Health History by Gordon's Functional Health Pattern

FAR EASTERN UNIVERSTITY Institute of Nursing Associate in Health Science Education Gordon’s Functional Health Pattern lient Profile Biographical Data What is our name? Tell me about your background. When were you born? What level of education have you completed? Have you ever served in the military? Do you have a religious preference? Specify. Specify. Where do you live? What form of transportation do you use to come here or go other places? Where is the closest health care facility to you that you would go to if ill or in an emergency?

Reason for Seeking Health Care and Current Understanding of Health Eplain your ma!or reason for seeking health care. What has the doctor told you regarding your health? Do you understand your medical diagnosis? Eplain. Treatments / Medications Describe the treatments and medications you have received. How has your illness been treated in the past? What is being planned for your treatment now? Do you understand the purpose of your treatment? Have you been satisfied with past treatments? Eplain. What prescribed medications are you taking? What over"the"counter medications are you taking? Do you have any difficulties difficulties with these medications? How do they make you feel? What is the purpose of these medications? Past Illnesses / Hospitalizations Hospitalizations Tell Tell me about any past illnesses # surgeries you have had? Have you had other illnesses in the past? Specify. How were the past illnesses treated? Have you ever been in the hospital before? Where? $or what purpose? How did you feel about past hospital stays? How can we help to improve this hospital stay for you? Have you received any home health care? Eplain. How satisfied were you with this care?  Allergies  %re you allergic to to any drugs& foods& foods& or other environmental environmental substances 'eg& Dust& molds& molds& pllens& late( Describe the reaction you have when eposed to the allergen. What do you do for your allergies? !e"elo#$ental Histor% Su!ecti"e #ata Describe any physical handicaps you have. Tell Tell me about your health and growth as a child. Tell Tell me about your accomplishments in life. What are your lifelong goals? Has your illnesses interfered with these goals?

$!ecti"e data Does this client have obvious developmental lags that need further assessment? Do this client)s illnesses interfere with the ability to accomplish the necessary developmental& physical& psychosocial& and cognitive tasks re*uired at each age level for normal development? Does this client have any physical& psychosocial& or cognitive developmental lags that aggravate his or her illness or inhibit self" care? Health Perce#tion & Health 'anage$ent Pattern Client%s Perception of Health Describe your health. How would you rate you health on a scale of + to +, '+, is ecellent( now& - years ago& and - years ahead? Client%s Perception of Illness Describe your illness or current health problem. How has this affected your normal daily activities? How do you feel your current daily activities have affected your health? What do you believe caused your illness? What course do you predict your illness will take? How do you believe your illness should be treated? Do you have or anticipate any difficulties in caring for yourself or others at home? f yes& eplain. Health Management and Haits Tell me what you do when you have a health problem. When do you seek nursing or medical advice? How often do you go for professional eams 'dental& /ap smears& breast& blood pressure(? What activities do you believe keep you healthy? 0ontribute to illness? Do you perform self"eams 'blood pressure& breast& testicular(? When were your last immuni1ations? %re they up to date? Do you use alcohol& tobacco& drugs& caffeine? Describe the amount and length of time used.  %re you eposed to pollutants or toins? Describe. Compliance &ith the Prescried Medications and Treatments Have you been able to take your prescribed medications? f not& what caused your inability to do so? Have you been able to follow through with your prescribed nursing and medical treatment 'eg& diet& eercise(? f not& what caused your inability to do so? Nutritional & 'eta(olic Pattern #ietar' and (luid Intake Describe the type and amount of food you eat at breakfast& lunch& and supper on an average day. Do you attempt to follow any certain type of diet? Eplain. What time do you usually eat your meals? Do you find it difficult to eat meals on time? Eplain. What type of snacks do you eat? How often? Do you take any vitamin supplements? Describe. Do you take herbal supplements? Describe. Do you consider your diet high in fats? Sugar? Salt? Do you find it difficult to tolerate certain foods? Specify. What kind of fluids do you usually drink? How much per day? Do you have difficulty chewing or swallowing food? When was your last dental eam? What were the results? Do you ever eperience a sore throat& sore tongue& or a sore gums? Describe. Do you ever eperience nausea and vomiting? Describe. Do you ever eperience abdominal pains? Describe. Do you use antacids? How often? What kind? Condition of Skin Describe the condition of the skin.

Describe your bathing routine. Do you use sunscreens& lotions& oils? Describe. How well and how *uickly does your skin heal? Do you have any lesions? Describe. Do you have ecessively oily and dry skin? Do you have any itching? What do you do for relief? Condition of Hair and )ails Describe the condition of your hair and nails Do you use artificial nails? How long? How often? Do you had problems with these nails? Do you have ecessively oily or dr y hair? Have you had difficulty with scalp itching or sores? Do you use any special hair or scalp care products 'i.e. permanents& coloring& and straightness(? Have you noticed any changes in your nails ? 0olor? 0racking? Shape? 2ines? Metaolism What would you consider to be your ideal weight? Have you had any recent weight gain or losses? Describe. Have you used any measures to gain or lose weight? Describe. Do you have any tolerance to heat or cold? Have you noted any changes in your eating or drinking habits? Eplain. Have you noticed any voice changes? Have you had difficulty with nervousness? Eli$ination Pattern *o&el Haits Describe your bowel pattern. Have there been any recent changes? How fre*uent are your bowel movements? What is the color and consistency of your tools? Do you use laatives? What kind? How often do you use them? Do you use enemas? What kind? How often do you use them? Do you use suppositories? How often and what kind? Do you have any discomfort with your bowel movements? Describe. Have you ever had bowel surgery? What type? leostomy? 0olostomy? *ladder Haits Describe your urinary habits. How fre*uently do you urinate 'when and how many times(? What is the amount and color of your urine? Do you have any of the following problems with urinating? /ain? 3lood in urine? Difficulty starting a stream? ncontinence? 4oiding fre*uently at night? 4oiding fre*uently during the day? 3ladder infections? Have you ever had bladder surgery? Describe. Have you ever had a urinary catheter? When and how long?

Acti"it% & E)ercise Pattern  Acti"ities of #ail' +i"ing  Describe you activities on a normal day 'including hygiene activities& cooking activities& shopping& eating& house and yard activities& other self"care activities( How satisfied are you with these activities? Do you have any difficulties with any of these self"care activities? Eplain. Does anyone help you these activities? How? Do you use any special devices to help you with these activities? Does your current physical health affect any of these activities 'eg& dyspnea& shortness of breath& palpitations& chest pain& pain&

stiffness& weakness(? Eplain. +eisure Acti"ities Describe the leisure activities you en!oy. Has your health affected your ability to en!oy leisure? Eplain. Do you have time for leisure activities? Describe any habits you have. ,-ercise Routine Describe those activities that you believe give you eercise. How often are you able to do this type of eercise? Has your health interfered with your eercise? $ccupational Acti"ities Describe what you do to make a living. How satisfied are you with this !ob? Do you believe it has affected you health? f yes& how? How has your health affected your ability to work? Se)ualit%* Re#roduction Pattern Fe$ale Menstrual histor'  How old were you when you began menstruating? 5n what date did your last cycle begin? How many days does your cycle normally last? How many days elapse from t6he beginning of one cycle until the beginning of another? Have you noticed any change in your menstrual cycle? Have you noticed any bleeding between your menstrual cycles? Do you eperience episodes of chilling& flushing& or intolerance to temperature changes? Describe any mood changes before& during& and after your menstrual cycle. What was the date of your last /ap smear? 7esults? $stetric histor'  How many times have you been pregnant? Describe the outcomes of each of your pregnancy. f you have children& what are the age and se of each? Describe your feelings with each pregnancy. Eplain any health problems or concerns with each pregnancy. If pregnant no&. Was this planned or unepected pregnancy? Describe your feelings about his pregnancy. What changes in your lifestyle do you anticipate with this pregnancy? Describe any difficulties or discomforts you have had with this pregnancy. How can  help you meet your needs during this pregnancy? 'ale or fe$ale Contraception What do you or your partner do to prevent pregnancy? How acceptable is this method to both of you? Do this means of birth control affect your en!oyment of seual relations? Describe any discomfort or undesirable effects this method produces. Have you had any difficulty with fertility? Eplain. Perception of Se-ual Acti"ities Describe you seual feelings. How comfortable are you with your feelings of masculinity or femininity? Describe your level of satisfaction from seual relationship's( on scale of + to +, 'with +, being very satisfying( Eplain any changes in your seual relationship's( that you would like to make. Describe any pain or discomfort you have during intercourse.

Have you 'your partner( eperienced any difficulty achieving an orgasm or maintaining an erection? f so& how has this affected your relationship? Concerns Related to Illness How has your illness affected your seual relationship? How comfortable are you discussing seual problems with your partner? $or whom would you seek help for seual concerns? Special Prolems Do you have or have you ever had a seually transmitted disease? Describe. What method do you use in contracting a seually transmitted disease? Describe any pain& discomfort& or burning you have while voiding. Describe any charge or unusual odor you have from your penis#vagina. Histor' of Se-ual Ause Describe the time and place the incident occurred. Eplain the type of seual contact that occurred. Describe the person who assaulted you. dentify any witness present. Describe your feelings about this incident. Have you had any difficulty in sleeping& eating& or working since the incident occurred? Slee# & Rest Pattern Sleep Haits Describe your unusual sleeping time and habits 'ie& reading& warm milk& medications& etc.( at home. How long does it take you to fall asleep? f you awaken& how long does it take you to fall asleep again? Do you use anything to help you fall asleep 'ie& medication& reading& eating( How would you rate the *uality of your sleep? Special Prolems Do you ever eperience difficulty with falling asleep? 7emaining asleep? Do you ever feel fatigued after a sleep period? Has your current health altered your normal sleep habits? Eplain. Do you feel your sleep habits have contributed to your current illness? Eplain. Sleep Aids What helps you fall asleep? 8edications? 7eading? 7elaation techni*ues? Watching T4? 2istening to music? Sensor%*Perce#tual Pattern Perception of Senses Describe your ability to see& hear& taste& feel& and smell. Describe any difficulty you have with your vision& hearing& ability to feel 'i.e. touch& pain& heat& cold(& taste ' i.e. salty& sweet& bitter& sour(& or smell Pain Assessment  Describe any pain you have now. What brings it on? What relieves it? When does it occur? How often? How long does it last? What else do you feel when you have this pain? Show me on this drawing on a scale of + to +,& with +, being the most severe pain. 'Have a child use an 5ucher Scale& with faces ranging from frowning to crying.( How has your pain affected your activities of daily living?

Special Aids What devices 'i.e. glasses& contact lenses& hearing aids( or methods do you use to help you with any of these problems? Describe any medications you take to help you with these problems. ogniti"e Pattern  Ailit' to Understand  Eplain what your doctor has told you about your health#  %re you satisfied with your understanding of your illness and prescribed care? Eplain. What is the best way for you to learn something new 'read& watch& television& etc(?  Ailit' to Communicate 0an you tell me how you feel about your current state of health?  %re you able to ask *uestions about your treatments& medications& and so forth? Do you ever have difficulty epressing yourself or eplaining things to others? Eplain.  Ailit' to Rememer   %re you able to remember recent events and events of long ago? Eplain.  Ailit' to Make #ecisions Describe how you feel when faced with a decision. What assists you in making decisions? Do you find decisions making difficult& fairly easy& or variable? Describe. Self&Perce#tion & Self*once#t Pattern Perception Identit'  Describe yourself. Has your illness affected how you describe yourself? Perception of Ailities and Self0orth What do you consider to be your strength? Weaknesses? How do you feel about yourself? How does the family feel about you and your illness? *od' Image How do you feel about your appearance? Has this changed since your illness? Eplain. How do you feel about other people with disabilities? Role*Relationshi# Pattern Perception of Ma!or Roles and Responsiilities in the (amil'  Describe your family. Do you live with your family? %lone? How does your family get along? Who makes the ma!or decisions in your family? Who is the main financial supporter in your family? How do you feel about your family? What is your role in the family? s this an important role? What is your ma!or responsibility in the family? How do feel about this responsibility? How does your family deal with problems?  %re there any ma!or problems now? Who is the person you feel closest to in your family? Eplain. How is your family coping with your current state of health? Perception of Ma!or Roles and Responsiilities at 0ork  Describe your occupation What is your ma!or responsibility at work? How do you feel about the people you work with? f you could& what would you change about your work?  %re there any ma!or problems you have at work? f yes& eplain.

Perception of Ma!or Social Roles and Responsiilities Who is the most important person in your life? Eplain. Describe your neighborhood and the community in which you live. How do you feel about the people in your community? Do you participate in an y social groups or neighborhood activities? f yes& describe. What do you see as your contributions to society? f you could& what would you change about your community? o#ing*Stress Tolerance Pattern Perception of Stress and Prolems in +ife Describe what you believe to be the most stressful situation in your life. How has your illness affected the stress you feel? 5r how do you feel stress has affected your illness? Has there been a personal loss or ma!or change in your life over the last year? Eplain. What has helped you to cope with this change or loss? Coping Methods and Support S'stems What do you usually do first when faced with a problem? What helps you to relieve stress and tension? To whom do you usually turn when you have a problem or feel under pressure? how do you usually deal with problems? Do you use medications& drugs& or alcohol to help relieve stress? Eplain. VA+UE*,E+IEF PATTERN 1alues2 3oals2 and Philosophical *eliefs What is most important to you in life? What do you hope to accomplish in your life? What is the ma!or influencing factor that helps you make decisions? What is your ma!or source of hope and strength in life? Religious and Spiritual *eliefs Do you have a religious affiliation? s this important to you?  %re there certain health practices or restrictions that are important to you to follow while you are ill or hospitali1ed? Eplain. s there a significant person 'eg. minister& priest( from your religious denomination whom you want to be contacted? Would you like the hospital chaplain to visit?  %re there certain practices 'eg& prayer& reading scripture( that are important to you? s a relationship with 9od an important part of your life? Eplain. Describe any other sources of strength that are important to you. How can  help you continue with this source of spiritual strength while you are ill in the hospital?