NRNP 6645 Mother and Daughter: A Cultural Tale video

NRNP 6645 Mother and Daughter: A Cultural Tale video

CC (chief complaint): We need help with the complex family dynamic issues we are facing.

HPI: The patient is a 40-year-old single mother of five children of Iranian origin. She presents to the facility for family therapy accompanied by her 23 year-old-old daughter who provided insights about their relationship with their mother. They need to be assessed for trauma-related issues attributed to their abusive husband and the failure of her children to respect the Iranian culture. The mother attempted to return to America with her daughters for medical purposes and flee from traumatic events back in Iran. Her younger daughter whom she left behind was raped by her husband and abused physically and emotionally. She finally joined them in the US. The mother attempted to solve issues with her ex-husband in futile. She became disabled after two failed surgeries and now depends on her children for help. She reports being lonely and depressed while coping with her situation. The daughters do not live at home and the mother is frustrated because they have abandoned the Iranian culture and adopted American culture and want their mother to stop controlling them because they are adults.

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Past Psychiatric History: Psychiatric review is crucial in ruling out comorbid conditions

• General Statement: I am lonely and depressed when my children are away from me.
• Caregivers (if applicable): She relies on her five children to help with her care.
• Hospitalizations: She was admitted for two surgeries on the feet but not mental health issues.
• Medication trials: Not indicated.
• Psychotherapy or Previous Psychiatric Diagnosis: Present family psychotherapy to manage trauma and tensions within the family.

Substance Current Use and History: None. It is vital to establish if the children are using any illicit drugs or alcohol.

Family Psychiatric/Substance Use History: Domestic violence perpetrated by the father to the client and children and Sexual abuse by the father to the daughter caused trauma to the mother. No substance use is indicated.

Psychosocial History: 

The patient is a single mother of five children who came to the US to flee from her abusive husband. She divorced her spouse, who lives in Iran. When she migrated to the US, her younger daughter remained in Iran with her father. The father reportedly abused the younger daughter physically, emotionally, and sexually by raping her. The patient is a professional caregiver but has since left the profession after disability emanating from two failed surgeries. Three daughters have moved out of their home and she is currently staying with two younger sons. One daughter is married while the other is working towards a real estate license. Her sons are still in school.

Medical History:

• Current Medications: None
• Allergies: Unknown

• Reproductive Hx: Five children. Three girls and two boys

ROS:

• GENERAL: The mother reports tiredness and fatigue. No fevers, night sweats, and chills. The daughter claims she is fine but bothered by the excessive demands of her mother and misinformed to handle the situation.

• HEENT: No noticeable head injuries on mother and daughter. They deny changes in hearing and vision. No ear pain. Ears, Nose, Throat: No hearing loss, congestion, sneezing, or sore throat.

• SKIN: No noted skin problems in both patient.
• CARDIOVASCULAR: No syncope, chest pain, edema, or heart palpitations on patients.
• RESPIRATORY: No wheezing, cough, or weakened breathing sounds. Sporadic dyspnea with exertion was identified. This can be attributed to depression or anxiety.
• GASTROINTESTINAL: No nausea, constipation, diarrhea, and abdominal pain.
• GENITOURINARY: No burning on urination, dysuria, hematuria, or flank pain.
• NEUROLOGICAL: No dizziness, headache, paralysis, syncope, tingling, numbness, or ataxia. Normal bowel and bladder movement.
• MUSCULOSKELETAL: No joint pain, no myalgias.
• HEMATOLOGIC: No bleeding or easy staining. No anemia.
• LYMPHATICS: No problem noted in lymph nodes.
• ENDOCRINOLOGIC: No thyroid disorders, no diabetes. No polyphagia, polyuria.

Physical exam: Vital signs, RR:16 bpm, BP: 106/72, Temp — 98.3 F, P- 69, Weight — 117 lbs. Height — 5’7, and 5’11.

Diagnostic results: Various diagnostic results are crucial in distinguishing mental and physical health. They include vital signs, the Beck Depressive Inventory and Hamilton-anxiety rating scale for members of the family, baseline EKG, and laboratory works such as CMP, CBC, TSH, and infection tests.

Assessment

Mental Status Examination:

The mother and daughter maintained a positive attitude throughout the assessment sessions. They were supportive, maintained eye contact, smiled, and laughed where appropriate during the therapy. They were oriented and alert with in-depth knowledge of their situations. No abnormalities in psychomotor were noted. The clients dressed properly for the weather.  The speech was normal, with sound thought the process. The mood was suitable for the situation, with a full range of affect.  The thought content of the mother was vulnerable and hopeless. No suicide contemplation.

Differential Diagnoses:

The first differential diagnosis is adjustment disorder. This disorder is caused by experiences of extremely stressful events. The diagnostic criteria highlight that emotional or behavioral symptoms in response to traumatic events should manifest within three months from the beginning of the stressors (O’Donnell et al., 2019). The disorder is also attributed to stressful incidences that lead to frequent dysfunctions in the comparative to tolerable cultural customs. This disorder impacts the patient because of stress from disability and defiance by daughters to adopt the American lifestyle and not the Iranian lifestyle.

The second differential diagnosis is post-traumatic stress disorder (PTSD). PTSD occurs as a result of experiencing life-threatening or traumatic events. These symptoms can deeply impair the routine life function of an individual and can alter both the physical and mind of patients. Various symptoms of PTSD are consistent thoughts about previous events, and extreme thoughts of fear, horror, shame, anger, and guilt (Kim et al., 2020). The mother and daughter in this case are likely to experience chronic signs of PTSD because of the abusive husband and having a sister who was raped by their father. PTSD is also attributed to factors such as a toxic home, verbal aggression, and economic challenges. These factors are consistent with the mother’s behaviors in this case.

The third differential diagnosis is major depressive disorder (MDD). This diagnosis is consistent with the mother and the five children in this case. The mother claims she suffers from loneliness and depression because her daughters are not home and her disability. The diagnostic criteria for MDD entail five symptoms of depression within two weeks and the symptoms must entail the loss of interest in daily activities that were once enjoyable and a depressed mood (Kennedy, 2022). The mother is depressed because she is disabled and in a wheelchair. The daughters have defied their Iranian culture and live away from her.

Case Formulation and Treatment Plan:

When designing a treatment plan, it is important to involve everyone who is connected to this family to enhance the treatment outcomes. This case involves a mother, five children, and her alienated ex-husband. However, the treatment, in this case, will only cover the mother and her children.

Concerning the treatment plan, the adjustment disorder can affect not only the mother but also the entire family.  The treatment involves cognitive-behavioral therapy coupled with skills for life adjustment and resilience (SOLAR) (O’Donnell et al., 2019).  The treatment for PTSD involves drugs such as first-class SSRIs. Group psychotherapy can also be used in this case since the mother and her five children experience almost similar triggers and aggravating factors. Also, both interventions can be used. A mental health nurse should take cognizance that PTSD affects people distinctively. As such, treatment should be individualized (Kim et al., 2020). The first-line treatment for MDD is selective serotonin reuptake inhibitors. The dosage should be determined by the severity of the condition based on the Hamilton depression scale and the renal and hepatic function test. Psychotherapy interventions such as interpersonal therapy, supportive therapy, and cognitive behavioral therapy are also effective in the treatment of MDD.

Reflections:

Handling mental health issues is associated with various ethical and legal issues. Therefore, the PMNHP must be aware of the ethical and legal environments to evade the associated implications (Bipeta, 2019). Confidentiality in practice is the major issue to consider and HIPPA laws must be upheld to the full scope allowed by the law. The ethical principles of beneficence, nonmaleficence, justice, and autonomy must also be upheld in the entire interaction with patients. The mother and her children should be given the true and current information concerning their condition and given the option to either choose or decline care.

References

Bipeta, R. (2019). Legal and ethical aspects of mental health care. Indian Journal of psychological medicine, 41(2), 108-112. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6436399/

Kennedy, S. H. (2022). Core symptoms of major depressive disorder: relevance to diagnosis and treatment. Dialogues in clinical neuroscience. https://doi.org/10.31887/DCNS.2008.10.3/shkennedy

Kim, T. D., Lee, S., & Yoon, S. (2020). Inflammation in post-traumatic stress disorder (PTSD): a review of potential correlates of PTSD with a neurological perspective. Antioxidants, 9(2), 107. https://doi.org/10.3390/antiox9020107

O’Donnell, M. L., Agathos, J. A., Metcalf, O., Gibson, K., & Lau, W. (2019). Adjustment disorder: Current developments and future directions. International journal of environmental research and public health, 16(14), 2537. https://doi.org/10.3390/ijerph16142537

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• 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.