Read the following information and answer the following questions

Section 1

Following your recent qualifying as a Chiropractor you’ve decided to undertake some travel and work in a number of clinics throughout Australia. For the last two days you’ve been working in a well-established clinic in a small country town (population approximately 12 000 people).
Your first patient of the day (Evelyn) is new to the practice and a new arrival in town.

General Appearance in waiting room:
Evelyn a 52 year old, immaculately groomed lady of average height and weight appears very nervous in the waiting room. She has positioned herself on the chair in the corner of the waiting room away from everyone else. On being handed the completed patient history your jaded reception staff member whispers to you, “Good luck with this one, I think she’s a bit strange. She’s been looking down fidgeting in her hand bag the whole time”.

Reading through the history you find Evelyn has presented for ongoing headaches which commenced nine weeks ago following a fall at home. She has had plain x-rays and a CT- Scan which showed no fractures but she has had ongoing pain, today she rates it as 7 out of 10.

The original Doctor’s letter she presents provides you with a diagnosis of Uncomplicated Myalgia of the cervical para spinal muscle.
Studying the history further you note she has also ticked sleeping problems, anxiety and depression as well as the above.

Question 1 – 10 marks
Given the above information please detail:
Communication techniques you would use to place Evelyn at ease before commencing any further assessment and treatment.


Question 2 – 20 marks
On entering the treatment room Evelyn tells you the fall was down four stairs and occurred two days after her twin brother’s funeral. The cause was put down to stress following the funeral.
She also informs you four weeks ago she has been prescribed Endep (Amitriptyline) and Tramadol both of which she has been taking intermittently. She is reluctant to take the Tramadol “too often” and at differing times Evelyn breaks down crying telling you “it’s hard at the moment but I’m coping. Sorry I don’t know what these tears are all about, I don’t normally cry”.

In order of priority outline any questions and actions you would ask/perform when assessing the patient. This should include:
• Completing the Chiropractic Case History which would assist you to assess the severity and nature of the patient’s current condition. This should include questions you would ask related to the information provided so far.
• Completing a Mental State Examination using the information provided. If information isn’t provided describe what actions you would undertake and/or what you would observe to perform this.
** These should be specific questions and make use of the questioning techniques outlined in your prescribed text and Moodle site. The aim of these questions should be to further assess the severity and nature of the patient’s current condition.

Section 2
This relates to specific management of your patient.
Following successfully calming the situation Evelyn allows you to undertake a full physical assessment. The results of which are as follows:
• Postural analysis: the patient has a forward head carriage.
• Range of motion: the patient has a slight restriction in right rotation and left lateral flexion.
• Muscle palpation: The patient displays sub-occipital muscle tension bilaterally with associated muscle tension in the right upper cervical spine neck area.
• Static spinal palpation – (RP , PL, Left Rotation Restriction, Right Rotation Malposition)

Question 3 – 15 Marks
Given the above information it is obvious there are multiple aspects to managing Evelyn’s current situation which would require an open and professional discussion on options.

Within this question you are required to complete the following:
• Develop a structured plan for how you would approach the conversation with Evelyn and provide justification on why you have undertaken it. Note there is no one right answer to this section, it’s about you providing a plan and justifying why? For example would you discuss her anxiety, depression and sleeping problems first or Chiropractic care?

Within this plan you would need to:
• Discuss various options you would advise for dealing with her anxiety/depression/sleeping problems.

Question 4 - 5 marks
Outline how your management priorities would change if Evelyn told you she had planned to kill herself. Please include in your answer:
• How you would determine if she posed an imminent threat to her own life?
• The management option/s you would take if you determined the threat was imminent.
• The management option/s you would take if you determined the threat was not imminent.
This segment may be in dot point form but should outline the above information.

To gain a high distinction within this assessment you will be expected to undertake the following:

Question 1. Communication Techniques

Applies extensive (in excess of 10) verbal and non-verbal communication techniques to gain meaningful interaction with the patient. AND
The communication techniques applied are grounded in the recovery based framework and relate to the given situation. AND
Techniques should not just be listed but expanded on e.g. What you would do and how you would achieve it in this given situation.

Question 2. Patient Assessment
Completes all aspects of the Mental State Examination (MSE) including all patient specific questions related to the MSE.

Question 3. Patient Management
Develops a structured plan for how to approach the conversation with the patient which includes the following:
Provides extensive (in excess of 8) options the patient has available to manage her anxiety, depression and sleeping problems.

Question 4. Patient Management-complications
Outlines the threat assessment process to determine if the patient is an imminent risk to her own life. Assessment is completed without error or omission.
AND
Completes all aspects of management without error or omission.

Assessment component 2.1

Aim
The aim of this assessment is develop the essential skill of a health care professional, that of communicating and advocating on behalf of your patient.

Format
Using the template located in your Moodle site please write a referral letter for the patient discussed at the On-campus tutorial by your Unit Coordinator.
Your letter should include information on all relevant aspects of the Mental State Examination as well as a history which is comprehensive (given the information you have already gained through observation and interview).

The format of the Mental State Examination in the letter is to be narrative so the reasons you have referred the patient are clearly outlined. As part of this assessment you will also be required to attach a completed depression and or anxiety scale of your choosing. This form is to be filled out on the fictitious patient presented to you in Week 6.
Example referral letters are contained within your Moodle site.

Assessment component 2.2: Mixed question style online test
Introduction
During this assessment you will be asked to complete a mix of short answer, matching questions, true false and multiple choice questions on content from weeks 1, 2, 5, 6, 7, and 9.

Aim
This assessment aims to test specific content knowledge not assessed within component one.

Format
The online test will include a mix of short answer, matching questions, true false and multiple choice questions. Questions will be derived from a variety of sources including lectures, tutorials and online readings. Refer to your moodle site for further details.

Assessment criteria 2.1: Referral Letter

To gain a high distinction in this assessment you will be required to:

1. Grammar and Spelling
Practitioner makes no errors in grammar or spelling whilst documenting.

2. Components of the Mental State Examination
Documents all aspects of the Mental State Examination with examples of patient behaviour in each.

3. Uses accepted Mental Health/Medical terminology within the relevant categories of the Mental State Examination.

4. All aspects of the depression/anxiety scale are completed.

Assessment Criteria Component 2.2: Mixed Style Questions

High distinction: 84.5 – 100%
Distinction: 74.5 – 84.4%
Credit: 64.5 – 74.4%
Pass: 49.5 – 64.4%
Fail: <49.5%