1.Health Perception and Health Management Pattern.

o Are you using any medicine recently?

o How do you maintain your health?
o How do you feel about your health?
o Any immunization?
o Do you have any allergy? If yes then type of allergy.
2.Nutrition and Metabolism Pattern
o What type of exercise you do or any problem during exercise?
o Any food allergy?
o What is your diet menu?
o Do you consider yourself a healthy eater?
o Do you skip meals? (Why)
o Do you avoid any kind of food? (Why)
o Do you drink alcohol? (If yes, what kind and how often)
3.Elimination Pattern
o Have you used or is currently using any laxative? (If yes, why)
o Describe your regular urinary elimination pattern? (Frequency, Discomfort, Problems with control,
C discharges)
o Bowel elimination pattem? (Describe.) Frequency?
Character? Discomfort? Problem in control?
Laxatives?
4.Activity and Exercise Pattern
o Do you have cough? (Productive or non productive
o Any changes in heart beat during exercise?
o Sufficient energy for desired or required activities?
5.Cognition and Perception Pattern
o Any change in memory lately?
o How do you learn best? Preference for visual or audio aids? Do you have difficulty learning?
o Do you have any difficulty hearing others?
o Important decision easy or difficult to make?
6.Sleep and Rest Pattern
o Generally rested and ready for daily activities after sleep?
o Do you awaken feeling rested and ready to take on the day?
7.Self-Perception and Self-Concept Pattern
o Most of the time, do you feel good about yourself?
o Do you ever feel that you have lost hope?
o If I may ask, was there a time that ypu may have been conscious of yourself?
o Do you feel good about your whole Being?
o Do you constantly feel angry and/or sad?
o How do you feel and think about yourself lately?
8.Roles and Relationships Pattern
o How often do you see your friends?
o Can you describe your relationship with your family? What is your role in your family?
o Do you have friends/peers? Can you describe your relationship with them?
9.Sexuality and Reproduction Pattern
o are you sexually active?
o are you fertile?
o Do you have any menstruation problem?
o How would you describe your sexual relationship?
10.Coping and Stress Tolerance Pattern
o What stresses you?
o Have you been under stress recently?
o Who are the people vou can talk to about your stress? when rfeling stressed,how do you feel
physically?
o Has anything been bothering you lately or causing stress?
o Things that frequently make you angry? Annoyed? Fearful? Anxious?
Depressed?
11.Values and Belief Pattern
o Do you believe that your life has purpose or meaning?
o What is your religion?
o Do you feel being religious and spiritual is different?