Gordons 11 Functional Health Patterns Assessment Questions

1.

Health Perception-Health Management Patterna.

In general, how is the familys

health?b.

What do you do to stay healthy? Do you drink alcohol or use tobacco products?c.

Do you have regular check-ups with your physician and/or specialists

(Pediatrician,Ob/Gyn, Cardiologist, etc.)? Do you listen to and follow any suggestions
made by yourhealth care providers?2.

Nutritional-Metabolic Patterna.

Describe your

Familys

typical daily food intake? Do you consider your family healthyeaters?b.

Describe your

familys

typical daily fluid intake? Do you drink alcohol?c.

Does anyone consider themself over or under weight? Is there any unexplained
weightgain or loss?3.
Elimination Patterna.

Describe you

r familys

regular bowel elimination pattern? Frequency? Character?Discomfort? Difficulty?b.

Describe you

r familys

regular urinary elimination pattern? Frequency? Discomfort?Problems with control?

4.

Activity-Exercise Patterna.

Do you exercise? What type? How often? If not, why?b.

What do you like to do in your spare time? What sports do you participate in?5.

Sleep-Rest Patterna.

Do you feel that you are generally well rested and able to perform your daily
activities?b.

How well do you fall asleep? Stay asleep? Do you use any aids to help you sleep?c.

Do you awaken feeling rested and ready to take on the day?6.

Cognitive-Perceptual Patterna.

Does anyone have any difficulty hearing others?b.

Does anyone have difficulty seeing? Do you have routine eye exams?c.

How do you learn best? Preference for visual or audio aids? Do you have
difficultylearning?7.

Self-Perception

Self-Concept Patterna.

Most of the time, do you feel good about yourself?b.

Do you ever feel that you have lost hope?

8.

Roles-Relationships Patterna.

Who do you live with? Alone, family, others? What was the structure in which you
grewup?b.

Do you belong to social groups? Do you interact with others outside of work or
school?9.
Sexuality-Reproductive Patterna.

Parents: How would you describe your sexual relationship? Satisfying? Changes?
Problems?b.

Female: Describe menstruation cycle. Problems? Last menstrual period? Para?

Gravida?10.

Coping-Stress Tolerance Patterna.

Any big changes in the past year or two?b.

Who is most helpful in talking things over? Are the frequently available to you?c.

Do you use any medications, drugs, or alcohol?11.

Values-Beliefs Patterna.

Is religion important in your

familys

life? Does this help when you are faced withdifficult situations?b.

Describe your plans for the future. Do you generally get what you want from life?