 HEALTH PERCEPTION AND HEALTH
MANAGEMENT PATTERN
1.Reason for visit?
2.General state of health?
3. Any colds in past years?
4.Most important things done to keep
healthy?
5.Health compliance problems?
6.Cause of illness? Action taken? Result?
7.Things important to you while here?
8.Family Health History
9.Illness and injury risk factors?
10.Allergies?
 NUTRITIONAL METABOLIC PATTERN
1.Typical daily food intake? Supplements?
2.Typical daily fluid intake?
3.Weight loss or gain?
4.Desired weight?
 STATEMENT
= According to client, he complaint that he has
abdominal pain.
= The client stated, he has bad condition on
this 3 days.
=None
=According to client, it's really important to
check the testicular self exam.
=The client complaints that he has a heart
problem, then sometimes he experiences
hypertension.
=sometimes the client stated it because of
stressness, always monitored the bp, avoid
alcohol and the result was satisfying.
=Always taking care the health, and eat a
healthy food
=According to the client, he has from the
father side, his grandfather has a
hypertension.
=Mostly because of cigarette and alcohol.
=According to the client that he has allergies
on Shrimp.
 STATEMENT
= According to the client, he always eat rice,
fish and vegetables.
=The client loves to drink tea.
=The client admit that sometimes his weight is
gain of 57.6kg but it also can be loss as 45kg.
=The client want his weight become 55kg

5.Appetite?
6.Food or eating? Discomfort? Diet
restrictions?
7.Appetite?
8.Heal well? Or poorly?
9.Skin problems? Lesions? Dryness?
10.Dental problems?
11.Change in appetite with anxiety?
12.Food preferences?
13.Food allergies?
ELIMINATION PATTERN
1.Bowel elimination pattern? Frequency?
2.Urinary elimination pattern?
3.Any external devices?
4.Excess persiperation? Odor problems?
Itchings?
ACTIVITY - EXERCISE PATTERN
1.Sufficient energy for desired or required
activities?
2.Exercise pattern? Type? Regularly?
3.Spare time? Activities?
4.Dyspnea? Chest pain? Palpitations?
Softness? Atching?
above.
=The client states that he loss his appetite 5
days ago.
=The client limiting to aet the red meat and
drink alcohol.
=The client states that he loss his appetite 5
days ago.
= Heal poorly because of the low nutrient
intake.
=There's None.
=None.
=Sometimes.
=Sometimes the client want to ear the
beefsteak everyday but because of his
condition so he limit it.
=The clients states that he has food allergies
on anything that has shrimp.
 STATEMENT
= The client usually void 3-4 times a day, he
defecate once a day daily, he doesn't
experienced any problems in voiding and
defecating.
=None
=He never used any chemical laxatives.
=None.
STATEMENT
=According to client he does some household
chores at home such as cleaning their
backyard and gardening.
=According to client he always do the
exercises jogging every morning.
=The client loves to play basketball.
=The client states that sometimes he
5.Perceived ability for? (code for level)
SLEEP-REST PATTERN
1.Generally rested and ready for daily
activities after sleep?
2.Sleep onset problems?
3.Usual sleep rituals?
4.Usual sleep pattern?
COGNITIVE PERCEPTUAL PATTERN
1.Hearing difficulty?
2.Vision? Wear glasses? Last checked?
3.Any change in taste? Any change in smell?
4.Any recent change in memory?
5.Easiest way to learn things?
6.Any discomfort? Pain? How managed?
7.Ability to communicate?
8.Understanding of illness?
9.Understanding of treatment?
SELF-PERCEPTION/SELF-CONCEPT
1.Self description? Self perception?
2.Effect of illness on self image?
experiences palpitations.
=The client choose level 1: Required uses of
equipment or devices.
STATEMENT
= The client states that he usually sleeps in 7-8
hours.
= The client states that he doesn't have any
difficulties on sleep and doesn't uses any
medication to promote sleep.
=According to the client, his time in going to
sleep at 8. 30pm and wakes up at 4.30pm and
sometimes he takes a nap at noon for about
30 minutes to 1 hour.
STATEMENT
=None
=Yes,has problem with the far-sighted. He
doesn't remember the date.
=None at all.
=None
=The client states that say out loud if u want
to remember things, and take note by hand
and not by computer.
=Yes, The client states that he has abdominal
pain and he managing through the
medication.
=The client can speak malaysian language,
chinese, tagalog and english.
=Yes, by reading the information about it.
=Yes.
STATEMENT
= According to the client, his able to express
his feelings about his condition. He feels
annoyed about his condition.
= The client said that even though he annoyed
 about his condition but he want to feel better.
3.Relieving factors? = The client contented seeing his family, their
support, love and care, and that's what make
him stronger.

ROLE - RELATIONSHIPS PATTERN STATEMENT

1.Live alone? Family? Family structure
diagram?
2.Difficulty family problems?
3.Family problem solving?
4.Family dependence on you for things? How
managing?
5.Family and others feelings about illness?
Hospitalizations?
6.Problems with children?
7.Belong to social group? Have close friends?
8.Work satisfaction?
9.Feel part of or isolated to neighbourhood
where living?
= The client live alone for now because of his
works, he stay in boarding house.
=The client having arguments with his dad.
=The client find suitable time to fix their
misunderstanding.
= No
= The client states that he is well supported by
his family.
=None.
= Yes, many and some of them is his couzins.
= According to the client he got promotion on
his works.
=The client states that he has no conflicts with
his neighbours.

SEXUALITY-REPRODUCTIVE PATTERN STATEMENT

1.Any changes or problems in sexual relations? =None
2.Effect of illness?
3.Use of contraceptive? Problems? =None
4.When menstruation started? =None
5.Effect of present conditions or treatment on =None
sexuality? =None
6.Sexually transmitted disease? =None

COPING STRESS TOLERANCE PATTERN STATEMENT

1. Tense a lot of time? What helps? Use any
medicines, drugs and alcohol?
2.Have someone to confide in? Available to
you now?
=According to the client, he copes up with
stress by watching tv, playing games, cleaning
the backyard and gardening.
=According to the client, he has his fiance that
always right by his side.
3.Recent life changes?
4.Problem-solving technique? Effectives?
VALUE-BELIEF PATTERN
1.Satisfied with life?
2.Religion important in your life?
3.Conflict between treatment and beliefs?
Demographic Data
Name of client: Aljhay Kong Mangona
Address : Sea Orchids Bongao, Tawi-tawi
Age: 29 years old
Occupation : Supervisor
=The client states that more income and his
sideline business is expanding more and more.
=According to the client, his effective way is
List all the possible solution, evaluate the
options, select the best solution and create an
implementation Plan.
STATEMENT
= The client said Yes, Absolutely
= The client religion is Islam but even though
he seldom go to mosque due to his work but
he never forgot to pray.
=According to the client, sometimes because
some illness can be treat through the beliefs.