Read the patient’s chart and Wash Hands

• Good Day! Sir/Ma’am I am Nhel Joshua from Pamantasan ng Lungsod ng Marikina

and I am your student nurse for today. May I know your name sir/ma’am? And your
birthday
• So, I am here to do the Gordon’s 11 functional health pattern. The reason why
we’re doing this is because to let me know or gather a holistic information about
your personal health and well-being.
Provide Privacy- Any Information that you will share with me is strictly confidential
unless, other health workers would want to access health information about you.
Marjorie Gordon (1987) proposed functional health patterns as a guide for establishing
a comprehensive nursing data base. These 11 categories make possible a systematic
and standardized approach to data collection, and enable the nurse to determine the
following aspects of health and human function:
So for the first set of questions is about your HEALTH PERCEPTION AND
MANAGEMENT Health Perception and Health Management Pattern: Data collection is
focused on the person's perceived level of health and well-being, and on practices for
maintaining health.
➢ How would you describe your usual health status?
➢ Are you satisfied with your usual health status?
➢ Tobacco use? Number of packs everyday?
➢ Alcohol use? How much and what kind?
➢ Street drug? What and how much?
➢ Any history of chronic disease? Describe
➢ Immunization history
➢ Have you sought any health care assistance in the past year? Why?
➢ Current work and how would you rate your working conditions.
➢ How would you rate living condition at home
➢ Do you have any difficulty securing any of the of the following services?
➢ Medications (otc & prescription) Have you followed the routine prescribed for you?
➢ Have you had any accident/injuries/falls in the past? Describe
➢ Have you had any problems with cuts healing?
➢ Do you exercise on a regular basis? Type & Frequency
➢ Do you have any suggestions or requests for improving your health? Describe
➢ Do you do (breast/testicular) self-examination? How often?
Next set of questions is about your NUTRITIONAL-METABOLIC PATTERN for me
to know your diet intake that is important for your health. Assessment is focused
on the pattern of food and fluid consumption relative to metabolic need.
➢ Any weight gain? Or weight loss in the past 6 months? How many?
➢ How would you describe your appetite?
 ➢ Do you have food intolerance/restrictions? Describe
➢ Describe an average day’s food intake for you (meals/snacks)?
➢ Describe an average day’s fluid intake for you.
➢ Describe food like and dislikes.
➢ Would you like to gain weight or lose weight?
➢ Any problems with: Nausea, vomiting, swallowing, chewing, and indigestion?
➢ FOR BREASTFEEDING MOTHERS ONLY: Do you have concerns about breast
feeding? describe
For the next set of questions is about your ELIMINATION PATTERN to know the
regularity of your stool and urine Data collection is focused on excretory patterns
(bowel, bladder, skin) Excretory problems such as incontinence, constipation, diarrhea,
and urinary retention.
➢ What is your usual frequency of bowel movement?
➢ Character of Stool: Character, color, and bleeding
➢ History of constipation (usage of bowel aids)
➢ History of Diarrhea
➢ History of Incontinence
➢ Usual voiding pattern: Frequency, awareness/ urge to void, amount, color,
incontinence
For the next set of questions is about your ACTIVITY-EXERCISE PATTERN to know
the balance of your rest and physical activity Assessment is focused on the activities
of daily living requiring energy expenditure, including self-care activities, exercise, leisure
activities respiratory and cardiac system.
➢ How does the client perceive her/his own self-care activities?
➢ How many pillows do you use to sleep on?
➢ Do you experience fatigue/weakness? Describe.
➢ Occupation
➢ Describe your usual leisure time activities/ hobbies
➢ Any problems with concentration? Describe
For the next set of questions is about your SLEEP-REST PATTERN for us to know
how well you meet your need for restorative sleep and relaxation. Assessment is
focused on the person's sleep, rest, and relaxation practices. Dysfunctional sleep
patterns, fatigue, and responses to sleep deprivation may be identified
➢ Usual sleep habits? Describe
➢ Problems: difficulty going to sleep? Awakening at night, early awakening?
Insomnia.
➢ Methods used to promote sleep: medication, warm fluids, techniques.
For the next set of questions is about your COGNITIVE-PERCEPTUAL PATTERN for
us to know your ability to understand, retain information and your decision making.
Assessment is focused on the ability to thinking. decision making, and problem solving.
➢ Pain: Provoking, Quality, Region/Radiation, Severity, Timing
➢ Perception of decision making?
➢ Knowledge Level: Current Problems, restate current therapeutic regimen
For the next set of questions is about your SELF PERCEPTION AND SELF
CONCEPT PATTERN for us to understand how you view yourself and your overall
emotional health that is important for your mental well-being. Assessment is focused
on the person's attitudes toward self, including identity, body image, and sense of self-
worth What is your self-perception about yourself?
➢ What is your major concern at the current time?
➢ Do you think this admission will cause any lifestyle and result in any body changes
for you?
➢ What is your visual of yourself?
➢ Do you believe you will have any problems dealing with your current health
situation? Describe
➢ On a scale of 0-5 rank your perception of your level of control in this situation.
➢ On a scale of 0-5 rank your usual assertiveness level.
For the next set of questions is about your ROLE-RELATIONSHIP PATTERN to
acquired understanding in your social life which is important for providing a
holistic care. Assessment is focused on the person's roles in the family and relationships
with others.
➢ Status of your px: If married, rate your parenting skills.
➢ Any loses: physical, psychologic, social in past year?
➢ How is the px handling this loss at this time?
➢ Do you believe this admission will result in any type of loss?
➢ Do you think this admission will cause changes in family role?
➢ How would you rate your usual social activities?
➢ How would you rate your comfort in social situations?
➢ What activities or jobs do you like or dislike to do? Describe.
For the next set of questions is about your SEXUALITY AND REPRODUCTIVE
PATTERN to acquired understanding in your sexual identity, and your reproductive
health. Assessment is focused on the person's satisfaction or dissatisfaction with
sexuality patterns and reproductive functions.
➢ Female: LMP, Pregnancy, Menopause? Birth Control measures, history of vaginal
discharge, bleeding, lesions, pap smear, sexually transmitted disease.
➢ Male: Prostate problems, penile discharge, bleeding, lesions, sexually transmitted
disease.
 ➢ BOTH: Problems in sexual functioning, sexual relationship. Describe.
➢ Do you believe this admission will have any impact on sexual functioning?
Describe.
For the next set of questions is about your COPING-STRESS PATTERN to know
how effectively you copes with your stressor which can have an impact on you
well-being. Assessment is focused on the person's perception of stress and on his or her
coping strategies Support systems are evaluated, and symptoms of stress are noted.
➢ Have you experienced any stressful or traumatic events?
➢ How would you rate your usual handling of stress?
➢ What is the primary way you deal with stress or problems?
➢ Have you used any counselling groups in the past year?
➢ What do you believe is the primary reason behind this admission?
➢ Do you seek health assistance at the first symptom?
➢ Are you satisfied with the care you have been receiving?
For the last set of questions is about your VALUE-BELIEF PATTERN to acquired
knowledge how your beliefs affect your decisions, behaviors and overall sense of
purpose and meaning in life. Assessment is focused on the person's values and beliefs
(including spiritual beliefs).
➢ Are you satisfied with the way your life has been developing?
➢ Will this admission interfere with your plans for the future?
➢ Religion? Any religious restrictions to care?
➢ Will this admission interfere with your spiritual or religious practices?
➢ Have your religious beliefs helped you to deal with problems in the past?