WESLEYAN UNIVERSITY-PHILIPPINES

COLLEGE OF NURSING
Bachelor of Science in Nursing

NCM 114 – CARE OF OLDER ADULT

(LECTURE)

GORDON’S ASSESSMENT TOOL

Submitted by:
Surname, First Name MI.
BSN 3-4

Submitted to:
Ma’am Maria Sunny S. Dumaya
 WESLEYAN UNIVERSITY-PHILIPPINES
COLLEGE OF NURSING
Bachelor of Science in Nursing

CARE OF OLDER ADULT

A. CLIENT’S PROFILE
Name:
Address:
Age:
Birthdate:
Sex:
Status:
Occupation:
Educational Attainment:
Ethic Group:
Dialect/Language Spoken:
Religion:

HEALTH ASSESSMENT
A. GENERAL HEALTH HABITS
•

B. CURRENT HEALTH
•

C. PAST HEALTH
•

D. FAMILY HEALTH HISTORY

•

E. MEDICATIONS
•

JOURNAL
 WESLEYAN UNIVERSITY-PHILIPPINES
COLLEGE OF NURSING
Bachelor of Science in Nursing

B. NURSING HISTORY (11 FUNCTIONAL HEALTH PATTERNS)

1. HEALTH PERCEPTION – HEALTH MANAGEMENT PATTERN

2. NUTRITION – METABOLIC PATTERN


 The following are the typical meal of the client:
 Breakfast –
 Lunch –
 Snacks –
 Dinner -

3. ELIMINATION PATTERN

4. ACTIVITY – EXERCISE PATTERN

PERCEIVED ABILITY FOR:

 Bathing –
 Bed Mobility –
 Cooking –
 Feeding –
 General Mobility –
 Grooming –
 Home Maintenance-
 Shopping –
 Toileting –

FUNCTIONAL LEVEL CODES:

Level 0: Full Self-Care
Level 1: Requires use of equipment or device
Level 2: Requires assistance of supervision from another person
Level 3: Requires assistance or supervision from another person
and equipment or device
Level 4: Is dependent and does not participate

5. SLEEP – REST PATTERN


 WESLEYAN UNIVERSITY-PHILIPPINES
COLLEGE OF NURSING
Bachelor of Science in Nursing

6. COGNITIVE – PERCEPTUAL PATTERN

7. SELF-PERCEPTION – SELF-CONCEPT PATTERN

8. ROLE – RALATIONSHIP PATTERN

9. SEXUALITY – REPRODUCTIVE PATTERN

10. COPING – STRESS TOLERANCE PATTERN

11. VALUE – BELIEF PATTERN