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Gordon's Functional Health Pattern For Adult (General)
Gordon's Functional Health Pattern For Adult (General)
________________________________________________________________________
Type:_____________Since:____________Amount of intake:______________Frequency?____________
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MANUAL OF PATIENT ASSESSMENT TOOL
GORDONS FUNCTIONAL HEALTH PATTERN FOR ADULT CLIENTS
Weight/Height?________/__________ BMI:____________
Time
Food/
Drin
ks
Con
sum
ed
o Before:__________________
o Today:__________________
Favorite food:_________________________
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MANUAL OF PATIENT ASSESSMENT TOOL
GORDONS FUNCTIONAL HEALTH PATTERN FOR ADULT CLIENTS
Skin Problems:_____________________________
Skin turgor:________________
Temperature:___________Warm to touch?___________
IVF:_______________
o Before:_______________
o After:________________
Favorite Drink:________________
Elimination Pattern
Bowel Habits:
During Admission
Before Admission
* Use of enemas laxatives suppositories
Before:________BMs/Day Usual Time:_________
Before:________BMs/Day Usual Time:_________
WNL Constipation Date of Last:
WNL Constipation Date of Last:
Diarrhea Incontinence Excessive flatus ostomy
Diarrhea Incontinence Excessive flatus
Amount: Color: Odor: Self Care:
yes no
Amount: Color: Odor: Self Care:
yes no
*Bladder Habits:
*BEFORE: Frequency:
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MANUAL OF PATIENT ASSESSMENT TOOL
GORDONS FUNCTIONAL HEALTH PATTERN FOR ADULT CLIENTS
Color: Odor:
*AFTER:Frequency:
Color: Odor:
*Activity Tolerance: How much and what type of activities make you tired?
*Musculoskeletal impairment?
Cognitive/Perceptual Pattern
glaucoma
vertigo
*Pupils reaction?
*Smell:
*Taste:
Description:
Onset: Location:
Duration: Frequency:
Aggravates when?
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MANUAL OF PATIENT ASSESSMENT TOOL
GORDONS FUNCTIONAL HEALTH PATTERN FOR ADULT CLIENTS
Pain management:
*Decisions? ok abnormal
Works as a?_______________________
*how is it?
*Breastfeeding? yes no
*satisfactions/disturbances in roles/responsibilities?
*support system?
Value/Belief Pattern
Self-Concept/Perception Pattern
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MANUAL OF PATIENT ASSESSMENT TOOL
GORDONS FUNCTIONAL HEALTH PATTERN FOR ADULT CLIENTS
*Strengths:
*Weaknesses:
*Eye contact:
*Grooming:
Work/school?
regular irregular
History of miscarriage:
*Family planning?
How handle:
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MANUAL OF PATIENT ASSESSMENT TOOL
GORDONS FUNCTIONAL HEALTH PATTERN FOR ADULT CLIENTS
Withdraws from the situation Go for walk/ exercise finds solution Pray Laughs
Support system:___________________________
# of hours:________ # of hours:________
Cause:______________
Sleeping Aids?_____________________Others:__________________
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MANUAL OF PATIENT ASSESSMENT TOOL