Foundations of Nursing in the Community 4th Edition by Marcia Stanhope,Jeanette Lancaster

Exercise 1

Although not even 2 years old, twins Reba and Tracy have had an eventful childhood. Their 16-year-old mother, Sheri, started prenatal care late in her pregnancy and delivered them at 35 weeks of gestation; they were small for gestational age. Sheri and the baby's father, Jeb, who was 21, had dropped out of high school; he used illegal drugs. The twins left the hospital at 2 weeks of age to live with Sheri at the Salvation Army apartments. Sheri's erratic and hostile behavior was impossible for her parents to tolerate. Her father was on disability compensation for extreme hypertension, and his elderly, bedridden mother lived in the mobile home as well.
Sheri, Jeb, and the twins were evicted from the Salvation Army when Sheri was found to be using drugs, so they moved in with some other young friends. By the time the twins were 15 months old, they showed clear signs of developmental delay. Tracy seemed not to see well, and Reba did not walk yet. Neither of the twins spoke an intelligible word, and neither was up to date on immunizations. With Sheri's permission, public health nurse Gina Smith talked with Sheri's parents about taking custody of the twins so that they might get the stability and care they needed. The grandparents agreed, and Sheri looked relieved when she moved the girls in with her parents. Sheri returned to living with friends.
Ms. Smith assessed the safety of the grandparents' mobile home for toddlers. She reviewed the normal milestones the girls should be attaining and taught the grandparents games they could play that would help the girls progress in their speech. She brought children's books from the local Book Buddies program for them to look at together. Normal nutritional needs for toddlers were reviewed. Within months the girls started talking and gaining weight. Tracy got glasses, and Reba got physical therapy to help her learn to walk. With the help of the nurse and their grandparents, the twins began to thrive. Are there other actions that the nurse could take to provide comprehensive care to the grandparents who have now become the caregivers for these young twins