Professional Documents
Culture Documents
PSYCHOSOCIAL HISTORY
From: ☐Admitting ☒ ER ☐ Home ☐ Nursing Home ☐Other Coping Mechanism“strength is God & my children”
Support System children, friends, co workers____
Admitting M.D. _Cathy Den___ Time Notified __3.30pm__
ORIENTATION TO UNIT Calm:☒Yes ☐No __________________________
YES NO YES NO Anxious:☐Yes ☐No tense facial muscle; trembling
Arm Band Correct ☒ ☐ Visiting Hour ☒☐ Religion ______________ Roman Catholic______
Allergy Band ☒☒ Smoking Policy ☒☐ Tobacco Use:☒Yes ☐No _____1 pack/day______
Telephone ☒☐ TV, Lights, Bed Controls, Alcohol Use:☒Yes ☐No ____occasionally______
Electrical Policy ☒☐ Call Lights, Side Rails ☒ ☐ Drug Use:☐Yes ☒No ______________________
ADMISSION DATA
NEUROLOGICAL
Weight __38 kg__. Height ____5”__. BP: R125/79_ L _ ☐Alert ☐Restless ☒Lethargic ☐Comatose
Temp. 37.9˚C__ Pulse _93; weak__ Resp.30; shallow_ Pupils: ☒Equal ☐Unequal ☒Reactive ☐Sluggish
Source Providing Information ☒ Patient ☐ Other _____ ☐Others __________________________
Unable to Obtain History ☐ ______________________ Extremity Strength:☒Equal ☐Unequal
Reason for Admission (Onset, Duration, Pt.’s Perception)
Speech:☒Clear ☐Slurred ☐Other
__S.O.B. on exertion, “chest pain when
______________
coughing, cold x wk., unable to sleep properly,
Normal ROM of Extremities ☒Yes ☐No
fever” “Dr. says I have Pneumonia” and “I feel
MUSCULO-
exhausted” _______________________________
☐Joint Swelling ☒Pain
☐Other weakness(fatigue); pain (when coughing)
Pattern: ☐Even ☐Uneven ☒Shallow ☒Dyspnea
Drugs _______________Amoxycillin_______________
RESPIRATORY
☐Incontinent
☐Wheelchair ☐Contacts ☐Venous ☐Dentures ☒Other decrease amount and frequency since ill
SPECIAL ASSISTIVE
Patient informed Hospital not responsible for personal ☐Meals ☒Hygiene ☐Dressing
belongings. ____________while fatigue__________________
VALUABLES
Health Assessment
LESSON _: GFHP, V&D of Data
Name: ________________________________________________________BSN 1_____
DATE: ____________________ SCORE: ________________ EQUIVALENT: ___________
Instruction: Select all the information/data from the above tables, that belongs or related to
Gordon’s functional health pattern. Write your answers on the space provided.
Elimination Pattern