Diverse Populations and Health Care African American and Appalachian Cultures

Case StudiesAFRICAN AMERICAN CASE STUDY #1Robert Collins is a 49-year-old African American. He resides in the inner city of Detroit,Michigan, with his extended family. He has a 43-year-old wife and five children, aged26, 18, 16, 14, and 10. His wife, his elderly mother, three of his children (aged 16, 14,and 10), two grandchildren, and his sick sister-in-law represent the householdmembership.Mr. Collins completed the 11th grade and maintains employment in a steelfactory. Although he works more than 40 hours a week, his income places him at thepoverty level. He cannot afford to purchase health insurance.Mr. Collinsâ??s 18-year-old daughter, Chloe, is pregnant for the third time and is asingle parent. Mr. Collins is caring for her other two children. Chloe is going to nightschool to complete her high school education.The Collins family goes to church every Sunday and is actively involved in thechurch.Mrs. Collins was diagnosed with cancer, and she is receiving spiritual healingfrom her pastor and church for this illness. Mr. Collins is extremely concerned about hiswifeâ??s health and has increased his tobacco use.Study Questions1. Name one occupation-related disease for which Mr. Collins is at risk.2. Identify one family member who is likely to be caring for the youngerchildren in the family.3. Describe three cultural beliefs that Chloe may have regarding herpregnancy.4. Discuss the role of spirituality in this family.5. Identify two religious or spiritual practices in which Mrs. Collins may beengaging.6. Because Mrs. Collins has cancer, discuss possible cultural thoughts shemay have regarding death and dying.7. Identify two diseases common among African American men.8. Identify the high school dropout rate among African American teens in theinner city.9. Name one tobacco-related disease found in the African Americanpopulation.10. Name two dietary health risks for African Americans.11. Identify five characteristics to consider when assessing the skin of AfricanAmerican clients.12. Name two skin conditions common among African Americans.APPALACHIAN CASE STUDY #1William Kapp, aged 55 years, and his wife, Gloria, aged 37, have recently moved from anisolated rural area of northern Appalachia to Denver, Colorado, because of Gloriaâ??sfailing health. Mrs. Kapp has had pulmonary tuberculosis for several years. They decidedto move to New Mexico because they heard that the climate was better for Mrs. Kappâ??spulmonary condition. For an unknown reason, they stayed in Denver, where Williamobtained employment making machine parts.The Kappâ??s oldest daughter, Ruth, aged 20, Ruthâ??s husband, Roy, aged 24, andtheir daughter, Rebecca, aged 17 months, moved with them so Ruth could help care forher ailing mother. After 2 months, Roy returned to northern Appalachia because he wasunable to find work in Denver. Ruth is 3 monthsâ?? pregnant.Because Mrs. Kapp has been feeling â??more poorlyâ? in the last few days, she hascome to the clinic and is accompanied by her husband, William, her daughter Ruth, andher 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 andweighs 92 pounds. Her temperature is 101.4°F, her pulse is regular at 96 beats perminute, and her respirations are 30 per minute and labored. Her skin is dry and scaly withpoor turgor.While the physician is examining Mrs. Kapp, the nurse is taking additionalhistorical and demographic data from Mr. Kapp and Ruth. The nurse finds that Ruth hashad no prenatal care and that her first child, Rebecca, was delivered at home with theassistance of a neighbor. Rebecca is pale and suffers from frequent bouts of diarrhea andcolicky symptoms. Mr. Kapp declines to offer information regarding his health status andstates that he takes care of himself.This is the first time Mrs. Kapp has seen a health-care provider since theirrelocation. Mr. Kapp has been treating his wife with a blood tonic he makes from soakingnails in water; a poultice he makes from turpentine and lard, which he applies to her chesteach 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 morebeneficial than the prescription medication given to them before they relocated.The child, Rebecca, has been taking a cup of ginseng tea for her colickysymptoms each night and a cup of red bark tea each morning for her diarrhea.Ruthâ??s only complaint is the â??sick headacheâ? 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 anantibiotic and with instructions to return in 1 week for follow-up based on the results ofblood tests, chest radiograph, and sputum cultures. She is also told to return to the clinicor emergency department if her symptoms worsen before then. The nurse gives Ruthdirections for making appointments with the prenatal clinic for herself and the pediatricwell-child clinic for Rebecca.Study Questions1. 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 complywith 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 continuingthem?7. What might the nurse have done to help ensure that Ruth would make theappointments for herself and her daughter?8. What advice would you give Ruth regarding the home remedies that sheand her daughter are currently taking? Would you encourage or discouragetheir 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 andher daughter?11. What would you do to encourage Mr. Kapp to consent to a healthassessment?12. What additional services could you suggest to assist the Kapp family atthis time?13. What additional follow-up do you consider essential for the Kapp family?14. What advice would you give Ruth regarding her daughterâ??s frequent boutsof diarrhea?

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