PILAR COLLEGE OF ZAMBOANGA CITY, INC.

R.T. Lim Boulevard, Zamboanga City

Tertiary Education Department
Nursing Program

GORDON’S FUNCTIONAL HEALTH PATTERN ASSESSMENT ACTIVITY SHEET

Name of Student: Date: ____________________

Year & Section: _______________________________________ Rating: ____________________

Activity No: _________________ Remarks: __________________

Instruction: Perform a comprehensive assessment using the Gordon’s functional health pattern.
Choose a relative to act as a patient and collect the data needed. Fill out the demographic data
and the table. Analyze and based on your findings prioritize the top 3 problems of your patient.

PATIENT’S DEMOGRAPHIC DATA

A. Patient Personal Data

NAME: JOHN KENNETH RODRIGO
AGE: 23
GENDER: MALE
DATE OF BIRTH: FEB /6/1999
ADDRESS: GUIWAN AURORA VILLAGE ZAMBOANGA CITY.
EDUCATIONAL ATTAINMENT:  Bachelor of Science in Nursing
 B. Vital Signs Data
Vital Signs:
Temperature: 35.5 C
Blood pressure: 120/80 mm Hg.
Pulse rate: 87 bpm
Respiratory rate: 15
Height: 5’11
Weight: 124 lb.
Gordon’s Functional Health Pattern

1. Health Perception and Health Management (Assessment, Analysis, and Interpretation)

 PAST HEALTH HISTORY: No history of any illness.
 Patient has been immunized in covid vaccine.
 Present condition of the patient: Having trouble to focus on studies and work
overload due to heavy tasks.
 Has said that has slight of habit in alcohol consumption and smoking but not
using illegal substance nor injectable drugs.

2. Nutrition and Metabolism (Assessment, Analysis, and Interpretation)

 Patient has a well diet
 Eating 3-5 times a day excluding snacks
 Patient has allergies to crabs, chicken skin
 Have no difficulties with eating and swallowing
 Fluid intake: 3-6 liters of water per day
 Temperature: 35.5 C
 Blood pressure: 120/80 mm Hg.
 Pulse rate: 87 bpm
 Respiratory rate: 15
 Height: 5’11
 Weight: 124 lb.

3. Elimination (Assessment, Analysis, and Interpretation)

 Bowel: has regular bowel at least once daily
 Bladder: normal frequency of urination and has no problem at all

4. Activity and Exercise (Assessment, Analysis, and Interpretation)

 Patient has scheduled plan at the gym during 1-4pm at the gym
 Performs morning exercise usually jogging depends on his mood

5. Cognition and Perception (Assessment, Analysis, and Interpretation)

  Has good sensory and auditory adequacy
 has no difficult in learning
 patient do sometimes have problem in focusing things due to heavy tasks
 good memory
 family oriented

6. Sleep and Rest (Assessment, Analysis, and Interpretation)

 Has difficult in sleeping sometimes
 Never used sleeping pills
 Has 3-9 hrs. of sleeping pattern

7. Self-perception and Self-concept (Assessment, Analysis and Interpretation)

 kind person and has respect to other peoples

 shows interests on his surroundings especially his friends and family.

8. Roles and Relationships (Assessment, Analysis and Interpretation)



9. Sexuality and Reproduction (Assessment, Analysis and Interpretation)

10. Coping and Stress Tolerance (Assessment, Analysis and Interpretation)

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11. Values and Belief (Assessment, Analysis and Interpretation)
________________________________________________________________________
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C. According to your analysis, prioritize the top 3 main problems.

1.
2.
 3.

Criteria for Grading

30% - contents are clear, accurate and valid 20% - there is congruence and alignment among the components 50% - findings and rationale are
correctly identified and explained

Submitted by: ___________________________________________

Name and section

Checked by: ___________________________________________

Clinical Instructor