GERIATRIC ASSESSMENT

PERSONAL INFORMATION
NAME: Uldarico D. Jumangit
AGE: 87
SEX: Male
STATUS: Married
BIRTHDATE AND PLACE: July 4, 1935; Bohol
ADDRESS: 157, Veterans Avenue, Tetuan Ext. Zamboanga City
ETHNICITY: Boholano/Zamboangueno
RELIGION: Roman Catholic
NAME OF CAREGIVER/ GUARDIAN: Glenda J. Hadjirani
HEALTH HISTORY
CHIEF COMPLAINTS: Numbness and itchiness on the leg
HISTORY OF PRESENT ILLNESS: Numbness and tingling accompanying pain in the leg
MEDICAL DIAGNOSIS (IF ANY): Cellulitis
DIAGNOSTIC/ SCREENING TESTS AND FINDINGS (IF ANY):
PAST MEDICAL HISTORY (ILLNESS/SURGERY/HOSPITALIZATIONS): Cirrhosis
NUTRITIONAL HISTORY:
MEDICATIONS:
ALLERGIES:
IMMUNIZATIONS:

PHYSICAL ASSESSMENT
WEIGHT:_60kg________ HEIGHT: _5’5_____________ BMI:__22_______________
VITAL SIGNS: (GELEEN)
GENERAL CONDITION/CONSTITUTIONAL:
INTEGUMENT:
EYES:
EARS/NOSE/MOUTH/THROAT:
NECK:
CHEST:
RESPIRATORY:
CARDIOVASCULAR:
GASTROINTESTINAL:
GENITOURINARY:
REPRODUCTIVE:
MUSCULOSKELETAL:
NEUROLOGIC:
ENDOCRINE:
HEMATOLOGIC/LYMPHATIC:
ALLERGIC/IMMUNOLOGIC:

COGNITION
Mini-Cog Screening Test Results
3 item recall
Clock Drawing Test
MMSE Results
MOOD
Yale Depression Screen “Do you often feel sad or depressed? £Yes £No
Two Questions “During the past month, have you often feel bothered by:
1. Little interest or pleasure in doing things? £Yes £No
2. Feeling down, depressed or hopeless? £Yes £No
Geriatric Depression Scale Result:
 ACTIVITIES OF DAILY LIVING
BASIC ADLs

ACTIVITIES NO Supervision, WITH supervision, COMPLETELY

direction, or assistance direction, or assistance UNABLE
BATHING
DRESSING
TOILETING
AMBULATING
FEEDING
GROOMING
TOTAL SCORE: 5 1 0

INSTRUMENTAL ADLs
ACTIVITIES WITHOUT HELP SOME HELP/ COMPLETELY
ASSSITANCE UNABLE
TELEPHONE
TRANSPORTATION
SHOPPING
PREPARING
MEALS
HOUSEKEEPING
MEDICATION
MONEY
LAUNDRY

SOCIAL ASSESSMENT
Who is/are your caregiver/s? I don’t really need a caretaker because I can handle my own but sometimes when I’m
in need, I ask my youngest daughter, Glenda, to do things for me.
Do you live alone? No, I am with my whole family
Is there any one special person you could call or contact if you needed help? My wife, daughter and grandchildren
When you need help, can you count on anyone for house cleaning, groceries, or a ride? Yes
Who could you turn for help in the event that you are unable to take care of yourself? My wife, daughter and
grandchildren
Can you count on anyone for emotional support? Yes

SPIRITUAL ASSESSMENT
1. “Is religion or God significant to you?” Yes, I am a God fearing and a God-centered type of person. I always
believe in the presence of God in any ways.
2. “What is your source of strength and hope?” My source of strength and hope is my entire family.
3. “Are there any religious practices that are important to you?” We pray the holy rosary every day and I pray most
of the time to keep me safe and guided.
4. “Has being sick made any difference in your feelings about God or the practice of your faith?” Actually, yes,
there was a time wherein I really lost hope that I started to surrender everything to God and told myself that “If this
is already my time then so be it.”

GORDON’S 11 FUNCTIONAL HEALTH PATTERNS (FATH)

1. HEALTH PERCEPTION- HEALTH MANAGEMENT PATTERN
2. NUTRITIONAL METABOLIC PATTERN
3. ELIMINATION PATTERN
4. ACTIVITY-EXERCISE PATTERN
5. SLEEP-REST PATTERN
6. COGNITIVE PERCEPTUAL PATTERN
7. SEL PERCEPTION- SELF CONCEPT PATTERN
8. ROLE RELATIONSHIP PATTERN
9. SEXUALITY-REPRODUCTIVE PATTERN
10. COPING- STRESS TOLERANCE PATTERN
11. VALUE-BELIEF PATTERN