Week 2: Assignment: Family Assessment
College of Nursing-PMHNP, Walden University
NRNP 6645: Psychotherapy with Multiple Modalities
Subjective:
CC (chief complaint): Mother: “I feel depressed, I cannot move, I need my kids to come and visit me, spend a night with me. I cannot move, I need them to come and visit me, spend time with me”. Daughter: “She makes her own plans for me, she expects me to like to go with her and spend time with her because she is bored. I have too much to do, I can’t unwind your boredness, find something else to do, but I have plans.”
HPI: The is a family section about a 40 years old Iranian mother, and her 23 years old daughter who came in due to family and cultural conflit they have at home. The mother came to United State 12 years ago with her four children and left one of her daughter with her husband, which was later brought to United State two years ago. She is now 21. The mother currently lives with her two boys and others have moved out of the house. The mother has a conflit with her 23 years old daughter and other children. She feel she doesn’t come to spend time with her at home because she is bored. She feels hopeless and thinks that her children are out of control. She feels that they don’t do enough for her. The 23 years old daughter feels that their mom is trying to control their life by making her own plans for her, and expect her to come over and stay with her because she gets bored alone. The mother feels depressed and she cannot move due to her past surgeries on legs and feels they don’t do enough for her. The daughter feels that their mother still lives the Iranian culture and that she need to understand that they are in American now. She feel like their mother keep asking for more, even when she try to do as much as she can to please her mother.
Past Psychiatric History:
• General Statement: Both patient seeked counselling due to family conflict at home and also mother’s depression.
• Caregivers (if applicable): None for both
• Hospitalizations: None
• Medication trials: N/A
• Psychotherapy or Previous Psychiatric Diagnosis: None
Substance Current Use and History: None
Family Psychiatric/Substance Use History: No history of substance use, or psychiatric history. Though her husband was abusive to her third daughter both sexually and physically.
Psychosocial History:
This is a 40 years old Iranian female and her 24 years old daughter. The mother was born in Iran and moved to United states with her 4 children, and later reunite with the other daughter in United States. She has 3 girls (24,23,and 21) and 2 boys (18,and 15). She had an arranged marriage at the age of 14. She currently lives with her 2 boys and the other children have moved out of the house. She has no educational background. She used to work s a caregive, but she is currently disable. She used to love to go shopping at the mall after she get off work. There is no legal history, but she mentioned how her husband used to physically and verbally abuse her and her children when she was living with him in Iran. Her 3rd daughter blames the mother for abandoning her in Iran with her father that physicalland sexually abused her.
Medical History: Two leg surgeries, and obese
• Current Medications: Non mentioned
• Allergies: NKA reported
• Reproductive Hx: The mother has five children. 3 daughters and 2 sons. Currently married to her husband, but have not seen each other since she moved to United States.
Review of System:
General: Mother was complaining about fatigue, weakness, and pains on her legs.
HEENT: Negative head trauma, no visual loss or blurred vision. No hearing loss. Negative nose bleed or runny nose. No sore throat.
Respiratory: No shortness of breath or cough.
Cardiovascular: No chestpain or chest discomfort.
Musculoskeletal: Leg pain and wekness reported.
Psychiatric: Mother reports depression.
Skin: Negative skin rash or itches.
Objective:
Physical Assessment:
Respiratory: No SOB noted
Skin: No skin rash noted. Appropriate color for their ethnicity.
Psychiatric: Adequate mood and good sense of humor from mother. No Hallucination noted
Vitals: No Vitals information provided.
Diagnostic results: No lab or screening tool used.
Assessment:
Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudo hallucinations, illusions, etc.), cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements— He is an 8 yo African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking. He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.
Differential Diagnoses:
Major depressive disorder
Adjustment Disorder
PTSD
You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case.
Reflections: . Reflect on this case and discuss whether or not you agree with your preceptor’s treatment of the patient and why or why not. What did you learn from this case? What would you do differently?
Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc).
References
You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.
Week 2: Assignment: Family Assessment
College of Nursing-PMHNP, Walden University
NRNP 6645: Psychotherapy with Multiple Modalities
Subjective:
CC (chief complaint): Mother: “I feel depressed, I cannot move, I need my kids to come and visit me, spend a night with me. I cannot move, I need them to come and visit me, spend time with me”. Daughter: “She makes her plans for me, she expects me to like to go with her and spend time with her because she is bored. I have too much to do, I can’t unwind your boredness, find something else to do, but I have plans.”
HPI: This is a family section about a 40 years old Iranian mother and her 23 years old daughter who came in due to family and cultural conflicts they have at home. The mother came to United State 12 years ago with her four children and left one of her daughters with her husband, which was later brought to the United State two years ago. She is now 21. The mother currently lives with her two boys and others have moved out of the house. The mother has a conflict with her 23 years old daughter and other children. She feels she doesn’t come to spend time with her at home because she is bored. She feels hopeless and thinks that her children are out of control. She feels that they don’t do enough for her. The 23 years old daughter feels that their mom is trying to control their life by making plans for her, and expects her to come over and stay with her because she gets bored alone. The mother feels depressed and cannot move due to her past surgeries on her legs and feels they don’t do enough for her. The daughter feels that their mother still lives the Iranian culture and that she needs to understand that they are in America now. She feels like their mother keeps asking for more, even when she tries to do as much as she can to please her mother.
Past Psychiatric History:
- General Statement: Both patient and duaghther sought counselling due to family conflict at home and also due to mother’s depression.
- Caregivers (if applicable): None for both
- Hospitalizations: None
- Medication trials: N/A
- Psychotherapy or Previous Psychiatric Diagnosis: None
Substance Current Use and History: None
Family Psychiatric/Substance Use History: No history of substance use, or psychiatric history. Though her husband was abusive to her third daughter both sexually and physically.
Psychosocial History:
This is a 40 years old Iranian female and her 23-year-old daughter. The mother was born in Iran and moved to United States with her 4 children, and later reuniteD with the other daughter in United States. She has 3 girls (24,23,and 21) and 2 boys (18,and 15). She had an arranged marriage at the age of 14. She currently lives with her 2 boys and the other children have moved out of the house. She has no educational background. She used to work as a caregive, but she is currently disabled. She used to love to go shopping at the mall after she get off work. There is no legal history, but she mentioned how her husband used to physically and verbally abuse her and her children when she was living with him in Iran. Her 3rd daughter blames the mother for abandoning her in Iran with her father that physically, and sexually abused her.
Medical History: Two leg surgeries, and obese
- Current Medications: Non mentioned
- Allergies: NKA reported
- Reproductive Hx: The mother has five children. 3 daughters and 2 sons. Currently married to her husband, but have not seen each other since she moved to United States.
Review of System:
General: Mother was complaining about fatigue, weakness, and pains on her legs.
HEENT: Negative head trauma, no visual loss or blurred vision. No hearing loss. Negative nose bleed or runny nose. No sore throat.
Respiratory: No shortness of breath or cough.
Cardiovascular: No chestpain or chest discomfort.
Musculoskeletal: Leg pain and weakness reported.
Psychiatric: Mother reports depression.
Skin: Negative for skin rash or itches.
Objective:
Physical Assessment:
Respiratory: No SOB noted
Skin: No skin rash noted. Appropriate color for their ethnicity.
Psychiatric: Adequate mood and good sense of humor from mother. No Hallucination noted
Vitals: No Vitals information provided.
Diagnostic results: No lab or screening tool used.
Assessment:
Mental Status Examination:
The 40-year-old female patient appears her age. She is well dressed for the weather and occasion. The patient has a logical and coherent speech. She is oriented to place and time. The patient uses appropriate facial expressions and body movements that align with the content that she is communicating. The patient claims that she is depressed and feels hopeless. She however denies any suicidal ideations or hallucinations.
Differential Diagnoses:
Based on the patient’s clinical manifestation and history, the differential diagnosis would be a major depressive disorder, adjustment disorder, and post-traumatic stress disorder.
Major depressive disorder
The priority differential diagnosis is a major depressive disorder. Major depressive disorder refers is a psychiatric condition that is characterized by low energy levels, depressed mood, poor sleep patterns, poor concentration, loss of interest in previously pleasurable activities, and poor feeding habits (American Psychiatric Association, 2013). The patient confirms that she has been depressed due to the conflicts in her family especially a few months after her 23-year-old traveled to the US from Iran. She claims that her daughter has been blaming her for the physical and sexual abuse that she went through under her father’s care. She also feels depressed and hopeless and in a lot of pain yet she claims her kids do not do enough to help her cope.
Adjustment Disorder
Adjustment disorder refers to a maladaptive emotional or behavioral reaction that is attributed to a psychosocial stressor or difficulty adjusting after a stressful event (O’Donnell et al., 2019). Some of the stressors that could be linked to the patient’s condition are the conflict between her daughter and herself and the blame the daughter has put on her. The 40-year-old claims that since her daughter got married and moved out her life has been quiet though of late she feels depressed and hopeless. She also claims she feels so much pain yet her children do nothing to help.
PTSD
Post-traumatic stress disorder is the third differential diagnosis. The condition is most common among individuals that have gone through traumatic events such as violence, rape, or personal assault. The cluster symptoms that a patient must present with for the PTSD diagnosis to be made are avoidance symptoms, intrusion symptoms, reactive symptoms, and arousal symptoms (Jonker et al., 2018). During the interview, the client confirms that just like her daughter she went through domestic violence. The daughter also confirms that her mother is in pain concerning her past rape experience. The daughter’s accounts and memories of violence and abuse seem to awaken her mother’s pain about the assault that she went through back in Iran.
Reflections:
If I were to see the patient again I would try to create a better environment for both parties to encourage open and therapeutic communication. I would educate the patient concerning the need for family therapy with not only the 23-year-old daughter but also with the other family members to enable them to rebuild their relationships, trust, and tolerance once more.
Legal and Ethical Considerations
The ethical issue that would arise when dealing with the case is the intolerance between the mother and daughter which would hinder the achievement of the set goals and objectives of therapy and counseling. I would need to demonstrate lots of professionalism to prevent the possibility of conflicts of interest between the two family members.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Jonker, I. E., Lako, D. A., Beijersbergen, M. D., Sijbrandij, M., van Hemert, A. M., & Wolf, J. R. (2019). Factors related to depression and post-traumatic stress disorder in shelter-based abused women. Violence against women, 25(4), 401-420.
Shendre, A., Parmar, G. M., Dillon, C., Beasley, T. M., & Limdi, N. A. (2018). Influence of Age on Warfarin Dose, Anticoagulation Control, and Risk of Hemorrhage. Pharmacotherapy, 38(6), 588–596. https://doi.org/10.1002/phar.2089