Writing a nursing case study: The case of Santiago Gordon Cruz who witnessed the murder of his father (Solved)

Writing a nursing case study: The case of Santiago Gordon Cruz who witnessed the murder of his father (Solved)

Case study prompt:

Santiago Gordon-Cruz is a six-year-old Argentinian boy who witnessed the murder of his father, Manuel, six months ago. Manuel was shot multiple times during a robbery in the bodega where he worked. Since the murder, Santiago has had trouble sleeping, often cries, and has been refusing to leave the house. His mother, Adelina, notes that Santiago regularly complains that his tummy hurts, is startled by any sudden or loud noises, and constantly wants to be held by family members. He has a poor appetite and he sleeps poorly.

The family is Catholic. Adelina says that she has told Santiago many times that his father is in heaven, and they pray for him every day. Her son does not appear to be comforted by this.

The Gordon-Cruz family legally immigrated to the United States about four years ago. Santiago and Adelina speak English, although the family primarily speaks their native Spanish at home and in their community.

Questions

From your perspective as Santiago’s psychiatric nurse practitioner, answer the following questions in a three-page double-spaced paper (not including the reference page) in APA format. Include at least two peer-reviewed, evidence-based references (not including your textbooks).

1. What type of psychotherapy might you recommend for Santiago (Cognitive Behavioral Therapy or Cognitive Behavioral Therapy for Anxiety)? Provide a rationale. How would you explain to Adelina how this intervention could help her son?

2. Identify a case conceptualization based on cognitive behavioral therapy for this case (Ex: Santiago shows a case of Post-traumatic stress disorder, grief, and anxiety).

3. What level of care would you recommend for Santiago (Ex: inpatient or outpatient therapy)? How often would you want to see him? Are there any recommendations you would make for the family as a whole?

SOLUTIONS

 Question 1

Santiago Gordon Cruz witnessed the murder of his father.  From the history, the boy is likely suffering from post-traumatic stress disorder. The therapy I would recommend to the patient is cognitive-behavioural therapy. It is a psychological therapy that can effectively manage a range of problems such as post-traumatic stress disorder and anxiety symptoms (Keen et al., 2017). Various studies indicate that CBT significantly improves the quality of life and the functioning of patients.  The therapy has core principles.  Firstly it believes that post-traumatic stress disorder occurs due to unhelpful and faulty patterns of thinking.  The approach helps the patient to learn various better ways of coping through relieving certain symptoms.

In the boy, cognitive-behavioural therapy enables the boy to recognize that thinking of the traumatic experience is responsible for the symptoms he is showing. The patient’s symptoms include loss of appetite, anxiety, hurting tummy, and being startled by loud noises.  This will enable the boy to reevaluate the scenario in light of reality.  CBT will also enable the child to understand that the scenario happened a long time ago, and there is no need for him to fear.  The therapy will also utilize various problem-solving skills to help the child cope with certain difficult situations that remind him of the traumatic experience (Heslop-Marshall et al., 2018). After the therapy, the boy will be able to face his fears instead of avoiding them. A simulated scenario involving loud noise can be used to help address their fear of loud noises.  Finally, the therapy will enable the child to adopt various relaxation techniques whenever they are faced with various situations that remind them of the particular traumatic experience.

Post therapy, the boy’s health and wellbeing are likely to improve. All the physical symptoms associated with certain trigger situations will fade awareness. In future, these symptoms will not manifest when the boy feels anxious as they will be able to cope effectively.

Question 2: Case Conceptualization

Santiago shows a case of acute post-traumatic stress disorder, anxiety disorder and panic attacks. He witnessed the death of his father six months ago. Since the instance, Santiago has been experiencing certain physical symptoms. These symptoms are related to the traumatic experience the boy witnessed. Post-traumatic stress disorder commonly occurs in individuals who experience or witness a traumatic event. The intense and disturbing thoughts and feelings are responsible for the symptoms the patient shows long after the actual traumatic event involving witnessing the murder of his own further.

The symptoms shown in the patient varies in various categories.  The first category involves intrusion, whereby the patient experiences flashbacks related to the traumatic experience.  This makes the boy feel like he is reliving the traumatic experience or seeing it as it happened before his own eyes. The second category is avoidance; the boy tends to avoid certain situations in their current life that are likely to remind him of the past traumatic experience. The patient is avoiding living in the house due to the fear that the shooters may be around. The third category is the alteration in cognition and mood.  The negative thoughts may cause alterations in Santiago’s mood and behaviour. This is evident with the boy being constantly startled by any sudden loud noises.

Question 3 Level Of Care

The level of care I would recommend to Santiago is outpatient therapy.  Outpatient therapy will enable the boy to receive care in their community. Since the boy avoids being outside, outpatient treatment will be more beneficial to him.  It will improve the quality of life of the boy. The patient will be required to visit the healthcare facility according to the cognitive behaviour therapy.

The therapy sessions will depend on the patient s recovery rate. Therapy will stop when the patient can address their fears and cope with the various situations that trigger the physical symptoms. The patient will be required to go for therapy every weekend. The therapy sessions can last for about six months but depend on the patient’s progress (Pantain & Cassidy, 2018). In each appointment, the patient will undergo 2 to three progressive therapy sessions to help him cope with the psychiatric illness.

Recommendations To Make To The Family

The disorder may affect the boy’s family members.  The family members need to be supportive of the child in numerous ways. Firstly the family members need to provide the boy with various emotional and psychological needs. They can express closeness and affection to the boy. Closeness will enable the boy to cope with his situation. They should also utilize open communication when interacting with the child (O’Connell et al., 2017). If the child wants to play, they should provide him with a conducive environment. Family members also should be involved in ensuring their child develops socially by organizing activities that will require the child’s friends to come over. When the child interacts with his friends, they will be able to cope effectively. Finally, the family members can support the patient spiritually and intellectually. They can encourage the child to be focused and forget the events that happened in the past.

                                                                  

 

 

                                                                    References

Heslop-Marshall, K., Baker, C., Carrick-Sen, D., Newton, J., Echevarria, C., Stenton, C., & De Soyza, A. (2018). Randomized controlled trial of cognitive behavioural therapy in COPD. ERJ Open Research4(4).

Keen, N., Hunter, E., & Peters, E. (2017). Integrated trauma-focused cognitive-behavioural therapy for post-traumatic stress and psychotic symptoms: a case-series study using imaginal reprocessing strategies. Frontiers in psychiatry8, 92.

O’Connell, K., Fritze, J., Guzzetta, C. E., Clark, A. P., Lloyd, C., Scott, S. H., … & Kreling, B. (2017). Family presence during trauma resuscitation: family members’ attitudes, behaviours, and experiences. American Journal of Critical Care26(3), 229-239.

Paintain, E., & Cassidy, S. (2018). First‐line therapy for post‐traumatic stress disorder: A systematic review of cognitive behavioural therapy and psychodynamic approaches. Counselling and psychotherapy research18(3), 237-250.

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