Gordon's 11 Functional Health

Patterns
• Marjorie Gordon (1987) proposed functional
health patterns as a guide for establishing a
comprehensive nursing data base. These 11
categories make possible a systematic and
standardized approach to data collection,
and enable the nurse to determine the
following aspects of health and human
function:
Gordon's 11 Functional Health
Patterns
1. Health Perception and Health Management.
2. Nutrition and Metabolism
3. Elimination
4. Activity and Exercise.
5. Cognition and Perception.
6. Sleep and Rest.
7. Self-Perception and Self-Concept.
8. Roles and Relationships.
9. Sexuality and Reproduction.
10. Coping and Stress Tolerance.
11. Values and Belief.
HEALTH PERCEPTION &
MANAGEMENT
Describes the client’s perceived
health & well being and how health
is managed.
•History (subjective data):
•Client’s general health?
•Any colds in past year?
•If appropriate: 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?
•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 appropriate) What do you think caused current illness?
•What actions have you taken since symptoms started?
•Have your actions helped?
•(If appropriate) What things are most important to your health?
•How can we be most helpful? done exercise every what?

HEALTH PERCEPTION & MANAGEMENT

This pattern describes food and
fluid consumption relative to
metabolic need & pattern
indicators of local nutrient supply.

NUTRITIONAL/ METABOLIC
History (subjective data):

• Typical daily food intake including snacks?

• Use of supplements, vitamins?
• Typical daily fluid intake?
• Weight loss/gain? Height 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
DIET RECALL

M T W TH F SA SU

Breakfast
(include time of meal)

Snack

Lunch

Snack

Dinner

Snack
ELIMINATION

Describes the pattern of

excretory function (bowel,
bladder, skin).
ELIMINATION
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? Odour problems? Body cavity
drainage, suction, etc.?

Examination (examples of objective data):

• If indicated, examine excretions or drainage for
characteristics, colour, and consistency. Abdominal
assessment.
ACTIVITY/ EXERCISE

This pattern describes activity

level, exercise program, and
leisure activities.
ACTIVITY/ EXERCISE
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 the following 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.
MONDAY, NOV. 7 ACTIVITIES

5:00 am Woke up

5:30 am Ate Breakfast

6:00 am Took a bath

6:30 am Dress up for school

7:00 am Walked to school

7:45 am Reached school

Etc.

Until sleeping time

ACTIVITY DIARY/RECALL
SLEEP/REST

Describes patterns of sleep, rest,

and relaxation.
SLEEP/REST

History (subjective data):

• Generally rested and ready for activity after sleep?
• Sleep onset problems? Aids? Dreams (nightmares),
early awakening?
• Rest / relaxation periods?

Examination (examples of objective data):

• Observe sleep pattern and rest pattern if applicable
• Dark circles around the eyes, eye bags, yawning,
inability to concentrate, etc.
M T W TH F SA SU

Time went to bed

Approximate time fell asleep

Wake up period/ sleep interruptions (how

long)
Time woke up the next morning

Feeling after waking up

Naps(time slept & woke up; duration)

Activities done before bedtime

Bedtime rituals

SLEEP DIARY
COGNITIVE/PERCEPTUAL

Describes the ability of the

individual to understand and
follow directions, retain
information, make decisions,
and solve problems. Also
assesses the five senses.
COGNITIVE/PERCEPTUAL
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? COLDSPA C - Character O - Onset L - Location
D - Duration S – Severity P - Pattern A - Associated factors (Weber,
2003)

Examination (examples of objective data):

• Orientation.
• Hears whispers? Reads newsprint?
• Grasps ideas and questions (abstract, concrete)?
• Language spoken. Vocabulary level.
• Attention span.
SELF PERCEPTION/SELF CONCEPT

Describes client’s self-worth,

comfort, body image, feeling
state.
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 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)
ROLES/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.
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 (advanced nursing skill).
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?
VALUE/BELIEF PATTERN

Describes the patterns of values,

beliefs (including spiritual), and
goals that guides the client’s
choices or decisions.
VALUE/BELIEF PATTERN
History (subjective data):
• Generally get things you want from life?
• Important plans for future?
• 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?
COMPLETE HEALTH
HISTORY
- Provides foundation for identifying
health problems and provides a focus for
the physical assessment

-should begin with an explanation to the

client of why the information is being
requested.
8 Sections of a Complete Health History
• Biographical data
• Reasons for seeking health care (Chief Complaint)
• History of present health concern
• Past health history
• Family health history
• Review of systems for current health problems
• Lifestyle and practices profile
• Developmental level
1. BIOGRAPHICAL DATA

• Includes information that identifies the client and

who provided the information.
• INITIALS (not name) are used when STUDENTS
ARE COLLECTING the information and sharing
it with the instructors. Address and contact no.
should be deleted.
• CLIENT- primary source of data and all others
are secondary
BIOGRAPHICAL DATA
NAME
ADDRESS
PHONE NUMBER
GENDER
PROVIDER OF HISTORY ( PATIENT OR OTHER)
BIRTH DATE
PLACE OF BIRTH
RACE OR ETHNIC BACKGROUND
PRIMARY AND SECONDARY LANGUAGE/DIALECT
MARITAS STATUS
RELIGIOUS OR SPIRITUAL PRACTICES/ RELIGION
EDUCATIONAL LEVEL
OCCUPATION
SIGNIFICANT OTHERS OR SUPPORT PERSON (AVAILABILITY
2. REASON(S) FOR SEEKING HEALTH CARE

INCLUDES 2 QUESTIONS:

1. “What is your major health problem or

concerns at this time?”
-also known as client’s chief
complaints( CC)
“What is your major health problem or
concerns at this time?”

• Assist the client to focus on his most significant concern

• Other questions like, “ Why are you here?” and “How

can I help you?” can also be asked

– Reminder: use holistic approach in phrasing

questions, draw out concerns that are beyond
just a physical complaint and address other
associated factors like stress or lifestyle changes
2. REASON(S) FOR SEEKING HEALTH CARE

INCLUDES 2 QUESTIONS:
2. How do you feel about having to seek
health care?
-encourages the client to discuss
fears or other feelings /past experiences
about having to see a health care
provider.
3. HISTORY OF PRESENT HEALTH CONCERN

• includes questions that provide detailed

descriptions of the client’s present health
problem
Encourage the client to explain:
• health problem or symptom in as much detail as
possible focusing on onset, progression and duration
• signs and symptoms and related problems
• what the client perceives as causing the
problem/symptom
• what makes the problem worse
• what makes the problem better
• which treatments have been tried
• what effect the problem has had on daily life
• what is the client’s ability to provide self-care
TIP: USE MNEMONICS

• To gather a comprehensive history of

present concern as a nurse you may use
the following mnemonic to organize data:

• PQRST or COLDSPA
Character (how does it feel, look, smell, sound?)
Onset (When did it begin: is it better, worse, or same
since it began?)
Location/radiation (Where is it? Does it radiate?)
Duration (How long it lasts? Does it recur?)
Severity (use rating scale)
Pattern (What makes it better, worse?)
Associated factors (What other symptoms do you have
with it? Will you be able to continue doing your work or
other activities ?)
Precipitating factors (What brought
about the pain? What do you do to be
relieved?)
Quality/character (What the pain feels
like? Piercing? Scalding? Crushing?
Unbearable? Killing? Intense?, How
does it look like?)
Region/Radiation (Where do you feel the
pain?)
Severity (Use rating scale 0-10/ 1-10)
Time/duration ( How long it lasts?)
4. PAST HEALTH HISTORY
• elicit data related to the client’s strengths and
weaknesses in his health history
– Adult illneses: Physical, social, emotional or
spiritual
• may also include trends of unhealthy behaviors
– Vices or lack of physical activity
• data obtained in this section aids the nurse to
identify risk factors that stem from previous health
problems (risk factors may be to the client or
significant others)
Past Health History
includes questions about...
• birth, growth and development
• childhood diseases
• immunizations to date
• Allergies (food, medicine, pollens others)
• Use of prescription and OTC medications
• previous health problems
• hospitalizations and surgeries
• Pregnancies/ births (if applicable)
• previous accidents and injuries
• pain experiences
• emotional or psychological problems
5. FAMILY HEALTH HISTORY

• focuses on health problems that seem to run in

families or those that are genetically based
• should include as many genetic relatives as the
client can recall
• include maternal and paternal grandparents,
aunts and uncles on both sides, parents,
siblings and the client’s children
FAMILY HEALTH HISTORY
• drawing a genogram helps to organize and illustrate the
client’s family history
• use a standard format
• provide a key for the entries
– female relatives: circle
– male relatives: square
– deceased relative: marking an X in the circle or square and listing
the age at death
– cause of death noted inside a parenthesis e.g. (heart failure )
– AW (Alive and well) should be placed next to the age
– Straight or vertical lines to denote relationship
– Horizontal doted line to indicate client’s spouse
– Vertical dotted line to indicate adoption
6. LIFESTYLE AND HEALTH PRACTICES

- Describe how they are managing

their lives, their awareness of
healthy versus toxic living
patterns
- Elicits data in the client related to
his strengths and weaknesses
Questions:

1. Description of typical day – usual pattern of daily living

2. Nutrition and weight management- recall 24 hour intake
3. Activity Level and exercise
4. Sleep and rest
5. Substance abuse
6. Self concept and self care responsibilities
7. Social Activities –det. social dev.
8. Relationships-composition of family
9. Value and belief system
[Link] and work
[Link] level and coping styles
[Link]
7. DEVELOPMENTAL LEVEL

-Focuses on growth and development of

an individual throughout the lifespan

- Freuds theory of psychosexual devt

- Erik eriksons psychosocial devt
- Piaget theory of cognitive devt
- Kholberg theory of moral devt
8. REVIEW OF SYSTEMS (SYMPTOMS)
/FOR CURRENT HEALTH PROBLEM
Functional Assessment of Newborns, Infants
& Children, Adults/Elderly

• Newborn (APGAR Scoring & anthropometric

measurements)
• Infants & Children (MMDST & some major
developmental milestones)
• Adults/Elderly (PADC, Lawton Scale for IADL,
KATZ index of independence on ADL, Barthel
Index)
Initial Newborn Assessment...Apgar
Scoring
• provides numeric indicator of newborn’s physiologic
capacity to adapt to extra-uterine life
• assessed at 1 and at 5 minutes after delivery
• each of the five aspects is assigned a maximum score of
2
• maximum achievable total score is 10
• score under 7 suggests that the baby is having difficulty
• score under 4 indicates that the baby’s condition is
critical
• those with very low scores require special resuscitative
measures and care
Initial Newborn Assessment...Apgar Scoring
Sign Score: 0 Score: 1 Score: 2

Heart Rate absent slow (below over 100/min

100/min)
Respiration absent slow, irregular, regular rate,
hypoventilation good lusty cry
Muscle Tone flaccid some flexion of active
extremities movements/flexi
on
Reflex Irritability no response crying, some crying, coughing
motion/grimace
Color Blue (cyanotic), pink body, blue pink body, pink
pale hands & feet extremities
Initial Newborn Assessment...Anthropometric
Measurements

• weight
• length
• head and chest circumference
Newborn’s Anthropometric
Measurements...weight
• at birth most babies weigh from 2.7 to 3.8 kg (Kozier et
al)...2500 to 4000 g (Weber & Kelly)
• just after birth, newborns lose 5% to 10% of their birth
weight because of fluid loss (normal)
• regains birth weight in about 1 week
• at 5 to 6 months, infants usually reach twice their birth
weight
• by age 12 months, infants weight is usually 3 times their
birth weight
• weigh the newborn unclothed using a newborn scale
Newborn’s Anthropometric
Measurements...length

• average length varies

• female babies are usually smaller in length than
male babies
• rate of increase in height/length is largely
influenced by the baby’s size at birth and by
nutrition
• measure the newborn from head-to-heel (from
the top of the head to the base of the heels)

55
Newborn’s Anthropometric
Measurements...head & chest circumference
• normal head circumference (normocephaly) should be assessed in
relation to chest circumference
• chest circumference of the newborn is usually less than the head
circumference by about 2.5 cm (1 in)
• as the infant grows, chest circumference becomes larger than the
head circumference
• at about 9 or 10 months, head and chest circumferences are almost
the same
• after 1 year of age, chest circumference is larger
• a newborn’s head circumference is measured around the skull
above the eyebrows
• measure chest circumference by placing tape measure at nipple line
and wrap it around the newborn
Developmental Screening Test

57
Developmental Assessment of Infants
and Children...MMDST

• adopted from Denver Developmental Screening

Test (DDST)
• a screening tool to identify developmental delays
among children from birth to 6 years of age
• intended to estimate the abilities of a child
compared to those of an average group of
children of the same age
• not a test of intelligence
Developmental Assessment of Infants
and Children...MMDST

•four main areas of development are screened:

1. personal-social
2. fine-motor adaptive
3. language
4. gross motor
Developmental Assessment of Infants and
Children...MMDST
• personal-social – tasks which indicate the child’s
ability to get along with people and to take care of
himself
• fine motor adaptive – tasks which indicate the
child’s ability to see and use his hands to pick up
objects and to draw
• Language – tasks which indicate the child’s ability
to hear, follow directions and to speak
• Gross motor – tasks which indicate the child’s
ability to sit, walk and jump
Assessment of an Elderly Client

• differentiate findings that result from the usual

“wear and tear”/degenerative processes and
those that indicate pathologic process

• “frail elderly”– vulnerability of aged people to be

in poorer health, to have more chronic
disabilities and to function less independently
Assessment of an Elderly Client

• symptoms of a disease may be more subtle in

advanced age
• changes in functional abilities may herald the
occurrence of a potential health problem
• recognizing changes in functional ability is often
crucial for prompt and accurate management of
both acute and chronic illness in an elderly
Assessment of an Elderly Client

• geriatric syndromes – the unique way in which a

disease presents in a frail elderly. These syndromes
include:
• sleep disorders
• problems with eating or feeding
• incontinence (bladder and bowel)
• confusion
• evidence of falls
• skin breakdown
Determining Functional Status of an Elderly

• functional assessment – an evaluation of the

person’s ability to carry out the basic self-care
activities of daily living (ADLs) such as bathing,
eating, grooming and toileting
• functional assessment also includes those activities
necessary for well-being and survival as an
individual in a society (instrumental activities of
daily living
Determining Functional Status of an
Elderly

• Instrumental Activities of Daily Living (IADL) –

focus primarily on household chores, mobility-
related activities (ex. shopping and
transportation) and cognitive abilities (ex. money
management, making decisions affecting basic
safety and social needs) )...see display 30-8 on
page 820 of your book by Weber & Kelly
Determining Functional Status of an
Elderly

• Katz Activities of Daily Living – a commonly

used tool for measuring the ability to perform
basic personal tools such as bathing, dressing,
toileting, transferring and eating...see display 30-7
on page 819 of your book by Weber & Kelly
Goal of Elderly Assessment

• the ultimate goal of elderly assessment and

intervention should be to empower clients to
maintain the relationships, activities and events that
elderly clients find meaningful

• elderly assessment may not be focused on disease

prevention as it is on minimizing the disability
associated with chronic illness and preventing
complications and exacerbations of chronic
maladies