FUNCTIONAL HEALTH PATTERNS

VALERIE SUGE - MICHIEKA

Gordon's functional health patterns

 a method proposed and developed by Marjory Gordon to be

used by nurses in the nursing process.
 Used to provide a more comprehensive nursing assessment of
the client.
 It’s divided into 11 categories which form a systematic and
standardized approach to data collection.
 The 11 areas are assessed through questions asked by the nurse
and physical exams to provide an overview of the individual's
health status and health practices that are used to reach the
current level of health or wellness.
1. Health Perception and Mgt (Perceived Health Status)

 subjective ratings by the affected individual of his or her health

status.
 Illness perceptions are the organized cognitive representations
or beliefs that patients have about their illness.
 These perceptions have been found to be important
determinants of behavior and have been associated with a
number of important outcomes, such as treatment adherence
and functional recovery.
 Perceived health is an indicator of overall health status.
 Health status can be measured using pathological and clinical
measures
 Usually observed by clinicians or measured using instruments.
Health Perception and Mgt Cont;
History (subjective data):
 Client’s general health? Any colds in past year?
 If app: any absenteeism from work/school?
 Most important things you do to keep healthy?
 Use of cigarettes, alcohol, drugs?
 Do you perform self exams, i.e. breast/testicular self-exam?
 Accidents at home, work, school, driving?
 In past, has it been easy to find ways to carry out doctor’s or nurse’s
suggestions?
 (If app) What do you think caused current illness?
 What actions have you taken since symptoms started?
 Have your actions helped?
 (If app) What things are most important to your health?
 How can we be most helpful?
Health Perception-Health Management
Pattern
1- Determine how the client perceives and manages his or her
health.
2- Compliance with current and past nursing and, medical
recommendations.
3- The client's ability to perceive the relationship between
activities of daily living and health.
Subjective Data
Client's Perception of Health:
Describe your health.
Client's Perception of Illness
Describe your illness or current health problem.
Health Management and Habits
Tell me what you do when you have a health problem.
Compliance with Prescribed Medications and Treatments
Have you been able to take your prescribed medications?
If not, what caused your inability to do so?

Objective Data
Refer to General Physical Survey
Associated Nursing Diagnoses
Wellness Diagnoses
Effective Management of Therapeutic Regimen
Risk Diagnoses
Risk for Injury
Risk for Suffocation
Risk for Trauma
Actual Diagnoses
Altered Growth and Development
Ineffective Management of Therapeutic Regimen: Individual
Ineffective Management of Therapeutic Regimen: Family
Ineffective Management of Therapeutic Regimen: Community
Noncompliance.
 2. Nutritional metabolic
 Describes nutrient intake relative to metabolic need.
History (subjective data):
 Typical daily food intake?
 (Describe), use of supplements, vitamins, types of snacks?
 Typical daily fluid intake?
 (Describe) weight loss/gain? Appetite? Breastfeeding? Infant
feeding?
 Food or eating: Discomfort, swallowing difficulties, diet
restrictions, able to follow?
 Healing – any problems? Skin problems: lesions? Dryness? Dental
problems?
Examination (examples of objective data): Skin assessment,
oral mucous membranes, teeth, actual weight/height,
temperature. Abdominal assessment.
Nutritional-Metabolic Pattern
Assessing the client's nutritional-metabolic pattern is to determine the
client's dietary habits and metabolic needs. The conditions of hair,
skin, nails, teeth and mucous membranes are assessed.
Subjective Data
Dietary and Fluid Intake
Describe the type and amount of food you eat at breakfast, lunch, and
supper on an average day
Do-you take any vitamin supplements? Describe.
Do you find it difficult to tolerate certain foods? Specify.
Do you ever experience nausea and vomiting? Describe.
Do you ever experience abdominal pains? Describe
Metabolism
What would you consider to be your "ideal weight"?
Have you had any recent weight gains or losses?
Do you have any intolerance to heat or cold?
Have you noted any changes in your eating or drinking habits?
Explain.
Have you noticed any voice changes?

Objective Data
Assess the client's temperature, pulse, respirations, and height and
weight.
Wellness Diagnoses
0pportunity to enhance nutritional metabolic pattern

Opportunity to enhance effective breastfeeding

Opportunity to enhance skin integrity

Risk Diagnoses
Risk for Altered Body Temperature
Hypothermia

Risk for Infection

Risk for altered nutrition less than body requirements .

Risk for Aspiration
Actual Diagnoses
Fluid Volume Deficit
Fluid Volume Excess
Altered Nutrition: Less than body requirements
Altered Nutrition: More than body requirements
Ineffective Breastfeeding
Altered Oral Mucous Membrane
Impaired Skin Integrity.
 3. Elimination
 Describes the function of the bowel, bladder and skin.
 Through this pattern the nurse is able to determine regularity,
quality, and quantity of stool and urine.
 Excretion patterns and problems need to be evaluated
(constipation, incontinence, diarrhea)
History (subjective data): Bowel elimination pattern
(describe) Frequency, character, discomfort, problem with
bowel control, use of laxatives (i.e. type, frequency), etc.?
Urinary elimination pattern (describe) Frequency, problem
with bladder control? Excess perspiration? Odor problems?
Examination (examples of objective data): If indicated,
examine excretions or drainage for characteristics, colour, and
consistency. Abdominal assessment.
Elimination Pattern

Adequacy of the client's bowel and bladder.

The client's bowel and urinary habits.

Bowel or urinary problems

Use of urinary or bowel elimination devices.

 Subjective Data

Bowel Habits
How frequent are your bowel movements?

Do you use laxatives? What kind and how often do you use them?

Do you use enemas or suppositories? How often and what kind?

Do you have any discomfort with your bowel movements?

Describe.
Bladder Habits
How frequently do you urinate?
What is the amount and color of your urine?
Do you have any of the following problems with urinating:
✓ Pain? Blood in urine? Difficulty starting a stream? Incontinence?
Voiding frequently at night? Voiding frequently during day?
Bladder infections?
✓ Have you ever had a urinary catheter? Describe. When? How
long?

Objective Data
Refer to abdominal assessment, and the rectal assessment.
Associated nursing-Diagnoses

Wellness Diagnoses

Opportunity to enhance adequate bowel elimination pattern

Opportunity to enhance adequate urinary elimination pattern

Risk Diagnoses

Risk for constipation

Risk for altered urinary elimination

Actual Diagnoses
Altered Bowel Elimination Constipation

Diarrhea

Bowel Incontinence

Altered Urinary Elimination Patterns of Urinary Retention

Total Incontinence

Stress Incontinence
 4. Activity exercise
 This pattern centers on activity level, exercise program, and
leisure activities.
History (subjective data): Sufficient energy for desired and/or
required activities? Exercise pattern? Type? regularity? Spare time
(leisure) activities? Child-play activities? Perceived ability for
feeding, grooming, bathing, general mobility, toileting, home
maintenance, bed mobility, dressing and shopping?
Examination (examples of objective data): Demonstrate
ability for above criteria. Gait. Posture. Absent body part. Range
of motion (ROM) joints. Hand grip - can pick up pencil?
Respiration. Blood pressure. General appearance.
Musculoskeletal, cardiac and respiratory assessments.
Activity-Exercise Pattern

Activities of daily living, including routines of exercise, leisure, and

recreation.

Activities necessary for personal hygiene, cooking, shopping, eating,

maintaining the home, and working.

An assessment is made of any factors that affect or interfere with the

client's routine activities of daily living.
Subjective Data
Describe your activities on a normal day. (Including hygiene activities,
eating activities.)
Do you have difficulty with any of these self-care activities? Explain.
Does anyone help you with these activities? How?
Do you use any special devices to help you with your activities?
Does your current physical health affect any of these activities e.g. dyspnea,
shortness of breath, palpations, chest pain. pain, stiffness, weakness)?
Explain.

Occupational Activities
Describe what you do to make a living.
Do you feel it has affected your health?
How has your health affected your ability to work?
Objective Data
Refer to Thoracic and Lung Assessment
Cardiac Assessment
PeripheralVascular Assessment
Musculoskeletal Assessment.
Associated Nursing Diagnoses
Wellness Diagnoses
Opportunity to enhance effective cardiac output
Opportunity to enhance effective self-care activities
Opportunity to enhance adequate tissue perfusion Opportunity to
enhance effective breathing pattern
Risk Diagnoses
Risk for Disorganized Infant Behavior
Risk for Peripheral Neurovascular Dysfunction
Risk for altered respiratory function
Actual Diagnoses
Activity Intolerance
Impaired Gas Exchange
Ineffective Airway Clearance
Ineffective Breathing Pattern
Disuse syndrome
Impaired Physical Mobility
Inability to Sustain Spontaneous Ventilation
Altered Tissue Perfusion
 5. Sleep rest

 Assesses sleep and rest patterns.

History (subjective data): Generally rested and ready for
activity after sleep? Sleep onset problems? Aids? Dreams
(nightmares), early awakening? Rest / relaxation periods? Sleep
routine? Sleep apnea symptoms?
Examination (examples of objective data): Observe sleep
pattern and rest pattern.
 6. Cognitive-perceptual
 Assesses the ability of the individual to understand and follow
directions, retain information, make decisions, and solve
problems. Also assesses the five senses.
History (subjective data): Hearing difficulty? Hearing aid?
Vision? Wears glasses? Last checked? When last changed? Any
change in memory? Concentration? Important decisions
easy/difficult to make? Easiest way for you to learn things? Any
difficulty? Any discomfort? Pain?
Examination (examples of objective data): Orientation.
Hears whispers? Reads newsprint? Grasps ideas and questions?
Language spoken. Vocabulary level. Attention span.
Sensory-Perceptual Pattern
Subjective Data
Describe your ability to see, hear, feel, taste, and smell.
Describe any difficulty you have with your vision, hearing, and ability
to feel (e.g., touch, pain, heat, cold), taste (salty, sweet, bitter, sour),
or smell.
Pain Assessment
Complete Symptom Analysis
Special Aids:
What devices (e.g., glasses, contact lenses, hearing aids)
Describe any medications you take to help you with these problems.
Objective Data
Refer to the section on Nose and Sinus Assessment, Eye Assessment,
and Ear Assessment.
Associated Nursing Diagnoses
Wellness Diagnosis:
Opportunity to enhance comfort level
Risk Diagnoses
Risk for pain
Actual Diagnoses
Pain
 Cognitive Pattern
Subjective Data
Ability to Understand:
Explain what your doctor has told you about your health.
Ability to Communicate:
Can you tell me how you feel about your current state of health?
Ability to Remember:
Are you able to remember recent events and events of long ago?
Explain.
Ability to Make Decisions:
Describe how you feel when faced with a decision.
Objective Data
Refer to the Mental Status Assessment

Associated nursing Diagnoses

Wellness Diagnosis: Opportunity to enhance cognition

Risk Diagnosis: Risk for altered thought processes

Actual Diagnoses:
Acute confusion
Chronic Confusion
Knowledge Deficit (Specify)
Impaired Memory
7. Self perception/self concept

 History (subjective data): How do you describe yourself?

Most of the time, feel good (or not so good) about self? Changes
in body or things you can do? Problems for you? Changes in the
way you feel about self or body (generally or since illness
started)? Things that frequently make you angry? Annoyed?
Fearful? Anxious? Depressed? Not able to control things? What
helps? Ever feel you lose hope?
 Examination (examples of objective data): Eye contact.
Attention span (distraction?). Voice and speech pattern. Body
posture. Client nervous (5) or relaxed (1) (rate scale 1-5) Client
assertive (5) or passive (1) (rate scale 1-5)
 8. Role relationship

History (subjective data): Live alone? Family? Family structure?

Any family problems you have difficulty handling
(nuclear/extended family)? Family or others depend on you for
things? How well are you managing? If appropriate – How
families/others feel about your illness? Problems with children?
Belong to social groups? Close friends? Feel lonely? (Frequency)
Things generally go well at work / school? If appropriate –
income sufficient for needs? Feel part of (or isolated in) your
neighborhood?
Examination (examples of objective data): Interaction with
family members or others if present.
 Role-Relationship Pattern
Subjective Data

Perception of Major Roles and Responsibilities in Family

Describe your family.
Are there any major problems now?
Perception of Major Roles and Responsibilities at Work
Describe your occupation.
What is your major responsibility at work?
Perception of Major Social Roles and Responsibilities
Describe your neighborhood and the community in which you live.
Objective Data
1. Outline a family genogram for your client.
2. Observe your client's family members.

Associated Nursing Diagnoses

Wellness Diagnoses:
Opportunity to enhance effective relationships
Opportunity to enhance effective communication
Risk Diagnoses:
High risk for Loneliness
Risk for Altered Parent/Infant/Child Attachment
Actual Diagnoses:
Impaired Verbal Communication
Impaired Social Interaction: Social Isolation
 9. Sexuality reproductive
History (subjective data): If appropriate to age and situation –
Sexual relationships satisfying? Changes? Problems? If
appropriate – Use of contraceptives? Problems? Female – when
did menstruation begin? Last menstrual period (LMP)? Any
menstrual problems? (Gravida/Para if appropriate)
Examination (examples of objective data): None unless a
problem is identified or a pelvic examination is warranted as
part of full physical assessment.
Sexuality-Reproduction Pattern

Subjective Data
1- Female
Menstrual history:

Last cycle begin?

Duration ?

Any change or abnormality ?

Describe any mood changes or discomfort before, during, or after

your cycle
Obstetric history
How many times have you been pregnant?

Describe the outcome of each of your pregnancies.

If you have children, what are the ages and sex of each?

Explain any health problems or concerns you had with each pregnancy.
If pregnant now .
Contraception
What do you or your partner do to prevent pregnancy?
Describe any discomfort or undesirable effects this method produces.

Have you had any difficulty with fertility? Explain

Special problems
Do you have or have you ever had a sexually transmitted disease?
Describe.

Describe any pain, burning, or discomfort you have while voiding.

Objective Data
Refer to Breast Assessment, d Abdominal Assessment, and urinary-
Reproductive Assessment
Associated nursing Diagnoses

Wellness Diagnosis:
Opportunity to enhance sleep
Risk Diagnosis
Risk for sleep pattern disturbance
Actual Diagnosis:
Sleep Pattern Disturbance.
 10. Coping-stress tolerance
History (subjective data): Any big changes in your life in last
year or two? Crisis? Who is most helpful in talking things over?
Available to you now? Tense or relaxed most of the time? When
tense, what helps? Use any medications, drugs, alcohol to relax?
When (if) there are big problems in your life, how do you handle
them? Most of the time, are these ways successful?
 Examination (examples of objective data): None.
 Coping-Stress Tolerance Pattern
Subjective Data
Perception of Stress and Problems in Life
Describe what you believe to be the most stressful situation in your
Life.
How has your illness affected the stress you feel?
Coping Methods and Support Systems:
What do you usually do first when faced with a problem?
What helps you to relieve stress and tension?
Do you use medication, drugs, or alcohol to help relieve stress?
Explain.
Objective Data
Refer to the Mental Status Assessment.
Associated nursing Diagnoses
Wellness Diagnoses
Opportunity to enhance effective individual coping.
Opportunity to enhance family coping
Risk Diagnoses:
Risk for self-harm
Risk for suicide
Actual Diagnoses:
Ineffective Individual Coping
Ineffective Family Coping: Disabling
11. Value-Belief Pattern

 History (subjective data): Generally get things you want

from life? Important plans for future? Religion important to
you? If appropriate - Does this help when difficulties arise? If
appropriate will being here interfere with any religious
practices?
 Value-Belief Pattern
Subjective Data
Values, Goals, and Philosophical Beliefs
Religious and Spiritual Beliefs:
Are there certain health practices or restrictions that are important
for you to follow while you are ill or hospitalized? Explain.
Objective Data
Observe religious practices
Bible , clergy
Observe client's behavior for signs of spiritual distress
Anxiety, Anger , Depression , Doubt, Hopelessness and Powerlessness
Associated Nursing Diagnoses

Wellness Diagnosis:

Potential for Enhanced Spiritual Well-Being

Risk diagnosis:

Risk for spiritual distress

Actual Diagnosis:

Spiritual disturbance (distress of the human spirit).

SUMMARY -Functional health pattern (NANDA)
1- Health Perception-Health Management Pattern
2- Nutritional—Metabolic Pattern
3- Elimination Pattern
4- Activity—Exercise Pattern
5- Sexuality—Reproduction Pattern
6- Sleep—Rest Pattern
7- Cognitive /Sensory—Perceptual Pattern
8- Role—Relationship Pattern
9- Self-Perception-Self-Concept Pattern
10- Coping-Stress Tolerance Pattern
11-Value—Belief Pattern
  Thank you

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