Week (2 #): (Family Assessment)

Nura
College of Nursing-PMHNP, Walden University
NRNP 6645: Psychopathology and Diagnostic Reasoning
Nursing
Assignment Due Date
 NRNP/PRAC 6645 Comprehensive Psychiatric Evaluation Note Template
CC (chief complaint): “We are here for a family therapy”
HPI: In this healthcare facility is a patient by the name Mrs. Patti, who is a 60-year-old mother
who has five adult children that is 3 girls namely, Sharleen aged 23 years, Shirleen of age 21,
and Sheela, age 24. Patti has also two male children who are of ages 18 and 15 and this is her
complete family. Mrs. Pattis family present with trauma from / a history of child sexual abuse, a
background of domestic violence and a history of immigration. When they parted ways with her
husband, she left her youngest daughter back in Iran and moved to a new place which is the
United States with her four children; two daughters and two youngest sons. In America is where
both girls were born. While she is in the United States, the mother wishes to be living together
with her girls due to some reasons such those of medical and also, to avoid uncomfortable
situations at home. The youngst daughter who was let back home, It was reported she suffered
from physical, psychological, and sexual abuse at the hands of her divorced ex-husband. The
family whole family fell into disarray when the daughter finally moved in. While working as a
caregiver for her children, the mother attempted get along with her ex-husband, but all the
attempts turned ou unsuccessful. After two failed surgeries, the mother is now incapacitated and
is seeking help from her children.The mother needed to go through a psychotherapy session
since she is continuously suffering anguish, helplessness, and hopelessness due to the effects of
her new environment from the place where she relocaed to. Because the girls resides away from
where she lives, she is all frustrated by her current challenges in relation to her expectations of
her family. For example, her daughter's refusal to visit or help her. In contrary to ther mother’s
expectations, as adults exploring their options, the children urge their mother to be patient, take
up new hobbies, and refrain from attempting to control their life.
Past Psychiatric History:
 General Statement: This patient has no psychiatric history mentioned
 Caregivers (if applicable): She has not yet found a suitable person to be her caregiver.
 Hospitalizations: Patti has zero hospitalizations
 Medication trials: She has no medical trials
 Psychotherapy or Previous Psychiatric Diagnosis: Patti is actively participating in
therapy sessions.

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Substance Current Use and History: This patient has no recisrded history of substance use
including use of alcohol.
Family Psychiatric/Substance Use History: There is no family member who has a psychiatric
history.

Psychosocial History: Patti was born and grew up in Iran under the care of her both parents. At
the age of 14, her parents planned for her marriage. Her husband physically mistreated her prior
to her immigrating to the United States. She was able to bring her four children to the United
States after obtaining a medical visa. She is now crippled due to unsuccessful foot surgeries and
requires personal help.
Medical History: She has two listed surgeries on her feet which did not work.
 Current Medications: She is not undergoing any medications
 Allergies: She has unknown allergies.
 Reproductive Hx: Paragraph 5 of Gravida 5.
ROS:
 GENERAL: Obesity, exhaustion and general weakness
 HEENT: This patient did not suffer a runny nose, sore throat, sneezing, or trouble
swallowing. Eyes: Her eyes were alright with no eye pain, blurred vision, or trouble
seeing.

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  SKIN: She disputes suffering any rashes, bruising, or sores.
 CARDIOVASCULAR: Patti denies experiencing either tachycardia, chest pain,
exhaustion, or edema.
 RESPIRATORY: She disputes having a cough, tachycardia, shortness of breath or even
sputum
 GASTROINTESTINAL: She disputes suffering stomach ache.
 GENITOURINARY: She disputes urgency, polyuria, incontinence, and frequency.
 NEUROLOGICAL: This patient denies experiencing any for of hallucination. Either
auditory hallucinations or visual hallucinations
 MUSCULOSKELETAL: Foot discomfort as a result of unsuccessful procedures
 HEMATOLOGIC: absence of anemia, bruising, or bleeding
 LYMPHATICS: Absence of swellings
 ENDOCRINOLOGIC: Patti does not suffer from either polyuria or polydipsia
Physical exam: This patient is of Height 5 feet 24 inches, 148/74, weight of 176 pounds, HR:
83, BP: R: 22 and her temperature reads 37.1
Diagnostic results: No results were made
Assessment
Mental Status Examination: This patient Patti expressed her frustration and sadness while
lamenting her loneliness and lack of hope. According to Trustam et al., (2021) individual therapy
help people reconcile their feelings about children and disabilities. Throughout the session, she
speaks clearly and coherently and seems focused and directed. She says that she does not
experience suicidal or homicidal thoughts. Patti is well groomed for the session. Since her
children have abandoned her culture and are unwilling to help, she attributes her issues to the
lack of support she receives from them
Differential Diagnoses:
Adjustment Disorder: It all about a behavioral or emotional response brought on by a stressful
incident or a change in the quality of living. According to Morgan et al., (2022) making
reference to the DSM-5 criteria this condition is describes as emotional or behavioral symptoms
that a patient might experience within three months of the onset and are caused by the body's
reaction to stresses. Patti is anxious because her kids have rejected her culture, despite the fact
that she was raised in Iran. Her mental health is impacted by the dissonance that follows her

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relocation to a foreign nation, which leads to cumulative stress. As a result, this patient could be
suffering from adjustment disorder.
Major Depressive Disorder: For a patient to be diagnosed with this condition he or she must be
suffering from at least five symptoms which include exhaustion, agitation, suicidal thoughts, lack
of interest, depression, hypersomnia, sleeplessness, and inappropriate guilt. These symptoms
must last for at least two weeks as per the DSM-5 criteria (Marx et al., 2023). Because Patti has
not lost interest in former hobbies and does not have suicidal thoughts, Patti does not fit the
diagnostic criteria.
Generalized Anxiety Disorder: The disorder is manifests itself by excessive anxiety, constant
worrying, and problems controlling worrying. One must experience thesesymptoms for at least
six months as per the DSM-5. These symptoms include fatigue, restlessness, irritability, and
tense muscles (Showraki et al., 2020). In this case, Patti does not suffer excessive concern,
restlessness, or tiredness, hence she does not meet the DSM-5 criteria.
Case Formulation and Treatment Plan:
o Individual therapy sessions begins, taking into account her impairment.
o Give time for inquiries and respond to them while listening with encouragement. This
patient clearly understood the reflecting team and all the conversations, but she was
reluctant to adapt. She committed to following the course of treatment.
o Follow-up consultations to assist with drug modification
o Encourage the use of emotional intelligence assessments.
o It appears that Patti is unaware of the adverse consequences of being overly emotional
and demanding of her kids. However, how Patti controls, recognizes, and interprets her
emotions can be better understood by using the emotional intelligence exam.
o Make an appointments in intervals of two.
Predisposing factors: One of the factors that led the mother making adecision of relocating
to the United States was the trauma she endured while being abused at home by her ex-
husband. After coming to the US, she performed two foot surgeries that went horribly wrong,
leaving her disabled. As her older daughters attempted to live on their own, she too
experienced loneliness and melancholy, which resulted to a situation worse.

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 Precipitating factor: What was the root cause for the family's turmoil is the youngest
daughter's reuniting with her relatives in the United States. The youngest daughter said that
the family was unstable because of her father's emotional, physical, and sexual abuse of her.
Perpetuating factor: The reason for this is that her daughters are trying to live their lives.
This made her feel even more alone and depressed.
Reflections:
This paper consists an analysed case of a lively and captivating family dispute that requires time
to resolve. As a practitioner, I really value the approach taken by the interviewer and the
involvement of the family therapist. The interviewer did an excellent job of connecting with all
of the participants, using open-ended questions to start a conversation, and occasionally pausing
for reflection. He or she established a therapeutic contact with the family therapist right away,
and as the conversation went on, he kept seeking for more information about this family. The
only thing still missing is the rest of the family, most especially the daughter who arrived from
Iran at the age of 21. Her viewpoint on the family's disagreement would be interesting to hear.
The interviewer and therapist put into account the ethical and cultural considerations since they
both recognize the moral conundrum that the culture the children tried to live in and are
weighing it against the mother's view of her own cultural background.
Some of the essential ethical considerations are cultural sensitivity, cultural prejudices, and
hesitancy identification according to (Hasan et al., 2021). It's very critical to identify the
variables that may impede the delivery of high-quality care and the accomplishment of treatment
objectives. To learn about the patient's perception, it is good to assess how the health services are
perceived. In order to facilitate the most suitable delivery of healthcare services, it is important to
assess cultural prejudice and preconceptions. As a practitioner, I would advise the patient to seek
for further help from other relatives and not put too much pressure on her kids.
To summarize, disagreements may arise between individuals and families. Those who are unable
to resolve cultural issues undergo devastating internal readjustment. This family is dealing with
two problems. The first problem is despite the mother's commitment to her identity as an Iranian
dissident, the children made an effort to live independently and assimilate into American society.
The second one is the mother suffers from severe depression and has trouble adjusting, while the
youngest daughter has reactive attachment disorder. Through group, family, and cognitive-
behavioral therapy, family fights were decreased, facilitating therapeutic recovery.

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 References
Hasan, N., Rana, R. U., Chowdhury, S., Dola, A. J., & Khan Rony, M. K. (2021). Ethical
considerations in research. Journal of Nursing Research,Patient Safety and Practise, 1-
4. https://doi.org/10.55529/jnrpsp.11.1.4
Marx, W., Penninx, B. W., Solmi, M., Furukawa, T. A., Firth, J., Carvalho, A. F., & Berk, M.
(2023). Major depressive disorder. Nature Reviews Disease
Primers, 9(1). https://doi.org/10.1038/s41572-023-00454-1
Morgan, M. A., Kelber, M. S., Bellanti, D. M., Beech, E. H., Boyd, C., Galloway, L., Ojha, S.,
Garvey Wilson, A. L., Otto, J., & Belsher, B. E. (2022). Outcomes and prognosis of
adjustment disorder in adults: A systematic review. Journal of Psychiatric Research, 156,
498-510. https://doi.org/10.1016/j.jpsychires.2022.10.052
Showraki, M., Showraki, T., & Brown, K. (2020). Generalized anxiety disorder:
Revisited. Psychiatric Quarterly, 91(3), 905-914. https://doi.org/10.1007/s11126-020-
09747-0
Trustam, E., Chapman, P., & Shanahan, P. (2021). Making recovery meaningful for people with
intellectual disabilities. Journal of Applied Research in Intellectual Disabilities, 35(1),
252-260. https://doi.org/10.1111/jar.12944

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