Lesson 13 Discussion

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Case Study

Chapter 28 – 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

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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 treatments?