Reference no: EM133324216

Case: Jimmy's mother, Clara, took him to the emergency room close to the end of the afternoon shift. She was rather annoyed at the thought of taking him to the hospital as she saw no need to get medical treatment. As she entered, she could be heard shouting, "I'm only here to get a prescription for this little rash on my baby's hands. I don't need nobody telling me how to be a mother so can one of you nurses just call the doctor so I can get what I need and go? No need to have me take up your time when someone more ill needs your attention."

Three hours earlier, Jimmy's mother was visited by two Community Health Aides. The Health Centre was half a mile from the house (and the hospital a little less than three-quarters of a mile in the opposite direction). The visit was unexpected and unwelcomed but she allowed them in after they explained it was simply to help her out if she needed any assistance. The Aides detected a pungent odour on entering the yard and saw five-year-old Jimmy sitting on the ground looking dirty with numerous lesions all over his skin. They insisted that the child needed medical attention and informed Clara that if she did not get help for Jimmy, they would have to call the police. Page 2 of 5

Clara is a single mother and Jimmy is her only child. She sells sweets and coal to get by as no one will hire her due to her bad employment history and psychiatric condition (bipolar disorder). She takes her meds but has been finding it exceptionally difficult of late to take care of herself and Jimmy.

On examination, Jimmy's scalp was covered in crusts from healing and infected wounds due to deep and vigorous scratching. His hair was dirty and there was evidence of pediculosis. His arms, legs, torso and groin had numerous circular rashes with raised edges and grey, scaly skin inside the circles. His nails were dirty and dental caries marred his innocent smile.

Question 1: Jimmy's mother identifies you as the nurse she wants to help her son. Describe in three paragraphs how you would professionally handle the situation.

Question 2: What is the most likely skin condition Jimmy is having? Give a rationale for your response.

Question 3: What referrals would be necessary in this situation?

Question 4: What are the possible reasons for the time lapse between the visit from the Aides and Clara's arrival at the hospital? Why was she in such a hurry to leave? Why did she choose you to look after her son?