Question

The Case of Lanesha Johnson

This case focuses on a family living in an urban community. As you read through this story, pay special attention to the various social, cultural and emotional factors that influence the child’s treatment.

Lanesha Johnson is a 12-year-old firestorm—teetering on that edge between childhood and adolescence. Her temper, much like her asthma, is persistent. When Lanesha blows into clinic, it’s like she’s dragging her Grandma Marietta along, even though it’s the other way around. Marietta tries her best as Lanesha’s legal guardian, but she’s got a lot on her hands: she’s also raising her 10-year-old grandson Marcus and caring for her aging mother, Lillian.

Lanesha is a fourth grader in a predominately African-American school where her desk often sits empty. She’s been out of school with asthma 14 days this year, many of which coincide with Lanesha’s serious seasonal allergy problems. She spends at least one night a week awake with a nighttime cough and has wheezing and coughing fits about 4 days out of the week. All this distraction probably doesn’t help with Lanesha’s grades, and she’s failing half of her classes.

Lanesha shows up in clinic regularly with empty medicines (her daily controller and quick relief asthma meds) and complains about her Grandma Marietta’s lack of responsibility in refilling them. Marietta doesn’t have a financial problem buying medicine—all costs are paid by Medicaid—but she never can explain why she doesn’t get refills. She just says that it’s Lanesha’s responsibility anyway.

Review Questions: One paragragh response for each question (6-7 sentences).

• Is it unusual that Grandmother Marietta is the primary caregiver?

• What responsibilities do health care providers have in this situation?

• How does Lanesha's temperament affect the situation?

Answer 1

Is it unusual that grandmother is primary caregiver?

No, its not unusual since there are many possibilities that will make child responsibility of grandparents, e.g. in case of untimely demise of parents of child, or if parents are not able to look for their children due to workload etc. Also, grandparents can take care of their grandchildren, as in this above mentioned case.

Responsibility of healthcare providers

Health care provider should counsel this patient and her grandmother about the seriousness of the illness i.e. asthma. This can turn into emergencies like status asthmaticus if not treated adequately. As patient is covered under Medicaid, there should not be any financial problem for grandmother. Marietta should help lanesha in taking medicines initially and then ask lanesha to take medicines herself under surveillance. Also healthcare provider should counsel patient Lanesha about her responsibility to take medicines regularly as directed by physician, as her grandmother is also taking care of other 2 persons in house. This will make her independent about taking medicines and hence it will not affect her studies.

Effect of Lanesha's temperament on this situation

Temparament is emotional character as shown in behaviour. One of most important risk factors of asthma and status asthmaticus is stress or emotional outbreaks. Since lanesha is suffering from asthma which is disabling her to do her daily activities like schooling and sleeping, she is susceptible for developing life-threatening status asthmaticus. Also Lanesha's age shows that she has just entered adolescence and this will also affect her mood and temper due to hormonal changes happening inside body. Healthy mental practices such as meditation should be considered and medical compliance will help lanesha to deal with this problem. Counselling should be done accordingly.