2Assessing Clients“A comprehensive assessment of the patient who presents for psychotherapy is necessary to develop an appropriate treatment plan.  This assessment is a relational process that sets the tone for subsequent sessions” (Wheeler, 2014, p. 131). As a future Psychiatric Mental Health Nurse Practitioner, it is essential to be able to accurately assess clients to determine whether yourtherapeutic approach would contribute to improved clinical outcomes.  The purpose of this assignment is to select a client that was observed or counseled at my practicum site and completea comprehensive client assessment and genogram for the client selected.Comprehensive Client AssessmentDemographic information for the client chosen is as follows:  The client is a 27-year-old African female who resides in Maryland.  She is a single, heterosexual, mother of fraternal twins,a boy and a girl.  She was referred by her psychiatrist to the current counselor for psychotherapy and is primarily followed by the psychiatrist for medication management.  The client has been receiving psychotherapy for the past two years.  Her presenting problem revolves around learning how to be independent while coping with her mental illness.  She stated, “I need help with figuring out my finances.”  History of present illness:  Client has a history of bipolar and presented to the office with complaints about her “baby daddy” not wanting to help her out with their children and about how difficult it’s going to be when her cousin stops keeping her twins because daycare is expensive.  She also expressed discontent towards her father interfering in herpsychiatric care because he shares the same Nigerian ethnicity as her psychiatrist and she wants to be on less medication and receives more psychotherapy.  The client’s past psychiatric history includes two psychiatric hospitalizations for manic episodes with psychosis.  Medical history includes a previous diagnosis of hypertension (HTN), but that diagnosis was later removed.  The  3client never took any medications for HTN diagnosis, and HTN resolved through life modifiers. Currently takes Lithium and Cogentin.  The client has no substance use history, and developmental milestones were reached as expected.  No family psychiatric history reported.  Psychosocial history:  She currently lives with her father.  Her youngest brother and cousin, who is married, also reside in the same house.  She works a full-time minimum wage job and is recently single.  She has been in contact with her ex-boyfriend who is trying to ‘hook up’ with her to have sex.  She is the mother of fraternal twins, a boy and a girl.  No history of abuse or trauma.Psychiatric Review of SystemsClient denies “shortness of breath, heart palpitations, panic attacks, sweating flushing, hyperventilation, sense of doom, fear of death or collapse, cold or clammy skin, and tingling sensations in extremities” (Wheeler, 2014, p. 140).  Client denies feeling sad, irritable, tired, h.

1. 2Assessing Clients“A comprehensive assessment of the patient
who presents for psychotherapy is necessary to develop an
appropriate treatment plan. This assessment is a relational
process that sets the tone for subsequent sessions” (Wheeler,
2014, p. 131). As a future Psychiatric Mental Health Nurse
Practitioner, it is essential to be able to accurately assess clients
to determine whether yourtherapeutic approach would
contribute to improved clinical outcomes. The purpose of this
assignment is to select a client that was observed or counseled
at my practicum site and completea comprehensive client
assessment and genogram for the client selected.Comprehensive
Client AssessmentDemographic information for the client
chosen is as follows: The client is a 27-year-old African female
who resides in Maryland. She is a single, heterosexual, mother
of fraternal twins,a boy and a girl. She was referred by her
psychiatrist to the current counselor for psychotherapy and is
primarily followed by the psychiatrist for medication
management. The client has been receiving psychotherapy for
the past two years. Her presenting problem revolves around
learning how to be independent while coping with her mental
illness. She stated, “I need help with figuring out my finances.”
History of present illness: Client has a history of bipolar and
presented to the office with complaints about her “baby daddy”
not wanting to help her out with their children and about how
difficult it’s going to be when her cousin stops keeping her
twins because daycare is expensive. She also expressed
discontent towards her father interfering in herpsychiatric care
because he shares the same Nigerian ethnicity as her
psychiatrist and she wants to be on less medication and receives
more psychotherapy. The client’s past psychiatric history
includes two psychiatric hospitalizations for manic episodes
with psychosis. Medical history includes a previous diagnosis
of hypertension (HTN), but that diagnosis was later removed.
The

2. 3client never took any medications for HTN diagnosis, and HTN
resolved through life modifiers. Currently takes Lithium and
Cogentin. The client has no substance use history, and
developmental milestones were reached as expected. No family
psychiatric history reported. Psychosocial history: She
currently lives with her father. Her youngest brother and
cousin, who is married, also reside in the same house. She
works a full-time minimum wage job and is recently single. She
has been in contact with her ex-boyfriend who is trying to ‘hook
up’ with her to have sex. She is the mother of fraternal twins, a
boy and a girl. No history of abuse or trauma.Psychiatric
Review of SystemsClient denies “shortness of breath, heart
palpitations, panic attacks, sweating flushing, hyperventilation,
sense of doom, fear of death or collapse, cold or clammy skin,
and tingling sensations in extremities” (Wheeler, 2014, p. 140).
Client denies feeling sad, irritable, tired, having a decreased
appetite or energy, changes in sleep or libido, suicidal ideation,
homicidal ideation, s/s of hypomania, and feeling of
hopelessness. The client did not present with hallucinations,
delusions, flight of ideas, thought insertion, thought blocking
and thought broadcasting in sessions (Wheeler, 2014).
Physical Assessment Vital signs: BP128/72; P 78 and regular,
R 18 and regular; Temp 98.3 orally. Current weight is215
pounds. Height is 5’9” General: She is a well-developed, well-
nourished African American female who is alert and
cooperative. Se is a good historian and answers questions
appropriately. HEENT: No loss of vision or hearing. No nasal
congestion, sneezing, rhinorrhea, and postnasal drainage. Nasal
mucosa pink and moist. No enlarged tonsils.Neck: No enlarged
lymph nodes.Chest: Thorax symmetrical.Lungs: Breath sounds
clear throughout all lung fields; no rhonchi or wheezes
noted.Heart: Heart rate is regular with good S1, S2; S3
auscultated.Peripheral Vascular: 2+ edema present to bilateral
ankle. Abdomen: Nondistended and nontender with active
bowel sounds auscultated x4 quadrants.

3. 4Genital/Rectal: Not assessed. Denies vaginal/rectal discharge
and bleeding.Musculoskeletal: No joint pain or discomfort
present.Neurological: Awake, alert, and oriented to person,
place, and time.Skin: Cool and dry Intact. No ecchymosis or
edema. Skin turgor good. No cyanosis, pallor, or jaundice
present.Mental Status ExamAppearance/Attitude: Pleasant
groomed African American female sitting up on the couch, good
hygiene.Psychomotor Behavior: Good eye contact, appears
comfortable. No abnormal movements, normal
speed.Speech/Language: Fluent, appropriate quantity, volume,
rate, latency.Affect: Euthymic.Mood: "I’m good."Thought
Process/Form of thought: Goal-directed and logical. Thought
Content/Perceptions: No delusions, hallucinations, or
SI/HI.Sensorium/Level of awareness: Fully awake and
alertAttention/Concentration: Fully intact and attentive. Can
name days of week backward. Memory/recent/remote: Intact for
immediate, recent, and remote. 3/3 delayed recall.Fund of
knowledge: Appropriate for educational level. Executive
Functions: Intact.Insight/Judgment: fair/fairDifferential
DiagnosisDifferential diagnoses that could be considered for
this client include anxiety, obsessive-compulsive disorder
(OCD), and attention deficit hyperactivity disorder (ADHD).
Everyone experiences occasional anxiety, but for a person with
anxiety disorder, it doesn’t go away and can worsen over time
(National Institute of Mental Health, 2013). Anxiety was
selected as a differential diagnosis due to this disorder being
prevalent in Bipolar disorder (BD) patients, and these “patients
have particularly high rates of lifetime anxiety disorders”
(Yuen, Miller, Wang, Hooshmand, Holtzman, Goffin, Shah, &
Ketter, 2016, p. 101). “ADHD is an early-onset
neurodevelopmental disorder characterized by developmentally
inappropriate symptoms of inattention, hyperactivity, and
impulsivity, that affects 5% of childhood population and
persists into adulthood in up to 50% of the cases” (Torres,
Garriga, Sole, Bonnín, Corrales, Jiménez,

4. 5Sole, Ramos-Quiroga, Vieta, Goikolea, & Martínez-Aran,
2018, p. 118). ADHD was chosen as a differential diagnosis
due to its presence in clients that have a BD diagnosis. “It is
known that between 10 to 30% of adult patients with BD present
comorbidity with lifetime ADHD” (Torres et al., 2018, p.118).
Not only are their clinical correlations between BD and anxiety
but the treatment approaches overlap with them (Torres et al.,
2018). OCD was chosen as a differential diagnosis due to the
prevalence in individuals with BD. “The estimated prevalence
of BD in OCD has been reported to be 6–56% in various
studies” (Saraf, Paul, Viswanath, Narayanaswamy, Math, &
Reddy, 2017, p. 70). Case FormulationThe client is an African
American 27-year-old female and mother of twins learning how
to become independent and cope with her mental illness. She
has had a history of being hospitalized for mania with psychosis
twice. Her mother recently passed away with whom she was
very close. She is currently having financial difficulties and
issues with the father of her children not contributing to her
children’s lives and experiences anxiety related to these issues.
She lives at home with her father but is trying to prepare
herself for independent living. She would like to be in control
of her mental health as it pertains to receiving more
psychotherapy and decreasing the doses of her current
medications because she stated they maker her “slow”
especially at work. She has impairment with her occupational
functioning and has concerns about with management not being
understanding of her mental illness. She also voiced that she
did not want her father involved in her treatment plan any
longer. Treatment PlanThe current plan is for the client to
continue the medication regimen of Lithium and Cogentin and
report any side effects. Individual psychotherapy will continue
and goals
6discussed with the client regarding her employment, financial
planning, and familial changes andoverall management of her

5. concerns