It was recently discovered that he had an MI and he was treated for the condition. He continues to smoke three packs of cigarettes per day, and he works approximately 60 hours per week at a stressful job.

Antonio is in the middle age adult developmental stage in which he is working out generativity vs. stagnation (Springhouse Corporation, 1990). He is the primary breadwinner for the family and this is how he identifies himself. He seems to be a type A personality who prides himself on the work that he does and the fact that he is able to care for his family.

As a Cuban American, Antonio comes from a patriarchal system in which he is looked on as the provider for the family (Franco & Wilson, 2008). However, it seems that this fact is killing him. Cigarettes are a habit, but they are often used by people who are overly stressed to combat the anxiety that occurs (Dichter, 1947). Thus, the fact that he is stressed by both his responsibility and by his actual job contribute to the smoking. The nurse needs to understand how his culture affects his need to continue working.

Lourdes Garcia

This is a 45-year-old woman who is a native of Cuba who works from home as a publisher of historical novels. She is the primary caretaker of Mercedes and she carries the burden of trying to be a go between for her husband and son. She has hypertension which is being controlled by medication.

Lourdes is, along with her husband, in the middle age adult stage of life. She is trying to work out generativity vs. stagnation, and she seems to feel that she is caught in the middle of a lot of issues. Lourdes is having issues with completing her work because of the demands placed upon her and this may increase her hypertension. Her developmental angst (trying to make something lasting of herself, while in danger of stagnating into traditional roles), may cause her medical issues to worsen.

Traditionally, the Cuban American wife is submissive to her husband and is likely to work as a homemaker (Franco & Wilson, 2008). This is true of Lourdes in one way because she does care for the home, but she is also trying to establish a business at home which is non-traditional. This could increase her angst since she is not following a typical Cuban American way.


The family has a myriad of health issues which can be overcome with some directed interventions. Someone needs to help with Mercedes and the stress that Lourdes feels could be alleviated if Mercedes went to a senior center three times per week. This would give Lourdes a break. The family also needs to seek counseling (at least Antonio, Lourdes and Gerardo) about the fact that Gerardo is gay. This could reduce the tension in the family further. Antonio needs to continue the smoking cessation, but he also needs to look into cutting his hours at work. Mercedes needs to have someone with her that she trusts during these visits also.


Dichter, E. (1947). Why do we smoke cigarettes? The Psychology of Everyday Living. Retrieved from

Springhouse Corporation. (1990). Erikson's development stages. Retrieved from son.htm

Text book chapter 28 on Cuban Americans.