NRNP 6645 Mother and Daughter a Cultural Tale Video Family Assessment Assignment

NRNP 6645 Mother and Daughter: A Cultural Tale Video Family Assessment Assignment Brief

Assignment Overview:

The main goal of this assignment is to thoroughly assess a family based on the case study presented in the “Mother and Daughter: A Cultural Tale” video. The focus is on understanding family dynamics, roles, and the potential root causes of the identified issues. The assignment involves using the Comprehensive Evaluation Note Template to document key aspects of the family’s history, psychosocial context, and individual mental health.

Understanding Assignment Goals:

• Family Assessment: The assignment aims to show the student’s ability to assess families, emphasizing the importance of looking beyond the identified “problem” individual to understand broader family dynamics. Students should use knowledge from the provided Learning Resources, with a specific focus on psychotherapy genograms.
• Documentation Skills: The assignment requires the use of the Comprehensive Psychiatric Evaluation Note Template. Students should show careful documentation skills in addressing various aspects, including chief complaint, history of present illness, and psychosocial history. The provided exemplar should serve as a guide for meeting documentation requirements.
• Video Analysis: Students are expected to critically analyze the “Mother and Daughter: A Cultural Tale” video, extracting relevant information for the family assessment. The analysis should consider cultural factors, communication patterns, and observable behaviors within the family.

The Student’s Role:

As a student undertaking this assignment, your role is to act as a mental health professional conducting a thorough family assessment. Approach the case study with sensitivity to cultural factors, trauma, and familial dynamics. Utilize the provided resources, including the psychotherapy genograms, to enhance your understanding of family structures and relationships.

Your documentation skills will be crucial in addressing each section of the Comprehensive Psychiatric Evaluation Note Template. Be attentive to details, and where information is not directly available from the video, provide a thoughtful explanation of how you would gather the missing data and justify its relevance to diagnosis and treatment planning.

Additionally, demonstrate critical thinking in the formulation of a differential diagnosis based on DSM-5-TR diagnostic criteria. The treatment plan should be comprehensive, incorporating psychotherapeutic interventions, medications, and additional support services.

Detailed Assignment Instructions: Assessment Description

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.

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.

NRNP 6645 Mother and Daughter a Cultural Tale Video Family Assessment Assignment Example

CC (chief complaint):

The mother’s chief complaint revolves around experiencing considerable pain with a sense of inadequate support. Sharleen, her daughter, aspires to bring peace to her mother’s life by encouraging her to adjust expectations and embrace life changes. Sharleen perceives a constraint from her mother, hindering her personal growth. The mother seeks consistent companionship from her daughters and occasionally grapples with loneliness-induced depression.

Sharleen reveals discomfort in her mother’s home due to two dogs, expressing a dislike for them and their hair. This discomfort extends to avoiding meals at her mother’s house due to the pervasive dog smell. Sharleen also raises concerns about her mother’s prompt decision-making influenced by high expectations.

Complicating matters, there’s a disclosure about a sibling experiencing sexual assault by their biological father, significantly impacting mental health. The relationship between Patti and Sharleen is characterized by disagreements, and Gonzalo Baciga is expressing worry about the overall well-being of the mother and daughter. As these issues are presented, it becomes apparent that the family is navigating intricate challenges requiring a comprehensive assessment for effective intervention.

History of Present Illness (HPI):

The patient, a 40-year-old woman of Iranian-American origin, is seeking evaluation due to intricate family dynamics affecting both herself and her children. Her 23-year-old daughter has brought up various concerns regarding family relationships, particularly focusing on trauma related to domestic violence from their father, as portrayed in the “Mother and Daughter: A Cultural Tale” video. The patient acknowledges challenges in adapting to American norms, displaying symptoms consistent with an adjustment disorder.

Amidst family conflicts, a significant issue arises – the father’s history of sexual assault on one of the daughters. This traumatic event exacerbates the mother’s declining health, marked by multiple foot surgeries. Another layer of discord involves disparities in beliefs and traditions, with the mother desiring care from her children while the children lean towards utilizing nursing facilities.

The unresolved family issues have taken a toll, resulting in depression and trauma, evident in observed symptoms such as fumbling, fluctuations in enthusiasm, impulsivity, hyperactivity, repetitive speech, and irritability. Despite these challenges, there’s no apparent difficulty in focus, memory, or attention. The intricate nature of the family’s challenges necessitates a thorough assessment to formulate an effective treatment plan addressing both the psychological and physical aspects of the patient’s well-being.

Past Psychiatric History:

In exploring the mother’s past psychiatric history, she discloses instances of experiencing depressive moments. However, she explicitly denies any formal psychiatric diagnoses, emphasizing that she has not been diagnosed with conditions such as depression. Notably, the patient vehemently disputes any thoughts of suicide, providing insight into her mental and emotional state. Furthermore, she asserts a lack of engagement with illegal substances and categorically denies suffering from any significant mental illness or insanity.

Hospitalizations:

There is no documented history of acute admissions for mental illness, suggesting that the mother has not required inpatient psychiatric care in the past.

Psychotherapy or Previous Psychiatric Diagnosis:

The available records do not indicate any current psychiatric diagnosis or ongoing psychotherapeutic treatment for the patient. While the mother admits to experiencing episodes of depression, there is no mention of specific medications prescribed for the management of depressive symptoms. This information highlights a gap in the therapeutic interventions and underscores the need for a comprehensive mental health assessment.

Substance Current Use and History:

The patient reports no current abuse of substances, indicating a lack of ongoing issues related to substance use.

Family Psychiatric/Substance Use History:

The family history does not reveal any substance use or psychiatric disorders among the family members. This absence of familial psychiatric history adds a layer of complexity to the understanding of the mother’s individual mental health challenges.

Psychosocial History:

The mother and daughter find themselves grappling with the challenges of adjusting to a new way of life, reflecting the broader context of cultural adaptation. Seeking assistance, they have visited a mental health institution for a diagnostic assessment, specifically focusing on trauma disorders and adjustment disorders. During these assessments, the current psychiatrist participated in addressing questions related to the patients’ past issues, providing a collaborative approach to understanding the family’s mental health landscape.

The mother, reliant on disability, is brought to the institution by her daughter, a school-going girl. However, there is a notable absence of specific details about the daughter’s school, an area that could provide valuable insights into the daughter’s daily life and potential stressors. Recognizing the significance of comprehensive patient information, it becomes evident that a more thorough exploration of the daughter’s experiences and challenges may contribute to a more holistic treatment plan.

The family denies both current and medical history, and the assessment predominantly focuses on the mother’s surgery without specifying its underlying reason. This prompts a critical consideration of the importance of probing deeper into the patients’ health histories to glean relevant information that could inform a comprehensive and tailored treatment plan. The narrative underscores the need for a thorough and nuanced understanding of the patients’ experiences, incorporating both individual and familial perspectives for effective mental health interventions.

Medical History:

1. Current Medications: The patient is not currently taking any medications.
2. Allergies: There is no information available regarding any known allergies.
3. Reproductive History: While reproductive history for the children is not disclosed, the mother has six children.

Objective:

Review of Systems (ROS):

• Skin: No reported issues.
• Respiratory System: No complaints of shortness of breath, cough, or sneezing.
• Cardiovascular System: No reported chest pains.
• Gastrointestinal: No complaints of constipation, abdominal pains, or diarrhea.
• Hematologic: No reports of easy bleeding or anemia.
• Genitourinary: No complaints of hematuria or flank pain.
• Neurological: Absence of dizziness, headaches, ataxia, or paralysis.
• Endocrine System: No indications of polyuria, diabetes, polyphagia, or polydipsia.

Assessment:

Mental Status Examination:

The mother, a 40-year-old Iranian female, and her Americanized Iranian daughter, aged 23, present for evaluation. The mother’s physical appearance reflects the toll of early and abusive marriage stress, making her appear older than her chronological age. In contrast, the daughter appears unfazed by her mother’s aged appearance, demonstrating a lack of concern.

Both individuals exhibit cooperation during the examination, presenting as cleanly dressed with no observable abnormal mental activity. However, a sense of restlessness, anxiety, and irritation pervades their demeanor. The absence of auditory or visual hallucinations or delusions is noted. Both individuals communicate with clear and loud speech, maintaining normal volume and tones.

Observable behaviors include fidgeting, impulsivity, excitability, and annoyance, accompanied by an aggressive tone and repetitions. Despite these manifestations, their thought processes remain logical, and their goals appear driven. Notably, when engaged in conversation, they exhibit a present-minded focus. Cognitively, remote and recent memories are intact, concentration is within normal limits, and they demonstrate average insight. Importantly, attention, judgment, and abstraction are unbroken, indicating preserved cognitive functions.

The combined observations suggest a complex interplay of emotional distress, potentially influenced by the trauma and familial conflicts discussed earlier. The apparent emotional turmoil is manifested through observable behaviors, emphasizing the need for a nuanced and comprehensive approach to address both the mental health and interpersonal dynamics within the family unit.

Differential Diagnoses:

POST-TRAUMATIC STRESS DISORDER (PTSD); ICD-10 CODE: F.43

Post-Traumatic Stress Disorder (PTSD) is considered a potential diagnosis based on the reported traumatic experiences within the family, specifically the history of domestic violence and sexual assault. PTSD can emerge following exposure to life-threatening or extremely distressing events, such as physical assault or combat. Individuals afflicted by PTSD often undergo a process of reliving trauma through their thoughts, distancing themselves from social connections, and experiencing prolonged anger. The prevalence of PTSD is not fixed and affects individuals of various demographics, emphasizing the universality of its impact.

People with PTSD may struggle to cope with the aftermath of terrifying events, and while many recover fully, a significant portion continues to grapple with the trauma. Common symptoms include extreme anger, fear, guilt, shame, and negative emotional thoughts. Neurotransmitters, particularly dopamine, play a role in the sustainability and formation of PTSD. Moreover, individuals with PTSD are at an increased risk of developing physical impairments affecting both daily life and mental well-being.

Reflections:

The assignment reflects the misconception surrounding PTSD, emphasizing the need for accurate understanding. The complexity of PTSD is highlighted by its association with neurotransmitters, such as dopamine. Additionally, the link between PTSD and severe health difficulties throughout the lifespan is underscored, with an elevated incidence of type II diabetes mellitus reported in affected individuals.

The assignment draws attention to the high-risk behaviors associated with PTSD, including substance misuse, binge eating, obesity, and unsafe sexual conduct. Educating patients on the importance of modern contraception, healthy eating habits, and physical activity is deemed critical in mitigating the potential health consequences of PTSD.

Case Formulation and Treatment Plan:

The treatment plan for PTSD involves a multidimensional approach, recognizing the uniqueness of each individual’s experience and response to interventions. A comprehensive management strategy includes psychotherapy, medications, and lifestyle modifications. An experienced healthcare professional, such as a nurse practitioner, is recommended to oversee the treatment process.

Specific medications are prescribed to address symptoms and manage the root cause of PTSD. In this case, a daily dosage of 20mg Prozac and 15mg twice daily (BID) Buspar is proposed. Additionally, stress management is integral to the treatment plan, emphasizing the importance of addressing the psychological and physiological aspects of stress.

The inclusion of a nutrition and diet specialist underscores the holistic nature of treatment, recognizing the interconnectedness of mental and physical well-being. Education on the potential side effects of medications and setting realistic expectations contributes to informed decision-making and patient empowerment.

References:

Mitchell, J. M., Bogenschutz, M., Lilienstein, A., Harrison, C., Kleiman, S., Parker-Guilbert, K., … & Doblin, R. (2021). MDMA-assisted therapy for severe PTSD: a randomized, double-blind, placebo-controlled phase 3 study. Nature Medicine, 27(6), 1025-1033.

Unnikrishnan, R., Radha, V., & Mohan, V. (2021). Challenges Involved in Incorporating Personalised Treatment Plan as Routine Care of Patients with Diabetes. Pharmacogenomics and personalized medicine, 14, 327.

Watkins, L. E., Sprang, K. R., & Rothbaum, B. O. (2018). Treating PTSD: A review of evidence-based psychotherapy interventions. Frontiers in behavioral neuroscience, 12, 258.

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