Lesson 18 Discussion

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Case Study

Chapter 27 – Behavioral Health in the Community

The principal escorted Audrey, aged 13, an overweight

girl with long blonde braids into the rural middle school

nurse’s office. “Ms. Schmitz will help you, Audrey.” The

principal signaled for the girl to sit down and then

handed Ms. Schmitz, RN, a note and left. The note

bulleted three lines: “Disruptive, fighting, teacher

requests a home visit.”

Ms. Schmitz extended a wet facecloth while assessing

Audrey’s appearance. Audrey wiggled on the wooden chair wearing torn and too small

clothing, tennis shoes with holes, and a full backpack. “Place this on your eyes, and see if it helps.”

The crying child’s tongue poked out the right side of her mouth and she swallowed several times

as she reached for the cloth. “Are you hurt?” asked the nurse.

Audrey shook her head. “I have a sore throat though.”

She shrugged her shoulders. “I wish I were dead. I could jab a pencil in my eye and bleed to

death. That would fix them.”

“You sound pretty upset. Tell me what happened.”

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“Brian made fun of my tics. I can’t help it. I am so tired

of people laughing at me, my clothes and my mother. I hit him with a book because

he wouldn’t stop. I bet he never thought I would hit him. I am not a bully, Brian is.” A fresh bout of

sobbing doubled the girl in half.

The nurse read Audrey’s health record. Learning

disabilities, ADHD, Tourette’s disorder, prenatal drug exposure, R. 20/80 and L. 20/100 vision,

a normal scoliosis screening, and free lunch eligibility. The nurse searched for a telephone

number. “I need to call your mother.”

The school secretary said, “There is no phone. I can

give you the case worker’s contact.”

“Momma is sick,” said Audrey and swallowed. “She

won’t answer the door”.

1. What will be included in the school nurse’s

assessment plan?

2. What resources should be explored?