Assessment tool: Gordon’s Functional Health Pattern

Patient name: Abdullah MR No. 11-1455 Unit/Ward: _medical ward_

Date of Admission: March 24,2022 Age: 33 Sex: _male__

Religion: muslim Occupation/Profession: Teacher Ethnic Group: _shudar __________

Language: (1) Saraiki (2) urdu Education: _Master__________

Marital status: Married Children: N/A M: N/A F: N/A _____

Medical diagnose: ___Acute kidney failure __

Past medical history: (1) Hospitalization: ___No history of hospitalization___

(2) Surgery: _No history of Surgery____

Present complaints: _Abdominal Pain since 10 days _

Surgeries: N/A Immunization status: Fully immune _ Vital signs: BP:

___130/80 mm hg__ Pulse: 80/min__ RR: _20/min___ Temp:

_98F◦__________

1. Health perception Health management pattern:

Patient views about his health, illness and management: ___Patient knows that he is suffering from
disease under going treatment_______

Patient’s knowledge about his/her disease and prevention: __Patient have no definite knowledge
about his disease__

Current medication:

Drug Route Dose Indications

Loop diuretics I/V 60 mg Treatment of fluid over bad
every 24
hour
Cortisteriod P/N 0.5mg Reduce inflammation
Potassium binder P/O 15mg For muscle twitching

Over the counter drugs: ___nill____

Allergies: Food Drug: N/A Others: _ N/A_____

Nursing Diagnose: Deficient knowledge related to lack of exposure as evidenced by request for
information.

2. Nutrition pattern:
Number of meals per day: 1_______________

Foodpreferences:1) Like: __Vegetable ___2) Dislike meat _______

Amount of fluid per day _2000 ml__ Route: 1) IV: 500ml _ 2) Oral: _1500ml _____

Tube feeding (explain):_____N/A____ Any dietary restriction: ____Nill_______________

Skin turgor:____Normal___ Color: ___Black ___Texture: _Bloated ___Edema: ___yes __

Hair: ____Straight___Color:____Black___ Texture: __wary____Distribution:___Disperse___ Scalp:

_Dry___

Oral mucous membrane: _Wet _____ Gums: _intact________No. of teeth: 32 _ Alignment:

____Normal_______Dentures: /__ Height:___180cm___ Weight: __175lbs_______

Labs: Hb: 105g/L Hct: __0.13 vol%____WBC: __6000______ESR___-0.31________ Platelets:

__130×10 g/L_____

PT: _____13.4______APTT: ______21.6_____INR: ___2.1___Albumin: __286_____Na: _135_______

K:____4.6______ Ca: ______0.6____Mg: _____3.2_______ Others: _______/________

T4: _____/________

Nursing Diagnosis:_ _Risk for imbalanced nutrition related to dietary restriction as evidenced by weight
loss

3. Elimination Pattern

Urine frequency in 24 hours: __4 time____

Self-voiding/catheterized: self ____ Color: _amber______Amount: __1000 ml/day_______Odor:

__________________

Any pain/discomfort: ______N/A______________Any problem with bladder: _N/A____

Control: retention/incontinence: ______normal_____________________________

Stool: Color: ___brown____Texture: ___hard________Stool/24hours: ___3 times/week______ Odor:

_________
Characteristics: ____/_____Amount: ____/________

Any laxatives used: __Lactoluse_____Any problem with bowel control: __No________ Ostomy:
___no__

Abdomen assessment: Inspection: ______N/A__________Auscultation: ___N/A______________

Percussion:
__________Palpation: __N/A________ Liver: _____N/A________Kidney: ___N/A______

Nursing Diagnose:___Nill ___

4. Activity/Exercise pattern:

Lifestyle: __sedentry______Breathlessness: _no______Cyanosis: __No____Chest shape: _Normal_____

Palpitations: Tactile fremitus: __normal______Respiratory expansion: __3cm______ Percussion:

___resonant______ Diaphragmatic excursion: _2cm____Breath sounds: _normal___

Adventitious sounds: ___/___ Cough (Dry/productive): _No___If productive: Color: _/_____

Odor: __/______ Characteristics: _/___Amount: __/___

SOB: no___O2/min: __/___Via:__/__ Suction (type): __/__

Chest tubes: _/___Inhalation therapy: _/___

Nursing diagnoses: ___No diagnose _______

Circulation:

BP: _130/80 mm hg__________Pulse rate/min: __85________Rhythm:___Normal____

Amplitude: ___/_______________JVP: _____/_____Peripheral pulses: ___/______

Edema: ___/________Varicose veins: ___/________

Peripheral cramps: _____/_________Capillary refill: ______/__________

Extremities: Color: ____/_____ Temperature: _____/______Heart sounds: __Lubb dubb___

Murmurs: ____Nol_____EKG monitor: ________/________________________

Nursing diagnoses: _________No diagnose____________________________________

5. Cognitive perceptual pattern:

Level of consciousness: ____fully concious______Orientation: __√___time____√____ place ______

Persons: _____/_________If unconscious GCS: ___/________Any speech difficulty: /_________

Memory: Recent: _√____Remote: ______√___________

Vision: ___6/6___Glasses: __no___Hearing: _√_____Pain: __√_____Characteristics: _acute___Onset:

_sudden____

Location: __left lower Quadrant_____Duration: ___frequently___Exacerbation: _______ Radiation:

Relieving factor:_______ Associated factor: ____________

Nursing diagnose ____ Nill____________________________

6. Rest and sleep pattern:

No. of hours of sleep/24 hours: Home: __/_____________Hospital: ___8hours_________Naps: 30
minute_

Any problem to fall/stay sleep: ___no_______Use of tranquilizers: _no______ Any home remedy:
_____no____

Evidence of lack of sleep: Posture: __/_____Yawning: ____/______Dark circles under eyes:

__no__Inability to concentrate: ___no___

Nursing
diagnose:______Nill_______________________________________________________________
____________________________________________________________________________________

7. Self-perception/ Self-concept pattern:

Patient’s perception of his or herself: ____Patient is satisfied about

herself_________________________________________________

Grooming/ dressing/make-up: ____√_______________Body parts (likes and dislikes):

___________√____

Non-verbal clues about self-concept: _______√________________________Voice tone: ____√______

Facial expression: _______√_________ Eye contact: ______√____________ Gestures congruent with
words: __________/__________

Nursing diagnoses:
_____Nill_______________________________________________________________
______________________________________________________________________
8. Role Relationship pattern:

Family (extended/nuclear): _____Nuclear________________Roles in family:

_unemploy__Daughter______________

____/__Role shared by: _______/_______Role in decision making: ___Nill______Financial status:

_____unemploy_________Leisure/Entertainment activities: ____Watching TV________Socialization:
____√_____Satisfaction with family or work: ____Satisfied________

Nursing Diagnose:
__Nill___________________________________________________________________
___________________________________________________________________________

9. Coping/ stress pattern:

Affect/mood: Calm: ___√_____________Angry:______×___ Irritable: __×__Fearful: _×___

Anxious:__________×___________ Withdrawal: ________×_____________________Pathetic:

___________

Common stressors: _________________Fanancial

disturbance___________________________________
________________Coping behavior during stress: ________good___________
Sharing of stress with: ________friend______________Use of alcohol /pan /tobacco /cigarette/drug:
______

Nursing diagnoses:
___________Nill_________________________________________________________
____________________________________________________________________________________
10. Sexuality/reproductive pattern:

History of birth control: __N/A___Age of puberty: ___13 Y___Onset of menses (F): __28 days
cycle______ Menstruation cycle: ___normal______ Amount: ____/____ Pain/problem:
___/__Frequency: __/____Menopause: ____/_____ No. of children: _/_ Alive: __/_Dead: __/_ Marital
relations with spouse: ________/_________________

Self-breast examination: ______√___________Self testicular examination: ____/_________Sexually

active or passive: ___Passive_______ Views about opposite sex:________/_____________

Nursing diagnose:
____________________Nill_______________________________________________ __
____________________________________________________________________________________

11. Value belief pattern:

Things important in life: ____Parents_______________Professional/occupational values:

__________/_______

Spirituality: ___/____ Religious beliefs: ___Follow the Islamic studies_____________Any spiritual

conflict: ________/___________

Satisfaction with life:

______________Mostly_________________________________________________

Nursing Diagnose:
_____________Nill______________________________________________________ __
____________________________________________________________________________________