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Answer & Explanation:Family Genetic History   Family Genetic History Form.docx
Guidelines and Grading Rubric
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
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 with MS Word, therefore you are not expected to use
symbols, lines, or other drawing elements. Instead, describe the relationships
among the various people in the adult 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”.
family_genetic_history_form.docx

Unformatted Attachment Preview

Family Genetic History Form
Your Name:
Date:
Your Instructor’s Name:
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.”
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:
Paternal grandmother
First and last
He was diagnosed with chronic lung disease, diabetes, and hypertension.
He died from a heart attack.
ML
initials:
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’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
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:
Description
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 the family’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’s family’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.
…
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