NR 305 Week 2 Assignment: Family Genetic History Form (Smoker, Developed and Died from Lung
Cancer)
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 the form to
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 (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 RL
First and last
initials:
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
NR305_Family_Genetic_History_Form 10/29/14 vh 1
, NR 305 Week 2 Assignment: Family Genetic History Form (Smoker, Developed and Died from Lung
Cancer)
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’s health 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 NA
First and last initials:
Birthdate: Dec. 10, 1910
Death date: Nov. 26, 1991
Occupation: Farmer
Education: H.S. Graduate
Primary language: Spanish
Health summary: Diagnosed with COPD, from smoking cigarettes. Died from lung cancer.
Paternal grandmother JA
First and last initials:
Birthdate: Dec. 07, 1913
Death date: Jun 18, 1998
Occupation: homemaker
Education: HS graduate
Primary language: Spanish
Health summary: Died of natural causes.
Father RA
First and last initials:
Birthdate: Apr. 03, 1946
Death date:
Occupation: Mechanical Engineer (retired)
Education: B.S. in ME
Primary language: Spanish
Health summary: Diagnosed with hyperlipidemia, COPD, hypertension
Father’s siblings (write a Have 12 siblings (10 males and 2 females). Hypertension runs in the
brief summary of any family. Also the female siblings acquired DM2 at the age of 40. 1 male
significant health issues) sibling died of a heart attack, and another male sibling died of pancreatic
cancer. Another male sibling suffered a stroke in 2014 with L sided
defecits.
Maternal grandfather EB
First and last initials:
Birthdate: Jun. 06, 1908
Death date: Aug. 02, 1971
Occupation: Farmer
Education: HS graduate
Primary language: Spanish
Health summary: Diagnosed with hypertension, CAD, CHF. Died of a sudden heart attack.
Maternal grandmother AB
NR305_Family_Genetic_History_Form 10/29/14 vh 2
Cancer)
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 the form to
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 (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 RL
First and last
initials:
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
NR305_Family_Genetic_History_Form 10/29/14 vh 1
, NR 305 Week 2 Assignment: Family Genetic History Form (Smoker, Developed and Died from Lung
Cancer)
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’s health 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 NA
First and last initials:
Birthdate: Dec. 10, 1910
Death date: Nov. 26, 1991
Occupation: Farmer
Education: H.S. Graduate
Primary language: Spanish
Health summary: Diagnosed with COPD, from smoking cigarettes. Died from lung cancer.
Paternal grandmother JA
First and last initials:
Birthdate: Dec. 07, 1913
Death date: Jun 18, 1998
Occupation: homemaker
Education: HS graduate
Primary language: Spanish
Health summary: Died of natural causes.
Father RA
First and last initials:
Birthdate: Apr. 03, 1946
Death date:
Occupation: Mechanical Engineer (retired)
Education: B.S. in ME
Primary language: Spanish
Health summary: Diagnosed with hyperlipidemia, COPD, hypertension
Father’s siblings (write a Have 12 siblings (10 males and 2 females). Hypertension runs in the
brief summary of any family. Also the female siblings acquired DM2 at the age of 40. 1 male
significant health issues) sibling died of a heart attack, and another male sibling died of pancreatic
cancer. Another male sibling suffered a stroke in 2014 with L sided
defecits.
Maternal grandfather EB
First and last initials:
Birthdate: Jun. 06, 1908
Death date: Aug. 02, 1971
Occupation: Farmer
Education: HS graduate
Primary language: Spanish
Health summary: Diagnosed with hypertension, CAD, CHF. Died of a sudden heart attack.
Maternal grandmother AB
NR305_Family_Genetic_History_Form 10/29/14 vh 2
