Family Genetic History Form

Family Genetic History Form
Purpose: This assignment is to help you gain insight regarding the influence of genetics on an individual’s health and risk for disease. You are to obtain a family genetic history on a willing, nonrelated, adult participant.
Disclaimer: When taking a family genetic history on an actual client, it is essential that the information is accurate. Please inform the person you are interviewing that they do NOT need to disclose information that they wish to keep confidential. If the adult participant decides not to share information, please write, “Does not want to disclose.”
Directions: Refer to the Family Genetic History guidelines and grading rubric found in Doc Sharing to complete the information below. This assignment is worth 100 points.
Type your answers on this form. Click “Save as” and save the file with the assignment name and your last name, e.g., “NR305_Family_Genetic_History_Form_Smith”.When you are finished, submit theform to theFamily Genetic History Dropbox by the deadline indicated in your guidelines. Post questions in the Q&A Forum or contact your instructor if you have questions about this assignment.
1: Family Genetic History (35 points):
Develop a family genetic history that includes,at a minimum, three generations of your chosen adult’s family, including grandparents, parents, and the adult’s generation. If the adult has any children, include them as the fourth generation. **PLEASE NOTE: This assignment is to reveal the potential impact of the family’s health on the adult participant. You do not need to identify anyone who is not biologically related to the adult except for a spouse or significant other.
You do not need to use symbols, but instead write brief descriptions for each person. Each description should include the following information: first name, birthdate, death date, occupation, education, primary language, and a health summary, including any medical diagnoses. An example is below:
Family Member Description
Paternal grandfather
First and last initials: RL
Birthdate: 1921
Death date: 1981
Occupation: Retired as a coal miner
Education: 6th grade
Primary language: English
Health summary: He was diagnosed with chronic lung disease, diabetes, and hypertension. He died from a heart attack.
Paternal grandmother
First and last initials: ML
Birthdate: 1932
Death date: 1998
Occupation: House wife
Education: Does not want to disclose
Primary language: English
Health summary: Diagnosed with chronic lung disease from smoking cigarettes. Died from heart failure.
This example points to common problems among this generation on both sides of the family. Consider the implications this would have for the adult participant’shealth if these were that person’s family members.
Complete the family genetic history form below. Indicate if any information is N/A (not applicable) or unknown. Indicate any information the person did not want to disclose by noting “Does not want to disclose.”
Family Member Description
Paternal grandfather
First and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Paternal grandmother
First and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Father
First and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Father’s siblings (write a brief summary of any significant health issues)
Maternal grandfather
First and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Maternal grandmother
First and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Mother
First and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Mother’s siblings (write a brief summary of any significant health issues)
Adult Participant
First and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Adult participant’s siblings (write a brief summary of any significant health issues)
Adult participant’s spouse/significant other
First and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Adult participant’s children (write a summary for each child, up to four children)
Child #1 first and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Child #2 first and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Child #3 first and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Child #4 first and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:

2. Evaluation of family genetic history (25 points)
Evaluate the impact of thefamily’s genetic history on your adult participant’s health. For example, if the adult participant’s mother and both sisters have diabetes, hypertension, or cancer, what might that mean for the adult participant’s future health?

3. Planning for future wellness (35 points)
Plan changes based on the evaluation of the adult participant’sfamily’s health history that will promote an optimal level of wellness both now and in the future. Include what information you would provide to the adult participant regarding the results of the family genetic history.
Family Genetic History
c
PURPOSE
This assignment is to help you gain insight regarding the influence of genetics on an individual’s health and risk for disease. You are to obtain a family genetic history on a willing, nonrelated, adult participant.
COURSE OUTCOMES
This assignment enables the student to meet the following course outcomes:
CO #3: Utilize effective communication when performing a health assessment. (PO #3)
CO #5: Explore the professional responsibilities involved in conducting a comprehensive health assessment and providing appropriate documentation. (PO #6)
POINTS
This assignment is worth a total of 100 points.
DUE DATE
TheFamily Genetic History Assignmentis to be submitted at the end of Week 3.There is a MS Word document form in Doc Sharing that you need to download, fill in, and submit to the Family Genetic History Dropbox by Sunday, 11:59 p.m. MT at the end of Week 3. Post questions to the weekly Q&A Forum. Contact your instructor if you need additional assistance. See the Course Policies regarding late assignments. Failure to submit your paper to the Dropbox on time may result in a deduction of points.
DISCLAIMER
When taking a family genetic history on an actual client, it is essential that the information is accurate. Please inform the person you are interviewing that they do NOT need to disclose information that they wish to keep confidential. If the adult participant decides not to share information, please write, “Does not want to disclose.”
DIRECTIONS
1. Refer to the examples in Chapter 4 of your textbook that discuss development of a genogram.
2. Download the NR305_Family_Genetic_History_Form from Doc Sharing. You will document the adult participant’s family genetic history using this MS Word document.
3. Complete the family genetic history using the information that the adult participant is willing to share with you. The focus of this course is on the normal “healthy” individual so your paper does not need to contain much medical/nursing detail. Refer to your textbook or the Internet to learn what impact the family’s health history may have on the adult participant’s personal state of wellness both now and in the future.
This paper does not require APA formatting, but you are expected to write clearly and use proper grammar and spelling.
Developing a pictorial genogram using symbols to identify certain relationships(e.g., divorced, sibling, deceased, etc.), may provide more insight, however, drawing may be difficult to accomplish withMS Word, therefore you are not expected to use symbols, lines, or other drawing elements. Instead, describe the relationships among the various people in theadult participant’s family’s genetic history. Remember, the goal is not to learn how to draw with Word, but to gather information about the family and recognize its significance to the adult participant and that person’s health.
4. Save the completed form by clicking on “Save as” and add your last name to the file name, e.g., “NR305_Family_Genetic_History_Form_Smith”.
5. Submit the completed form to the Family Genetic Historybasket in the Dropbox by Sunday, 11:59 p.m. MT at the end of Week 3. Please post questions about this assignment to the weekly Q&A Forums so the entire class may view the answers.
GRADING CRITERIA
Category Points % Description
Family Genetic History 35 35 Develop a family genetic history that includestheadult participant’s grandparents, parents, the adult participant, the adult participant’s spouse or significant other, and any children that the adult participant may have.You do NOT need to use symbols or other drawing elements, but instead describe each person mentioned and their relationships.
Evaluation of Family Genetic History 25 25 Evaluate the impact of the family’s history on the adult participant’s health. For example, if the mother and both her sisters have diabetes, hypertension or cancer, what might that mean for the future health of the adult participant?
Planning for Future Wellness 35 35 Plan changes based on the evaluation of the adult participant’sfamily genetic historythat will promote an optimal level of wellness both now and in the future.
Scholarly writing 5 5 Use proper grammar, spelling, and medical language.
Total 100 pts
100%
A quality paper will meet or exceed all of the above requirements.
GRADING RUBRIC
Assignment Criteria A
Outstanding or highest level of performance B
Very good or high level of performance C
Competent or satisfactory level of performance F
Poor or failing or unsatisfactory level of performance
Family Genetic History
(35 pts) All required criteria included; no errors
(32–35 points) Three or four generations included in the history; information is provided about each person but lacks detail about relationships and/or health information
(29–31 points) Two generations included; no relationships described or no health information provided
(26–28 points) No history or fewer than two generations included; no relationships described or no health information provided
(0–25 points)
Evaluation of Family Genetic History
(25 pts) Evaluation complete; thoroughly covers all required elements
(23–25 points) Evaluation addresses only two of apparent health risks within the history
(21–22 points) Evaluation addresses only one of apparent health risks within the history
(19–20 points) Evaluation missing
(0–18 points)
Planning for Future Wellness
(35 pts) Plan for wellness incorporates all areas of risk within the family genetic history, demonstrating critical thinking; answered all required questions
(32–35 points) Plan for wellness demonstrated basic understanding of the family genetic history; answered all but one of the required questions
(29–31 points) Plan for wellness demonstrated basic understanding of the family genetic history answered two of the required questions
(26–28 points) Plan for wellness does not demonstrate basic understanding of the family genetic history or is missing
(0–25 points)
Scholarly writing
(5 pts) No grammar, spelling, or syntax errors. Writes in complete sentences.
(5 points) No more than two errors of any type
(4 points) Three or more errors of any type
(3 points) APA, grammar, spelling and/or punctuation contain multiple errors
(0–2 points)
Total Points Possible = 100 points

 

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