X.
Appendices
A. GORDON’S TYPOLOGY OF 11 FUNCTIONAL HEALTH PATTERNS ENGLISH and FILIPINO GUIDE QUESTIONS
Functional Health Patterns Definition
I. Health Perception Data collection is focused
and Health on the person's perceived
Management level of health and well-
Pattern being, and on practices for
maintaining health. Habits
that may be detrimental to
health are also evaluated,
including smoking and
alcohol or drug use. Actual
or potential problems
related to safety and health
management may be
identified as well as needs
for modifications in the
home or needs for
continued care in the home.
English Guide Questions
A. How is your health condition?
1. When was your last sickness
before the hospitalization?
B. How often do you have cough, colds
and fever?
C. How do you maintain good health
(example. eating vegetables and fruits,
avoidance of high cholesterol, salty
food and etc.)
D. During sickness, where do you have
your consultation, Medical doctors or
traditional doctors?
E. Do you smoke?
1. At what age did you start
smoking?
2. How many sticks do you consume
in one day?
3. Who among the members of the
family smoke?
4. Did you ever try to stop smoking?
5. Can you stop smoking?
F. Do you drink alcoholic beverages
(Brandy, Beer, Gin, etc.)
G. Do you use any prohibited drugs?
1. Had you use any prohibited drugs?
H. Do you regularly check your breast
(Before and after menstruation)?
I. Do you regularly check your
genitalia/scrotum?
NPI Filipino Guide Questions
A. Kumusta ang inyong kalagayang
pangkalusugan?
1. Kailan po ang inyong huling
pagkakasakit?(bago pa man
maospital)
B. Madalas ka bang sipunin, ubuhin o
lagnatin?
C. Sa paanong paraan ninyo pinapanatili
ang iyong kalusugan (hal. Pagkain ng
gulay at prutas, pag iwas sa matabang
pagkain, maalat atbp)?
D. Sa panahong kayo ay nagkakasakit,
saan kayo nagpapatingin sa doctor o
sa katutubong paraan ng
pagpapagamot?
E. Ikaw po ba ay naninigarilyo?
1. Ilang taon ka nagsimulang gumamit
ng sigarilyo?
2. Ilang stick ang nauubos mo sa buong
araw?
3. Sinu-sino sa mga miyembro ng
pamilya/kasambahay mo ang
naninigarilyo?
4. Nasubukan mo na bang tumigil na sa
paninigarilyo?
5. Handa ka ba na itigil ang iyong
paninigarilyo ?
F. Umiinom ka ba ng alak?
• Anong klaseng alak ang inyong
iniinom ? (Brandy, Beer, Gin etc.)
G. Gumagamit ng ipinagbabawal na
gamot?
1. Nakagamit na po ba ng ipinagbabawal
na gamot ?
H. Regular mo bang sinusuri ang iyong
suso ?
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II. Nutritional and Assessment is focused on
Metabolic Pattern. the pattern of food and
fluid consumption relative
to metabolic need. The
adequacy of local nutrient
supplies is evaluated.
Actual or potential
problems related to fluid
balance, tissue integrity,
and host defenses may be
identified as well as
problems with the
gastrointestinal system.
III. Elimination Pattern Data collection is focused
on excretory patterns
(bowel, bladder, skin).
Excretory problems such as
incontinence, constipation,
diarrhea, and urinary
retention may be identified.
A. What are your different kinds of food
every day?
1. How many servings of food do you eat
every meal?
2. How many times do you eat every
meal?
B. Do you take any vitamin supplement?
C. What kind of beverages do you drink
everyday?
1. How many glasses of beverage do
you drink?
D. Do you experience change in your
weight?
1. Does it increase or decrease?
E. Do you have a good appetite?
F. Do you have any difficulty when
eating (ex. swallowing)?
G. Is there any food that should be
avoided as recommended by the
doctors?
H. Can you easily get well after you had
any illness
I. Do you have any skin disease?
1. Do you have any dryness of the
skin?
A. How many times in a day/week do you
defecate?
1. Kind of feces (hard, soft, watery?
2. Color?
B. Do you have difficulty in defecation?
C. How many times do you urinate in a
day?
I. Regular mo bang sinusuri ang iyong
ari lalo na ang bayag o scrotum ?
A. Ano- ano ang karaniwang
kinakain/pagkain mo sa araw-araw.
1. Gaano kadami kada kain po ninyo?
2. Ilang beses po kayo kumakain sa
isang araw?
B. Umiinom ba kayo ng mga bitamina at
iba pang supplements?
C. Karaniwang uri at dami ng inumin mo
sa araw-araw. Isalarawan.
D. Nakaranas ka ba ng biglaang
pagbaba o pagbigat ng timbang?
Gaano kalaki/kaliit ang
nabawas/nadagdag sa timbang mo?
E. Magana ka bang kumain?
F. Nahihirapan ka bang kumain ? Sa
paanong paraan ?
G. May mga ipinagbabawal po ba na
pagkain ?
H. Madali ka bang gumaling mula sa
pagkakasakit ?
I. May mga sakit ka ba sa balat?
Panunuyo ng balat?
A. Ilang beses sa isang araw/linggo ang
inyong pagdumi?
1. Uri (matigas, basa, matubig)?
2. Kulay?
B. Nakaranas ka ba ng hirap sa
pagdumi?
C. Gaano kadalas ang inyong pag-ihi sa
isang araw?
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 1. Color? 1. Karaniwang kulay?
2. Odor? 2. Amoy?
D. Do you have any difficulty in D. Nahihirapan bang umihi?
E. Nakakaranas ka ba ng labis na
urination?
pagpapawis?
E. Do you experience excessive F. May problema ka ba sa amoy ng
sweating? katawan?
F. Do you have a bad odor?

IV. Activity and Assessment is focused on A. Do you finish your daily activities? A. Natatapos mo ba ang mga
Exercise Pattern the activities of daily living B. Do you exercise? gawain sa araw-araw?
requiring energy 1. What kind of exercises do you do? B. Nag-eehesisyo ka ba?
expenditure, including self- 1. Uri ng ehersisyo?
2. How many times do you exercise?
care activities, exercise, 2. Gaano kadalas ang pag ehersisyo?
and leisure activities. The C. What are your leisure activities? 3. Anu-ano ang iyong mga libangan?
status of major body 1. What are the types of play do you C. Ano ang mga karaniwang
systems involved with do? (if child) laro? (kung bata)
activity and exercise is D. Assess the different level of activities D. Alamin ang kakayanan ng
evaluated, including the on the following: pasyenteng gampanan
respiratory, cardiovascular, • Getting up from bed ang mga sumusunod:
and musculoskeletal - pagbangon sa pagkakahiga
systems. • Sitting on his/her own
- pag -upo
• Eating
- pagkain
• Taking a bath - pagligo
• Elimination - pagdumi
(Defecation/Urination) - pagbihis
• Change of clothes - pagpapanatili ng kalinisan ng katawan
• Hygiene and grooming (grooming)
• Movement - pagkilos sa araw-araw
• Cooking - pagluluto
• Household chores
- paggampan ng mga gawaing bahay
- pamimili
• Marketing
Level 0: Full self-care
Level 0: Full self-care Level I: Requires assistance of equipment
Level I: Requires assistance of equipment or device
or device Level II: Requires assistance or
Level II: Requires assistance or supervision from another person
supervision from another person Level III: Requires assistance or
Level III: Requires assistance or
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V. Cognitive- Assessment is focused on
Perceptual Pattern the ability to comprehend
and use information and on
the sensory functions. Data
pertaining to neurologic
functions are collected to
aid this process. Sensory
experiences such as pain
and altered sensory input
may be identified and
further evaluated.
VI. Sleep-Rest pattern Assessment is focused on
the person's sleep, rest, and
relaxation practices.
Dysfunctional sleep
patterns, fatigue, and
responses to sleep
deprivation may be
identified.
supervision from another person or device
Level IV: Is dependent and does not
participate.
A. Can you hear clearly?
1. Do you use a hearing aid?
B. Do you have any problem on your
visual acuity?
1. Do you use a reading glass?
2. When was the last time you had your
consultation to an optometrist?
C. Is there any change in your memory
(ex. Forgetful)
D. How can you easily learn (Visual,
Auditory, Demonstrated)?
E. Do you have any difficulty in learning
things?
F. Do you experience any pain in your
body?
1. Which part of the body?
2. When did it started?
3. How can you relieve from pain?
A. How many hours do you sleep?
1. What time do you sleep?
2. What time do you wake up?
3. Do you have difficulty in
sleeping?
4. Do you take any medications
for you to sleep?
5. Do you wake up in the middle
of the night?
6. Do you take naps in the
morning/afternoon?
B. What do you do to relax ( ex.
supervision from another person or device
Level IV: Is dependent and does not
participate.
A. Maayos po ba ang pandinig ?
1.Gumagamit ka ba ng hearing aid ?
B. May problema ka ba sa paningin?
1. Nagsusuot ka ba ng salamin?
2. Kailan ka huling nagpatingin ng mata?
C. May pagbabago ba sa iyong memorya o
ala-ala?
D. Sa paanong paraan ka madaling
matuto? ( pag pinapakita, sinasabi lamang,
naririnig)
E. Nahihirapan ka bang matuto ng mga
bagay-bagay?
F.Nakakaramdam ka ba ng pananakit ng
katawan?
1. Anong parte ng katawan?
2. Kailan pa nagsimula ang pananakit?
3. Paano mo ito nilulunasan/ginagamot?
A.Ilang oras po kayo natu tulog sa araw-
araw?
1.Anong oras ang inyong pagtulog?
2. Anong oras kayo gumigising?
3. Nahihirapan ka bang makatulog?
4.Umiinom ka ba ng gamot para
makatulog?
5. Napuputol/pagising gising po ba kayo?
6. Naiidlip ka ba sa umaga?
Sa hapon ?
B. Ano ang inyong ginagawa upang
makapag relak kayo (hal. Panunuod ng
sine, pagbabasa, pagsasayaw, pamimili,
atbp.) ?
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VII. Self-perception- Assessment is focused on
Self concept pattern the person's attitudes
toward self, including
identity, body image, and
sense of self-worth. The
person's level of self-
esteem and response to
threats to his or her self-
concept may be identified.
VIII. Role relationship Assessment is focused on
pattern the person's roles in the
world and relationships
with others. Satisfaction
with roles, role strain, or
dysfunctional relationships
may be further evaluated.
Watching TV, See a movie,
reading and etc.)
A. Describe yourself before
hospitalization?
B. Do you have any changes in your
body?
C. What are your activities that you
cannot do now?
D. Do you have any problems
regarding the activities that you
cannot do?
E. Are there any changes on how you
perceived yourself when you get
ill?
F. Do you easily get angry?
G. Do you easily cry?
H. Do you worry on simple things?
I. Are you afraid of something?
J. What are the ways to resolve this?
A. Who are the members of the
family?
B. How many siblings do you have?
C. How many daughters and sons do
you have?
D. What are the problems do you have
in your family that you think it is
hard to solve?
E. How does your family resolve this
problem?
F. Does your famliy depends on you (
ex. Financial)
A. Isalarawan ang iyong sarili bago
magkasakit/ ma ospital
B. May mga pagbabago sa sa iyong
pangangatawan/mga bagay na kaya mong
gawin na hindi na magawa?
C.May mga problema ba kaugnay nito?
D. May pagbabago ba sa pagtingin mo sa
iyong sarili simula nang magkasakit ka?
E. Madali ka bang magalit?
F. Madali ka bang Mainis?
G. Madali ka bang Mapaiyak?
H. Madali ka bang Kabahan?
I. Madali ka bang Malungkot?
J. Madali ka bang Matakot?
K.Anu-ano ang nakakatulong upang
mabawasan/mawalan ito?
A. Sino- sino ang kasama mo sa bahay?
B. Ilan ang iyong kapatid?
C. Ilan ang iyong mga anak?
D.Anu-ano ang mga kasalukuyan mong
problema sa pamilya na sa tingin mo ay
mahirap solusyunan?
E. Paano mo sinusulusyunan/nireresolba ng
inyong pamilya ang mga problemang ito?
F. Umaasa ba sa iyo ang iyong pamilya
kaugnay ng ilang bagay (hal. Pinansyal)?
G.Sa paanong paraan?
H. Paano tinitignan ng iyong pamilya ang
iyong pagkakasakit? Ano ang
nararamdaman nil;a kaugnay nito?
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O. Do you have friends/enemies in your
neighborhood?
IX. Sexuality- Assessment is focused on
reproductive the person's satisfaction or
pattern dissatisfaction with
sexuality patterns and
reproductive functions.
Concerns with sexuality
may he identified.
1. On what aspect does your
family depends on you?
G. How does your family see you
while you have an illness?
1. What does your family feels
about it?
H. Do you have any problems on the
following:
• Mother
• Father
• Children
• Siblings
I. How do you solve the problem?
J. Are you a member of an
organization in your community?
1. What kind of organization?
K. Do you have friends?
L. Do you want be alone often?
M. How are the following:
• Work
• Study
• Household chores
N. Do you have enough salary for
everyday expenses?
A. Are there changes in sexual
relationship with your
wife/husband/ partner?
B. Do you practice family planning?
1. Do you have problems
regarding this?
I. May mga problema ka ba sa iyong mga
anak/nanay/tatay/kapatid? Paano mo ito
sinosolusyunan?
J.Miyembro ka ba ng organisasyon sa
inyong lugar? Ano ito?
K. May mga kaibigan ka ba na
nakakausap/nalalapitan?
L.Madalas ka bang malungkot? Mapag-
isa?
M. Kumusta ang iyong trabaho/pag-
aaral/gawaing bahay?
N.Sapat ba ang iyong kinikita sa pang-
araw-araw ninyong pangangailangan?
O.Malapit sa ka ba sa inyong mga
kapitbahay?
A. May pagbabago ba sa sekswal na
relasyon ninyong mag-asawa/mag-
partner ?
B. Nag family planning ba kayo? May
mga problema ba kayong nararanasan
kaugnay nito? Ano?
C. Kung babae:
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X. Coping Stress Assessment is focused on
tolerance pattern the person's perception of
stress and on his or her
coping strategies Support
systems are evaluated, and
symptoms of stress are
noted. The effectiveness of
a person's coping strategies
in terms of stress tolerance
may be further evaluated.
C. If female:
1. Menarche
2. When was your last menstrual
period?
3. Do you have problems during
menstruation?
4. How many times do get
pregnant?
5. How many times you deliver?
D. If Male:
1. Do you have any problems in
your genitalia?
2. Do you experience any pain on
the following:
• Sexual intercourse
• Urination
E. Is there any infection in your
genitalia?
A. Do you always worry on different
things?
1. What do you do to solve it?
2. Do you have any medication for this?
B. To whom do you confide when you
worries?
C. Is there a major change in your life for
the past two years? What?
D. How do you resolve this problem?
1. Is it effective?
1. kalian ka unang dinatnan ng regla?
2.Kailan ka huling niregla?
3.May mga problema ka bang nararanasan
sa tuwing nireregla ka?
4. Ilang beses ka nang nagbuntis?
5. Ilang beses ka na ng nanganak?
D. kung lalaki:
1.May problema ka bang nararanasan sa
iyong ari( masakit tuwing nakikipag talik,
pag ihi)
E. May impeksyon o nana?
A. Madalas ka bang nag aalala sa ibat-
ibang bagay?
1. Ano ang ginagawa mo para
mawala/mabawasan ito?
2.May iniinom ka bang gamot upang
mabawasan ito?
B. Sino ang madalas mong kausapin sa
tuwing nakakaramdam ka ng kaba/takot/o
tuwing may problema?
C. May mga malaking pagbabago ba sa
buhay mo nitong nakalipas na dalawang
taon?
Ano ito?
D. Paano mo sinosulusyunan.
sinusolusyunan/ginagawan ng paraan ang
mga malaking problemang kinakaharap
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XI. Value-Belief Assessment is focused on
pattern the person's values and
beliefs (including spiritual
beliefs), or on the goals
that guide his or her
choices or decisions.
A. Have you fulfilled your
plans/dreams in your life?
B. What do you consider as important
things in your life?
C. Is religion important to your life?
1. How does religion helps you?
D. Do you consider that during
hospitalization is a barrier to your
faith?
mo?
1. Epektibo ba ang mga ito?
A. Natutupad/Nagawa ba ang mga
pangarap/plano mo sa buhay?
B. Anu-anong mga bagay ang
pinakamahalaga sa iyo?
C. Imporatante ba sa iyo ang relihiyon?
1. Paano ito nakakatulong sa iyo?
D. Maituturing mo bang balakid sa iyong
paniniwala ang pagkakaospital mo?
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