Topic: Ruby’s Medications – Prescribed and Non-Prescribed

QUESTION

Aim of the Assessment

By working in a group, students will have the opportunity to develop their oral skills, learn about professional advocacy and how to work collaboratively in a team environment to obtain the best outcome for the person in your care who are experiencing mental ill-health or mental illness.

Task

Using the scenario, Ruby’s story, you will need to demonstrate your professional advocacy role as a nurse by presenting strong, coherent and evidence-based knowledge in your team discussion. You will need to discuss, justify and advocate for Ruby to be seen by the Mental Health Clinical Nurse Consultant (CNC) to perform a comprehensive mental health assessment. Each member will engage the team in a discussion why Ruby needs to be seen by the CNC. It is important that the topic you choose complements the other team members’ topics and that you are able to link this to Ruby’s current situation.

Nurses

You begin your morning shift in a busy Emergency Department (ED).  After hearing the handover from the night shift nurses, you and your team start a discussion about whether making a referral to the Mental Health Clinical Nurse Consultant (CNC) to conduct a thorough Mental Health Assessment is needed for Ruby. Team collaboration is needed to ensure that Ruby receives the best possible outcome for her mental health. Each member of your team is to choose a topic to contribute to the discussion regarding planning for Ruby’s care.

Just choose the topic and answer it 

Ruby’s medications- prescribed and non-prescribed

Ruby’s story 

Ruby is a 20-year-old woman who presented in Emergency Department (ED) due to changes in her mental health. She was brought in by her mother, Sylvia, who reported that she picked her daughter up from Melbourne and brought her back to Western Sydney after Ruby’s flatmate, Alicia, contacted her about the changes in Ruby’s mental health.

Ruby has been living in Melbourne for the past year, where she works as a shoe sale assistant on a casual basis. She planned to return to Sydney before the end of the year to start her teaching degree in 2024. This was cut short due to the changes in Ruby’s mental health. According to Sylvia, Ruby has been going out and drinking alcohol every night the past few weeks with friends she met recently. Ruby has not had much sleep the past few weeks as she comes home most mornings just sleep for 2 to 3 hours and have a shower before going to work for 9 am. The manager of the shoe shop where Ruby work has warned her that she will lose her job if she continues arriving to work late and smelling of alcohol. Ruby has admitted to her flatmate Alicia that she has been smoking marijuana and experimenting with other illicit drugs with her new friends. Ruby stated, ‘I don’t’ know what I’ve been taking, but it made me feel good.’

Lately, the two friends would get into a verbal altercation when Alicia tried to talk to Ruby about the changes in her behaviour. Ruby would become irritable and angry and would say to Alicia, ‘you’re just jealous that I have met other people and I am enjoying myself without you. I can’t help it if people love me more than they love you. I want to make the most of this before I start uni.’

A few nights ago, Ruby called Alicia at 3 am to pick her up from their local pub. Ruby explained that she felt unsafe to go home on her own because she thought that she was being watched and followed by a guy who was in love with her. When they arrived at their flat, Ruby ran to her room and locked her door. The next day, she did not go to work and did not contact her employer. The manager of the shoe store contacted Ruby and informed her that she is no longer required to work in the store. Alicia thought that she would be devastated by this news as this is her only source of income. But Ruby told Alicia that ‘I was too good for that job anyway. It’s their loss’.

Ruby did not leave the flat for the next few days. Alicia noticed changes in Ruby’s mood. She stayed in her room most of the time. She has not showered in days, ate little amounts of food, and had barely any sleep and would watch TV instead all night or watch YouTube videos on her phone. She stated to her flatmate that ‘I don’t want to sleep; I feel that something bad is about to happen’. One night, Ruby asked Alicia for help as she started to have thoughts of suicide, but with no plan of how she would hurt or kill herself. Alicia felt she had no choice but to contact Ruby’s mum, Sylvia, to ask her for help.

During the interview, Ruby sat next to her mother, slumped with her head on her hands. She would get up and pace while wringing her hands. Although she presented as well-groomed and neat, Ruby was wearing clothes that were big for her small stature. When her mother excused herself to go to the toilet, Ruby opened about her experience to the nurse. She stated that she did not want her mother to know. She told the nurse that she had been feeling unmotivated, loss interest in going to university (when all she wanted was to become a teacher) and has been having suicidal thoughts with no plan. She mentioned that her ‘heart has been beating 100 miles per hour and feels like something bad is about to happen. I don’t know why, and I will do anything to make it stop.’ She mentioned that she was commenced on 20mg of Paroxetine daily by a GP in Melbourne four weeks ago and asked if she should keep taking this medication.

ANSWER

Topic: Ruby’s Medications – Prescribed and Non-Prescribed

In Ruby’s complex case, it is crucial to address the topic of her medications, both prescribed and non-prescribed, as it has significant implications for her mental health and overall well-being.

Prescribed Medication (Paroxetine)

Ruby has been prescribed 20mg of Paroxetine daily by a GP in Melbourne four weeks ago. Paroxetine is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat depression, anxiety disorders, and obsessive-compulsive disorder. It’s essential to consider the following points:

1. Medication Adherence: It is crucial to assess whether Ruby has been taking her prescribed medication consistently. Non-adherence or discontinuation without medical guidance could exacerbate her symptoms.

2. Therapeutic Response: Evaluate whether Ruby has experienced any improvement in her mental health symptoms since starting Paroxetine. Understanding the medication’s effectiveness helps in treatment planning.

3. Side Effects: Inquire about any side effects Ruby might be experiencing, such as increased anxiety or restlessness, which can be associated with starting SSRIs. Addressing side effects is essential for her well-being.

Non-Prescribed Medication and Illicit Substances

Ruby has admitted to experimenting with illicit drugs and smoking marijuana. This information has critical implications:

1. Drug Interactions: Illicit substances can interact with prescribed medications, potentially leading to adverse effects or reducing the effectiveness of Paroxetine. Understanding potential interactions is vital.

2. Substance-Induced Symptoms: The use of illicit substances can contribute to or exacerbate mental health symptoms. Assess whether Ruby’s symptoms coincide with drug use and if substance-induced issues need to be addressed.

3. Substance Misuse Assessment: Conduct a comprehensive assessment of Ruby’s substance use patterns, including frequency, quantity, and recent use. Identify any signs of substance misuse or dependence.

Advocacy for Mental Health Assessment

Given Ruby’s complex presentation, advocating for her to be seen by the Mental Health Clinical Nurse Consultant (CNC) is crucial. The mental health assessment should consider her prescribed medication, non-prescribed substances, and their potential impact on her mental state. The assessment can help:

1. Clarify Diagnosis: Determine whether Ruby’s symptoms are primarily related to a mental health condition, substance misuse, or a combination of factors.

2. Treatment Planning: The assessment will inform a tailored treatment plan, considering medication adjustments, psychotherapy, and substance use interventions if needed.

3. Safety: Assess Ruby’s immediate risk, especially in light of her suicidal thoughts. Ensure appropriate safety measures are in place.

In conclusion, understanding Ruby’s medications, both prescribed and non-prescribed, is crucial for her care. Advocating for a comprehensive mental health assessment by the CNC will provide valuable insights into her condition and guide effective interventions to support her recovery.