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Trisha Mae Pascual Health Assessment

This document contains demographic information about Trisha Mae B. Pascual, a 22-year-old single female student from Cavite, Philippines. It also lists Gordon's 11 Functional Health Patterns that are used to assess patients. These patterns include health perception, nutritional status, elimination, activity, sleep, cognitive function, self-perception, roles/relationships, sexuality, coping, and values/beliefs. Questions are provided under each pattern to gather information from patients about their health, behaviors, relationships, and lifestyle.

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335 views4 pages

Trisha Mae Pascual Health Assessment

This document contains demographic information about Trisha Mae B. Pascual, a 22-year-old single female student from Cavite, Philippines. It also lists Gordon's 11 Functional Health Patterns that are used to assess patients. These patterns include health perception, nutritional status, elimination, activity, sleep, cognitive function, self-perception, roles/relationships, sexuality, coping, and values/beliefs. Questions are provided under each pattern to gather information from patients about their health, behaviors, relationships, and lifestyle.

Uploaded by

teuuuu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

I.

Demographic Data
a. Name: Trisha Mae B. Pascual
b. Age: 22 years old
c. Sex: Female
d. Marital Status: Single
e. Religion:
f. Occupation: Student
g. Socio-economic Status
h. Address: Bulihan, Silang, Cavite
i. Informant: Patient
j. Information

GORDON’S 11 FUNCTIONAL HEALTH PATTERNS

A. Health Perception – Health Management


 What is your opinion about health?
 Any colds in past year?
 If appropriate: any absences from work/school?
 Most important things you do to keep healthy?
 What things are most important to your health?
 Use of cigarettes, alcohol, drugs?
 Perform self-exams? (BSE)
 Accidents at home, work, school, driving?
 Last immunization?
 Do you have any allergy? If yes then type of allergy.
 Any surgery in past? What type of surgery?
 Last physical examination & for what purpose.
 Are you using any medicine recently?
 Do you know about these medicines?

B. Nutritional – Metabolic

 Typical daily food intake including snacks?


 Use of supplements, vitamins?
 Typical daily fluid intake?
 Weight loss/gain? Height loss/gain?
 Appetite?
 Food or eating: Discomfort, swallowing difficulties, diet restrictions, able to follow?
 Healing – any problems? Skin problems: lesions? Dryness? Dental problems?
 How is your skin, scalp and nails?
 Any food restriction regarding disease point of view?
 Any food restriction regarding religious point of view?
 Any food like or dislike?
 Any food allergy?
 3-day diet food recall

C. Elimination
 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?
 Color of urine, amount, frequency, odor and any discharge.
 Excess perspiration? Odor problems? Body cavity drainage, suction, etc.?

D. Activity & exercise


 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?
 Do you have any breathing problem? (eg. apnea, hypoxia, hypoxemia, hypercapnia.)
 Do you have cough? (Productive or non-productive)
 Any changes in heart beat during exercise?
 Do you feel pain during exercise?
 What type of exercise you do or any problem during exercise?
 7-day activity diary

E. Sleep & rest pattern


 Sleeping hour?
 Are you using nap (evening type sleeping)
 What do you feel after waking? (Fresh, headache, drowsy).
 Are you using any medication for sleeping?
 Do you have any exercise or walking at night?
 Generally rested and ready for activity after sleep?
 Sleep onset problems? Aids? Dreams (nightmares), early awakening?
 Rest / relaxation periods?
 Observe sleep pattern and rest pattern if applicable
 Dark circles around the eyes, eye bags, yawning, inability to concentrate, etc.

F. Cognitive/Perceptual
 Orientation about time place and person.
 Hearing difficulty? Hearing aid?
 Vision? Wears glasses? Last checked? When last changed?
 Any change in memory? Concentration?
 Any difficulty in sentence making?
 Important decisions easy/difficult to make?
 Easiest way for you to learn things? Any difficulty?
 Any discomfort? Pain?
G. Self-perception/self-concept
 Changes in the way you feel about self or body
 Things frequently make you angry? Annoyed? Fearful? Anxious? Depressed?
 Not able to control things? What helps?
 Ever feel you lose hope?
 Anong mga characterictics mo ang gusto mo sa iyong sarili?
 -Mayroon ka bang gusting baguhin sa mga ito? At ano yun?
 -Anong mga ginagawa mo kapag may problema ka?
 -Paano mo sinosolusyunan ang iyong problema?
 -Anong mga ginagawa mo kapag galit ka?

H. Roles/Relationship
 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?
 Do you feel close to your family?
 Do you have or want a relationship with a significant other?
 Are your relationships meeting your needs for companionship or intimacy?
 Can you meet your sexual needs satisfactorily?
 Have you been involved in any abusive relationships?
 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?

I. Sexuality/Reproductive
 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?

J. Coping/stress tolerance
 Any big changes in your life in last year or two? Crisis?
 If you have stress then what is your coping mechanism towards stress?
 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?

K. Value Belief Pattern


 Generally, get things you want from life?
 Important plans for future?
 What is your religion?
 Do you offer prayer?
 Religion important to you? f appropriate - Does this help when difficulties arise?
 If appropriate – will being here interfere with any religious practices?
 Health beliefs/values?

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