UNIVERSIDAD DE MANILA

Republic of the Philippines

City of Manila

COLLEGE OF HEALTH SCIENCES

DEPARTMENT OF NURSING

NCM 101 - HEALTH ASSESSMENT – RLE

Name:_________________________________________ Year/Section:_______________
Instructor:______________________________________

FUNCTIONAL HEALTH PATTERN ASSESSMENT

Functional Health Patterns Before During Illness/ Identified Nursing Problems

Illness/Hospitalization Hospitalization Nursing Diagnosis
1. Health Perception and
Health Management

2. Nutritional Metabolic
Pattern

3. Elimination Pattern.

4. Activity and Exercise

Pattern

5. Cognitive-Perceptual
Pattern.

6. Sleep Rest Pattern.

7. Self-Perception-Self-
Concept Pattern

8. Role-Relationship Pattern.

Public service through quality education.

Justice Cecilia Muñoz – Palma corner Mayor Antonio J. Villegas Street Mehan Gardens, Ermita, Manila, Philippines 1000
Tel. Nos. (+632)5336-6582/(+632)5336-8956/(+632)5336-8966 Fax No.(+632)336-6554 www.udm.edu.ph
 UNIVERSIDAD DE MANILA
Republic of the Philippines
City of Manila

9. Sexuality and
Reproduction.

10. Coping-Stress Tolerance

Pattern.

11. Value-Belief Pattern

Grading Criteria

Criteria Excellent Very Satisfactory Satisfactory Poor

16-20 11-15 6-10 1-5
Accuracy of Data
Completeness of
Data
Organization and
Coherence
Grammar and
Mechanics
Clarity and
Neatness
Subtotal
Total Score: ___________________

Conformed: Evaluated by:

___________________________________ ____________ _________________________________

Student Date: Instructor

Public service through quality education.

Justice Cecilia Muñoz – Palma corner Mayor Antonio J. Villegas Street Mehan Gardens, Ermita, Manila, Philippines 1000
Tel. Nos. (+632)5336-6582/(+632)5336-8956/(+632)5336-8966 Fax No.(+632)336-6554 www.udm.edu.ph