Question

Case study Josh Wallace

Demographic data

Josh Wallace is an indigenous 20-year-old second-year university student. He likes to write music and plays several musical instruments, including the didgeridoo. He is studying music at university and hopes to compose music for orchestras. Josh works part-time as a barista in a coffee shop and performs with an indigenous dance group. He lives in the city with his mother’s sister, her three teenage children, and Uncle Bill, the brother of his grandmother. Josh’s parents live in a large regional town. His parents are teachers who work in a ‘Flexi- school’. He has two younger siblings. His parents are very active in the local indigenous community.

Past Medical-Surgical and Psychiatric history.

At the age of 14, Josh experienced mental health issues because of problems at home. Firstly, his uncle, a man in his early 50’s, completed suicide. And then both his parents experienced illness. His mother was diagnosed with depression several months after his father recovered from a life-threatening illness. After Josh returned to school where he was a boarder, he found himself crying in his room at night because he felt sad all the time. He began to self-harm. He didn’t want to talk to his friends because he thought he might be considered weak, and he didn’t want to worry his family. His Year 9 Coordinator, Mr. Adams, noticed a change in Josh, who was usually an outgoing and active participant in the school community. Mr. Adams arranged a meeting, and at that time he noted the cuts on Josh’s arms. Josh was referred to the school counselor and the school nurse, and he was eventually referred to as Child and Youth Mental health services (CYMHS). He was seen on a regular basis by a team including a mental health nurse. He was prescribed Fluoxetine 20 mg. With support from family, the school, and CYMHS, he put in place strategies to benefit his recovery. He was discharged from CYMHS when he turned 18. He decided to accept support from the services offered at Headspace and attended three appointments over a 6 - month period when he was 19. Mid last year, Josh has experienced the death by completed suicide, of his 21-year-old cousin Luke. His cousin lived in a regional area, and Josh was unable to join family members because of his study commitments. At present, he is enrolled in a summer intensive unit, because he failed a unit in the second semester. The teacher is dismissive of students who do not speak up, and Josh has been targeted for comments on several occasions. Josh is the only indigenous student in the tutorial group, and he does not know anyone else. Josh also misses his girlfriend Aimee. She is on placement for four weeks, and Josh does not have a car to visit her. Josh has experienced shortness of breath and chest pain during rehearsals with his dance group. He hadn’t told anyone, believing it was probably muscle pain. Last night he experienced chest pain prior to leaving the house to attend rehearsals. It became so bad he thought he was going to die and alerted his Aunt Alice for help. He was transported to the local emergency department for assessment. Josh is told he has experienced a panic attack. No physical abnormalities were detected in ECG or blood, and he will be referred to his GP, and to Headspace for follow up appointments.

Presenting History

Josh arrives for his appointment at Headspace. He is accompanied by his Aunt Alice. Josh is unkempt, disheveled, and looks sad. His voice is monotone and flat, and he has poor eye contact. He tells you “I am sorry to worry everyone, it was just a panic attack- I can never get things right.” He says he feels worried and on edge all the time, and has difficulty concentrating. His Aunt tells you Josh has been isolating himself Faculty of Health | School of Nursing, Midwifery & Paramedicine in his room, and has missed a couple of shifts at the coffee shop and some tutorials on campus. He also becomes easily irritated, yelling at his cousins and his Aunt. This is not his usual behavior.

Q. What historical and cultural issues need to be considered when caring for Josh?

II. What are the signs and symptoms of depression? Considering the case study, describe the different types of behavior and verbal responses, that may indicate Josh may be experiencing depression?

III. What is meant by culturally safe practice and what are the key skills that nurses need to develop to provide culturally safe practice for Josh?

IV. Identify the psychotropic medication previously prescribed for the treatment of the symptoms of depression experienced by Josh, and consider the importance of effective monitoring, consumer experiences (side effects) and safety factors;

Answer 1

1. Historical and cultural issues while caring Josh.

• Since he himself is a victim of depression as well as has family history of depression, proper care must be taken for Josh.
• Depression is a condition characterized by depressed mood or loss of interest in activities causing significant impairment in daily life.
• the historical and cultural issues are some of the contributing factors of depression and that is the reason why we want to look into those aspects.
• these factors cause changes in the brain function including changes in the activity of the brain.
• since Mr. Josh has made sucidial attempt, the previous history should be known for starting the treatment.
• he should be encouraged to mingle with the society to divert his mind from suicidal thoughts.

2. Signs and symptoms of depression;

• depressive symptoms usually affect the mood and also it affects the body too.
• depressive mood
• reduced interest or pleasure in activities once enjoyed
• loss of sexual desire
• change in appetite
• unintentional weight loss or gain
• sleeping too much or little
• agitation, restlessness, and pacing up and down
• slowed movement and speech
• fatigue or loss of energy
• recurrent thoughts of death or suicide.

Different types of behavior and verbal responses.

• he himself crying the room and felt sad all the time
• he began to self-harm
• he didn't want to talk to his friends
• he himself considered as weak
• he committed suiicide
• he is dishelved and sad
• he has monotonus voice and poor eye contact
• he exhibits unusual behaviour
• he hells at his cousins and aunt

3. culturally safe practices include actions which recognise and respect the cultural identities of others and safely meet their needs,expectations and rights.

the key skills that nurses need to develop are;

• ability to deal with the depressive patient to help him to devlop g good health status and well-being
• secondly improve the delivery health services through a culturally safe workforce.
• accept the differences among the people who are treated
• understanding the health services and nalyse how health care impacts individuals and families.

4. He was given Fluoxetine 20mg..

Importance of effective monitoring;

• because this drug can cause dizziness or drowsiness
• if any medications he is taking then it should be informed as certain medications can cause a serious reaction when combined with alcohol.
• this drug can cause serious side effects like bleeding and loss of coordination as loss of coordination can increase the risk of falling.
• chance of developing low sodium in the blood if they are taking diuretics.

Side effects;

• hives
• itching or skin rash
• inability to sit still
• restlessness
• chills or fever
• joints or muscle pain
• anxiety
• cold sweats
• confusion
• covulsions
• cool pale skin
• seizures
• difficulty with concentration
• racing heart beat
• trouble with breathing.

safety factors;

The drug interactions of this medicine to be considered. So, proper history should be taken from the patients to know whether he/she is taking other medications. Address the patient that he is not supposed to take any alcohol-containing beverages as it can seriously affect the patient. if the patient experiences any symptoms of agitation ,hallucinations etc, it should be consulted immediately as it can case affect the lifeof the patient.