this is an outline of 11 functional health patterns

1. Gordon’s (Functional) Approach of health patterns
Prepared by: Abebe Dilie (BSc, MSc), DMU, Department of Nursing Page 1
Nursing Assessment using Functional Health Pattern
Name_____________________________ ID _______________ ward/OPD________________
Demographic data
 Date
 Time
 Identification
 Name
 Age
 Address
 Ethnicity
 Source of referral
 Source of information.
 Date of admission(if admitted)
 Medical diagnosis(if established)
 Surgical procedure if any
 Condition on admission
 Vital sign
 Temperature
 Blood pressure
 Pulse rate
 Respiratory rate
1. Health perception and health management pattern
 Reason for seeking health care / chief complain
 Where did you go when you are sick?
 Family history of chronic illness
 Any absences from work/school?
 Most important things you do to keep healthy?
 Use of cigarettes, alcohol, drugs?
 Perform self-exams, i.e. Breast/testicular self-examination?
 What do you think caused current illness?
 What actions have you taken since symptoms started?
 Have your actions helped? (if appropriate)
Significant clustered data: _______________________________________________
Nursing diagnosis _____________________________________________________

2. Gordon’s (Functional) Approach of health patterns
Prepared by: Abebe Dilie (BSc, MSc), DMU, Department of Nursing Page 2
2. Nutritional and metabolic pattern
 Appetite
 Taste sensation
 Blood glucose monitoring
 Tube feeding
 Total parenteral nutrition
 Output
 Nails: color, shape
 General skin color/ texture
 Skin
 Edema
 Skin turgor
 Skin lesion
 Braden scale
 Height
 Weight
 Body mass index
 Undernourished
 Eating /digesting problems
 Antacid use or other / explain
 Dentition
 Oral mucosa
Significant clustered data _____________________________________________
Nursing diagnosis ___________________________________________________
3. Elimination pattern
 Bowel sound
 Abdomen
 Bowel habit
 Stool: color, consistency, amount
 Rectum
 Bladder function
 Urine: color, odor
 Skin
Significant clustered data________________________________________________
Nursing diagnosis _____________________________________________________
4. Activity and exercise pattern
Date Temperature Pulse Respiration Blood pressure
o Apical rhythm
o Capillary refill
o Supplemental oxygen
o Use of tobacco currently
o Respiratory effort, depth
o Response to activity of daily living
o Musculoskeletal: gait
o Upper extremities
o ROM
o Difficulty of breathing
o Cough
o Breath sounds
o Suctioning
o Artificial airway
o Chest tube
o Lower extremities: strength

3. Gordon’s (Functional) Approach of health patterns
Prepared by: Abebe Dilie (BSc, MSc), DMU, Department of Nursing Page 3
o ROM
o Assistive devices
o Physical therapy
o History of falls
Significant clustered data _______________________________________________
Nursing diagnosis _____________________________________________________
5. Sleepand rest pattern
 Typical home sleep pattern
 Typical hospital sleep pattern
 Sleep difficulties
 Naps
Significant clustered data ____________________________________________
Nursing diagnosis __________________________________________________
6. Sexuality and reproduction pattern
 Verbalized impact of illness, medication and treatment on sexuality
 History of STD’s
 Sexually active
 Annually/monthly screening exams: prostate/ testicular
7. Cognitive and perception pattern
 Mental status: PPT
 Level of consciousness
 Memory
 Thought
 Pupils :PERRLA
 Vision
 Hearing
 Peripheral sensory perception
 Pain assessment
 Pain lasting longer than six
months
8. Role and relationship pattern
 Current occupation
 Support systems: marital status
 Socialization
 Changes in life/ roles/
relationships
 Verbalized fears of violence
Significant clustered data __________________________________________
Nursing diagnosis ________________________________________________
9. Self-perception and self-concept pattern
 Erickson’s age related developmental stage
 Clients developmental stage (from Erickson’s)
 Identified major losses or life changes
 Emotional/ behavioral state
Significant clustered data__________________________________________
Nursing diagnosis _______________________________________________

4. Gordon’s (Functional) Approach of health patterns
Prepared by: Abebe Dilie (BSc, MSc), DMU, Department of Nursing Page 4
10. Coping and stress tolerance pattern
 Mechanism to cope the stressors
 Use of drugs or alcohol for coping
 Interest in alternative coping strategies
Significant clustered data__________________________________________
Nursing diagnosis _______________________________________________
11. Values and belief pattern
 Most valued thing for him/ her in his / her life
 Consider himself as religious person
 Request of spiritual support in hospitals
 Spiritual cues around him
Significant clustered data__________________________________________
Nursing diagnosis _______________________________________________
Future health care needs/ discharge plans
 Anticipated discharge needs _______________________________________
 Nursing/ nurses aid______________________________________________
 Dietary/nutrition________________________________________________
 Equipment/ medication___________________________________________
 Medical _______________________________________________________
 Specific discharge instruction______________________________________
 Nursing diagnosis: knowledge deficit________________________________
Medications currently prescribed including IV solutions
Name
Dose,
frequency,
time , IV rate
Major
action
Common
side effect
Nursing
action and
implication
Why this
medication is
prescribed
Diagnostic studies /procedures (include date, time & diagnostic finding)
Procedure Normal value Result Date Explain why
the test is
ordered

5. Gordon’s (Functional) Approach of health patterns
Prepared by: Abebe Dilie (BSc, MSc), DMU, Department of Nursing Page 5
Nursing care plan
Assessment
Nursing
diagnosis
Plan Implementation Evaluation
Goal Expected outcome
Subjective data
Objective data
Case of the patient (Literature review)
Text book description of medical diagnosis
Etiology
Pathophysiology
Diagnostics- how the condition diagnosed
Signs and symptoms
Medical and nursing management