Case Study
Chapter 25 – 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?
