Chamberlain College of Nursing NR305 Health Assessment
Family Genetic History Form
NOTE: Please do NOT remove any of the text on this form. Fill it in and submit in its entirety to aid in its
grading. Failing to complete this assignment using an adult participant other than yourself will result in a
20% penalty deduction being applied. Thank you.
Your Name: Date: 10/31/2017
Your Instructor’s Name: Professor Brenda Trigg
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
m
accurate. Please inform the person you are interviewing that they do NOT need to disclose information
er as
that they wish to keep confidential. If the adult participant decides not to share information, please
co
eH w
write, “Does not want to disclose.” If you find that the client is unwilling to answer several questions, you
will need to find another client who can provide more information.
o.
rs e
ou urc
Directions: Refer to the Family Genetic History guidelines and grading rubric found in Course Resources
to complete the information below. This assignment is worth 150 points.
o
Type your answers on this form. Click Save as and save the file with the assignment name and your last
aC s
name, e.g., “NR305_Family_Genetic_History_Form_Smith”. When you are finished, submit the form to
vi y re
the Family 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 (60 points):
ed d
ar stu
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
is
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.
Th
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,
sh
education, primary language, and a health summary, including any medical diagnoses. An example is
below.
Family Member Description
Paternal grandfather RL
First and last
initials:
NR305_Family_Genetic_History_Form Rev. 2/8/17 als 1
This study source was downloaded by 100000819032824 from CourseHero.com on 03-25-2021 01:43:23 GMT -05:00
https://www.coursehero.com/file/26260830/NR305-Family-Genetic-Historydocx/
, Chamberlain College of Nursing NR305 Health Assessment
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 ML
grandmother
First and last
initials:
Birthdate: 1932
Death date: 1998
Occupation: House wife
Education: Does not want to disclose
Primary language: English
Health summary: Diagnose with chronic lung disease from smoking cigarettes. Died from
heart failure
m
This example points to common problems among this generation on both sides of the family.
er as
Consider the implications this would have for the adult participant’s health if these were that
co
person’s family members.
eH w
o.
Complete the family genetic history form below. Indicate if any information is N/A (not applicable) or
rs e
unknown. Indicate any information the person did not want to disclose by noting “Does not want to
ou urc
disclose.”
*Please note any areas left blank will be considered missing information and will result in loss of points*
o
Family Member Description
aC s
Paternal grandfather MB
vi y re
First and last
initials:
Birthdate: December 18th 1923
Death date: September 8th 1972
ed d
Occupation: Bus Driver
ar stu
Education: 6th grade
Primary language: Spanish
Health summary: Diagnosed with hypertension, alcohol dependence, diabetes type II,
cardiovascular disease, and ultimately died from leukemia
is
Paternal grandmother SB
First and last
Th
initials:
Birthdate: July 4th 1919
Death date: May 11th 2001
Occupation: Maid
sh
Education: 9th grade
Primary language: Spanish
Health summary: Diagnosed with arthritis, heart murmur, diabetes type II, and ultimately
died from respiratory failure
Father AB
First and last
initials:
NR305_Family_Genetic_History_Form Rev. 2/8/17 als 2
This study source was downloaded by 100000819032824 from CourseHero.com on 03-25-2021 01:43:23 GMT -05:00
https://www.coursehero.com/file/26260830/NR305-Family-Genetic-Historydocx/
Family Genetic History Form
NOTE: Please do NOT remove any of the text on this form. Fill it in and submit in its entirety to aid in its
grading. Failing to complete this assignment using an adult participant other than yourself will result in a
20% penalty deduction being applied. Thank you.
Your Name: Date: 10/31/2017
Your Instructor’s Name: Professor Brenda Trigg
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
m
accurate. Please inform the person you are interviewing that they do NOT need to disclose information
er as
that they wish to keep confidential. If the adult participant decides not to share information, please
co
eH w
write, “Does not want to disclose.” If you find that the client is unwilling to answer several questions, you
will need to find another client who can provide more information.
o.
rs e
ou urc
Directions: Refer to the Family Genetic History guidelines and grading rubric found in Course Resources
to complete the information below. This assignment is worth 150 points.
o
Type your answers on this form. Click Save as and save the file with the assignment name and your last
aC s
name, e.g., “NR305_Family_Genetic_History_Form_Smith”. When you are finished, submit the form to
vi y re
the Family 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 (60 points):
ed d
ar stu
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
is
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.
Th
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,
sh
education, primary language, and a health summary, including any medical diagnoses. An example is
below.
Family Member Description
Paternal grandfather RL
First and last
initials:
NR305_Family_Genetic_History_Form Rev. 2/8/17 als 1
This study source was downloaded by 100000819032824 from CourseHero.com on 03-25-2021 01:43:23 GMT -05:00
https://www.coursehero.com/file/26260830/NR305-Family-Genetic-Historydocx/
, Chamberlain College of Nursing NR305 Health Assessment
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 ML
grandmother
First and last
initials:
Birthdate: 1932
Death date: 1998
Occupation: House wife
Education: Does not want to disclose
Primary language: English
Health summary: Diagnose with chronic lung disease from smoking cigarettes. Died from
heart failure
m
This example points to common problems among this generation on both sides of the family.
er as
Consider the implications this would have for the adult participant’s health if these were that
co
person’s family members.
eH w
o.
Complete the family genetic history form below. Indicate if any information is N/A (not applicable) or
rs e
unknown. Indicate any information the person did not want to disclose by noting “Does not want to
ou urc
disclose.”
*Please note any areas left blank will be considered missing information and will result in loss of points*
o
Family Member Description
aC s
Paternal grandfather MB
vi y re
First and last
initials:
Birthdate: December 18th 1923
Death date: September 8th 1972
ed d
Occupation: Bus Driver
ar stu
Education: 6th grade
Primary language: Spanish
Health summary: Diagnosed with hypertension, alcohol dependence, diabetes type II,
cardiovascular disease, and ultimately died from leukemia
is
Paternal grandmother SB
First and last
Th
initials:
Birthdate: July 4th 1919
Death date: May 11th 2001
Occupation: Maid
sh
Education: 9th grade
Primary language: Spanish
Health summary: Diagnosed with arthritis, heart murmur, diabetes type II, and ultimately
died from respiratory failure
Father AB
First and last
initials:
NR305_Family_Genetic_History_Form Rev. 2/8/17 als 2
This study source was downloaded by 100000819032824 from CourseHero.com on 03-25-2021 01:43:23 GMT -05:00
https://www.coursehero.com/file/26260830/NR305-Family-Genetic-Historydocx/
