UNIT 6
Risk Diagnosis
Introduction
Risk Diagnosis
A risk diagnosis is a statement implicating that a health problem does not yet exist, but that the
patient is at a higher than normal risk of developing it in the near future. In other words, certain risk
factors are present in the client. The risk diagnosis contains the phrase Risk for followed by the
diagnostic label listing the specific risk factor(s). An example of a risk diagnosis is: Risk for injury
related to altered mobility and disorientation. Similar to an actual nursing diagnosis, the definition in a
risk diagnosis expresses a clear and precise meaning of the diagnosis.
Content goals
In this module the student will:
1. Review and use phrases and idioms people used when making a risk diagnosis
2. Identify and demonstrate proper note-taking techniques; take notes of a risk
diagnosis
3. Listen to an interview with a patient and make a risk diagnosis
4. Identify actual diagnosis two-part statements
5. Review the past perfect tense
6. Practice making a risk nursing diagnosis based on an case
7. Identify ways to improve communication between health care workers and clients.
1
Unit 6
RISK DIAGNOSIS
Terminology/Vocabulary Development
H6:1
A. Read the following words / phrases, their definitions and example of usage.
Idiom/ phrase/word
Meaning
Example
living it rough
homeless/ person who lacks housing
and basic resources
The number of people living rough in the streets has
increased dramatically in the United States.
shoot- up
The act of shooting up in most cases
an illegal drug.
The police caught the man shooting-up and
immediately arrested him.
do drugs
to take illegal drugs
I’ve gotten my act together
The singer confessed to doing drugs.
to put things in order in ones life and
be more responsible
After many years of doing nothing, Karen finally got
her act together and started college.
can’t keep it down
to vomit
Three months pregnant, Marcia couldn’t keep anything
down and began to lose a little weight.
makes me sick/ puke
feel nauseous/ vomit
When I was pregnant the smell of fish would make me
sick / puck.
nasty diarrheaddd di
feeling down in the dumps
bad / horrible
The wound looked nasty. It was red and oozing pus.
depressed
Ricky felt down in the dumps after losing his job and
being unemployed for over a year.
A disease-producing micro-organism /
minor temporary illness
a bug
having trouble catching (my)
breath
… give it to me straight
shortness of breath
tell me the truth
The kids came down with some sort of bug that
caused a slight fever and upset stomach.
John, who suffers from asthma, often has trouble
catching his breath after a short walk.
The terminally ill patient wanted the doctor to give it to
him straight and tell him how long he had to live.
B. Read the sentences and choose the best word from the box to complete each sentence.
bug
nasty
feel down in the dumps
made the nurse sick
do drugs
1. During chemotherapy, the patient started to_____________________________and was not as responsive.
2. People who __________________and share needles are more prone to getting hepatitis or AIDS.
3. Many students got ill from a ____________that was going around school.
4. Watching an autopsy for the first time ________________________.
2
5. The man suffered a ________________cut to the forehead in the accident.
Unit 6
RISK DIAGNOSIS
Listening & Writing
H6:2
A. Listen to and complete the following sentences with the words and expressions from your
vocabulary list.
1. Some Olympic athletes have been suspended because of _______________ steroids to improve
their strength.
2. Peter, who suffers from AIDS, needs an oxygen mask because he is having trouble
_______________________.
3. The smell of anything burning made Lisa _________________ because it reminded her of the fire.
4. Robert swore that he _________________________ and would find a job in order to support his
family.
5. Because of lack of job opportunities and poverty, many people are now having to
______________________ and often suffer from hate crimes and violence.
6. After waking up from anesthesia, it is often difficult to ______________________ for a few hours.
7. Putting her hand up to her mouth, the little girl ran up to her teacher and told her she was going to
_______________.
8. __________________________, the lonely old man sat no longer left his house and stopped
socializing with his friends.
B. Listen to the following conversation taking place between nurse Joy Adams and a 34 year
old homeless patient. You will hear the conversation twice. The first time just listen, the
second time fill in the blanks with the phrases, letters or numbers you hear. Finally, listen
again and recheck your answers.
Nurse Adams: Mr. Gordon, you said you are homeless is that correct?
Mr. Gordon: Yes. I lost my job, and home and have been ________________ in the streets now for five years.
Nurse Adams: At the present are you on any drugs or medication?
Mr. Gordon: I used to _____________ once in awhile, but I’ve _____________________ and am clean now.
Nurse Adams: I see. Did you ever share needles with any other person?
Mr. Gordon: Once in a while. But like I said, I no longer _________________.
Nurse Adams: Mr. Gordon, is there any particular reason why you have come to the clinic today?
Mr. Gordon: Yeah. I don’t feel like eating and ________________________. Just the thought of food
_______________________.
Nurse Adams: How often have you been vomiting?
3
Mr. Gordon: Well for some time now. Just the thought of food makes me want to _______________.
Unit 6
RISK DIAGNOSIS
H6:2 (Cont.)
Nurse Adams: Does your body ache?
Mr. Gordon: Yeah. All over, I just don’t feel like moving or anything. My body aches and I feel like I have a
slight fever.
Nurse Adams: How long have you been feeling like this?
Mr. Gordon: Oh, I wanna say……………..for at least a month now. Nurse, I’ve noticed these sores on my arms
have really turned _________ and refuse to heal. I am just a mess right now and am really
_____________________________.
Nurse: How long have you had the sores? And can you tell me how they have been red like this?
Mr. Gordon: Like a said, about a month now.
Nurse: Do you have diarrhea?
Mr. Gordon: Yes. It comes and goes. Thought I had ____________ but I am not getting any better and I seem
to be getting worse.
Nurse Adams: Is there anything else you’d like to tell me?
Mr. Gordon: Well, lately, I’ve been ___________________________. I don’t know what’s wrong with me.
What have I done to deserve all this? Just when I start getting my act together I go and get sick like this.
Nurse Adams: I am sure things will be okay. I just have one more question to ask you before the doctor comes
in. How long have you had your cough?
Mr. Gordon: Oh, I’d say about two months now. It keeps me awake at night.
Nurse Adams: Well, Mr. Gordon the doctor will soon be in to see you.
Mr. Gordon: Nurse what’s wrong with me? I’m not dying am I? I can take it! You can
_________________________.
Nurse Adams: Like I said Mr. Gordon the doctor will be in to see you soon. Bye.
4
Unit 6
RISK DIAGNOSIS
Note Taking
H6:3
Note Taking:
A.Tips for taking notes while making an at risk nursing diagnosis:
A nursing diagnosis is different from a medical diagnoses in that the nursing diagnosis focus on
human response to stimuli, whereas, medical diagnosis focus on the disease process. A nursing
diagnosis identifies potential or possible problems. The diagnosis of "at risk for aspiration" is an
example of a diagnosis that recognizes the potential for a given problem to occur. For an at risk
diagnosis to be made, risk factors must be present and identified upon assessment. In this example,
the absence of the gag reflex, and the presence of facial droop or paralysis may be among the risk
factors for impaired swallowing that would lead a nurse to make the diagnosis of "at risk for
aspiration."
Another example of a family nursing diagnosis is "risk for altered parent-infant
attachment." In this case, the nursing diagnostic statement might read, "risk for altered parentinfant attachment related to maternal distancing as evidenced by lack of eye contact between
mother and infant." These diagnoses are important because they allow nursing to take a preventive
approach to patient care.
B. Listen again to the conversation between Nurse Adams and Mr. Gordon. Write down your
nursing diagnosis. It should include an at risk diagnosis.
_____________________________________________________________
_____________________________________________________________
5
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Unit 6
RISK DIAGNOSIS
Listening & Writing
H6:4
Listening:
B. Listen carefully to a short introduction to a case history and fill in the blanks with the
appropriate words or phrases.
Jose is a ____-month-old _________ who was referred to ______________________ after
being returned to his home with his mother from the children's home of the county. Jose; his
_____-year-old sister, Rosa; and _____-yearold sister, Maria-Carmen, __________________
from their home by the juvenile ___________ while their mother, Teresa, completed a
________rehabilitation ______________. At the present, Teresa is _______________ and is
supported by ________. Her family support consists of her aunt, who has a history of
_______________. Teresa has an ______ grade education. The public health nurse (______)
was referred to the home to check on Jose’s growth and development and to connect Teresa
and the family to ________________ resources.
C. Critical Thinking: Mrs. Murry was admitted to your unit an hour ago. The following data has been
written on her chart. Which data are subjective (personal) and which are objective(based on facts)?
Write “S” or “O” in front of each piece of data.
___Temperature 101˚F
___Pulse 98, irregular
___Nausea
___Vomiting for 2 days
___ “My back aches”
___Skin flushed and hot
___Closes eyes and grimaces when blinds are opened
___Rash all over body
6
D. Use the following phrases in sentences of your own.
1. a bug:___________________________________________________________________________
2. makes me sick:____________________________________________________________________
___________________________________________________________________________________
3. feeling down in the dumps: _________________________________________________________
___________________________________________________________________________________
Unit 6
RISK DIAGNOSIS
Grammar Tips
H6:5
Grammar Note: Past Perfect Tense
In this module, you will be introduced to the past perfect tense. The following page contains
many examples of the past perfect tense in use.
E.g. Maria-Carmen had been removed from their home by the juvenile court.
E.g. The living room window was cracked and had been duct-taped.
You can sometimes think of the past perfect tense like the present perfect tense, but instead of
the time being now the time is past.
When we want to describe an action that started in the past and finished in the past we use
the following formula:
subject + had + past participle
I had worked all day.
He had worked all day.
You had worked all day.
She had worked all day.
We had worked all day.
It had worked all day.
They had worked all day.
Imagine that you arrive at the bus station at 6:30am. The stationmaster says to you:
"You are too late. The bus has left."
7
Later, you tell your mother:
"I was too late. The had had left."
We often use the past perfect tense in reported speech after verbs like said, told, asked, thought,
wondered:
Unit 6
RISK DIAGNOSIS
Case Study
H6:6
A. Put the verbs into the correct form (past perfect).
2. The nurse ________________(decide) that the infant was in danger of harming himself.
3. The mother _________________(neglect) to feed her children.
4. The patient _________________(check) herself out of the ward.
5. How long had the patient had a fever?
He __________________________(have) a fever for three days.
6. The doctor explained that Mr. Allen ___________________(have) a mild heart attack.
A. Study the following case and be prepared to make a nursing diagnosis based on the
data given.
Jose is a 13-month-old infant who was referred to Public Health Field Nursing after being
returned to his home with his mother from the children's home of the county. Jose; his 3 1/2year-old sister, Rosa; and 14-yearold sister, Maria-Carmen, had been removed from their
home by the juvenile court while their mother, Teresa, completed a drug rehabilitation
program. At the present, Teresa is unemployed and is supported by AFDC. Her family support
consists of her aunt, who has a history of alcoholism. Teresa has an 8th grade education. The
public health nurse (PHN) was referred to the home to check on Jose’s growth and
development and to connect Teresa and the family to community resources.
Upon arriving at the apartment complex, the PHN walked through an area with broken glass
and past a pool area with a broken gate. Teresa’s apartment was on the second floor, facing
the pool. A 3 1/2-year-old was playing unattended at the top of the stairs.
8
The PHN noted that the living room window was cracked and had been duct-taped along the
broken edges, and the door had one large hole. She knocked on the door five times, the door
opened slowly, and a woman looked through the security chain. Upon questioning, the woman
said she was Teresa and eventually opened the door. The house was dirty and smelled like
unwashed dishes and dirty diapers. Teresa’s breath smelled of alcohol. Flies were sitting on
half-eaten bowls of cereal that were on the kitchen table. Roaches could be seen on the
kitchen cabinets.
Unit 6
RISK DIAGNOSIS
Case Studies
H6:6 (cont.)
Before beginning the visit routines, the PHN asked Teresa to call Rosa into the house from the
stairway. Jose who was crying on the floor was surrounded by soiled blankets and diapers, and
a bottle of punch. The PHN noted an unfilled antibiotic prescription for Rosa that had expired 2
weeks earlier. When asked about this, Teresa said she did not fill the prescription because she
had lost the children's MediCal cards (California Medicaid). Jose could be heard coughing and
looked feverish.
Further assessment revealed that Teresa knew that Jose needed the medication, but her
boyfriend had spent the money to buy some liquor. She and the boyfriend had fought about
this issue, which is how the living room window got broken. Teresa explained that her
boyfriend had been recently released from jail for cocaine possession. She also shared with the
PHN that she has a hard time taking care of the kids when Maria-Carmen goes to school, so
she likes having her home.
B. Based on what you have read what nursing diagnosis would you make? For a possible
diagnosis refer to the answer key at the back of your manual.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
9
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
10
Unit 6
RISK DIAGNOSIS
Summary
H6:7
Reading Comprehension and Note Taking
A. Read the following passage about the previous case paying attention to the
underlined words.
The PHN discussed environmental and child safety issues with Teresa, including caring for
her children under the influence of alcohol and other chemical substances. The PHN told
Teresa she would report this information to social services. During this visit, the mother was
taught to remove all small objects away from the infant. Topics related to nutrition were
discussed including risks to the infant of dental caries and malnutrition. Safety teaching
included never leaving the 3 1/2-year-old and 13-month-old unattended, and the dangers of
falls when a child plays on the stairway of a second-story apartment. Child abuse laws were
also explained so that Teresa would understand the seriousness of the situation.
Nursing interventions with this mother included referral and case coordination with social
services to connect the 14-year-old with counseling resources. Additionally, the mother was
referred to AFDC, as well as medical and food resources. The mother was given a referral
for the 3 1/2-year-old for a Head Start preschool program near the home. The PHN
encouraged Teresa to re-enter the county's alcohol and drug rehabilitation program with
her children, where she would receive parenting and home skills classes and counseling to
address parenting skills and domestic violence. This mother's history of drug abuse,
evidence of current alcohol abuse, and lack of knowledge and motivation to care for her
children made this situation a high-priority concern of the PHN.
11
Unit 6
ACTUAL DIAGNOSIS
Summary
H6:8
Reading Comprehension and Note Taking
B. Listen to the following passage once then listen again filling in the blanks.
The PHN discussed ______________ and ______________with Teresa, including caring for
her children under the ______________and other ______________substances. The PHN
told Teresa she would report this information to______________. During this visit, the
mother was taught to remove all ______________away from the infant. Topics related to
______________were discussed including ______________to the infant of
______________and______________. Safety teaching included never leaving the
______________and ______________unattended, and the dangers of falls when a child
plays on the stairway of a second-story apartment. ______________laws were also
explained so that Teresa would understand the seriousness of the situation.
Nursing ______________with this mother included ______________and case coordination
with social services to connect the 14-year-old with______________. Additionally, the
mother was referred to_______, as well as medical and food resources. The mother was
given a referral for the ____-year-old for a Head Start preschool program near the home.
The _____encouraged Teresa to re-enter the county's alcohol and drug
______________with her children, where she would receive ______________and
______________classes and counseling to address parenting skills and______________.
This mother's history of______________, evidence of current______________, and lack of
knowledge and motivation to care for her children made this situation a
______________concern of the PHN.
12
Unit 6
Answer Key / Risk Diagnosis
Terminology/Vocabulary Development
H6:1
A. Read the following words / phrases, their definitions and example of usage.
Idiom/ phrase/word
Meaning
Example
living it rough
homeless/ person who lacks housing
and basic resources
The number of people living rough in the streets has
increased dramatically in the United States.
shoot- up
The act of shooting up in most cases
an illegal drug.
The police caught the man shooting-up and
immediately arrested him.
do drugs
to take illegal drugs
I’ve gotten my act together
The singer confessed to doing drugs.
to put things in order in ones life and
be more responsible
After many years of doing nothing, Karen finally got
her act together and started college.
can’t keep it down
to vomit
Three months pregnant, Marcia couldn’t keep anything
down and began to lose a little weight.
makes me sick/ puke
feel nauseous/ vomit
When I was pregnant the smell of fish would make me
sick / puck.
nasty diarrheaddd di
feeling down in the dumps
bad / horrible
The wound looked nasty. It was red and oozing pus.
depressed
Ricky felt down in the dumps after losing his job and
being unemployed for over a year.
A disease-producing micro-organism /
minor temporary illness
a bug
having trouble catching (my)
breath
… give it to me straight
shortness of breath
tell me the truth
The kids came down with some sort of bug that
caused a slight fever and upset stomach.
John, who suffers from asthma, often has trouble
catching his breath after a short walk.
The terminally ill patient wanted the doctor to give it to
him straight and tell him how long he had to live.
B. Read the sentences and choose the best word from the box to complete each sentence.
bug
nasty
feel down in the dumps
made the nurse sick
do drugs
1. During chemotherapy, the patient started to feel down in the dumps and was not as responsive.
2. People who do drugs and share needles are more prone to getting hepatitis or AIDS.
3. Many students got ill from a bug that was going around school.
4. Watching an autopsy for the first time made the nurse sick.
5. The man suffered a nasty cut to the forehead in the accident.
13
Unit 6
Answer Key / Risk Diagnosis
Listening & Writing
H6:2
A. Read the following sentences twice. The first time read at a normal speed, and on
the second time read at a slower speed.
1. Some Olympic athletes have been suspended because of shooting up steroids to improve their
strength.
2. Peter, who suffers from AIDS, needs an oxygen mask because he is having trouble catching his
breath.
3. The smell of anything burning made Lisa feel sick because it reminded her of the fire.
4. Robert swore that he has gotten his act together and would find a job in order to support his
family.
5. Because of lack of job opportunities and poverty, many people are now having to live it rough and
often suffer from hate crimes and violence.
6. After waking up from anesthesia, it is often difficult to keep anything down for a few hours.
7. Putting her hand up to her mouth, the little girl ran up to her teacher and told her she was going to
puke.
8. Feeling down in the dumps, the lonely old man sat no longer left his house and stopped socializing
with his friends.
B. Read the following passage twice. The first time read at a normal speed, and on the second
time read at a slower speed.
Nurse Adams: Mr. Gordon, you said you are homeless is that correct?
Mr. Gordon: Yes. I lost my job, and home and have been living it rough in the streets now for five years.
Nurse Adams: At the present are you on any drugs or medication?
Mr. Gordon: I used to shoot- up once in awhile, but I’ve gotten my act together and am clean now.
Nurse Adams: I see. Did you ever share needles with any other person?
Mr. Gordon: Once in a while. But like I said, I no longer do drugs.
Nurse Adams: Mr. Gordon, is there any particular reason why you have come to the clinic today?
Mr. Gordon: Yeah. I don’t feel like eating and can’t keep anything down. Just the thought of food makes me
sick.
Nurse Adams: How often have you been vomiting?
Mr. Gordon: Well for some time now. Just the thought of food makes me want to puke.
Nurse Adams: Does your body ache?
14
Unit 6
Answer Key / Risk Diagnosis
H6:2 (Cont.)
Mr. Gordon: Yeah. All over, I just don’t feel like moving or anything. My body aches and I feel like I have a
slight fever.
Nurse Adams: How long have you been feeling like this?
Mr. Gordon: Oh, I wanna say……………..for at least a month now. Nurse, I’ve noticed these sores on my arms
have really turned nasty and refuse to heal. I am just a mess right now and am really feeling down in the
dumps.
Nurse: How long have you had the sores? And can you tell me how they have been red like this?
Mr. Gordon: Like a said, about a month now.
Nurse: Do you have diarrhea?
Mr. Gordon: Yes. It comes and goes. Thought I had a bug but I am not getting any better and I seem to be
getting worse.
Nurse Adams: Is there anything else you’d like to tell me?
Mr. Gordon: Well, lately, I’ve been having trouble catching my breath. I don’t know what’s wrong with me.
What have I done to deserve all this? Just when I start getting my act together I go and get sick like this.
Nurse Adams: I am sure things will be okay. I just have one more question to ask you before the doctor comes
in. How long have you had your cough?
Mr. Gordon: Oh, I’d say about two months now. It keeps me awake at night.
Nurse Adams: Well, Mr. Gordon the doctor will soon be in to see you.
Mr. Gordon: Nurse what’s wrong with me? I’m not dying am I? I can take it! You can give it to me straight.
Nurse Adams: Like I said Mr. Gordon the doctor will be in to see you soon. Bye.
15
Unit 6
Answer Key / Risk Diagnosis
Note Taking
H6:3
Note Taking:
A.Tips for taking notes while making an at risk nursing diagnosis:
A nursing diagnosis is different from a medical diagnoses in that the nursing diagnosis focus on
human response to stimuli, whereas, medical diagnosis focus on the disease process. A nursing
diagnosis identifies potential or possible problems. The diagnosis of "at risk for aspiration" is an
example of a diagnosis that recognizes the potential for a given problem to occur. For an at risk
diagnosis to be made, risk factors must be present and identified upon assessment. In this example,
the absence of the gag reflex, and the presence of facial droop or paralysis may be among the risk
factors for impaired swallowing that would lead a nurse to make the diagnosis of "at risk for
aspiration."
Another example of a family nursing diagnosis is "risk for altered parent-infant
attachment." In this case, the nursing diagnostic statement might read, "risk for altered parentinfant attachment related to maternal distancing as evidenced by lack of eye contact between
mother and infant." These diagnoses are important because they allow nursing to take a preventive
approach to patient care.
B. Re-read passage (6:2) twice. The first time read at a normal speed, and on the second time
read at a slower speed so that students may fill in the gaps.
16
Unit 6
Answer Key / Risk Diagnosis
Listening & Writing
H6:4
Listening:
A. Read the following passage twice. The first time read at a normal speed, and on the second
time read at a slower speed.
Jose is a 13-month-old infant who was referred to Public Health Field Nursing after being
returned to his home with his mother from the children's home of the county. Jose; his 3 1/2year-old sister, Rosa; and 14-yearold sister, Maria-Carmen, had been removed from their home
by the juvenile court while their mother, Teresa, completed a drug rehabilitation program. At
the present, Teresa is unemployed and is supported by AFDC. Her family support consists of her
aunt, who has a history of alcoholism. Teresa has an 8th grade education. The public health
nurse (PHN) was referred to the home to check on Jose’s growth and development and to
connect Teresa and the family to community resources.
C. Critical Thinking: Mrs. Murry was admitted to your unit an hour ago. The following data has been
written on her chart. Which data are subjective (personal) and which are objective(based on facts)?
Write “S” or “O” in front of each piece of data.
_O__Temperature 101˚F
_O__Pulse 98, irregular
_S__Nausea
_O__Vomiting for 2 days
_S__ “My back aches”
_O__Skin flushed and hot
_O__Closes eyes and grimaces when blinds are opened
_O__Rash all over body
D. Use the following phrases in sentences of your own. Sentences will vary.
1. a bug:___________________________________________________________________________
2. makes me sick:____________________________________________________________________
___________________________________________________________________________________
3. feeling down in the dumps: _________________________________________________________
___________________________________________________________________________________
17
Unit 6
Answer Key / Risk Diagnosis
Case Study
H6:6
B. Put the verbs into the correct form (past perfect).
2. The nurse had decided (decide) that the infant was in danger of harming himself.
3. The mother had neglected (neglect) to feed her children.
4. The patient had checked (check) herself out of the ward.
5. How long had the patient had a fever?
He had had (have) a fever for three days.
6. The doctor explained that Mr. Allen had had (have) a mild heart attack.
C. Possible diagnosis
Possible diagnosis to be considered for the children was high risk for injury. This diagnosis was
supported by observation of safety hazards (broken glass, open pool-side gate, and broken
windows and doors) at the entrance of the apartment complex. The 3 1/2-year-old child who
was playing in a dangerous area near the stairway of the second floor was at risk for injury. All
three children were at risk for injury in the dirty, unsafe apartment, which included a ducttaped front room window. The presence of flies sitting on old food and possibility of
malnutrition were also risk factors. The children were at risk for injury due to the lack of
attention paid by their mother to these hazards. The 13-month-old infant was at risk for
choking on scattered small toys in his crib and possible complications from a cough and fever.
18
Unit 6
Answer Key / Risk Diagnosis
Summary
H6:7
Reading Comprehension and Note Taking
B. Read the following passage twice. The first time read at a normal speed, and on the second time
read at a slower speed.
The PHN discussed environmental and child safety issues with Teresa, including caring for her
children under the influence of alcohol and other chemical substances. The PHN told Teresa
she would report this information to social services. During this visit, the mother was taught
to remove all small objects away from the infant. Topics related to nutrition were discussed
including risks to the infant of dental caries and malnutrition. Safety teaching included never
leaving the 3 1/2-year-old and 13-month-old unattended, and the dangers of falls when a
child plays on the stairway of a second-story apartment. Child abuse laws were also explained
so that Teresa would understand the seriousness of the situation.
Nursing interventions with this mother included referral and case coordination with social
services to connect the 14-year-old with counseling resources. Additionally, the mother was
referred to AFDC, as well as medical and food resources. The mother was given a referral for
the 3 1/2-year-old for a Head Start preschool program near the home. The PHN encouraged
Teresa to re-enter the county's alcohol and drug rehabilitation program with her children,
where she would receive parenting and home skills classes and counseling to address
parenting skills and domestic violence. This mother's history of drug abuse, evidence of
current alcohol abuse, and lack of knowledge and motivation to care for her children made
this situation a high-priority concern of the PHN.
19