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Behavioral Health in the Community

NUR4636 – Community Health Nursing

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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.”

“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?


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