Case Notes

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Case Studies Select one of the following case studies as the basis for Assessment 2 ‒ Case Notes.

Case Study 1 Thomas is an 18-year-old senior in high school. It is the end of the school year—and after feeling excited to graduate most of this past year—lately, he is not sure he is ready to leave high school. He has been feeling more irritable than usual and has been especially grouchy with his family. Everything his parents tell him annoys him.

He misses his girlfriend, who recently broke up with him. He is supposed to be leaving for college in August, but he is feeling nervous about it. Before, he was convinced he wanted to go into engineering, but now he is not so sure. He feels pressure to go to college, but right now what he really wants is just to stay in the area and get a job and an apartment so he can hang out with all his friends who are not going away to college.

Sometimes he is so frustrated he feels the urge to break things. A few days ago when no one else was home, he punched the doorframe of his bedroom.

Case Study 2 Nurse Jenkins is an RN who has just been assigned to do home visits with Mr. Wallace, an 81- year-old male. Mr. Wallace has a medical diagnosis of diabetes, hypertension, and lower- extremity neuropathy. The physician and caseworker recommend that Nurse Jenkins visit Mr. Wallace at least three times a week.

Mr. Wallace lives alone since his wife passed away a year ago. He has two living children: a son and a daughter. The son and his wife live about 80 miles from Mr. Wallace, and the couple visits frequently. The daughter lives out of town with her family and visits at least twice a year.

The caseworker has reported to Nurse Jenkins that Mr. Wallace's son is worried about his father because his father has been developing hoarding behaviors since his mother died. The son states that Mr. Wallace will not get rid of any of his deceased wife's clothing and refuses to let anyone near his bedroom. The bedroom is cluttered with a variety of items that are no longer useful. Some of these items include empty pill bottles, cardboard toilet tissue rolls, soap wrappers, empty toothpaste containers, and newspapers. In the kitchen, cans and boxes of food are overflowing from the cabinets. The dirty dishes in the sink are piled almost to the ceiling.

According to his son, Mr. Wallace has lost at least 20 pounds since his wife passed. The son and his wife have tried to help by bringing food to Mr. Wallace, but he refuses to eat. Instead, he leaves the food on the counter, where it rots. The son has taken to getting rid of the containers when his father is asleep, because Mr. Wallace becomes angry when he sees his son cleaning the kitchen.

Nurse Jenkins realizes that this atypical behavior needs to stop. She will be conducting an initial home assessment with the son present. She is careful to take an assessment sheet to her first visit with Mr. Wallace, so that she can gather environmental, objective, and subjective data.

Case Study 3

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Zoe is 8-year-old girl starting school in a new state. Her parents relocated due to her mother’s job. She resents the move and does not understand why they all had to come across the country, leaving all of their family and friends behind. She complains that her new room is smaller than old one, that the houses don’t look right, and that the neighbors are too close.

Her parents enrolled her in a private school, one with a reputation for quality. She is nervous that she will not fit in or make friends. She feels anxious that the new neighbors and classmates will think she is lower class because she is from a farm community and this is the first time she has lived in a city. She worries that the “rich” kids are more advanced in school than she is and that she won’t be able to catch up.

Recently, she has started throwing temper tantrums when her parents try to take her shopping for school. She is also spending more time in her room, rearranging her toys by color, and not spending as much time with her family.

Case Study 4 Imani is 43 years old and wants to make some life changes. She is unhappy with her career in marketing and with her relationship status. She was divorced five years ago from Robert, whom she met during her senior year of college. They had delayed marriage until after Robert finished medical school, and were married when Imani was 27. They had discussed having children, but Robert never felt that the time was right.

Even though Imani feels alone, she is not comfortable dating. She would like to go back to school, but is not sure what career she is interested in. Also, she has been spending a great deal of time taking care of her aging mother, with whom she has had a strained relationship over the years.

Lately, she has been thinking something is wrong with her. The kind of identity issues she is facing seem more typical of a teenager, not a 43-year-old woman. She is beginning to withdraw and to feel lonely. She feels like she has failed compared to acquaintances who are married, have children, and seem to be enjoying their careers.