# Situation: The public health nurse at a Barangay Health Station (BHS) is assessing a newly registered family. The father, 30, is a tricycle driver; the mother, 27, is a homemaker; their only child is a 20-month-old son; and the mother's widowed mother, 62, lives with them. No member has a current illness, and the son's immunizations are complete for his age under the National Immunization Program (NIP). The nurse wants to record how the son is related to relatives on both parents' sides who have had diabetes, hypertension, or an early death. Which tool should she use?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=627038  
> language: ko  
> subject: Nursing Practice I — Community Health Nursing

## 문제

Situation: The public health nurse at a Barangay Health Station (BHS) is assessing a newly registered family. The father, 30, is a tricycle driver; the mother, 27, is a homemaker; their only child is a 20-month-old son; and the mother's widowed mother, 62, lives with them. No member has a current illness, and the son's immunizations are complete for his age under the National Immunization Program (NIP).

The nurse wants to record how the son is related to relatives on both parents' sides who have had diabetes, hypertension, or an early death. Which tool should she use?

## 보기

1. Genogram **✔ 정답**
2. Ecomap
3. Family APGAR
4. Family Coping Index

**정답: 1**

## 해설

A genogram maps three or more generations of a family, showing members, their relationships, and their health conditions. It is the tool for spotting hereditary and familial health risks across both sides of the family. An ecomap shows the family's ties with outside systems, not blood relationships.

## 심화 해설

A genogram is the correct tool because it is specifically designed to map family structure across multiple generations while recording health conditions, causes of death, and relationship patterns within the family system. In this scenario, the nurse needs to identify whether the 20-month-old son has a family history of diabetes, hypertension, or early death on either the paternal or maternal side. A genogram organizes this information visually, making hereditary risk patterns immediately apparent across both bloodlines.

The core purpose of a genogram is to reveal patterns that may not be obvious when family history is collected through verbal questioning alone. By plotting at least three generations, the nurse can trace whether conditions such as diabetes or hypertension cluster in specific branches of the family, which informs anticipatory guidance and screening priorities for the child. The tool captures not only who is related to whom but also the health status of each member, age at death, and cause of death when applicable. This is why it is the standard instrument for assessing familial and hereditary health risks.

The distinction between a genogram and an ecomap is critical for licensure exams. Watch out! An ecomap illustrates the family's connections to external systems—schools, workplaces, health services, religious institutions, and social support networks. It does not depict blood relationships or internal family health history. In this situation, the nurse is asking about relatives on both parents' sides, which is entirely within the family's internal structure and health legacy. Therefore, an ecomap would not serve the stated purpose.

The Family APGAR and Family Coping Index are also inappropriate. The Family APGAR measures a family member's satisfaction with family function across five domains: adaptation, partnership, growth, affection, and resolve. It is a screening tool for family dysfunction, not a mapping tool for hereditary conditions. The Family Coping Index assesses how well a family manages stressors and health-related challenges. Neither tool records genealogical relationships or health conditions across generations.

From a clinical reasoning perspective, the genogram serves a dual function. First, it organizes data collection during the initial family assessment. Second, it becomes a reference document for ongoing care. When a nurse identifies that multiple relatives on one side of the family have early-onset diabetes, this shifts the child's risk profile and may influence counseling about lifestyle, growth monitoring, and the timing of blood glucose screening. The visual format allows the nurse and the family to see these patterns together, which can enhance the family's understanding of inherited risk.

The construction of a genogram follows standardized symbols. Males are typically represented by squares, females by circles, and the index person—in this case, the 20-month-old son—is marked with a double line or arrow. Relationships are shown with connecting lines, and health conditions or causes of death are noted beside each symbol. Key point! The nurse should include at least three generations: the son's generation, the parents' generation, and the grandparents' generation. In this family, that would include the son, both parents, the maternal grandmother who lives with them, and information about the paternal grandparents and other relatives on both sides.

The genogram's value extends beyond simply recording data. It helps the nurse identify patterns of illness transmission, recognize psychosocial stressors embedded in family history, and anticipate health needs before symptoms appear. For a young child with no current illness, the genogram provides a baseline for preventive care planning within the context of family health history.

| Tool | Primary Purpose | Shows Blood Relationships | Shows External System Connections | Appropriate for This Scenario |
| --- | --- | --- | --- | --- |
| Genogram | Maps family structure, health conditions, and hereditary patterns across generations | Yes | No | Yes |
| Ecomap | Illustrates family connections to community resources and external systems | No | Yes | No |
| Family APGAR | Screens satisfaction with family function (adaptation, partnership, growth, affection, resolve) | No | No | No |
| Family Coping Index | Assesses family's ability to manage stressors and health challenges | No | No | No |

The genogram originated within family therapy and family systems theory, but its application has expanded into primary care, community health, pediatrics, and geriatrics because it provides a comprehensive view of the client within the family context. For the public health nurse at a Barangay Health Station, the genogram is particularly valuable because community-based care often spans multiple generations within the same household or neighborhood. The nurse can use the genogram to identify not only genetic risks but also shared environmental and behavioral risk factors that run in families.

In this family, the maternal grandmother lives in the same household. Her health history—whether she has hypertension, diabetes, or other chronic conditions—is directly relevant to the son's risk assessment. A genogram would capture this multigenerational household structure while also recording the health status of relatives who do not live in the home, such as the paternal grandparents, aunts, and uncles. This completeness is essential because hereditary risk does not depend on cohabitation.

The nurse should also note that the son's immunizations are complete under the National Immunization Program. While immunization status is not the focus of the genogram, it reflects the family's engagement with preventive health services. The genogram can complement this information by revealing whether chronic disease prevention should be emphasized as the child grows, based on the family's health patterns.

## 임상 시나리오

Genogram for Hereditary Risk AssessmentMapping multigenerational health patterns in family nursing
A genogram maps three or more generations of a family, recording health conditions, causes of death, and relationship patterns. It is the standard tool for identifying hereditary risks such as diabetes, hypertension, or early death across both parental bloodlines.

When assessing a young child, plot both paternal and maternal relatives to trace whether conditions cluster in specific branches. This visual organization reveals patterns that verbal history alone may miss, informing anticipatory guidance and screening priorities.

CautionDo not confuse a genogram with an ecomap. An ecomap shows the family's ties to external systems like schools or health services, not internal blood relationships or health history.

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## 핵심 개념

- **Genogram** — A visual tool mapping three or more generations of a family, including relationships and health conditions, to identify hereditary risk patterns.
- **Ecomap** — A diagram showing a family's connections to external systems such as schools, workplaces, and health services.
- **Family APGAR** — A brief screening tool measuring family function through adaptation, partnership, growth, affection, and resolve.
- **Family Coping Index** — An assessment tool evaluating how effectively a family manages stressors and problem-solving.
- **Hereditary risk** — The likelihood of developing a condition based on genetic patterns observed across family generations.

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