NRNP 6645 Family Assessment Week 2: Family Assessment Paper

NRNP 6645 Family Assessment Week 2: Family Assessment Paper

NRNP 6645 Family Assessment Week 2: Family Assessment Paper

NRNP/PRAC 6645 Comprehensive Psychiatric

Evaluation Note Template

CC (chief complaint): “Household chaos”

HPI: Iranian patient Patty, 40, fled her husband’s physical and sexual violence and arrived in the United States 12 years ago. Her 23-year-old daughter, with whom she is receiving family therapy, is her current historian. The patient now has five children, but when she left Iran when she was eight years old, she left behind her firstborn daughter. Before the patient secured her visa and brought her to the country two years ago, the patient’s father had sexually assaulted the girl in Iran. The patient currently resides with her son, who is 15 years old. She underwent foot surgeries twice, leaving her permanently disabled. While the other two daughters live independently from her home, she claims to be lonely because one of her daughters recently got married and moved out. She lives a typical Muslim life, therefore her daughters will have to take care of her as she gets older. She hasn’t seen them in a while, but they have adapted to western culture. She claims that her girls are out of control and that she feels lost and powerless. In Iran, her hubby remarried.

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Past Psychiatric History:

• General Statement: The patient describes herself as lonely and powerless, unable to handle her girls, who blame her for the chaos in the house.
• Caregivers (if applicable): The patient is watched over by her five children, three girls, and two boys.
• Hospitalizations: Claims history of foot operations twice.
• Medication trials: None
• Psychotherapy or Previous Psychiatric Diagnosis: Both the patient and her firstborn were subjected to physical and sexual abuse. She affirms that she offers both individual and family therapy.

Substance Current Use and History: There have been no reports. To rule out drug use disorders as the cause of the patient’s symptoms, this data is essential.

Family Psychiatric/Substance Use History: The patient has experienced both physical and sexual abuse, along with her oldest daughter.

Psychosocial History: The patient had one child back in Iran. But after being assaulted physically and sexually, she decided to leave for the United States. Her husband got remarried. But she currently has five kids, four of whom she gave birth to when she was in the US. She is a devout Muslim who prefers a traditional lifestyle over the western one embraced by her daughters. She enjoys playing video games and following religious teachings in her spare time.

Medical History:

• Current Medications: None. This information is useful when determining the drug therapy to provide to the patient.
• Allergies: None

• Reproductive Hx: Heterosexual. Five children were born normally, two males and three daughters.

ROS: There was none offered. To exclude comorbid medical disorders, the patient should have been interrogated about the usual functioning of her bodily systems.

Physical exam: The patient’s vital signs and a physical examination are required to determine her impairment after past surgery.

Diagnostic results: To rule out other medical disorders, the following lab tests are required: Complete blood count, Thyroid function, CMP, and testing for STDs such as HIV and hep C. To create a differential diagnosis, the Beck Depression Inventory and the Hamilton-anxiety rating scale should be employed (Sangalang et al., 2018).

Assessment

Mental Status Examination: The video omitted to discuss this topic. Yet based on the interview, it appears that the patient was correctly attired and oriented in time, place, and person. Her daughter acted as the historian during the interview, and they both made sufficient eye contact. Both her long-term and short-term memories are still present. Her demeanor matches her melancholy mood. Her demeanor is appropriate for the circumstances. Her cognitive process is complete. She denies having hallucinations, delirium, or suicidal or homicidal thoughts.

Differential Diagnoses:

1. Major depressive disorder: To be diagnosed with MDD, a patient must exhibit at least five of the symptoms listed in the DSM-V for at least two weeks: low mood, loss of interest or pleasure, exhaustion, fluctuating weight, trouble sleeping, psychomotor agitation, feeling unworthy, lack of concentration, and suicidal or homicidal intrusive thoughts (Alang, 2018). The majority of these symptoms, such as hopelessness, remorse, loneliness, and worthlessness, are experienced by the sufferer. However, to support this diagnosis, the specified Beck Depression Inventory findings are required.
2. Reactive attachment disorder: According to the DSM-V, this disorder is frequently identified in kids who struggle to form strong bonds with their parents (Atkinson, 2018). The patient alleges that she cannot manage her daughters since they follow a different lifestyle than she does, creating chaos in the home.
3. Adjustment disorder: The patient’s emotional and behavioral responses to changes in his or her life or other stressful conditions serve as a defining characteristic of this mental disorder (Bachem & Casey, 2018). The patient departed Iran, leaving behind one of her kids who had been sexually molested by the patient’s husband.

Case Formulation and Treatment Plan: The patient exhibits signs of depression. She affirms her feelings of loneliness, helplessness, and hopelessness since she lacks appropriate assistance from her daughter as a result of her impairment from surgery. She has also been physically and sexually attacked in the past (Sangalang et al., 2018).

Treatment Plan: To help the family overcome communication barriers and manage their trauma history, psychotherapeutic methods such as group counseling, family therapy, cognitive behavioral therapy (CBT), and individual therapy are beneficial (Sangalang et al., 2018).

Reflections: The case study asserts that the Iranian lady, who is middle-aged, has five children, which exacerbates the chaos in the home. As she fled Iran, she left her maltreated firstborn child behind. The PMHNP did a great job gathering all the information necessary to diagnose the patient and provide the best course of treatment. Nonetheless, it would have been great if the expert had been permitted to individually examine each kid to ascertain their mental health difficulties (Pea-Sullivan, 2019). In conducting research and creating a targeted treatment plan, the provider must uphold moral and legal requirements such as informed consent and autonomous decision-making (Alexander & Robbins, 2019).

References

Alang, S. (2018). Contrasting depression among African Americans and major depressive disorder in the DSM-V. Journal of Public Mental Health, 17(1), 11-19. https://doi.org/10.1108/JPMH-12-2016-0061

Alexander, J. F., & Robbins, M. (2019). Functional Family Therapy. Encyclopedia of Couple and Family Therapy, 1232–1240. https://doi.org/10.1007/978-3-319-49425-8_161

Atkinson, L. (2018). Reactive Attachment Disorder and attachment theory from infancy to adolescence: review, integration, and expansion. Attachment & Human Development, 21(2), 205–217. https://doi.org/10.1080/14616734.2018.1499214

Bachem, R., & Casey, P. (2018). Adjustment disorder: A diagnosis whose time has come. Journal of Affective Disorders, 227, 243–253. https://doi.org/10.1016/j.jad.2017.10.034

Peña-Sullivan, L. (2019). The “Wrong Kind” of Immigrants: Pre-migration Trauma and Acculturative Stress Among the Undocumented Latinx Community. Clinical Social Work Journal. https://doi.org/10.1007/s10615-019-00741-z

Sangalang, C. C., Becerra, D., Mitchell, F. M., Lechuga-Peña, S., Lopez, K., & Kim, I. (2018). Trauma, Post-Migration Stress, and Mental Health: A Comparative Analysis of Refugees and Immigrants in the United States. Journal of Immigrant and Minority Health, 21(5), 909–919. https://doi.org/10.1007/s10903-018-0826-2

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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

 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

Learning Resources

Required Readings

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders

• Links to an external site. (5th ed., text rev.). https://go.openathens.net/redirector/waldenu.edu?url=https://dsm.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425787
• Nichols, M., & Davis, S. D. (2020). The essentials of family therapy (7th ed.). Pearson.
  Introduction
  • Chapter 2, “Basic Techniques of Family Therapy”
  • Chapter 3, “The Fundamental Concepts of Family Therapy”
  • Chapter 4, “Bowen Family Systems Therapy
• Therapist Aid. (2012–2020). Genograms for psychotherapy.
• Links to an external site. https://www.therapistaid.com/therapy-guide/genograms
  Therapist Aid LLC. (© 2012-2020). Genograms for psychotherapy. https://www.therapistaid.com/therapy-guide/genograms
• Document: Comprehensive Psychiatric Evaluation Note Template
• Download Comprehensive Psychiatric Evaluation Note Template
• Document: Comprehensive Psychiatric Evaluation Note Exemplar

• Download Comprehensive Psychiatric Evaluation Note Exemplar

Optional Resource

• Kaplin, D. (2021, Nov. 5).  Family systems therapy

• Links to an external site. [Video]. YouTube.  https://www.youtube.com/watch?v=UVPENypTc4k

Required Media

• Gehart, D. R. (2013, August 29). Progress note

• Links to an external site. [Video]. YouTube. https://www.youtube.com/watch?v=CEB1vBObUqc
• Masterswork Productions. (2003). Mother and daughter: A cultural tale
• Links 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 practice
• Links 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:

• 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.

By Day 7

Submit your Assignment.

submission information

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Rubric

NRNP_6645_Week2_Assignment_Rubric

NRNP_6645_Week2_Assignment_Rubric

Criteria	Ratings	Pts
This criterion is linked to a Learning Outcome 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)	20 to >17.0 ptsExcellent 90%–100% The assignment includes an accurate, clear, and complete description of the subjective and objective information for the client family. The response addresses each of the required elements and demonstrates thoughtful consideration of the client family’s situation and culture. 17 to >15.0 ptsGood 80%–89% The assignment includes an accurate, clear, and complete description of the subjective and objective information for the client family. 15 to >13.0 ptsFair 70%–79% The assignment includes a description of the subjective and objective information for the client family but is somewhat general or contains small inaccuracies. 13 to >0 ptsPoor 0%–69% The assignment includes a description of the subjective and objective information for the client family but is vague or contains many inaccuracies. Or, several of the required elements are missing.	20 pts
This criterion is linked to a Learning Outcome • Mental status exam • Differential diagnoses—Include a minimum of three differential diagnoses and include how you derived at each diagnosis in accordance with DSM-5-TR diagnostic criteria	20 to >17.0 ptsExcellent 90%–100% The response thoroughly and accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the family in the assigned case study, and it provides a thorough, accurate, and detailed justification for each of the disorders selected. 17 to >15.0 ptsGood 80%–89% The response accurately documents the results of the mental status exam…. Response lists at least three distinctly different and detailed possible disorders in order of priority for a differential diagnosis of the patient in the assigned case study, and it provides an accurate justification for each of the disorders selected. 15 to >13.0 ptsFair 70%–79% The response documents the results of the mental status exam with some vagueness or innacuracy…. Response lists at least three different possible disorders for a differential diagnosis of the patient and provides a justification for each, but may contain some vaguess or innacuracy. 13 to >0 ptsPoor 0%–69% The response provides an incomplete or inaccurate description of the results of the mental status exam and/or explanation of the differential diagnoses. Or, assessment documentation is missing.	20 pts
This criterion is linked to a Learning Outcome • Case formulation• Treatment plan that includes psychotherapy interventions	25 to >22.0 ptsExcellent 90%–100% Case formulation is thorough, thoughtful, and demonstrate critical thinking…. The assignment includes an accurate, clear, and complete treatment plan for the client family that includes psychotherapy interventions. The response demonstrates thoughtful consideration of the client family’s situation and culture. 22 to >19.0 ptsGood 80%–89% Case formulation demonstrates critical thinking…. The assignment includes an accurate, clear, and complete treatment plan for the client family that includes psychotherapy interventions. 19 to >17.0 ptsFair 70%–79% Case formulation is somewhat general or does not demonstrate critical thinking…. The assignment includes a treatment plan for the client family that includes psychotherapy interventions but is somewhat general or contains small inaccuracies. 17 to >0 ptsPoor 0%–69% The assignment provides a vague and/or inaccurate description of the case formulation and treatment plan for the client family. Or, many of the required elements are missing.	25 pts
This criterion is linked to a Learning Outcome • A psychotherapy genogram for the family	20 to >17.0 ptsExcellent 90%–100% The assignment includes an accurate, clear, and complete genogram of the client family. The documentation style is consistent and a key is provided. 17 to >15.0 ptsGood 80%–89% The assignment includes an accurate genogram of the client family. The documentation style is consistent and a key is provided. 15 to >13.0 ptsFair 70%–79% The assignment includes a genogram of the client family but is somewhat limited or contains factual inaccuracies or inconsistencies in documentation style. 13 to >0 ptsPoor 0%–69% The genogram provided is vague or contains many inaccuracies. Or, the genogram is missing.	20 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided which delineate all required criteria.	5 to >4.0 ptsExcellent 90%–100% Paragraphs and sentences follow writing standards for flow, continuity, and clarity…. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 4 to >3.0 ptsGood 80%–89% Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time…. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive. 3 to >2.0 ptsFair 70%–79% Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment are vague or off topic. 2 to >0 ptsPoor 0%–69% Paragraphs and sentences follow writing standards for flow, continuity, and clarity <60% of the time…. No purpose statement, introduction, or conclusion were provided.	5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation	5 to >4.0 ptsExcellent 90%–100% Uses correct grammar, spelling, and punctuation with no errors. 4 to >3.0 ptsGood 80%–89% Contains 1 or 2 grammar, spelling, and punctuation errors. 3 to >2.0 ptsFair 70%–79% Contains 3 or 4 grammar, spelling, and punctuation errors. 2 to >0 ptsPoor 0%–69% Contains many (≥5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.	5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.	5 to >4.0 ptsExcellent 90%–100% Uses correct APA format with no errors. 4 to >3.0 ptsGood 80%–89% Contains 1 or 2 APA format errors. 3 to >2.0 ptsFair 70%–79% Contains 3 or 4 APA format errors. 2 to >0 ptsPoor 0%–69% Contains many (≥5) APA format errors.	5 pts
Total Points: 100