This case study describes an older immigrant couple, Mr. and Mrs. Arahan, who feel isolated living with their daughter's family. They have expressed concerns about their future health, living situation, and who will care for them as they age. The couple attended their church's new parish nursing program and met with a nurse who offered to help address any health issues.

1. Prevention of Disease Case Study
Question One
The nurse would collect information about the child's physical health to assess Ricky. According
to Martin et al. (2019), the nurse would obtain a history of the child's eating habits and be aware
of any changes in appetite or refusal to eat. The nurse would inquire about any recent illnesses or
injuries that might have affected his appetite or ability to swallow food. The nurse would also
collect information about the child's emotional health. Ricky's physical health can be assessed by
noting signs of dehydration, fever, and changes in blood pressure. Ricky's emotional health can
be evaluated by recording anxiety symptoms, such as restlessness and irritability when preparing
or eating food. In addition, Shatkin (2019) supports that the nurse would collect information
about the family's socioeconomic status and diet.
Question Two
The nurse would first want to ascertain whether or not Ricky's refusal to eat is due to any
underlying medical condition. She would next like to determine whether or not Ricky is
experiencing any pain or discomfort with eating, as this could be a symptom of an underlying
medical condition (Lumba et al., 2018: Martin et al., 2019). The nurse should also ask Ricky's
mother about his recent behavior at school, including whether there were any new friends or
activities that he joined or participated in recently. If there were any changes, the nurse should
inquire about them so she can further explore the issue of Ricky. The question to the mother
should follow the following criteria. Nurses would ask the following questions: what are the
child's eating and dietary pattern? How has this changed over time, and why? What are his
preferences, likes, dislikes, and favorite foods? Is he eating enough at meals? Does he have a
problem with food? If so, what is it?
Question Three
The extended family residing far away influences the family's approach to health promotion. The
extended family can also help by being available for play dates or visits when needed since the
parents have a tight schedule as full-time workers (McNeil, Campbell & Crews, 2018). They can
also support other activities essential to the child's development, such as school events or
celebrations like holidays with Ricky. As such, Ricky feels it is necessary to have a close
relationship with his family, so he may be stressed about not being able to visit them often.
Dallacker, Hertwig, and Mata (2018) argue that their child is not getting to see them as much as
he would like. It also means that he will not be able to spend as much time with extended family
as he would like.
Question Four
There are several factors to consider when determining whether malnourishment is a factor in a
family of Ricky's. If the family is experiencing any other issues, it might contribute to Ricky's
refusal to eat. If so, you may consider those factors in evaluating their situation. For example, if
the family has recently experienced a divorce proposal or other significant life change, Lumba et

2. al. (2018) support that it may be difficult for them to focus on nutrition concerns when trying to
cope with their own emotional needs. Or if another child in the household shows signs of
malnutrition, such as not gaining weight or being underweight. Another factor is if the family is
currently experiencing a period of economic hardship. This entails whether the household
income is significantly lower than previously and whether the family's food budget has been cut
(Panda, 2019). This could mean they must make difficult choices about what they eat and how
much they spend on groceries.
References
Dallacker, M., Hertwig, R., & Mata, J. (2018). The Frequency of Family Meals and Nutritional
Health in Children: A Meta―Analysis. Obesity Reviews, 19(5), 638-653.
Lumba-Brown, A., Yeates, K. O., Sarmiento, K., Breiding, M. J., Haegerich, T. M., Gioia, G. A.,
... & Timmons, S. D. (2018). Centers for Disease Control and Prevention Guideline on The
Diagnosis and Management of Mild Traumatic Brain Injury Among Children. JAMA Pediatrics,
172(11), e182853-e182853.
Martin, M. A., Perry-Bell, K., Minier, M., Glassgow, A. E., & Van Voorhees, B. W. (2019). A
Real-World Community Health Worker Care Coordination Model for High-Risk Children.
Health Promotion Practice, 20(3), 409-418.
McNeil, J. C., Campbell, J. R., & Crews, J. D. (Eds.). (2018). Healthcare-Associated Infections
in Children: A Guide to Prevention and Management. Springer.
Panda, P. K. (2019). Metabolic Syndrome in Children: Definition, Risk Factors, Prevention and
Management—A Brief Overview. Pediatr Oncall J, 16, 67-72.
Shatkin, J. P. (2019). Mental Health Promotion and Disease Prevention: it's About time.
Copyright © 2018 by Elsevier Inc. All rights reserved.
Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition
AIDS (Acquired Immunodeficiency Syndrome)
Case Studies
The patient, a 30-year-old homosexual man, complained of unexplained weight loss, chronic
diarrhea, and respiratory congestion during the past 6 months. Physical examination revealed
right-sided pneumonitis. The following studies were performed:
Studies Results

3. Complete blood cell count (CBC), p. 156
Hemoglobin (Hgb), p. 251 12 g/dL (normal: 14–18 g/dL)
Hematocrit (Hct), p. 248 36% (normal: 42%–52%)
Chest x-ray, p. 956 Right-sided consolidation affecting the posterior
lower lung
Bronchoscopy, p. 526 No tumor seen
Lung biopsy, p. 688 Pneumocystis jiroveci pneumonia (PCP)
Stool culture, p. 797 Cryptosporidium muris
Acquired immunodeficiency syndrome
(AIDS) serology, p. 265
p24 antigen Positive
Enzyme-linked immunosorbent assay
(ELISA)
Positive
Western blot Positive
Lymphocyte immunophenotyping, p. 274
Total CD4 280 (normal: 600–1500 cells/L)
CD4% 18% (normal: 60%–75%)
CD4/CD8 ratio 0.58 (normal: >1.0)
Human immune deficiency virus (HIV)
viral load, p. 265
75,000 copies/mL
Diagnostic Analysis

4. The detection of Pneumocystis jiroveci pneumonia (PCP) supports the diagnosis of AIDS. PCP
is
an opportunistic infection occurring only in immunocompromised patients and is the most
common infection in persons with AIDS. The patient’s diarrhea was caused by
Cryptosporidium
muris, an enteric pathogen, which occurs frequently with AIDS and can be identified on a stool
culture. The AIDS serology tests made the diagnoses. His viral load is significant, and his
prognosis is poor.
The patient was hospitalized for a short time for treatment of PCP. Several months after he was
discharged, he developed Kaposi sarcoma. He developed psychoneurologic problems eventually
and died 18 months after the AIDS diagnosis.
Case Studies
Copyright © 2018 by Elsevier Inc. All rights reserved.
2
Critical Thinking Questions
1. What is the relationship between levels of CD4 lymphocytes and the likelihood of
clinical complications from AIDS?
2. Why does the United States Public Health Service recommend monitoring CD4
counts every 3–6 months in patients infected with HIV?
3. This is patient seems to be unaware of his diagnosis of HIV/AIDS. How would you
approach to your patient to inform about his diagnosis?
4. Is this a reportable disease in Florida? If yes. What is your responsibility as a
provider?
.

5. Copyright © 2018 by Elsevier Inc. All rights reserved.
Pagana: Mosby’s Manual of Diagnostic and Laboratory Tests, 6th Edition
Iron-Deficiency Anemia
Case Study
A 72-year-old man developed chest pain whenever he was physically active. The pain ceased on
stopping his activity. He has no history of heart or lung disease. His physical examination was
normal except for notable pallor.
Studies Result
Electrocardiogram (EKG), p. 485 Ischemia noted in anterior leads
Chest x-ray study, p. 956 No active disease
Complete blood count (CBC), p.
156
Red blood cell (RBC) count, p.
396
2.1 million/mm (normal: 4.7–6.1 million/mm)
RBC indices, p. 399
Mean corpuscular volume
(MCV)
72 mm 3 (normal: 80–95 mm
3 )
Mean corpuscular hemoglobin
(MCH)
22 pg (normal: 27–31 pg)

6. Mean corpuscular hemoglobin
concentration (MCHC)
21 pg (normal: 27–31 pg)
Red blood cell distribution width
(RDW)
9% (normal: 11%–14.5%)
Hemoglobin (Hgb), p. 251 5.4 g/dL (normal: 14–18 g/dL)
Hematocrit (Hct), p. 248 18% (normal: 42%–52%)
White blood cell (WBC) count, p.
466
7800/mm 3 (normal: 4,500–10,000/mcL)
WBC differential count, p. 466 Normal differential
Platelet count (thrombocyte
count), p. 362
Within normal limits (WNL) (normal: 150,000–
400,000/mm 3 )
Half-life of RBC 26–30 days (normal)
Liver/spleen ratio, p. 750 1:1 (normal)
Spleen/pericardium ratio <2:1 (normal)
Reticulocyte count, p. 407 3.0% (normal: 0.5%–2.0%)
Haptoglobin, p. 245 122 mg/dL (normal: 100–150 mg/dL)
Blood typing, p. 114 O+
Iron level studies, p. 287

7. Iron 42 (normal: 65–175 mcg/dL)
Total iron-binding capacity
(TIBC)
500 (normal: 250–420 mcg/dL)
Transferrin (siderophilin) 200 mg/dL (normal: 215–365 mg/dL)
Transferrin saturation 15% (normal: 20%–50%)
Case Studies
Copyright © 2018 by Elsevier Inc. All rights reserved.
2
Ferritin, p. 211 8 ng/mL (normal: 12–300 ng/mL)
Vitamin B12, p. 460 140 pg/mL (normal: 100–700 pg/mL)
Folic acid, p. 218 12 mg/mL (normal: 5–20 mg/mL or 14–34 mmol/L)
Diagnostic Analysis
The patient was found to be significantly anemic. His angina was related to his anemia. His
normal RBC survival studies and normal haptoglobin eliminated the possibility of hemolysis..
His RBCs were small and hypochromic. His iron studies were compatible with iron deficiency.
His marrow was inadequate for the degree of anemia because his iron level was reduced.
On transfusion of O-positive blood, his angina disappeared. While receiving his third unit of
packed RBCs, he developed an elevated temperature to 38.5°C, muscle aches, and back pain.
The transfusion was stopped, and the following studies were performed:
Studies Results
Hgb, p. 251 7.6 g/dL
Hct, p. 248 24%

8. Direct Coombs test, p. 157 Positive; agglutination (normal: negative)
Platelet count, p. 362 85,000/mm 3
Platelet antibody, p. 360 Positive (normal: negative)
Haptoglobin, p. 245 78 mg/dL
Diagnostic Analysis
The patient was experiencing a blood transfusion incompatibility reaction. His direct Coombs
test and haptoglobin studies indicated some hemolysis because of the reaction. His platelet count
dropped because of antiplatelet antibodies, probably the same ABO antibodies that caused the
RBC reaction.
He was given iron orally over the next 3 weeks, and his Hgb level improved. A rectal
examination indicated that his stool was positive for occult blood. Colonoscopy indicated a right-
side colon cancer, which was removed 4 weeks after his initial presentation. He tolerated the
surgery well.
Critical Thinking Questions
1. What was the cause of this patient's iron-deficiency anemia?
2. Explain the relationship between anemia and angina.
3. Would your recommend B12 and Folic Acid to this patient? Explain your rationale for
the answer
4. What other questions would you ask to this patient and what would be your rationale for
them?
MSN 5550 Health Promotion: Prevention of Disease Case Study Module 2 Instructions: Read
the following case study and answer the reflective questions. Please provide evidence-based
rationales for your answers. APA, 7th ed. must be followed. Due: Saturday by 23:59 pm
CASE STUDY: An Older Immigrant Couple: Mr. and Mrs. Arahan

9. Mr. and Mrs. Arahan, an older couple in their seventies, have been living with their oldest
daughter, her husband of 15 years, and their two children, ages 12 and 14. They all live in a
middle-income neighborhood in a suburb of a metropolitan city. Mr. and Mrs. Arahan are both
college educated and worked full-time while they were in their native country. In addition, Mr.
Arahan, the only offspring of wealthy parents, inherited a substantial amount of money and real
estate. Their daughter came to the United States as a registered nurse and met her husband, a
drug company representative. The older couple moved to the United States when their daughter
became a U.S. citizen and petitioned them as immigrants. Since the couple was facing
retirement, they welcomed the opportunity to come to the United States. The Arahans found life
in the United States different from that in their home country, but their adjustment was not as
difficult because both were healthy and spoke English fluently. Most of their time was spent
taking care of their two grandchildren and the house. As the grandchildren grew older, the older
couple found that they had more spare time. The daughter and her husband advanced in their
careers and spent a great deal more time at their jobs. There were few family dinners during the
week. On weekends, the daughter, her husband, and their children socialized with their own
friends. The couple began to feel isolated and longed for a more active life. Mr. and Mrs. Arahan
began to think that perhaps they should return to the home country, where they still had relatives
and friends. However, political and economic issues would have made it difficult for them to live
there. Besides, they had become accustomed to the way of life in the United States with all the
modern conveniences and abundance of goods that were difficult to obtain in their country.
However, they also became concerned that they might not be able to tolerate the winter months
and that minor health problems might worsen as they aged. They wondered who would take care
of them if they became very frail and where they would live, knowing that their daughter had
only saved money for their grandchildren’s college education. They expressed their
sentiments to their daughter, who became very concerned about how her parents were feeling.
This older couple had been attending church on a regular basis, but had never been active in
other church-related activities. The church bulletin announced the establishment of parish
nursing with two retired registered nurses as volunteers. The couple attended the first opening of
the parish clinic. Here, they met one of the registered nurses, who had a short discussion with
them about the services offered. The registered nurse had spent a great deal of her working years
as a community health
nurse. She informed Mr. and Mrs. Arahan of her availability to help them resolve any health-
related issues.
Reflective Questions
1. What strategies could be suggested for this older adult couple to enhance their quality of life?
2. What community resources can they utilize? 3. What can the daughter and her family do to
address the feelings of isolation of the older couple? 4. What health promotion activities can
ensure a healthy lifestyle for them?
 CASE STUDY: An Older Immigrant Couple: Mr. and Mrs. Arahan
 Reflective Questions