Read the following information and answer the following questions in essay written in an APA referencing style. As a guideline, the length of the main body of your essay should be around 3000 words or so, excluding references - essays that are substantially longer than this (say over 3500 words) or shorter than this (say less than 2500 words) are unlikely to score as highly as those that make the best use of the 3000 word length (being on-target and making the best use of the word allocation is always better than being off-message).

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” and not making any eye contact with anyone else in the reception area.

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 of the cervical spine which revealed no fractures or any other pathology but she has had ongoing pain, today she rates it as 7 out of 10 on the VAS pain disability scale.

The original Doctor’s letter she presents provides you with a diagnosis of uncomplicated myalgia of the cervical para spinal muscles with minor degenerative changes at C5/6 vertebral segments.
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:
What communication techniques you would use to place Evelyn at ease before commencing any further assessment and treatment. You should comment on both verbal and non-verbal approaches which would assist in this task.


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:
• Listing which further questions in the Chiropractic Case History 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, an increased thoracic kyphosis and dowagers hump.
• Range of motion: the patient has a slight restriction in right rotation and left lateral flexion of the cervical spine.
• 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 – Left Rotation Restriction, Right Rotation Malposition RPI C/C6

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.

When submitting your essay

Please note the following details: 

Text should be word-processed, with appropriate layout and use of headings/sub-headings. Font and line spacing are not part of the assessment criteria, listed below.

Diagrams should be used to illustrate specific aspects - a picture paints ten thousand words! (please ensure that you correctly cite/reference all sources of diagrams used, unless they are original and composed by you, since this is an important aspect of academic integrity). 

Please avoid images with very large file sizes, as this will make your essay too large to upload/download (save any images as lower resolution, to decrease the file size).

The list of references should form the last page or two, at the end of the assessment. Referencing should be in a consistent style - typically APA format. 

Please save/upload your file in Word format (.doc or .docx) , so that I can open the files in Word. Note: further support on writing, referencing, etc. is given on the Moodle site for this course

Assessment component 2.1: Mixed question style online test
Introduction

For this assessment you will be asked to answer a mix of short answer, matching questions, true false and multiple choice questions on content from the unit material from weeks 1, 2, 5, 6, 7, and 9

Aim
This assessment aims to test your specific content knowledge and mental health literacy in relation to the unit learning outcomes

To identify different presentations in people experiencing mental health challenges

To discuss the therapeutic options available for people who may be experiencing different types of mental health conditions and/or challenges

To apply the principles of interpersonal communication and professional behaviours to the standards expected of a chiropractic health professional

To apply recovery framework principles throughout the chiropractic assessment of and intervention process for clients experiencing mental health challenges.

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.

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