Case study : Sally Anne, aged 19, brought two children into the emergency room.
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NUR4636 – Community Health Nursing
Working with the Homeless
Sally Anne, aged 19, brought two children into the emergency room. The 6-month-old boy’s
complaints are a cold with mild fever, fatigue, vomiting with dry coughing spells, decreased intake
of cola (2 ounces every 3 hours—her version of clear liquids), one scraped diaper per 12 hours—
the diaper is not soaked so Mom recycles it after scrapping off the solids. The child’s cry is weak,
red eyes, sneezing moves thick mucus, prolonged cough, high-pitched noise during intake. The
child’s condition did not improve over the last 24 hours.
The family of three lives in the family sedan parked behind a service station due to Mom’s
fear of lack of shelter safety. Turk, the 3-year-old, sports bruises on arms and legs, and a knot on
his forehead. He appears semiconscious (responds to light pain), coughs when disturbed, refuses
fluids and food, and pulls away from touch. Mother states that he has been sick for more than a
week, but she is concerned that he has not been as fussy the last 24 hours. His skin tents when
pinched. Sally Anne believes he lost weight but has not used a scale. Turk does not look adults in
the eye or follow a finger point. He moans but has not communicated with words. He appears to
fantasize, and finger plays violently. His fingers seem to attack each other. He does not seem to
listen nor does he respond to questions. Both children are wearing dirty clothing. Mom is
exhausted and asks for help with formula and diapers.
Treatment: Both children kept overnight for assessment in a room with a bathroom and
couch. Mother permitted to bath and wash children’s clothing after their baths. Cooling mist tent
ordered. Children placed next to each other for convenience and for precautions. Social worker
involved for discharge planning. The boys are placed on IVs for hydration and given clear fluids for
drinking. Antibiotics are placed in the IV.
1. What information is needed for a complete assessment?
2. Will this family be worse off when released from the hospital? What community resources
for homeless families could be activated in the small town? What prevents the family from
falling through economic cracks that will prevent developmental assessments and