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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