AFRICAN AMERICAN CASE STUDY #2

Mr. and Mrs. Evans are an African American couple who retired from the school

system last year. Both are 65 years of age a

nd reside on 20 acres of

land in a large rural

community approximately 5 miles from a Superfund site and 20 miles from two

chemical plants. Their household consists of

 their two daughters, Anna, aged 40 years,

and Dorothy, aged 42 years; their grandc

hildren, aged 25, 20, 19, and 18; and their 2-

year-old great-grandson. Anna and Doro

thy and their children all attended the

university.

Mr. Evans’s mother and three of his

nieces and nephews live next door. Mr.

Evans’s mother has brothers, sisters, other

 sons and daughters, grandchildren, and

great-grandchildren who live ac

ross the road on 10 acres of land. Other immediate and

extended family live on the 80 acres adjacent

to Mr. Evans’s mother. All members of

the Evans family own the land on which they live.

Mrs. Evans has siblings and extended fa

mily living on 70 acres of land adjacent

to Mr. Evans’s family, who live across the road. Mr. and Mrs. Evans also have family

living in Chicago, Detroit, New York, Sa

n Francisco, and Houston. Once a year, the

families come together for a reunion. Every other month, local family members come

together for a social hour. The family believes in

strict discipline with

lots of love. It is

common to see adult members of the family

discipline the younger children, regardless of who the parents are.

 

Mr. Evans has hypertension and diabetes

. Mrs. Evans has hypertension. Both

are on medication. Their daughter Dorothy is

bipolar and is on me

dication. Within the

last 5 years, Mr. Evans has had several re

latives diagnosed with lung cancer and colon

cancer. One of his maternal uncles died last

 year from lung cancer. Mrs. Evans has

indicated on her driver’s licen

se that she is an organ donor.

Sources of income for Mr. and Mrs. Ev

ans are their pensions from the school

system and Social Security. Dorothy receives SSI because she is unable to work any

longer. Mr. Evans and his br

others must assume responsibility for their mother’s

medical bills and medication. Although she ha

s Medicare parts A and B, many of her

expenses are not covered.

Mr. and Mrs. Evans, all members of th

eir household, and al

l other extended

family in the community attend a large Bap

tist church in the city. Several family

members, including Mr. and Mrs. Evans, sing

in the choir, are members of the usher

board, teach bible classes, and do community ministry.

 

Study Questions

1.

Describe the organizational st

ructure of this family and identify strengths and 

   limitations of this

family structure

.

2.

Describe and give examples of what you be

lieve to be the family’s values about 

   education.   

       3. Discuss this family’s

 views about child rearing

 

4. Discuss the role that spirituality plays in this family.

5.

Identify two religious or spiritual practices in which members of the Evans

   family may engage for treating hypert

ension, diabetes, and mental illness.

6.

Identify and discuss cultural

 views that Dorothy and her parents may have about 

   mental illness and medication.

7.

To what extent are members of the Evans fa

mily at risk for illnesses associated 

   with environmental hazards?

8.

Susan has decided to become an organ donor. Describe how you think the Evans 

   family will respond to her decision.

       9. Discuss views that African Ameri

cans have about advanced directives.

       10. Name two dietary health risks for African Americans.

11.

Identify five characteristics to consider

 when assessing the skin of African 

     Americans.     

       12. Describe two taboo views that Afri

can Americans may have about pregnancy

 

PPALACHIAN CASE STUDY #1

William Kapp, aged 55 years, and his wife, Gloria, aged 37, have recently moved from an

isolated rural area of northern Appalachia

to Denver, Colorado, because of Gloria’s

failing health. Mrs. Kapp has had pulmonary t

uberculosis for several years. They decided

to move to New Mexico because they heard that the climate was better for Mrs. Kapp’s

pulmonary condition. For an unknown reason, they stayed in Denver, where William

obtained employment making machine parts.

The Kapp’s oldest daughter, Ruth, ag

ed 20, Ruth’s husband, Roy, aged 24, and

their daughter, Rebecca, aged 17 months, moved with them so Ruth could help care for

her ailing mother. After 2 months, Roy return

ed to northern Appalachia because he was

unable to find work in Denver. Ruth is 3 months’ pregnant.

Because Mrs. Kapp has been feeling “mor

e poorly” in the last few days, she has

come to the clinic and is accompanied by her husband, William, her daughter Ruth, and

her granddaughter, Rebecca. On admission, Glor

ia is expectorating greenish sputum,

which her husband estimates to be about a teac

upful each day. Gloria is 5 ft 5 in. tall and

weighs 92 pounds. Her temperature is 101.4°F,

her pulse is regular at 96 beats per

minute, and her respirations are 30 per minute

and labored. Her skin is dry and scaly with poor tugor

While the physician is examining Mrs. Kapp, the nurse is taking additional

historical and demographic data from Mr. Kapp and

the nurse finds that Ruth has

had no prenatal care and that her first chil

d, Rebecca, was delivered at home with the

assistance of a neighbor. Rebecca is pale and

suffers from frequent bouts of diarrhea andcolicky symptoms. Mr. Kapp declines to offer in

formation regarding his health status and

states that he takes care of himself.

This is the first time Mrs. Kapp has s

een a health-care provider since their

relocation. Mr. Kapp has been treating his wife

with a blood tonic he makes from soaking

nails in water; a poultice he ma

kes from turpentine and lard,

which he applies to her chest

each morning; and a cough medicine he makes from rock candy, whiskey, and honey,

which he has her take a tablespoon of four

times a day. He feels this has been more

beneficial than the prescription medicati

on given to them before they relocated.

The child, Rebecca, has been taking a

cup of ginseng tea for her colicky

symptoms each night and a cup of red ba

rk tea each morning for her diarrhea.

Ruth’s only complaint is the “sick headach

e” she gets three to four times a week.

She takes ginseng tea and Epsom salts for the headache.

Mrs. Kapp is discharged with prescr

iptions for isoniazid, rifampin, and an

antibiotic and with instructions to return in

 1 week for follow-up based on the results of

blood tests, chest radiograph, and sputum cultures.

She is also told to return to the clinic

or emergency department if her symptoms

worsen before then. The nurse gives Ruth

directions for making appointments with the pr

enatal clinic for herself and the pediatric

well cild clinic for Rebecca

tudy Questions

1.

Describe the migration patterns of

Appalachians over the last 50 years.

2.

Discuss issues related to autonomy

in the workforce for Appalachians.

3.

Identify high-risk behaviors common in the Appalachian region.

4.

Describe barriers to health car

e for people living in Appalachia.

5.

What might the nurse or physician do

to encourage Mrs. Kapp to comply

with her prescription regimen?

6.

What would your advice be regarding each of the home remedies that Mrs

 

Kapp is taking? Would you encourage or

 discourage her from continuing

them?

7.

What might the nurse have done to he

lp ensure that Ruth would make the

appointments for herself and her daughter?

8.

What advice would you give Ruth re

garding the home remedies that she

and her daughter are currently taking

? Would you encourage or discourage

their use?

9.

Do you think Mrs. Kapp will return for her appointment next week? Why?

What would you do if she did not return for her appointment?

10.

Do you think that Ruth will make and keep appointments for herself and

her daughter?

11.

What would you do to encourage Mr. Kapp to consent to a health

assessment?

12.

What additional services could you sugge

st to assist the Kapp family at this time.

 

Case study on African american And Appalachian popuplation