GORDON’S FUNCTIONAL HEALTH PATTERN HEALTH PERCEPTION ~ HEALTH MANAGEMENT PATTERN Purpose: To determine how the client perceives and maintains his or health. Subjective Data: Guideline Questions Client's Perception of Health Describe your health, How would you rate your health on a scale of 1 to 10(10 as excellent), now, 5 years ago, and 5 years ahead? Client's Perception of lliness Describe your iliness or current health problem. How has this affected your normal daily activities. How do you feel your current daily activities have affected your health? ‘What do you believe caused your illness? ‘What course do you predict your illness will take? How do you believe your illness? Do you have or anticipate any difficulties in caring for yourself or others at home? if yes, explain Health Management and Habits Tell me what you do when you have a health problem, When do you seek nursing or medical advice? How often do you go for professional exams(dental, PAP smears, breast, blood pressure)? ‘What activities do you believe keep you healthy? Contribute to illness? Do you perform self-exams(8P, breast, testicular)? Do you use alcohol, tobacco, drugs, caffeine? Describe the amount and length of time used. ‘Are you exposed to pollutants or toxins? ? Compliance with Prescribed Medications and Treatments Have you been able to take your prescribed medications? If not, what caused your inability to do? Have you been able to follow through with your prescribed nursing and medical treatment(e.g, diet, exercise)? if not, what caused your inability to do so? NUTRITIONAL- METABOLIC PATTERN Purpose: To determine the client's dietary habits, and metabolic needs. The conditions of hair, skin, nails, teeth, and mucous membranes are assessed. Subjective Data: Guideline Questions Dietary and Fluid Intake Describe the type and amount of food you eat at breakfast, lunch, and supper on an average day. Do you attempt to follow any certain type of diet? Explain. What time do you usually eat your meals? Do you find it difficult to eat meals on time? Explain What types of snacks do you eat? How often? Do you take any vitamin supplements? Describe. Do you take herbal supplements? Describe. Do you consider your diet high in fat? Sugar? Salt? Do you find it difficult to tolerate certain foods? Specify What kind of fluids do you usually drink? How much per day? Do you have difficulty chewing or swallowing food? When was your last dental exam? What were the results? Do you ever experience nausea and vomiting? Describe. Do you ever experience abdominal pains? Describe. Do you use antacids? How often? What kind? Condition of Skin Describe the condition of your skin. Describe your bathing routine. Do you use sunscreens, lotions, oils? Describe. How well and how quickly does your skin heal? Do you have any skin lesions? Describe. Do you have excessively oily or dry skin?4 Do you have any itching? What do you do for relief? Condition of Hair and Nails Describe the condition of your hair and nails. Bo you use artificial nails? How often? How long? Have you ever had problems with these nails? Do you have excessively oily or dry hair? Have you had difficulty with scalp itching or sores? Do you use any special hair or scalp care products (ie, permanents, coloring, straighteners) Have you noticed any changes in your nails? Color? Cracking? Shape? Lines? Metabolism ‘What would you consider to be your ideal weight? Have you had any recent weight gains or losses? Describe, Have you used any measures to gain or lose weight? Describe. Do you have any intolerances to heat or cold? Have you noted any changes in your eating or drinking habits? Explain, Have you noticed any voice changes? Have you had difficulty with nervousness? ELIMINATION PATTERN Purpose: To determine the adequacy of function of the client's bowel and bladder for elimination. Subjective Data: Guideline Questions Bowel Habits Describe your bowel pattern. Have there been any recent changes? How frequent are your bowel movements? ‘What isthe color and consistency of your stools? (Do you use laxatives? What kind and how often do you use them? o you use enemas? How often and what kind? (0 you use suppositories? How often and what kind? Do you have any discomfort with your bowel movements? Describe. Have you ever had bowel surgery? What type? lleostomy? Colostomy? Bladder Habits Describe your urinary habits. How frequently do you urinate (when and number of times)? ‘What is the amount and color of your urine? Do you have any of the following problems with urinatis Pain? Blood in urine? Difficulty starting a stream? Incontinence? Voiding frequently at night? Volding frequently during day? Bladder infections? Have you ever had bladder surgery? Describe. Have you ever had a urinary catheter? Describe. When? How long? ACTIVITY. EXERCISE PATTERN Purpose: To determine the client's activities of daily living, including, routines of exercise, leisure, and. recreation, Subjective Data: Guideline Questions Activities of Daily Living Describe your activities on a normal day (including hygiene activities, cooking activities, shopping activities, eating activities, house and yard activities, other self-care activities? Explain Does anyone help you with these activities? How? 10 you use any special devices to help you with your activities? Does your current physical health affect any of these activities(e.g. dyspnea, shortness of breath, palpitations, chest pain, pain, stiff, weakness)? Explain. —Leisure Activities Describe the leisure activities you enjoy. Has your health affected your ability to enjoy your leisure. Explain. Do you have time for leisure activities? Describe any hobbies you have. Exercise Routine Describe those activities you enjoy. How often are you able to do this type of exercise? Has your health interfered with your exercise routine? Occupational Activities Describe what you do to make a living. How satisfied are you with this job? Do you believe it has affected your health? If yes, how? How was health affected your ability to work? SEXUALITY-REPRODUCTION PATTERN Purpose: To determine the client's fulfillment of sexual needs and perceived level of satisfaction. Subjective Data: Guideline Questions Female ‘Menstrual history How old were you when you began menstruating, (On what date did your last cycle begin? How many days does your cycle normally last? How many days elapse from the beginning of one cycle until the beginning of another? Have you noticed any change in your menstrual cycle? Have you noticed any bleeding between your menstrual cycles? Do you experience episodes of flushing, chllings, or intolerance to temperature changes? Describe any mood changes or discomfort before, during, or after your cycle. ‘What was the date of your last Pap Smear? Results? Obstetric history How many times have you been pregnant? Describe the outcome of each of your pregnancies If you have children, what are the ages and sex of each? Describe your feelings with each pregnancy. Explain any health problems or concerns you had with each pregnancy. If pregnant now: Was this planned or unexpected pregnancy? Describe your feelings about this pregnancy. What changes in your lifestyle do you anticipate with this pregnancy? Describe any difficulties or discomfort you have had with this pregnancy. How can | help you meet your needs during this pregnancy? ‘Male or Female Contraception What do you or your partner do to prevent pregnancy? How acceptable is this method to both of you? Does this means of birth control affect your enjoyment of sexual relations? Describe any discomfort or undesirable effects this method produces. Have you had any difficulty with fertility. Explain. Has infertility affected your relationship with your partner? Explain, Perception of sexual activities Describe your sexual feelings. How comfortable are you with your feelings of feminity/masculinity? Describe your level of satisfaction from your sexual relationship(s) on scale of 1 to 10 (with 10 being very satisfying) Explain any changes in your sexual relationshp(s) that you would lke to make Describe any pain or discomfort you have during intercourse. Have youthas your partner) experienced any difficulty achieving an orgasm or maintaining an erection? If so, how has ths affected your relationship? eit teConcerns related to illness How has your illness affected your sexual relationship(s)? How comfortable are you discussing sexual problems with your partner? From whom would you seek help for sexual concerns? ‘Special problems Do you have or have you ever had a sexually transmitted disease? Describe. ‘What method do you use to prevent contracting a sexually transmitted disease? Describe any pain, burning, or discomfort you have while voiding. Describe any discharge or unusual odor you have from your penis/vagina. History of sexual abuse Describe the time and place the incident occurred. Explain the type of sexual contact that occurred. Describe the type of sexual contact that occurred. Identity any witnesses present. Describe your feelings about this incident. Have you had any dificulty sleeping, eating, or working since the incident occurred? SLEEP-REST PATTERN e the client's perception of the quality of his or her sleep , relaxation, and energy ‘Subjective Data: Guideline Questions Sleep Habits Describe your usual sleeping time and habits(ie, reading, warm milk, medications, etc.Jat home. How long does it take you to fall sleep? Ifyou awaken, how long does it take you to fall asleep again? Do you use anything to help you fall asleep(ie, medication, reading, eating)? How would you rate the quality of your sleep? Do you ever experience difficulty with falling asleep? Remaining asleep? Do you ever feel fatigued after a sleep period? Has your current health altered your normal sleep habits? Explain. Do you feel your sleep habits have contributed to your current iliness? Explain. Sleep Aids ‘What helps you fall asleep? Medications? Reading? Relaxation techniques? Watching TV? Listening to Music? ‘SENSORY-PERCEPTUAL PATTERN Purpose: To determine the functioning status of the five senses: vision, hearing, touch(including pain perception), taste, and smell Subjective Data: Guideline Questions Perception of Senses Describe your ability to see, hear, feel, taste, and smell Describe any difficulty you have with your vision, hearing, ability to feel(e.g. touch, pain, heat, cold), taste(salty, sweet, bitter, sour), or smell Pain Assesment Describe any pain you have now. ‘What brings it on? What relieves it? ‘When does it occur? How often? How long does it last? ‘What else do you feel when you have this pain? Show me on this drawing(of a figure) where you have pain. Rate your pain on a scale of 1 to 10, with 10 being the most severe pain. (Have a child use the Oucher Scale, with faces ranging from frowning to crying.) How has your pain affected your activities of daily living? nag *Special Aids What devices (e.g, glasses, contact lenses, hearing aids) or methods do you use to help you with any of these problems? Describe any medications you take to help you with these problems. ‘COGNITIVE PATTERN, Purpose: To determine the client's ability to understand, communicate, remember, and make decisions. Subjective Data: Guideline Questions Ability to Understand Explain what your doctor has told you about your health. ‘Are you satisfied with your understanding of your illness and prescribed care? Explain, ‘What is the best way for you to learn something new (read, watch television, etc.]? Ability to Communicate ‘Can you teli me how you feel about your current state of health? ‘Are you able to ask questions about your treatments, medications, and so forth? 0 you ever have difficulty expressing yourself or explaining things to others? Explain. Ability to Remember ‘Are you able to remember recent events and events of long ago? Explain. Ability to Make Decisions Describe how you feel when faced with a decision, ‘What assists you in making decisions? Do you find decision making difficult, fairly easy or variable? Describe. ROLE-RELATIONSHIP PATTERN Purpose: To determine the client's perceptions of responsibilities and roles in the family, at work, and in social life. Subjective Data: Guideline Questions Perception of Major Roles and Responsibilities in Family Describe your family. 0 you live with your family? Alone? How does your family get along? Who makes the major decisions in your family? ‘Who is the main financial supporter of your family? How do you feel about your family? ‘What is your role in the family? Is this an important role? ‘What is your major responsibility in your family? How do you fee| about your responsibility? How does your family deal with problems? ‘Are there any major problems now? ‘Who is the person you feel closest to in your family? Explain, How is your family coping with your current state of health? Perception of Major Roles and Responsibilities at Work Describe your occupation. What is your major responsibilty at work? How do you feel about the people you work with? | you could, what would you change about your work? Are there any major problems you have at work? If yes, explain. Perception of Major Social Roles and Responsibilities at Work Who is the most important person in your life? Explain, Describe your neighborhood and the community in which you live. How do you feel about the people in your community? o you participate in any social groups or neighborhood activities? If yes, describe. What do you see as your contribution to society? What would you change about your community if you could?10, SELF-PERCEPTION-SELF-CONCEPT PATTERN Purpose:To determine the client’s perception of his or her abilit behavior, attitude, and emotional patterns are also assessed. ies, body image, and self-worth. The client's Subjective Data: Guideline Questions Perception of identity Describe yourself Has your illness affected how you describe yourself? Perception of Abilities and Self-Worth What do you consider to be your strengths? Weaknesses? How do you feel about yourself? How does your family feel about you and your illness? Body Image How do you feel your appearance? Has this changed since your illness? Explain. How would you change your appearance if you could? How do you feel about other people with disabilities? 11. COPING-STRESS TOLERANCE PATTERN Purpose: To determine the areas and amounts of stress in a client's life and the effectiveness of coping methods used to deal with it. Availability and use of support systems. Subjective Data and Guideline Questions Perception of stress and Problems in Life Describe what you believe to be the most stressful situation in your life. How has your illness affected the stress you feel? Or how do fee! stress has affected your illness? Has there been a personal loss or major change in your life over the last year? Explain, What has helped you to cope with the change or loss? Coping Methods and Support Systems ‘What do you usually do first when faced with the problems? What helps you to relieve stress and tension? ‘To whom do you usually turn when you have a problem or feel under pressure? How do you usually deal with problems? Do you use medication, drugs, or alcohol to help relieve stress? Explain. 12. VALUE-BELIEF PATTERN Purpose: To determine the clients life values and goals, philosophical beliefs, religious beliefs, and spiritual beliefs that influence his or her choices and decisions. Subjective Data: Guideline Questions Values, Gools and Philosophical Beliefs ‘What is most important to you in life? ‘What do you hope to accomplish in your life? ‘What is the major influencing factors that helps you make decisions? What is your major source of hope and strength in life? Religious and Spiritual Beliefs Do you have religious affiliation? Is this important to you? Are there certain health practices or restrictions that are important for you to follow while you are ill or hospitalized? Explain. Is there a significant person (e.g, minister, or priest) from your religious denomination whom you want tobe contact? ‘Would you like the hospital chaplain to visit? Are there certain practices (e.g. prayer, reading Scripture,) that are important to you? Is the relationship with God an important part of your life? Explain. Describe any other sources of strength that are important to you. How can | help you continue with this source of spiritual strength while you are illin the hospital? pg G