mother reports tiredness as well as fatigue , she denieschills, night sweats and fevers.
- HEENT: The review of the head demonstrated no visible head injuries on either mother or daughter. They also denied blurred vision, ear pain, hearing problems or congestion in the nose. They did not report any throat problems such as trouble swallowing.
- SKIN: The were no reports of any skin issues.
- CARDIOVASCULAR: Both mother and child did not report any syncope, chest pain, palpitations or even edema.
- RESPIRATORY: There were no reports of a wheeze, diminished breath sounds, cough or even dyspnea that could occur once in a while due to depression or anxiety.
- GASTROINTESTINAL: There were no reports of anorexia, constipation, nausea, diarrhea or pain at the abdomen.
- GENITOURINARY: There were no reports of flank pain, hematuria, pain on urination or burning sensation while urinating.
- NEUROLOGICAL: There were no reports of dizziness, paralysis, headaches, ataxia, numbness or loss of bowel control.
- MUSCULOSKELETAL: The mother had surgery on her feet that were not as effective and left her disabled.
- HEMATOLOGIC: There were no reports of easily bleeding on minor bruises.
- LYMPHATICS: There was no history splenectomy.
- ENDOCRINOLOGIC: There was no polydipsia, polyuria or polyphagia reported (Masterwork Productions, 2003).
Physical exam: The physical exam is a relevant point of assessment in the various categories especially for the mother (Udey & Niranjan, 2020).
Vitals such as pulse rate, blood pressure (b.p) and oxygen saturation rate will be required. Also, height and weight of the mother in order to determine the BMI will also be required. These will be gathered using the various instruments such as b.p machine, oximeter, weight machine and a segmometer (Udey & Niranjan, 2020).
Also an ECG machine to identify the mother’s baseline EKG to determine the whether her heart is healthy will also be required (Udey & Niranjan, 2020).
Since the mother stated she could be depressed she will require to undergo a psychiatric exam through a tool such as the Beck’s Depression Inventory (Udey & Niranjan, 2020).
Diagnostic results: Additionally labworks and diagnostic tests may need to be performed to determine factors such as the mother’s CBC, CMP and TSH will need to be tested also she may need to undergo testing for infections through tests such as hep C and HIV/AIDS (Pesaran, 2021).
Mental Status Examination: Mother and daughter were cooperative while undergoing therapy.They maintained eye contacted and displayed appropriate feacila expressions to what was being discussed. They were also dressed accordingly to age, gender and situation. There were no noted psychomotor abnormalities and the mood was appropriate to the situation. Affect was also appropriate and displayed normal speech. In terms of though process it was tangential as well as logical while the mother’s thought content was hopeless and helpless. However, there were no indications of homicidal or suicidal ideations. Mother and daughter displayed good insight and they oriented as well as alert. Additionally, they both had good concentration and judgement (Masterwork Productions, 2003).
1. Post-Traumatic Stress Disorder (PTSD). This is the first likely diagnosis following the assessment of the 2 while they underwent therapy. PTSD develops after a distressing event. The patient was abused verbally and physically when she was married and lived with her spouse. DSM-V states that physical symptoms of PTSD, such as exhaustion or sleep difficulties, are present. Additionally, those who have this disease display stress-related behaviors like irritability. All of these symptoms are present in the patient, which makes a PTSD diagnosis more likely.
The patient did express feelings of depression and fatigue. The girl claimed that her mother can get very angry at times. The client meets the criteria for a PTSD diagnosis after analyzing the evidence. The diagnostic criteria involves persistent thoughts of a past event, negative emotional thoughts, extreme thoughts of fear, anger,guilt and horror. These clinical manifestations can be attributed from the abuse that was enacted by the mother’s husband (First et al., 2021).
2. Major Depressive Disorder (MDD): This is also another potential diagnosis especially in relation to the mother. The mother reports being depressed and lonely that could be attributed to that she is disabled and that her daughters are living far from her. The criteria to diagnose this condition constitutes of five symptoms of depression within 2 weeks and these clinical manifestations should include depressed mood or loss of interest in activities that used to bring about pleasure (First et al., 2021).
3. Persistent Depressive Disorder (PDD): The other differential diagnosis that could be for this patient is PDD, which is also referred to as dysthymia. PDD is a chronic but less severe type of depression. The cirteria to diagnose this condition involves a moderate version of common depression symptoms, such as hopelessness, low self-esteem, a general sense of inadequacy, anger, sadness and general unhappiness, as well as excessive tiredness or insomnia, slow activity, or indecision, describe this mood disorder. Depression, so the theory goes, can also happen after a painful event or occurrences. The information gathered in the video demonstrates that the mother may have this condition (First et al., 2021).
Case Formulation and Treatment Plan:
The case sis regarding a mother and five children as well as her ex-husband (Masterwork Productions, 2003).
Presenting problem: The mother is a 40-year-old immigrant from Iran to the US who at the time left her husband and the youngest daughter in Iran. While in the US she has been a single mother caring for her children though her daughters have grown up and moved out of the house now she’s left with her 2 youngest sons. She has also had two failed surgeries on her feet that have left her disabled that has affected her ablity to perform household chores.
Also she has become lonely frustrated and depressed as she complains her daughters do not spend as much time with her as she expects. The situation became somewhat worse when the youngest daughter came to the US and reported rape, verbal and emotional abuse from her father and blamed the mother for that(Masterwork Productions, 2003).
Predisposing factors: The trauma that the Mother experienced while she was a victim of abuse at home was a predisposing factor in her decision to immigrate to the United States. She underwent unsuccessful two-foot surgery after arriving in the US, leaving her unable to walk . She also struggled with depression and loneliness as her elder daughters tried to live independently, which made her predicament worse (Masterwork Productions, 2003).
Precipitating factors: Chaos in the family following the youngest daughter’s reunion with the family in the U.S. The youngest daughter said that her father had mistreated her emotionally, physically, and sexually, which caused instability in the family(Masterwork Productions, 2003).
Perpetuating factors: This is a result of her daughters’ ongoing disengagement from attempting to live their lives. She felt more isolated and depressed as a result(Masterwork Productions, 2003).
The first-line treatment for PTSD would involve serotonin-reuptake inhibitors. A low dose would initially be prescribed such as sertaline of about 50mg to be taken daily. Then it would be increased gradually increased to upto about 200mg daily depending on renal and hepatic functions. Additionally I would add anti-anxiety medications such as prazosin at a dose of 10 mg to be taken at night incase of nightmares. The prescription of other anti-depressants such as mirtazapine to be taken at night at a dose of 45 mg may also be required (IBM Micromedex, 2019).
Furthermore other interventions such as cognitive behavioural therapy would be required as part of the management. This has been established to have a positive impact in managing symptoms of PTSD. The patient may also need to undergo lifestyle changes such as adjustments to sleep, exercise and diet in order to support the rest of the PTSD treatment. Maintaing a routine can be quite beneficial in managing the clinical manifestations of PTSD(Boland et al., 2021).
Being a part of support groups can also be beneficial to patients with this condition as they can aid to normalize experiences and prevent isolation. Also, alternative therapies such as yoga and meditation can be helpful. Considering a support animal can also aid in the management of this condition (Boland et al., 2021).
The scenario, the topics covered for this task, and the range and variety of elements that distinguish each mental disease factor were all fascinating. Most people wrongly associate PTSD, a complicated condition, with veterans. Numerous neurotransmitters are involved in the development and persistence of PTSD. According to current estimates, dopamine and glutamate are this class’s biggest contributors. Additionally, the prefrontal cortex, or PFC, is thought to play a part in controlling the functioning of impulse control and attention. Elevated beta activity was observed in electroencephalography examinations (Boland et al., 2021).
There is a link between PTSD and complicated health issues across the lifespan. include conduct that, regardless of the results, can lead to high-risk behavior. Substance addiction, binge eating, obesity, inappropriate or dangerous sexual activity, etc. are some high-risk conducts that can be triggered by PTSD. Therefore, it is crucial to inform these patients of the value of healthy eating, exercise, and safe sex practices. In order to promote excellent health and impede diseases and complications, practitioners and patients alike may speak with this patient about healthy behaviors, wholesome meals, and exercise (Boland et al., 2021).
The confidentiality when applied has always been the front-runner in terms of ethical consequences. Today’s communities still stigmatize and make fun of those with mental illnesses. Therefore, it’s critical to uphold HIPPA regulations to the fullest extent allowed by the law. Finally, it is crucial to uphold the principles of fairness, beneficence, autonomy, and nonmaleficence both during and after interactions with patients. Every patient/provider interaction must take legal and ethical considerations into account. Patients and their loved ones must be provided with accurate and current information and given the choice to accept or reject care (Boland et al., 2021).
Daughter Daughter Daughter Son Son
To indicate divorced
Age is indicated inside the shapes.
“Mother and Daughter: A Cultural Tale.” , directed by Anonymous., Masterswork Productions, 2003. Alexander Street, https://video.alexanderstreet.com/watch/mother-and- daughter-a- cultural-tale.
Udey, B., & Niranjan, V. (2020). Physical illnesses among psychiatric inpatients in a tertiary care setup. Open Journal of Psychiatry & Allied Sciences, 11(1).
Pesaran, M. H. (2021). General diagnostic tests for cross-sectional dependence in panels. Empirical economics, 60(1), 13-50.
First, M. B., Gaebel, W., Maj, M., Stein, D. J., Kogan, C. S., Saunders, J. B., … & Reed, G. M. (2021). An organization‐and category‐level comparison of diagnostic requirements for mental disorders in ICD‐11 and DSM‐5. World Psychiatry, 20(1), 34-51.
Boland, R., Verdiun, M., & Ruiz, P. (2021). Kaplan & Sadock’s synopsis of psychiatry. Lippincott Williams & Wilkins.
Micromedex, I. B. M. (2019). DRUGDEX® [electronic version]. Truven Health Analytics GV, Colorado, USA.