Mele 1st Action Point by 04t6jy


Mele is a very close friend of Agnes’s from church. She has been visiting
Agnes in hospital every day. Mele lives in a housing corporation, three
bedroom home with her daughter Siu, and her six children ranging in age from
three to fourteen. Mele is on the universal pension and her daughter is on the
DPB. They have a car which does not have a current warrant of fitness or
registration. They can’t get a warrant because Siu can’t afford new tyres.
You are the district nurse doing a follow up with Mele to dress a skin tear on
her right forearm. When you visit the house, you note that it is very untidy and
smells musty.
You see that two of Mele’s grandchildren are there. You are really concerned to
note that both are preschool age and are covered in sores and have decayed

Action point
Discuss how you will handle this situation and what your concerns are. Include
in this discussion the long term effects of dental caries with primary dentition.

I would be concerned about:
 The children not attending pre-school
 The children being covered in sores
 The children having decayed teeth

I would handle this situation by asking Mele if the children attend preschool, and I
would ask about health care for children.

I would ask Mele if she is aware of the B4 School Check for children. I would give her
information about the B4 School Check programme, and try to arrange with Mele for
the children to get a B4 school check. This would be a good way of addressing the
concerns that I have for the children. E.g. sores and decayed teeth.

The B4 School Check
The B4 School Check is a FREE health check for pre-school children/ tamariki who
turn four after 1 June 2008 to make sure they are healthy and can learn well at
The B4 School Check will be undertaken by registered nurses and will take between
40-60 minutes. It will include:
 child health questionnaire
 behavioural/developmental screening – Strengths and Difficulties Questionnaire
(SDQ) and Parental Evaluation
 Developmental Status (PEDS) tools
 hearing and vision screening
 measurement of height and weight recording
 oral health assessment – Lift the Lip
 health promotion and education
 referrals to appropriate health, education or social services and follow up
 immunisation (if overdue) where possible
The B4 School Check is the eighth (and final) core contact of the Well Child Tamariki
Ora Schedule of services. It is not designed to pick up every health problem your
child might have, so if you have any concerns about your child at any time, talk to
your family doctor.

For more information on the B4 School Check visit the Ministry Of Health site or call
the free 24-hour health advice service Healthline on 0800 611 116 which includes a
Well Child line that provides parenting advice and health education information.

Long term effects of dental caries
Dental caries is the commonest disease affecting children in this region with 50% of
children having caries by age 5 years and about 200 children hospitalised annually
for caries. Dental caries is an almost completely preventable disease.
Badly decayed first teeth can cause a lot of problems:
 Pain and infection
 Sleep and behaviour disturbance
 Damage to permanent teeth
 Distortion of speech
 Prevention of normal mouth growth for correct spacing of permanent teeth
 Inability to bite and chew certain foods
 Need for an anaesthetic to treat severe decay
 Difficulty unlearning bad habits acquired in infancy
 Decay looks terrible


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