PLEASE FOLLOW THE INSTRUCTION BELOW

ZERO PLAGIARISM

5 REFERENCES

• Assess client families presenting for psychotherapy
• Develop genograms for client families presenting for psychotherapy

To prepare:

• Select a client family that you have observed or counseled at your practicum site.
• Review pages 137–142 of Wheeler (2014) and the Hernandez Family Genogram video in this week’s Learning Resources.
• Reflect on elements of writing a comprehensive client assessment and creating a genogram for the client you selected.

Assignment

Part 1: Comprehensive Client Family Assessment

Create a comprehensive client assessment for your selected client family that addresses (without violating HIPAA regulations) the following:

• Demographic information
• Presenting problem
• History or present illness
• Past psychiatric history
• Medical history
• Substance use history
• Developmental history
• Family psychiatric history
• Psychosocial history
• History of abuse and/or trauma
• Review of systems
• Physical assessment
• Mental status exam
• Differential diagnosis
• Case formulation
• Treatment plan

Part 2: Family Genogram

Develop a genogram for the client family you selected. The genogram should extend back at least three generations (parents, grandparents, and great grandparents).

Refer back to the interview and evaluation you conducted in the Topic 2 Family Health Assessment assignment. Identify the social determinates of health (SDOH) contributing to the family’s health status. In a 750-1,000-word paper, create a plan of action to incorporate health promotion strategies for this family. Include the following:

1. Describe the SDOH that affect the family health status. What is the impact of these SDOH on the family? Discuss why these factors are prevalent for this family.
2. Based on the information gathered through the family health assessment, recommend age-appropriate screenings for each family member. Provide support and rationale for your suggestions. 
3. Choose a health model to assist in creating a plan of action. Describe the model selected. Discuss the reasons why this health model is the best choice for this family. Provide rationale for your reasoning.
4. Using the model, outline the steps for a family-centered health promotion. Include strategies for communication.

Cite at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

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As Discussed

Why do cancer prevention recommendations suggest red meat intake be limited?

11 words 

Reply to Amanda 

Do you take any medications?

Some medications (Lithium) are notorious for causing hypothyroid.

Have you ever been diagnosed with a thyroid disorder?

Surgeries to the thyroid may result in hypothyroid.

Are you allergic to anything?

Relevant to treatment regimen.

Have you experienced any significant life changes? Additional stress etc?

Depression may manifest similar symptoms.

PE:

Hypothyroidism is six times more common in women than men, and is most common in older women (Carson, 2009). A thorough physical assessment should be completed. Clinical signs and symptoms may include paleness, brittle appearing hair and skin, elevated blood pressure, and bradycardia (Carson, 2009). The patient may have a “puffy” appearance to her face, irregular periods, and report sustained fatigue (Roberts et al, 2009).

Differential Diagnoses

Anemia, Depression

Diagnostics

           TSH – Will be elevated in Hypothyroid

           Free T4 – Result will be low in Hypothyroid

           Cholesterol – Often elevated with Hypothyroid

           CBC – To rule out anemia

           CMP – To monitor other electrolytes

           EKG – to assess for any blocks, prolonged QRS, or electrolyte abnormalities

Treatment

           Patients with symptomatic hypothyroidism should be treated to prevent long-term complications (Roberts et al, 2004) Depending on the results of her TSH & T4 I would initiate a daily regimen of Levothyroxine. 4-6 weeks after the initiation of Levothyroxine I would recheck the patients TSH. After the TSH has reached a therapeutic level – I would recheck it again in 6 months.

References

Carson, M. (2009). Assessment and management of patients with hypothyroidism. Nursing Standard (through 2013), 23(18), 48-56; quiz 58. Retrieved from https://prx-herzing.lirn.net/login?url=https://search.proquest.com/docview/219883523?accountid=167104 (Links to an external site.)Links to an external site.

Roberts, C. G. P., & Ladenson, P. W. (2004). Hypothyroidism. The Lancet, 363(9411), 793-803. doi:http://dx.doi.org/10.1016/S0140-6736(04)15696-1

reply to Quiana

1. What additional questions should you ask the patient and why?

Some questions include:

• How much weight has been gained? What kinds of meals/foods do you typically take? Do you exercise?
• Quantifying the amount of weight provides perspective. A gain of 5 lbs does not carry the urgency that a 20 lb weight gain does. Asking about her lifestyle habits can offer some insight into factors that can aggravate what sounds like hypothyroidism. This creates teachable opportunities for improving lifestyle habits.
• Are you still menstruating and if so, how regularly?
  • This can rule out pregnancy or hormone changes that precipitate menopause. Also, with hypothyroidism, this condition can disrupt a normal menstrual cycle. For a woman in menopause, hypothyroid symptoms can be masked or ignored when it is assumed that it is a lack of ooestrogen that is causing her concerns (Baisier, Hertoghe, & Eeckhaut, 2000).
• Bowel habits, specifically any problem with constipation?
  • (Chaker, Bianco, Jonklaas, & Peeters, 2017)
• Any hx of depression?
  • Her reported complaints are common findings for hypothyroid but they can also be related to depression. Though the rate of depression in hypothyroid patients is >60% (Bathla & Singh, 2016), the patient should be screened for depression. Her symptoms could be psychosomatic.

1. What should be included in the physical examination at this visit?

• Included items to address are skin for dryness, hair for thinning or irregular growth pattern, eyes for exopthalmus, neck/throat and thyroid for possible goiter, cardiac sounds for bradyarrhythmias, and also for peripheral manifestations like delayed relaxation of deep tendon reflexes (Chaker, et al., 2017).

1. What are the possible differential diagnoses at this time?

• Hypothyroidism
• Depression
• Anemia
• What tests should you order and why?
• TSH and free T3 and T4
• EKG
• CMP
• CBC
• Lipid Panel
• A depression screen can be done in office

Hypothyroidism can increase lipids and alter cardiac function (Chaker, et al., 2017). EKG may reveal cardiac abnormalities. CBC can reveal anemia. The metabolic panel can reveal diabetes or problems with hepatic or renal function. Hypothyroidism continues to be researched as far as the specific link to renal and hepatic dysfunction (Chaker, et al., 2017). The depression screen serves, like the other lab orders, to exclude causes of her symptoms. The most obvious test is a thyroid panel. To assess the circulating amount of hormone in the body is to judge her thyroid function.

1. How should this patient be managed?

• Pending the diagnosis, the patient should be encouraged to complete all lab work in a timely fashion. Since these labs can be resulted within 24hrs, if not same day, that would be my biggest priority for completion. For hypothyroidism, pending the thyroid results, the patient should start on hormone replacement with a drug like levothyroxine. Often, levothyroxine 50-100mcg is a starting dose (Dunphy, Winland-Brown, Porter, & Thomas, 2015), it should be taken daily, on an empty stomach, in the morning. She should return in about 1 mo to reassess symptoms and lab value. If the patient is difficult to manage, due to comorbid conditions or lack of therapeutic response, endocrine may be consulted.

References

Baisier, W. V., Hertoghe, J., & Eeckhaut, W. (2000). Thyroid insufficiency. is TSH measurement the only diagnostic tool? Journal of Nutritional & Environmental Medicine, 10(2), 105-113. Retrieved from https://prx-herzing.lirn.net/login?url=https://search.proquest.com/docview/215623935?accountid=167104

Bathla, M., & Singh, M. (2016). Reply to “how prevalent are depression and anxiety symptoms in hypothyroidism?”. Indian Journal of Endocrinology and Metabolism, 20(6) doi:http://dx.doi.org/10.4103/2230-8210.192913

Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P. (2017). Hypothyroidism. The Lancet, 390(10101), 1550-1562. doi:http://dx.doi.org/10.1016/S0140-6736(17)30703-1

Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary care: The art and science of advanced practice nursing, (4th ed.). [VitalSource Bookshelf version].  Retrieved from https://bookshelf.vitalsource.com/books/9780803655621