Case Study
Chapter 26 – 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?
