Cheryl Williams

cw@americansentinel.edu
Test Tenant 1

CARE PLAN
FAMILY SUPPORT ASSESSMENT
Interviewer Completing this Assessment Date
Cheryl Williams 05/12/2017

GENERAL FAMILY INFORMATION

Client Full Name
Candice Conway

Race/Ethinicity Age Marital Status

White / Non-Hispanic Not stated Single

Religious Preference Primary Language Spoken at Home

Unknown English

Highest Level Of Education Completed

High School Grad

FINANCIAL
Employment Status Total Annual Income from Employer
Employed $5984

Other Sources of Income Child Support

None None

Rent / Own Ability to Pay Rent / Mortgage

Rent Difficult

Ability to Pay Other Monthly Bills Total Household Occupants (Including Client)
Difficult 3

ADULTS IN THE HOME

Name Relationship
Candice Mother

Name Relationship
Jessi Father

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 CHILDREN IN THE HOME
Child Age Gender
Brayden 6 Male

Are immunizations up to date for this child? Are there any medical issues with this child?
Unsure Developmentally Delayed

Information About Child's Father

Was in jail for domestic abuse; recently released on work-release

Child Support
None

Child Age Gender

Brandi 2 Female

Are immunizations up to date for this child? Are there any medical issues with this child?
Unsure None

Information About Child's Father

Works at the dad's liquor shop; uses alcohol, marijuana & meth

Child Support
None

Is client currently pregnant?

Yes

How many weeks? Prenatal Care?

24 No

Plans to breastfeed or bottle feed Information About Child's Father

Not stated Not involved in care of the children

Child Support
none

General Childcare Arrangements / Concerns

Landlord provides childcare

Care for Newborn:

No arrangements made

SUBSTANCES
Smoker Use of Illegal Substances
Half a pack a day Marijuana

Alcohol Use Abuse of Prescription Medications

Yes No

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 OTHER
Grocery Food Nutrition Concerns
Joe's Grocery Frozen Foods Adequate Nutrition

Has client ever been a victim of domestic violence?

Yes

Is client currently a victim of domestic violence?

Yes. Verbal, Financial and Emotional Abuse was mentioned.

Does the client need to get away from an abusive relationship or harmful situation?
Yes

Does the client have concerns about someone threatening or physically hurting them?
Yes. Jessi is abusive and throws things when he becomes angry.

Does the client have concerns about harming their children?

No

Are there any concerns about physical, emotional, or behavioral problems with any of the children?
Brayden acts out at times, which the mom believes is due to his diagnosis.

Other Notes
Safety of the children, since client has a history of leaving the 6 year old to watch the younger sibling.
Jessi steals the money she needs to pay her bills.

APARTMENT ASSESSMENT

ENVIRONMENTAL
Burning cigarette Fire Client to ensure cigaretteas are
completely out in the ash tray to
prevent a house fire.

Stove on Burn Injuries Client to turn off stove after cooking;

always check stove & other electrical
appliances prior to leaving apartment.

HEALTH
Rodents Spread Disease Inquire about an exterminator service
through the landlord. Rodents can
spread diseases to the expectant
mother and children.

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Mold in the Bathroom Can Result in Illness Mold can cause breathing problems.
Discuss with the landlord to have mold
evaluated and removed.

SAFETY
Missing Window Guards Falls; Burglaries Speak with landlord to install window
guards; keep all windows closed for
safety.

Drug Needles Disease Risk; Overdose Remove drug needles; a needlestick can
result in hepatitis and possible overdose.

NURSING DIAGNOSIS
ANALYSIS
Nursing Diagnosis

1.Ineffective coping R/T situational crises as evidenced by (AEB) inability to meet role expectations.

2.Risk for injury R/T environmental hazards AEB unsafe and unsanitary living conditions.

Community Health Nursing Diagnosis

Increased risk of asthma among young children related to exposure to second hand smoke (disability,
disease, etc.) as demonstrated in or by reports from the Environmental Protection Agency and Centers
for Disease Control that asthma is a known health effect of second-hand smoke among children.

Expected Outcome
Client will prioritize concerns and address top 3 hazards such as: closing/locking windows, having landlord
add guards/screens to all windows, and put all cigarettes out and omit or limit smoking in the apartment.
Client to schedule an appointment for prenatal care. Seek counseling to improve coping skills.

PLANNING
How will the nurse evaluate if goals/outcomes are achieved?
Nurse will make 3 weekly follow-up home visits. Work with Family Support office to get a child support order,
food stamps, and restraining order to keep abusive boyfriend out of the home. Discuss other childcare
options so children are not left alone. Provide resources for free or low cost immunizations.

IMPLEMENTATION
Nursing Actions Evidence - Based Rationale(s)
1. Educate client on cleanliness of the apartment and 1. Increases awareness of safety.
environmental safety. 2. Build & maintain a trusting nurse-patiet relationship.
2. Follow-up with visiting nurse every week until all 3. Prenatal care healthy baby; immunizations prevent
hazards have been removed. diseases.
3. Teach patient about prenatal care & immunizations

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EVALUATION
Nurse will determine on the last visit if listed outcomes were met. Nurse will follow-up to determine whether
client attended scheduled weekly meetings and counseling. An additional visit will be added if all outcomes
were not met.

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