People of African-American, European American, and Appalachian Heritage
Complete the following Case Studies:
African-American case study #2
Appalachian case study #1
Write a 3-4 page APA essay
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 and 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 grandchildren, aged 25, 20, 19, and 18; and their 2
year-old great-grandson. Anna and Dorothy 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 across 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 family 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, San 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 medication. Within the
last 5 years, Mr. Evans has had several relatives 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 license that she is an organ donor.
Sources of income for Mr. and Mrs. Evans 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 brothers must assume responsibility for their mother’s
medical bills and medication. Although she has Medicare parts A and B, many of her
expenses are not covered.
Mr. and Mrs. Evans, all members of their household, and all other extended
family in the community attend a large Baptist 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 structure of this family and identify strengths and
limitations of this family structure.
2. Describe and give examples of what you believe 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 hypertension, 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 family 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 Americans 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 African Americans may have about pregnancy.
APPALACHIAN 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 tuberculosis 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, aged 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 returned to northern Appalachia because he was
unable to find work in Denver. Ruth is 3 months’ pregnant.
Because Mrs. Kapp has been feeling “more 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, Gloria is expectorating greenish sputum,
which her husband estimates to be about a teacupful 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 turgor.
While the physician is examining Mrs. Kapp, the nurse is taking additional
historical and demographic data from Mr. Kapp and Ruth. The nurse finds that Ruth has
had no prenatal care and that her first child, Rebecca, was delivered at home with the
assistance of a neighbor. Rebecca is pale and suffers from frequent bouts of diarrhea and
colicky symptoms. Mr. Kapp declines to offer information regarding his health status and
states that he takes care of himself.
This is the first time Mrs. Kapp has seen 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 makes 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 medication 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 bark tea each morning for her diarrhea.
Ruth’s only complaint is the “sick headache” she gets three to four times a week.
She takes ginseng tea and Epsom salts for the headache.
Mrs. Kapp is discharged with prescriptions 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 prenatal clinic for herself and the pediatric
well-child clinic for Rebecca.
Study 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 care 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 help ensure that Ruth would make the
appointments for herself and her daughter?
8. What advice would you give Ruth regarding 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 suggest to assist the Kapp family at
this time?
13. What additional follow-up do you consider essential for the Kapp family?
14. What advice would you give Ruth regarding her daughter’s frequent bouts
of diarrhea?
