GORDONS FUNCTIONAL HEALTH

ASSESSMENT

1. Assessment of Health Perception and Health Management

A. Client Perception of Health Status:

-How would you describe your health?

B. Preventive Practices:

-When was your last dental, medical and physical examination?

C. Compliance with Medical Treatment:

-Do you follow the doctors’ order?

D. Client Safety:

-What safety practices do you follow?

E. Use of cigarettes, alcohol, medications, drugs etc.

- How often?

2. Assessment of Activity and Exercise

1. Describe your activities in a normal day?

2. What limitations in ability do you have (eating, toileting, bathing, walking,
etc.)
3. Have you recently fallen or consider yourself to be at risk for falling?
4. What do you do to keep healthy or prevent disease progression?
3. Assessment of Nutrition and Metabolism

a. Questions about:

1. Dietary habits
2. Metabolic needs
3. Ability to ingest, digest, absorb and metabolize
4. Food intake and fluid

4. Assessment of Elimination

a. Bladder and bowel function

b. Problems in elimination
c. Coping with dysfunction

Ex: Describe your normal voiding and bowel pattern

Any changes?

5. Assessment of Rest and Sleep

a. Ask about the no. of hours; time usually go to sleep and when he/she
wake up
b. Can you easily fall asleep?
c. What do you do to promote sleep?

6. Assessment of Cognition and Perception

a. Awareness, thought process, memory, language, judgement and

attention span

7. Assessment of Self-concept and Self-perception

a. What are you most concerned about in relation to your health?

b. How would you describe yourself?
c. Do you feel differently when you are sick?

8. Assessment of Roles and Relationships

a. Are you employed?

b. What do you see as your primary role at work? Home?
c. Who does you live with?

d. Who does you ask for help when you need it?
e. Are there any problems at work or home

9. Assessment of Coping and Stress Tolerance

a. Have there been any changes or stress recently in your life? What are
they?
b. How do you handle stress?
c. Would you like help to deal with stress of being sick?

10. Assessment of Sexuality and Reproduction

a. Sexual Function questions

b. Pregnancy or STD’s
c. Abortion
d. Use of pills or contraception’s
e. Illness or surgery

11. Assessment of Values and Beliefs

a. Religion, beliefs
b. Spiritual Practices
c. Relationship with God