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Health Promotion and the Individual Gordon’s Functional Health Patterns Assessment (Adult)

Health Perception Health Management Pattern

1. History

a. How has general health been?

b. Any colds in past year? When appropriate: absences from work?

c. Most important things you do to keep healthy? Think these things make a difference to health?
(Include family folk remedies when appropriate.) Use of cigarettes, alcohol, drugs? Breast self-

d. Accidents (home, work, driving)?

e. In past, been easy to find ways to follow suggestions from physicians or nurses?

f. When appropriate: what do you think caused this ill- ness? Actions taken when symptoms perceived?
Results of action?

g. When appropriate: things important to you in your health care? How can we be most helpful?

2. Examination—general health appearance


1. History

a. Typical daily food intake? (Describe.) Supplements (vitamins, type of snacks)?

b. Typical daily fluid intake? (Describe.)

c. Weight loss or gain? (Amount) Height loss or gain? (Amount)

d. Appetite?

e. Food or eating: Discomfort? Swallowing? Diet restrictions?

f. Heal well or poorly?

g. Skin problems: Lesions? Dryness? h. Dental problems?

2. Examination

a. Skin: Bony prominences? Lesions? Color changes? Moistness?

b. Oral mucous membranes: Color? Moistness? Lesions?

c. Teeth: General appearance and alignment? Dentures? Cavities? Missing teeth?

D. Actual weight, height.

e. Temperature.

f. Intravenous feeding–parenteral feeding (specify)?


1. History

a. Bowel elimination pattern? (Describe) Frequency? Character? Discomfort? Problem in control?


b. Urinary elimination pattern? (Describe.) Frequency? Problem in control?

c. Excessive perspiration? Odor problems?

d. Body cavity drainage, suction, and so on? (Specify.) 2. Examination—when indicated: examine excreta
or drain- age color and consistency.


1. History

a. Sufficient energy for desired or required activities?

b. Exercise pattern? Type? Regularity?

c. Spare-time (leisure) activities? Child: play activities?

d. Perceived ability (code for level) for: Feeding_________________________

Dressing____________________________ Cooking_________________________
Bathing_________________________ Grooming___________________________
Shopping________________________ Toileting________________________ General
mobility______________________ Bed mobility______________________ Home maintenance
__________________ Functional Level Codes: Level 0: full self-care • Level I: requires use of equipment
or device • Level II: requires assistance or supervision from another person • Level III: requires
assistance or supervision from another person and equipment or device • Level IV: is dependent and
does not participate 2. Examination a. Demonstrated ability (code listed above) for:
Feeding_________________________ Dressing________________________
Cooking___________________________ Bathing_________________________
Grooming________________________ Shopping__________________________
Toileting________________________ General mobility___________________ b.
Gait_____________________________ Posture__________________________ Absent body
part?__________________ (Specify)_________________________ c. Range of motion (joints)
___________________ Muscle____________________Firmness_ 3


1. History

a. Hearing difficulty? Hearing aid?

b. Vision? Wear glasses? Last checked? When last changed?

c. Any change in memory lately?

d. Important decision easy or difficult to make?

e. Easiest way for you to learn things? Any difficulty?

f. Any discomfort? Pain? When appropriate: How do you manage it?

2. Examination

a. Orientation.

b. Hears whisper?

c. Reads newsprint?

d. Grasps ideas and questions (abstract, concrete)?

e. Language spoken.

f. Vocabulary level. Attention span.

4 Functional Health Patterns Assessment (Adult) - cont’d


1. History

a. How describe self? Most of the time, feel good (not so good) about self?

b. Changes in body or things you can’t do? Problem to you?

c. Changes in way you feel about self or body (since ill- ness started)?

d. Things frequently make you angry? Annoyed? Fearful? Anxious?

e. Ever feel you lose hope?

2. Examination

a. Eye contact. Attention span (distraction)

b. Voice and speech pattern. Body posture

c. Nervous (5) or relaxed (1); rate from 1 to 5. d. Assertive (5) or passive (1); rate from 1 to 5.


1. History a. Live alone? Family? Family structure (diagram)?

b. Any family problems you have difficulty handling (nu- clear or extended)?

c. Family or others depend on you for things? How managing?

d. When appropriate: How family or others feel about ill- ness or hospitalization?

e. When appropriate: Problems with children? Difficulty handling?

f. Belong to social groups? Close friends? Feel lonely (frequency)?

g. Things generally go well at work? (School?)

h. When appropriate: Income sufficient for needs?

i. Feel part of (or isolated in) neighborhood where living?

2. Examination
a. Interaction with family member(s) or others (if present). S


1. History

a. When appropriate to age and situations: Sexual relationships satisfying? Changes? Problems?

b. When appropriate: Use of contraceptives? Problems?

c. Female: When menstruation started? Last menstrual period? Menstrual problems? Para? Gravida?

2. Examination

a. None unless problem identified or pelvic examination is part of full physical assessment.


1. History

a. Any big changes in your life in the last year or two? Crisis?

b. Who’s most helpful in talking things over? Available to you now?

c. Tense or relaxed most of the time? When tense, what helps?

d. Use any medicines, drugs, alcohol? e. When (if) have big problems (any problems) in your life, how do
you handle them? f. Most of the time is this (are these) way(s) successful?

2. Examination: None.


1. History

a. Generally get things you want from life? Important plans for the future?

b. Religion important in life? When appropriate: Does this help when difficulties arise?

c. When appropriate: Will being here interfere with any religious practices?
2. Examination: None.

3. Other concerns a. Any other things we haven’t talked about that you would like to mention? b. Any

Gordon’s 11 Functional Health Patterns Assessment Questions


Health Perception-Health Management Patterna.

In general, how is the family’s


What do you do to stay healthy? Do you drink alcohol or use tobacco products?c.

Do you have regular check-ups with your physician and/or specialists (Pediatrician,Ob/Gyn,
Cardiologist, etc.)? Do you listen to and follow any suggestions made by yourhealth care

Nutritional-Metabolic Patterna.

Describe your
typical daily food intake? Do you consider your family healthyeaters?b.

Describe your
typical daily fluid intake? Do you drink alcohol?c.

Does anyone consider themself over or under weight? Is there any unexplained weightgain
or loss?3.

Elimination Patterna.

Describe you
r family’s
regular bowel elimination pattern? Frequency? Character?Discomfort? Difficulty?b.
Describe you
r family’s
regular urinary elimination pattern? Frequency? Discomfort?Problems with control?4.

Activity-Exercise Patterna.

Do you exercise? What type? How often? If not, why?b.

What do you like to do in your spare time? What sports do you participate in?5.

Sleep-Rest Patterna.

Do you feel that you are generally well rested and able to perform your daily activities?b.

How well do you fall asleep? Stay asleep? Do you use any aids to help you sleep?c.

Do you awaken feeling rested and ready to take on the day?6.

Cognitive-Perceptual Patterna.

Does anyone have any difficulty hearing others?b.

Does anyone have difficulty seeing? Do you have routine eye exams?c.

How do you learn best? Preference for visual or audio aids? Do you have


Self-Concept Patterna.

Most of the time, do you feel good about yourself?b.

Do you ever feel that you have lost hope?


Roles-Relationships Patterna.

Who do you live with? Alone, family, others? What was the structure in which you
Do you belong to social groups? Do you interact with others outside of work or school?9.

Sexuality-Reproductive Patterna.

Parents: How would you describe your sexual relationship? Satisfying?


Female: Describe menstruation cycle. Problems? Last menstrual period? Para? Gravida?10.

Coping-Stress Tolerance Patterna.

Any big changes in the past year or two?b.

Who is most helpful in talking things over? Are the frequently available to you?c.

Do you use any medications, drugs, or alcohol?11.

Values-Beliefs Patterna.

Is religion important in your

life? Does this help when you are faced withdifficult situations?b.

Describe your plans for the future. Do you generally get what you want from life?