GORDONS 11 FUNCTIONAL HEALTH PATTERNS

Assessment questions PostRN 1st Year

A HEALTH PERCEPTION AND HEALTH !ANAGE!ENT PATTERN 1. How has the general health been? How do you rate your own health? 2. What do you consider healthy about you? What are your health goals? 3. What are traditional concepts of health and illness? Beliefs and practices? 4. Do you have routine physical e a!ination? "f yes how often? #. $erfor! self%breast e a!ination? &fe!ale' (. "n the past year how !any ti!es have you seen a health care provider? )or what reasons? *. "n the past+ has it been easy to find ways to follow things nurses,doctors suggest? -. What safety practices do you follow? .. /ost i!portant things to 0eep health? 1ou thin0 these things will !a0e a difference to health, &include fa!ily,fol0 re!edies if appropriate'. 12.$ersonal hygienic practices3 Describe how do you ta0e care of your body? Bath+ hand washing+ tri!!ing of fingernails+ wearing of slippers+ use of deodorant,cologne+ brush teeth+ flossing+ dental visits? 11.4ubstance abuse3 5se of cigarette+ alcohol+ drugs? 6ind+ a!ount+ fre7uency? 8easons? 9ware of effects? $assive s!o0ing? 12.:nviron!ental condition3 ade7uacy of lighting+ and ventilation. 13.:nviron!ental sanitation practices3 water supply+ toilet facilities+ waste !anage!ent+ food preparation+ presence of vectors+ health ha;ards.

" NUTRITIONAL AND !ETA"OLIC PATTERN 1. <ypical daily food inta0e? Describe. 4upple!ents? %include 3 day diet recall 2. <ypical daily fluid inta0e? Describe. 3. What is your 0nowledge of proper nutrition?

4. )ood li0es and disli0es? #. )ood preparation? (. Where do you eat? *. Who! do you eat with? -. )ood budgeting? .. Weight loss? Weight gain? 9!ount? 12.9ppetite? 11.)ood or eating disco!forts? Diet restrictions? 12.Heal well or poorly? 13.40in proble!s? =esions? Dryness? 14.Dental proble!s?

C ELI!INATION PATTERN 1. Bowel eli!ination pattern. Describe. )re7uency? >haracteristics &color and consistency'? Disco!fort,pain? 2. 5rinary eli!ination pattern. Describe. )re7uency? >haracteristics &color+ clarity+ odor'? Disco!fort,pain? $roble! in control? 3. $ractices to achieve nor!al eli!ination pattern. 4. : cess perspiration? ?dor proble!s?

D ACTI#ITY$E%ERCISE PATTERN 1. Describe your usual activities in a day &or wee0'. 2. 6ind of physical activity do you engage in? : ercise pattern? <ype? 8egularity? )re7uency+ "ntensity+ Duration? 3. 9re you satisfied with the a!ount of e ercise do you get? 4. What type of wor0 do you do for a living? #. 4ufficient energy for co!pleting desired re7uired activities? (. 4pare ti!e &leisure activities' enough resources for leisure activities? 4atisfaction?

E SLEEP$REST PATTERN 1. Describe sleep pattern3 @u!ber of hours+ continuity+ satisfied?

2. 5sual ti!e of sleep? 5sual ti!e of wa0ing up? Do you wa0e up at night? 3. Do you feel refreshed when you wa0e up? 4. Describe sleeping environ!ent. 9ny proble!s? >oncerns? #. Describe bed ti!e routine? (. 9ny proble! falling asleep? *. What helps you sleep? &Bac0 rub+ !usic+ or war! !il0? Do you ta0e sleep !edications? -. <a0e naps? When &!orning,afternoon'? .. What do you do for rela ation? &Watch !ovie+ read+ dance+ shopping etc.'

F COGNITI#E$PERCEPTUAL PATTERN 1. >an you read and write? 2. How is your hearing? Hearing difficulty? 9id? 3. How is your vision? Wear eyeglasses? =ast chec0ed? 4. 9ny change in the !e!ory lately? #. :asiest ways to learn things? 9ny difficulty in learning? (. Do you have any proble! with spea0ing+ reading+ or writing? *. 9ny changes in s!ell or taste? -. How are you doing in school or wor0?

G SELF$PERCEPTION AND SELF$CONCEPT PATTERN 1. How do you describe yourself? /ost of the ti!e+ feel good &not so good' about yourself? 2. >hanges in your body or the things you can do? $roble! to you? 3. 9ny physical alterations? >hanges in way you feel about yourself or your body? Difficulty in acceptance of changes? How it affects the relationship between you and your fa!ily+ friends and how you see yourself? 4. How do you see yourself in relation to other people? &better than+ e7ual to+ or less than' #. How do you e press your thoughts and feelings to others? (. What are your goals in the ne t five years? How do you plan to achieve the!?

*. Describe characteristics of type of person you would !ost li0e to be. Do you see yourself as that person? -. What type of !ood you are usually in? &cal!+ depressed+ pleasant+ happy+ e cited+ agitated' .. )ind things that !a0e you angry? 9nnoyed? <earful? 9n ious? Depressed? What helps? 12.How do you e press yourself during !ood changes? Do your relations with others change your !oods? How? 11.9re you satisfied with your usual !ood? Why?

H ROLE$RELATIONSHIP PATTERN 1. =ive alone? )a!ily structure? 4ignificant people in life? 2. Describe relationship to each other !e!ber of the fa!ily. 3. 8ole assu!ed in the fa!ily. )ulfilled? Why? 4. 9ny fa!ily proble!s you have difficulty handling? &nuclear,e tended' #. How does your fa!ily usually handle proble!s? (. )a!ily dependent on you for things? "f appropriate? How !anage? *. What do you thin0 of voicing opinions to fa!ily? )riends? -. Who initiates activities with fa!ily or friends? .. What are usual fa!ily activities? 12.Belong to social groups? >lose friends? )eel lonely fre7uently? 11.How do you e press your feelings or thoughts to others? 12.9re things generally goes well with you at wor0? &4chool,college'? 9re there any proble!s in wor0,school that influence health? 13."nco!e,allowance sufficient for needs? 9ny financial proble!s or concerns? 14.)eel part of &or isolated' in neighborhood where living?

SE%UALITY$REPRODUCTI#E PATTERN

1. How do you e press yourself as a !an,wo!an? 9ny difficulty or proble!s in e pressing oneAs se uality?

2. How do you show affection to others? How do you want others to show affection? 3. 9ny concerns regarding fertility or fa!ily planning? 4. Do you engage in high ris0 se ual practice? #. "f appropriate3 any changes or proble!s in se ual relations? (. "f appropriate3 use of contraceptives? $roble!s? *. )e!ale3 when was !enstruation started? =ast !enstrual period? /enstrual proble!s?

&

COPING$STRESS TOLERANCE PATTERN

1. Describe a stressful event to you. 2. How do you handle stress or pressure? :ffective? 4atisfied? Why,Why not? 3. <ense a lot of ti!e? What helps? 5se of any !edicine? Drugs? 9lcohol? 4. WhoAs !ost helpful in tal0ing things over? 9vailable to you now? #. 9ny big changes in your life in the last year or two? (. When &if' you have big proble!s &any proble!s' in your life+ how do you handle the!? *. /ost of the ti!e+ is this &are' way&s' successful?

H #ALUE$"ELIEF PATTERN 1. What !a0es a person healthy? 2. How i!portant is health to you? 3. 9ny spiritual or religious practices i!portant to you relevance to health? 4. Do you generally get things you li0e out of your life? /ost i!portant things to you? #. "s religion i!portant in your life? Does this help when difficulties arise? (. What social values you were brought up with? Which ones i!portant to you now? *. How do you see yourself in relation to society?

OTHERS

1. 9ny other things that we havenAt tal0ed about that youAd li0e to !ention? Buestions?

/9C @usrat Bashir 8@+8/+ B4c@+/4c@ @,"nstor 9)$D/"