Functional Health Assessment

The University of Lahore
Gordon’s 11 Functional Health Pattern
Week No.
Case Study No: System:
Student Name: Student Roll no.
Patient Name: Age/Sex:
Patient MR # Language:
Marital Status: Religion:
Culture: Occupation:
Education: Allergies:
DOA: Physician:
Perform a nursing assessment using a functional health approach
1. HEALTH-PERCEPTION-HEALTH-MANAGEMENT PATTERN
• How has general health been?
• Any colds in the past year? If appropriate, absences from work/school?
• Most important things done to keep healthy. Did these things make a difference to health
(include family folk remedies, if appropriate)? Breast self-examination? Use cigarettes?
Drugs? Ever had a drinking problem? When was your last drink?
• Accidents (home, work, driving)? Falls?

• In past, easy to find ways to follow suggestions of doctors or nurses?
• If appropriate, what do you think caused this illness? Action taken when symptoms
perceived? Results of action?
• If appropriate, what is important to you while you are here? How can we be most
helpful?
2. NUTRITIONAL-METABOLIC PATTERN
• Typical daily food intake? Describe. Supplements?
• Typical daily fluid intake? Describe.
• Weight loss/gain? Amount? Height loss/gain? Amount?
• Appetite?
• Food or eating discomfort? Swallowing? Diet restrictions? If appropriate, breastfeeding?

Problems with breastfeeding?
• Heal well or poorly?

• Skin problems, such as lesions, dryness?
• Dental problems?
3. ELIMINATION PATTERN
• Bowel elimination pattern? Describe. Frequency? Character? Discomfort? Problem in
control? Laxatives?
• Urinary elimination pattern? Describe. Frequency? Discomfort? Problem in control?
• Excess perspiration? Odor problems?
4. ACTIVITY-EXERCISE PATTERN
• Sufficient energy for desired/required activities?
• Exercise pattern? Type? Regularity?
• Spare time (leisure) activities? Child’s play activities?
• Perceived ability for the following (code level according to Functional Levels Code
below)
• Functional Levels Code
• Level 0: Full self-care
• Level I: Requires use of equipment or device
• Level II: Requires assistance or supervision of another person
• Level III: Requires assistance or supervision of another person and equipment or device
• Level IV: Is dependent and does not participate
5. SLEEP-REST PATTERN
• Generally rested and ready for daily activities after sleep?
• Sleep-onset problems? Aids? Dreams (nightmares)? Early awakening?
• Rest/relaxation periods?
6. COGNITIVE-PERCEPTUAL PATTERN
• Hearing difficulty? Aid?
• Vision? Wear glasses? Last checked?
• Any change in memory lately?
• Easy/difficult to make decisions?
• Easiest way for you to learn things? Any difficulty learning?

• Any discomfort? Pain? How do you manage it?
7. SELF-PERCEPTION-SELF-CONCEPT PATTERN
• How would you describe yourself? Most of the time, do you feel good (not so good)
about yourself?
• Changes in your body or the things you can do? Are these problematics for you?
• Changes in way you feel about yourself or your body (since illness started)?
• Find things frequently make you angry? Annoyed? Fearful? Anxious? Depressed? What
helps?
• Ever feel you lose hope? Not able to control things in life? What helps?
8. ROLE-RELATIONSHIP PATTERN
• Live alone? Family? Family structure? Draw diagram.
• Any family problems you have difficulty handling (nuclear/extended)?
• How does the family usually handle problems?
• Family depends on you for things? How are you managing?

• If appropriate, how do family/others feel about your illness/hospitalization?
• If appropriate, problems with children? Difficulty handling?
• Belong to social groups? Close friends? Feel lonely (frequency)?
• Things generally go well for you at work. School? If appropriate, income sufficient for
needs?
• Feel part of (or isolated in) neighborhood where living?
9. SEXUALITY-REPRODUCTIVE PATTERN
• If appropriate to age/situation, sexual relationships satisfying? Changes? Problems?
• If appropriate, use of contraceptives? Problems?
• For females, when menstruation started? Last menstrual period? Menstrual problems?
Para? Gravida?
10. COPING-STRESS-TOLERANCE PATTERN
• Any big changes in your life in the last year or two? Crisis?
• Who’s most helpful in talking things over? Available to you now?
• Tense a lot of the time? What helps? Use any medicines, drugs, alcohol?
• When (if) problems occur in your life, how do you handle them?
• Most of the time, is this way(s) successful?
11. VALUE-BELIEF PATTERN

• Generally, get things you want out of life? Important plans for the future?
• Religion important in your life? If appropriate, does this help when difficulties arise?
• If appropriate, will being here interfere with any religious practices?
12. OTHER
• Any other things that we have not talked about that you would like to mention?
• Questions?

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The University of Lahore

Gordon’s 11 Functional Health Pattern

• Any colds in the past year? If appropriate, absences from work/school?

• Accidents (home, work, driving)? Falls?

• Typical daily fluid intake? Describe.

• Weight loss/gain? Amount? Height loss/gain? Amount?

• Food or eating discomfort? Swallowing? Diet restrictions? If appropriate, breastfeeding?

• Heal well or poorly?

• Urinary elimination pattern? Describe. Frequency? Discomfort? Problem in control?

• Excess perspiration? Odor problems?

• Exercise pattern? Type? Regularity?

• Spare time (leisure) activities? Child’s play activities?

• Sleep-onset problems? Aids? Dreams (nightmares)? Early awakening?

• Vision? Wear glasses? Last checked?

• Any change in memory lately?

• Easy/difficult to make decisions?

• Easiest way for you to learn things? Any difficulty learning?

• Any family problems you have difficulty handling (nuclear/extended)?

• How does the family usually handle problems?

• Family depends on you for things? How are you managing?

• If appropriate, problems with children? Difficulty handling?

• Belong to social groups? Close friends? Feel lonely (frequency)?

• Feel part of (or isolated in) neighborhood where living?

• If appropriate, use of contraceptives? Problems?

• Who’s most helpful in talking things over? Available to you now?

11. VALUE-BELIEF PATTERN

• If appropriate, will being here interfere with any religious practices?

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