case studies

 

PLEASE PUT THE PATIENT INFORMATION TO THE TEMPLATE ATTACH

 

Patient Intake and History

The patient is a 26-year-old college graduate who is currently euthymic but who has a history of major depressive episodes 

He has experienced major depressive episodes, mostly untreated, of varying lengths and severities since he was a teenager 

His symptoms have included insomnia, despondent thoughts, depressed mood, low interest in activities, poor energy, and impaired cognition 

He says his self-esteem drops and he feels rejection-sensitive and guilt-ridden for no apparent reason 

He has never had suicidal thoughts 

Some of the depressive episodes have been incapacitating and have interfered with school and work 

He appears to have good inter-episode recovery and is able to return to class and work

The patient also has symptoms of social anxiety

He is often nervous around new people and acquaintances 

He experiences anticipatory anxiety and will avoid certain social events 

These symptoms are present regardless of his affective state

He has asked for a consultation because he has legal issues regarding drinking and driving that he thinks were likely fueled by his psychiatric symptoms 

At the time of the infraction (several months ago, just before graduating college), he had been started on a selective serotonin reuptake inhibitor (SSRI) for the depression and SAD symptoms 

Within days of starting he experienced elevated mood in a sustained fashion over several days 

He lost all anxiety, fear, and avoidance 

He was unusually talkative; had racing thoughts; was distractible, hyperactive, and impulsive; and had decreased need for sleep 

He exhibited grandiosity, in which he felt invincible and that the law did not apply to him; this led him to purposefully antagonize a man in a bar, drive while drinking, and challenge authority when police were called

The mood elevation is complicated by the fact that the patient admits to heavy alcohol use on weekends throughout college 

The mood elevation abated with cessation of the SSRI treatment 

He has now completed college; he has few friends in the immediate area but his family is very supportive 

He wants to be a news reporter and is planning on applying to graduate school 

The patient has no family history of bipolar disorder; his mother has generalized anxiety disorder (GAD) 

He is not currently taking any medications

Vitals: 

  • 98.8
  • 160/80
  • 76
  • 18
  • 5’10”
  • 190 lbs.

Please use the case study template to complete the case and answer the questions listed below:

  1. Does the patient’s history support a diagnosis of bipolar disorder even though his symptoms appear to have been triggered by a selective serotonin reuptake inhibitor?
  2. What would be the expected future course of illness for this patient?
  3. If the patient develops another depressive episode, how would you treat it?
  4. What medication would you choose (there could be many correct answers). What is the MOA of this medication? (Be specific i.3. What receptor does it work on, etc.)
  5. Provide and reference a recent research article (Published over the last 3 years) on the  medication treatment of Mood Disorders

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case studies

case studies.

Identify a friend, peer, or family member you can interview to collect comprehensive subjective and objective data, as though they were a new patient in your office. 

Conduct an interview.

Document the subjective and objective findings in a word document and submit to Canvas.  This will be evaluated by the clinical faculty. 

Estimated time to complete: 1 hour

case studies

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A Page will cost you $12, however, this varies with your deadline. 

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Yes, we have an unlimited revision policy. If you need a comma removed, we will do that for you in less than 6 hours. 

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case studies

case studies.

NU610 Unit 3 Case Studies

 

Review the following case studies.

Document the subjective information only for each case in a Word document and submit it to Canvas.  This will be evaluated by the clinical faculty. 

 

 

Case 1

A 36-year-old female with a medical history of Multiple Sclerosis complains of constantly feeling tired even after a period of rest or sleep. She was diagnosed with MS 3 years ago and has been taking interferon to treat. As a wife and mother of 2 with a full-time job, she states that by the end of the day she has no energy whatsoever. The patient explains that she began noticing her lack of energy and tiredness a few months back, but it has gotten progressively worse. She also mentions that she has missed several days at work over the last 4 weeks because after getting showered and dressed, she had no energy left to go to work.  Reports occasional glass of wine on the weekends, denies tobacco use or illicit drug use.  She has tried some CBD oil to help with energy without relief.  Reports sleeping more than eight hours a night while needing several naps throughout the day.  She reports uncomfortable buzzing sensation traveling from neck down to spine with what sounds to be a Lhermitte’s sign.  She denies loss of bowel or bladder.  She denies fever, chills, weight loss or weight gain.  She reports some nasal congestion but contributes that to allergies which she takes cetirizine 10 mg PO daily for.  Reports she up to date on her pap smear, does monthly self-breast exam, denies concerns on exam.  Saw her dentist and eye doctor within the last year and no issues or concerns there.  Reports her mother who is alive has diabetes and hypertension.  Her father and siblings are also alive without any health issues.  She does have an aunt on her mother’s side who had MS as well who is currently wheelchair bound.  She is alert, oriented to person, place, time and situation. Does not appear in acute distress, well-developed, slightly obese in the abdominal section.  Skin is dry, warm, and intact.  Normocephalic, neck supple, no thyromegaly.  PERRLA about 4mm pupil size.  Conjunctivae rim pale. Optic fundi examined revealed uniform red to pink color, disk is pale pink, vessels emanate from optic cup, fovea was slightly darker.  Retinal vessels are free from hemorrhages or exudates.  Face symmetrical.  No lymphadenopathy.  Oral mucosa pink and moist.  Heart rate bradycardic at 56 beats per minute but regular without pauses or extra beats.  Lungs diminished bilaterally but otherwise clear.  Abdomen soft, non-distended, bowel sounds normoactive in all four quadrants.  No suprapubic or CVA tenderness.   Able to differentiate between light and deep tough, no dysmetria or ataxia, normal alternating hand movements, gait steady.  Muscle tone inspected and palpated, free from fasciculation, tenderness or atrophy.  Strength 5/5 in all extremities.

 

 

 

Case 2

A 35-year-old male presents with the onset of acute low back pain.  He was doing some yard work, including pulling out large bushes, when he experienced the acute onset of low back pain, radiating down the back of the left leg. Since then, the pain has worsened in intensity, and he is having difficulty bearing weight on the leg. He initially took 800 mg ibuprofen, which provided a small degree of relief, but he has not taken any medication since the problem initially occurred. The patient has no significant medical history. His general physical examination is within normal limits with regards to cardiovascular and pulmonary system.  On neurological examination, he has severe pain with active movement of the lower extremity, but only minimal pain with passive movement of the lower extremity. He has a positive straight leg raise but no other neurological deficits.  Denies loss of bowel or bladder or saddle anesthesia.  Denies fever, chills, weight loss or weight gain.  Denies headaches, dizziness, rashes or bruising.  Denies history of lower back pain or previous injury to back.  He is recently divorce and shares custody of three children.  He reports smoking about 1 pack of cigarettes a day for 10 years but quit 5 years ago, currently vapes daily.  He reports one beer with dinner, denies illicit drug use. Denies hospitalizations or surgical history.  He does not get regular health maintenance and only sees primary care provider when has acute issue.  He works for IT department from home and sits about 8 hours per day.  He reports running at least 30 minutes daily and overall eats “healthy.”  Denies family history of spine or musculoskeletal diseases or malignancy.  VS in office BP 124/78, HR 79, RR 16, Temp 97.3, 100% on RA.  Appears in acute distress related to pain.  Rates pain 8 out of 10, described as sharp, lightening sensation. 

 

Case 3

An 83-year-old female presents to the clinical with a productive cough for the last 3 weeks. She notices that she has had a fever off and on over that time with highest temperature of 100.3.  She coughs so much that she has chest pain which is worse at night. She reports having a mild sore throat and nasal congestion.  She tried taking guaifenesin without relief. She has no history of asthma or any chronic lung diseases. Past medical history includes osteoarthritis which she takes Tylenol 500 mg PO daily; depression which she takes citalopram 10 mg PO daily; GERD which she takes omeprazole 10 mg PO daily; and hypothyroidism which she takes levothyroxine 88 mcg PO daily as soon as she wakes every morning.  Allergy to PCN with reaction of hives.  Hospitalized for birth of three children and right knee replacement 2 years ago.  She lives in a retirement community, uses rolling walker for long distance walking and cane for around the house.  Her children live close by and help her with errands.  All her children are alive and well, no one with similar symptoms.  She reports being up to date on vaccines including flu and pneumonia vaccine.  She wears her mask when she goes out in public and maintains a physical distance of six feet while practicing good hand hygiene. She denies nausea, vomiting diarrhea and recent travel. She denies smoking, alcohol, or illicit drug use. Upon examination temperature is 98.6, pulse 96, blood pressure 124/82 and respirations are 18. O2 sat is 99% on room air.  Wt.: 235 lbs., Ht. 63 inches and BMI 41.62. She does not appear in acute distress or acutely ill.  Alert and oriented x 4.  Pupils are equal, round, reactive to light, no nystagmus or strabismus.  Mucous membranes moist.  No tonsillar exudate, oropharynx clear.  Nares patent with clear drainage.  TM gray color with cone of light present bilaterally. Neck examination is negative for JVD, bruits, adenopathy or masses. Chest examination reveals symmetrical chest motion with occasional wheezes but normal air movement. Heart irregular rate and rhythm with grade 2 systolic murmur heard greatest over the right sternal border. Capillary refill less than 3 seconds.  Bowel sounds present in all four quadrants with soft, non-distended and non-tender abdomen.  Peripheral pedal pulses +2 bilaterally without edema.

 

Case 4

A 64-year-old presents for a routine evaluation. The patient only complaint is of fatigue over the past 2 to 3 months although has had no changes in diet or lifestyle.  Consumes about 3 cups of coffee per day. The patient does report that they never smoked and admits to an “occasional beer with friends”. The patient has consumed a little more since retiring a year ago from the post office and admits to 2-3 now a day. The patient occasionally has headaches on the day after a night of heavier drinking. The headaches are relieved by over the counter non-steroidal anti-inflammatory medication (NSAID). While talking to the patient you notice no distress you note a 4-pound weight loss since his last visit 6 months ago and an increase in pulse at 103 BPM but regular with a blood pressure of 129/81. No history of allergies. Reports family history of diabetes, hypertension, cardiac disease and colon cancer.  Upon exam you notice paleness of conjunctivae and palmar pallor.  Abdomen round with distention, bowel sounds hyperactive in two of the four quadrants.  No suprapubic or CVA tenderness.  No lymphadenopathy or swelling.  You perform a digital rectal exam and find a smooth normal size prostate and some soft, reducible protrusions within the internal sphincter along with guaiac positive stools.  Denies any past medical history, surgical history or hospitalizations.  Reports fatigue but denies fever or chills.  Denies changes in visual or trouble swallowing.  Denies chest pain, palpitations, lightheadedness or sweating.  Denies nausea, vomiting, abdominal pain.  Has a bowel movement daily which recently has been dark in color.  Denies urinary frequency, burning or hematuria.  Denies cold or heat intolerance. 

 

Case 5

A 19-year-old female presents with a complaint of headaches frequently. She reports that she has had them since she was a teenager, but they have become more debilitating recently. The episodes occur once or twice a month and last for up to 2 days. The pain begins in the right temple or the back of the right eye and spreads to the entire scalp over a few hours. She describes the pain as a sharp, throbbing sensation that gradually worsens and is associated with sever nausea. Several factors aggravate the pain including loud noises and movement. She has taken several over the counter medication like naproxen and acetaminophen for the pain but the only thing that makes it better is going to sleep in a dark quiet room. Reports no drug allergies but has seasonal and allergies to pet dander.  A thorough history reveals her mother suffers from migraines. Last menses 4 weeks ago, is sexually active uses condoms.  Currently a freshman in college.  Denies alcohol, illicit drug and tobacco use.  Last health visit was over the Summer, up to date on health maintenance for her age.  She denies fever, chills, night sweats or neck stiffness.  She denies visual changes other than photophobia.  She denies chest pain, palpitations, shortness of breath or cough.  She denies abdominal pain, has some nausea with the headaches but no vomiting.  Denies numbness, tingling, weakness or changes in mood.  Vital signs: temperature 98.5, BP 112/70, HR 62, RR 17, 99% RA, Ht. 68 inches, Wt. 151 lbs.  Alert and oriented to self, place, time and situation.  Appears stated age with skin warm and dry.  Normocephalic, PERRL, TM gray with adequate conf of light bilaterally, no tenderness over sinuses.  Mucous membranes pink and dry.  No palpable masses, adenopathy or thyroid enlargement.  Regular heart rate and rhythm without murmurs. No edema.  Lungs clear bilaterally, no use of accessory muscles.  Soft, non-tender, non-distended abdomen with normoactive bowel sounds.  Normal visual acuity using Snellen chart 20/20, face symmetrical with symmetrical smile and puffing out cheeks.  Weber and rhinne test performed with normal bone and air conduction.  Palate and uvula at rest are free of fasciculations and symmetry noted at test and when pt. says “ah.” Positive gag reflex.  Shrug shoulders spontaneously and against resistance, hypoglossal nerve intact. Muscle tone inspected, palpated without atrophy and strength 5/5.  Bicep, patellar and Achilles reflexes 2+ bilaterally with negative Babinski.  Able to distinguish light and deep touch.  Able to complete heel to shin, gait steady. 

stimated time to complete: 1 hour

Rubric

NU610 Unit 3 Assignment – Case Studies Rubric

NU610 Unit 3 Assignment – Case Studies Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeSubjective Data

40 pts

Highly Proficient

Elements of subjective data (CC, HPI, PMH, Allergy identification, Medication Reconciliation, Social History, Family History, Health Promotion, and ROS) are adeptly documented and demonstrate consistent information across all aspects represented

32 pts

Proficient

Elements of subjective data (CC, HPI, PMH, Allergy identification, Medication Reconciliation, Social History, Family History, Health Promotion, and ROS) are appropriately documented and demonstrate consistent information across all aspects represented

24 pts

Marginally Proficient

Elements of subjective data (CC, HPI, PMH, Allergy identification, Medication Reconciliation, Social History, Family History, Health Promotion, and ROS) are satisfactorily documented but do not demonstrate consistent information across all aspects represented

16 pts

Approaching Proficiency

Elements of subjective data (CC, HPI, PMH, Allergy identification, Medication Reconciliation, Social History, Family History, Health Promotion, and ROS) are either not satisfactorily documented or do not demonstrate consistent information across all aspects represented

8 pts

Not Proficient

Elements of subjective data (CC, HPI, PMH, Allergy identification, Medication Reconciliation, Social History, Family History, Health Promotion, and ROS) are not satisfactorily documented and do not demonstrate consistent information across all aspects represented

0 pts

Not Evident

There are elements of subjective data (CC, HPI, PMH, Allergy identification, Medication Reconciliation, Social History, Family History, Health Promotion, and ROS) that are not provided in assignment.

40 pts

Total Points: 40

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case studies

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case studies

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case studies

"Looking for a Similar Assignment? Order now and Get a Discount!

Frequently Asked Questions

A Page will cost you $12, however, this varies with your deadline. 

When you pay us, you are paying for a near perfect paper and the time convenience. 

Upon completion, we will send the paper to via email and in the format you prefer (word, pdf or ppt). 

Yes, we have an unlimited revision policy. If you need a comma removed, we will do that for you in less than 6 hours. 

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case studies

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Instructions

Identify a friend, peer, or family member you can interview to collect subjective data, as though they were a new patient in your office. 

Conduct an interview.

Document the subjective findings in a word document and submit to Canvas.  This will be evaluated by the clinical faculty. 

Estimated time to complete: 1 hour

Rubric

NU610 Unit 2 Assignment – Case Studies Rubric

NU610 Unit 2 Assignment – Case Studies Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeSubjective Data

40 pts

Highly Proficient

Elements of subjective data (CC, HPI, PMH, Allergy identification, Medication Reconciliation, Social History, Family History, Health Promotion, and ROS) are adeptly documented and demonstrate consistent information across all aspects represented

32 pts

Proficient

Elements of subjective data (CC, HPI, PMH, Allergy identification, Medication Reconciliation, Social History, Family History, Health Promotion, and ROS) are appropriately documented and demonstrate consistent information across all aspects represented

24 pts

Marginally Proficient

Elements of subjective data (CC, HPI, PMH, Allergy identification, Medication Reconciliation, Social History, Family History, Health Promotion, and ROS) are satisfactorily documented but do not demonstrate consistent information across all aspects represented

16 pts

Approaching Proficiency

Elements of subjective data (CC, HPI, PMH, Allergy identification, Medication Reconciliation, Social History, Family History, Health Promotion, and ROS) are either not satisfactorily documented or do not demonstrate consistent information across all aspects represented

8 pts

Not Proficient

Elements of subjective data (CC, HPI, PMH, Allergy identification, Medication Reconciliation, Social History, Family History, Health Promotion, and ROS) are not satisfactorily documented and do not demonstrate consistent information across all aspects represented

0 pts

Not Evident

There are elements of subjective data (CC, HPI, PMH, Allergy identification, Medication Reconciliation, Social History, Family History, Health Promotion, and ROS) that are not provided in assignment.

40 pts

Total Points: 40

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case studies

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case studies

case studies.

Use the document attached below.

Review the following case studies. 

Document the subjective information only for each case study in a word document and submit to Canvas.  This will be evaluated by the clinical faculty.

 

 

 

 

 

case studies

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Case Studies

Complete the following:

  • African-American case study #2
  • Appalachian case study #1

Version:1.0 StartHTML:000000480 EndHTML:000083756 StartFragment:000001175 EndFragment:000083724 StartSelection:000001632 EndSelection:000083724 SourceURL:https://classroom.aspen.edu/d2l/common/assets/pdfjs/1.0.0.30/web/viewer.html?file=%2Fcontent%2Fenforced%2F43768-N512-KK8-08-20-19-Sect2%2FCaseStudies.pdf%3Fd2lSessionVal%3DFeuJBWYKC5d0CfstmT4x6NuRM%26ou%3D43768&lang=en-us&container=d2l-fileviewer-rendered-pdf&fullscreen=d2l-fileviewer-rendered-pdf-dialog&height=1186  PDF.js viewer

FRICAN 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, ot
her 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.

AMISH CASE STUDY
Elmer and Mary Miller, both 35 years old, liv
e with their five children in the main
house on the family farmstead in one of th
e largest Amish settlements in Indiana.
Aaron and Annie Schlabach, aged 68 and 70, live in the attached grandparents’
cottage. Mary is the youngest of their ei
ght children, and when she married, she and
Elmer moved into the grandparents’ cottage
with the intention that Elmer would take
over the farm when Aaron wanted to retire.
Eight years ago, they traded living space.
Now, Aaron continues to help with
the farm work, despite increasing pain in hi
s hip, which the doctor advises should be
replaced. Most of Mary’s and Elmer’s sibli
ngs live in the area, though not in the same
church district or settlement. Two of Elmer’s brothers and their families recently
moved to Tennessee, where farms are less expensive and where they are helping to
start a new church district.
Mary and Elmer’s fifth child, Melvin,
was born 6 weeks prematurely and is 1
month old. Sarah, aged 13, Martin, aged
12, and Wayne, aged 8, attend the Amish
elementary school located 1 mile from thei
r home. Lucille, aged 4, is staying with
Mary’s sister and her family for a w
eek because baby Melvin has been having
respiratory problems and their physician told
the family he will need to be hospitalized
if he does not get better within 2 days.
At the doctor’s office, Mary suggested
to one nurse, who often talks with Mary
about “Amish ways,” that Menno Martin, an
Amish man who “gives treatments,” may
be able to help. He uses “warm hands” to
treat people and is
especially good with

babies because he can feel what is wrong. Th
e nurse noticed that Mary carefully placed
the baby on a pillow as she prepared to leave.
Elmer and Mary do not carry any hea
lth insurance and are concerned about
paying the doctor and hospital bills associat
ed with this complicated pregnancy. In
addition, they have an appointment for Wayne
to be seen at Rile
y Children’s Hospital,
3 hours away at the University Medical Cent
er in Indianapolis, for a recurring cyst
located behind his left ear. Plans are being
made for a driver to take Mary, Elmer,
Wayne, Aaron, Annie, and two of Mary’s sist
ers to Indianapolis
for the appointment.
Because it is on the way, they plan to stop in
Fort Wayne to see an Amish healer who
gives nutritional advice and does “treatment
s.” Aaron, Annie, and Elmer have been
there before, and the other women are considering having treatments, too. Many
Amish and non-Amish go there and tell others
how much better they feel after the
treatments.
They know their medical expenses seem minor in comparison to the family
who last week lost their barn in a fire
and to the young couple whose 10-year-old child
had brain surgery after a fall from the hayl
oft. Elmer gave mone
y to help with the
expenses of the child and will go to the barn raising to help rebuild the barn. Mary’s
sisters will help to cook for the barn raisi
ng, but Mary will not help this time because
of the need to care for her newborn.
The state health department is concer
ned about the low immunization rates in
the Amish communities. One community-health nurse, who works in the area where
Elmer and Mary live, has volunteered to talk
with Elmer, who is on the Amish school
board. The nurse wants to learn how the health
department can work more closely with

the Amish and also learn more about what
the people know about immunizations. The
county health commissioner thinks this is a wast
e of time and that what they need to do
is let the Amish know that they are creating
a health hazard by ne
glecting or refusing
to have their children immunized.
Study Questions
1.
Develop three open-ended questions or
statements to guide you in your
understanding of Mary and Elmer and what
health and caring mean
to them and to
the Amish culture.
2.    List four or five areas of perinatal
care that you would want to discuss with Mary.
3.    Why do you think Mary placed the baby
on a pillow as she was leaving the doctor’s
office?
4.     If you were the nurse to whom Mrs. Mill
er confided her interest in taking the baby
to the folk healer, what would you do to le
arn more about their simultaneous use of
folk and professiona
l health services?
5.     List three items to discuss with the M
illers to prepare them fo
r their consultation at
the medical center.
6.    If you were preparing the reference fo
r consultation, what would you mention about
the Millers that would help to promote cu
lturally congruent ca
re at the medical
center?
7.    Imagine yourself participa
ting in a meeting with state
and local health department
officials and several local physicians and nur
ses to develop a plan to increase the

immunization rates in the
counties with large Amish
populations. What would you
suggest as ways to accomplish this goal?
8.
Discuss two reasons why many Old Orde
r Amish choose not to carry health
insurance.
9.
Name three health problems with genetic
links that are prevalent in some Amish
communities.
10.
How might health-care providers use the
Amish values of the three-generational
family and their visiting patterns in pr
omoting health in the Amish community?
11.   List three Amish values to consid
er in prenatal education classes.
12.
Develop a nutritional guide for Amish wome
n who are interested in losing weight.
Consider Amish values, daily lifestyl
e, and food production and preparation
patterns.
13.   List three ways in which Amish express caring.

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 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 turgor.
While the physician is examining Mrs. Kapp, the nurse is taking additional
historical and demographic da
ta from Mr. Kapp and Ruth. Th
e 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 and

colicky 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-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.

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