Family Genogram and Ecomap Case Study

Family Genogram and Ecomap Case Study
You are a public health nurse assigned to work with Ken Johnson and his wife Mary. Ken tripped and fell early this spring when he inadvertently stepped into a hole dug by an underground animal. He broke his hip and needed to have a total hip replacement. Following Ken’s surgery, he was referred to Freeport County Public Health Nursing Service for weekly home visits with skilled nursing and a home care assistant. His activities were limited to flat, level ground, mostly in the house. When you arrive for your weekly visit, you see Ken back outside helping Mary in the garden. They have spent many hours together working side-by-side planting, weeding, watering, and then harvesting their produce each year. After they turned most of the farm work over to their son, tending a garden became a way for the two of them to work together to keep them healthy and engaged in the out-of-doors that they both loved. But now that summer has arrived, he has been given clearance to walk around outside and do some work in the garden. He still uses a cane for support with walking and to ensure more stable footing outside.
Ken has continued to need some skilled nursing services since his hospitalization. As Ken’s public health nurse (PHN), you regularly monitor his diabetes, set up his medications, and help Ken and Mary with other concerns in the home.
Since Ken’s surgery, a home health aide has come twice a week to assist him with personal cares like bathing. Initially, the aide also assisted with regular exercises prescribed by the doctor and the physical therapist and helped Ken with some ambulation around the house. Additionally, you supervise the home health aide every two weeks, but now have come to evaluate whether that care needs to continue.
You sit down with the couple and have a conversation about what Ken is able to do at this time. Mary feels that Ken has been able to resume many of his normal activities and believes that the services of the home care aide are no longer necessary. Based on your observations and assessment of his ability to complete the activities of daily living (ADLs), you agree that he no longer needs the assistance of the aide. You reassure the Johnsons that if his condition changes, the aide can resume coming to the home on a regular basis.
As part of the care you provide the Johnson’s, you complete a family history, genogram, and ecomap. These tools can give the PHN and other health care providers information about the medical history and relationships in a family. It is often used to determine medical and social conditions and life expectancies that may continue from generation to generation. It can be used to help plan and evaluate effective nursing interventions.
You collect the following information to construct a family history, genogram, and ecomap on the Johnsons:
Demographics
· Ken was born May 15, 1942.
· Mary was born July 11, 1945.
· Ken and Mary were married January 20, 1965.
· Seven children were born to this marriage; two sons (oldest and youngest) separated by five daughters (youngest two are twins).
· Their oldest son was killed in an auto accident in 1990.
· All other children are alive and doing well.
· Ken had three brothers, one of whom lives next door. His two older brothers are still alive, but his youngest brother died last year following a stroke.
· Mary is the oldest child with two sisters and two brothers. Her two sisters are still alive; one brother died in a farming accident when he was only 14. Her other brother died last year of natural causes.
Additional information about the medical history of several family members.
· Ken receives Medicare benefits and has a Medicare supplemental plan through Blue Cross.
· Ken was diagnosed with diabetes when he was ten years old and has taken insulin ever since to control his blood sugar. He has some limited vision due to diabetic retinopathy but no other major complications from the diabetes.
· Mary has an irregular heart rate with periods of tachycardia. This condition limits her activities to some degree, but she is still very active. She also has high cholesterol.
· Ken’s father developed type II diabetes at age 64, but was able to control his blood sugar with oral hypoglycemic agents until he suffered a stroke at age 93.
· Ken’s mother died of natural causes at age 96.
· Mary’s mother lived until 92, but died from acute pancreatitis of unknown origin and kidney failure.
· Mary’s father had a stroke at age 62, but lived an additional 15 years before he died of pneumonia.
· No information is known about the cause of death for either Ken or Mary’s grandparents, but all grandparents died when Ken and Mary were teenagers.
· No significant medical conditions impacted any of Mary’s remaining siblings.
· Ken has one brother who also has diabetes, but his other remaining brother is alive and healthy.
· Two daughters have type I diabetes (daughters