Functional health pattern

(Gordon’s Approach)

Mulugeta Emiru
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 • Developed by Marjory Gordon.

• A method used by nurses in the nursing process to provide a

comprehensive nursing assessment of the patient.

Introduction • Gordon's functional health pattern includes 11 categories

which is a systematic and standardized approach to data
collection.

• NANDA Nursing Diagnosis classification is based on

Gordon's functional health patterns.
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 • For each pattern, it combines subjective and
objective data to identify diagnosis and

… etiological/contributing factors.

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 1. Health Perception – Health Management

2. Nutritional – Metabolic
List of Functional
Health Patterns 3. Elimination

4. Activity-Exercise

5. Cognitive-Perceptual

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 6. Sleep – Rest

7. Self-perception – Self-concept

… 8. Role – Relationship

9. Sexuality – Reproductive

10.Coping – Stress Tolerance

11.Value – Belief
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 • Name: • Unit/Ward:
• Date: • Ethnicity:
• Time: • source of information:
Identification • Age: • Source of referral:
Data
• Sex: • Date of admission :
• Bed No: • Medical diagnoses:
• Birth date: • Past Hospitalization:

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 • Chief compliant
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• History of present illness
Health • Past medical history
Perception
– • Allergies
Health
• Life Style Risk Factors
Management
• Familial Risk Factors: (Indicate Relationship)
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• Determine how the client perceives and manages

his or her health. (e.g. good/fair/ excellent)

• Compliance/adherence with current and past,

nursing and medical recommendations.

• The client's ability to perceive the relationship

between activities of daily living and health.

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 • Client's Perception of Health:
• Describe your health ( How has general health been?)

• Client's Perception of Illness:

• Describe your illness or current health problem.

Subjective • Health Management and Habits:

Data • Tell me what you do when you have a health problem.

• Most important things done to keep healthy? Did these things make a
difference? (include family folk remedies, if appropriate)

• Breast self examination? cigarettes? Drugs? Drinking problem? When

was your last drink?

• Accidents? Falls? 9
 • What do you think caused this illness? Actions taken? Results?

• Compliance with Prescribed Medications and Treatments:

• Have you been able to take your prescribed medications?

• If not, what caused your inability to do so?

… • What is important to you while you are here? How can we be

most helpful?

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Objective
• general health appearance
data

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Possible NDx • Wellness Diagnoses: Effective Management of
Therapeutic Regimen
• Risk Diagnoses: Risk for Injury; Risk for Trauma ; Risk for
Suffocation; Risk for Infection;
• Actual Diagnoses
• Deficient Knowledge
• Ineffective Health Maintenance
• Ineffective Management of Therapeutic Regimen: (Individual,
Family, Community Noncompliance)

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 2 • Describes pattern of food and fluid consumption
(dietary habits ) relative to metabolic need and
Nutritional • Pattern indicators of nutrient supply-
– • the conditions of hair, skin, nails, teeth and mucous
Metabolic membranes are assessed.

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 • Dietary and Fluid Intake

• Describe the type and amount of food you eat at

breakfast, lunch, and supper on an average day.

Subjective • Eating pattern: Individual, common or other specify

Data • Type of Diet in the Hospital: Breakfast, Lunch, Dinner,
Lunch and Snack; % eaten at each time

• Typical Dietary Intake at Home Prescribed Home Diet:

Breakfast, Lunch, Dinner and Snack.
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 • Do you take any vitamin supplements?
• Appetite: normal, decreased, increased
• Taste sensation: normal or impaired. explain
• Problems eating/digesting foods: Food tolerance, dysphagia,

… difficulty chewing, abdominal pain, nausea & vomiting,

diarrhea, constipation, antacid or laxatives use
• Fever, cold/hot intolerance
• Home Blood Glucose Monitoring (yes or no)
• Ideal body weight ; any recent weight gains or losses
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 Condition of Skin

• Describe the condition of your skin.

• How well and how quickly does your skin heal?

• Do you have any skin lesions? Describe.

… • Do you have any itching? What do you do for relief?

Condition of Hair and Nails

• Have you had difficulty with scalp itching or sores?

• Do you use any special hair or scalp care products?

• Have you noticed any changes in your nails? Color Cracking? Shape?
Lines? 16
 • Weight; Height; BMI; Temperature

• Overweight, Obese or undernourished (specify)

• Oral Mucosa: intact, pink, dry, lesion (sore tongue, sore

Objective gums, sore mouth).

Data • Dentition/dental problem: upper or/and lower teeth
number and condition

• Tube Feeding; Parenteral Nutrition, IV line and appearance

of IV Site
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 • Input and Output per day: input (PO, tube feeding, IV, other)
and output (urine, stool, emesis/NG Drains/other)
• Draining: site, color
• Edema: if present specify the site and grade(0-4+)

… Hair , Skin and Nail condition

• Hair: Texture (dry/soft); scalp lesion
• Skin: skin turgor, color, moisture, skin temp (warm/cold);
Identify and describe any skin lesions
• Nails: color: condition: texture: tenderness, capillary refill
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BRADEN SCALE (Circle the appropriate number and calculate the total the score)

Sensory/ Moisture Activity Mobility Nutrition Friction and Shear Total

Perception

Completely Limited=1 Constantly Moist =1 Bedfast =1 Immobile =1 Very Poor =1 Problem =1

Very Limited =2 Very Moist =2 Chair fast =2 Very Limited =2 Prob. Inadequate =2 Potential Prob. =2

Sl. Limited= 3 Occasion. Moist =3 Walks Occasion. =3 Sl. Limited =3 Adequate= 3 No Problem =3

No Impairment =4 Rarely Moist =4 Walks Freq. =4 No Limitations =4 Excellent= 4

TOTAL BRADEN SCORE LESS THAN 16 INDICATES RISK OF PRESSURE ULCER!

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 Wellness Diagnoses
• Opportunity to enhance nutritional metabolic pattern
• Opportunity to enhance effective breastfeeding
• Opportunity to enhance skin integrity
Possible NDx Actual/potential Nursing Diagnoses
• Risk for altered body temperature; Hypothermia /Hyper
• Risk for altered nutrition less than body requirements.
Risk/Nutrition: Imbalanced More Than; Nutrition Less Than;

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 • Risk/Deficient Fluid Volume; Excess Fluid Volume;
Risk/Imbalanced Fluid Volume;

• Nausea; Risk for Aspiration; Impaired Swallowing;

… • Impaired Dentition; Impaired Oral Mucous

Membranes;

• Risk/Impaired Skin Integrity; Risk for infection ;

• Risk for Unstable Blood Glucose.

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 3 • Describes pattern of excretory function (bowel,
bladder);

• Adequacy of the client's bowel and bladder;

Elimination
Pattern • The client's bowel and urinary habits;

• Bowel or urinary problems;

• Use of urinary or bowel elimination devices.

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 Bowel Habits

• Frequency of bowel movement

• Pain or discomfort on defecation; color of stool, amount

Subjective per day, consistency/incontinency.

Data • Use laxatives: kind and how often do you use them?

• Do you use enemas or suppositories? How often and what

kind?

• Ileistomy or colostomy
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 Bladder Habits
• How frequently do you urinate?
• What is the amount and color of your urine?
• Do you have any problems with urinating: like Pain, Blood in

… urine, difficulty starting a stream, Incontinence, voiding

frequently during day, frequent nocturia, bladder infections?
• Have you ever had a urinary catheter-When, How long?
• Dialysis: Hemo/ Pertonial

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 • Abdominal examination finding: inspection,
Auscultation; Percussion; Palpation

• Rectal examination finding: Rashes, Lesions,

Objective
data Tenderness

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 Wellness Diagnoses

• Opportunity to enhance adequate bowel

elimination pattern
Possible NDx • Opportunity to enhance adequate urinary
elimination pattern

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 Risk Diagnoses
• Risk for constipation
• Risk for altered urinary elimination

…
Actual Diagnoses
• Altered Bowel Elimination: Constipation; Diarrhea
• Bowel Incontinence
• Altered Urinary Elimination Patterns/ Urinary Retention
• Total Incontinence; Stress Incontinence
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 4 • Activities of daily living(ADL), including routines
of exercise, leisure, and recreation.
• Activities necessary for personal hygiene,
Activity
cooking, shopping, eating, maintaining the
_
home, and working.
Exercise
• Any factors that affect or interfere with the
client's routine ADL.
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 Daily activities

• Describe your activities on a normal day (hygiene, cooking, eating

grooming activities, toileting and etc

Subjective • Do you have difficulty with any of these self-care activities?

data • Does anyone help you with these activities? How?

• Do you use any special devices to help you with your activities?

• Does your current physical health affect any of these activities

e.g. dyspnea, sob , palpations, chest pain. Pain, stiffness,
weakness) ?
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 Self care Independent Assistive Assistance from Assistance from Dependent/Una
abilities device others person ble
&equipment
Eating/feeding
Bathing
Dressing
Toileting
Bed mobility
Cooking
Ambulating
Grooming
Shopping
Yard working
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Other specify
• Smoking (duration)

• Epistaxis, chest pain (location), joint pain (location), coughing

(duration/type/dry or productive, color of sputum)

• Weakness, Dyspnea, Palpitations, Fatigue, Myalgia

• SOB, Dizziness, Blurred Vision

• Effect of illness on activities

• Occupational activities

• Work or job; Do you feel it has affected your health?

• How has your health affected your ability to work?

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 • Vital sign

• Musculoskeletal assessment (Gait, Posture,

Extremity swelling, Symmetry, ROM, Crepitus,
Objective
Data Tone, coordination, Strength).

• Respiratory examination

• Cardiovascular examinations

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 • Risk/Activity Intolerance; Fatigue; Impaired Physical
Mobility;

• Self Care Deficit: bathing/hygiene, dressing/grooming,

feeding, toileting;
Possible NDx • Risk for Falls;

• Impaired Airway Clearance; Ineffective Breathing Pattern;

Ineffective Tissue Perfusion; Gas Exchange Impaired;

• Decreased Cardiac Output

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 • Describes patterns of sleep, rest, and relaxation.
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Subjective data
• Sleep Habits:
SLEEP
• How would you rate the quality of your sleep? – e.g.
_
optimum, enough/not, disturbed, REM, nightmare, etc
REST
• Typical Home Sleep pattern(hrs/night)
• Typical Hospital Sleep pattern(hrs/night)
• Naps (hrs/day)
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 • Special Problems: Do you ever experience
difficulty with falling asleep? Remaining asleep?
Do you ever feel fatigued after a sleep period?

… • Sleep Aids: What helps you to fall asleep?

medications? reading? relaxation technique?
Watching TV? Listening to music?

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 • Observe appearance: e.g. Puffy eyes

• Check for: Yawning; dozing during day;

Irritability; short attention span
Objective
Data

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 • Wellness Diagnosis: Opportunity to enhance
sleep; Readiness for enhanced sleep

• Risk Diagnosis:- Risk for sleep pattern

Possible NDx disturbance

• Actual Diagnosis: Insomnia; Sleep Pattern

Disturbance; Sleep Deprivation

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 6 • Describes client’s pattern of satisfaction and
dissatisfaction with sexuality pattern
Sexuality
• Describes reproductive patterns.
–
Reproductive • If any verbalized impact of illness, meds and
treatment on sexuality

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 • Female:
• Menstruation: Date began, Last cycle, Length,
Problems, Gravida, Para, Abortions, Still Birth,
Subjective Current pregnancy, Infertility, SBE(frequency)
Data

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 Male-Female
• Sex arche
• Contraception used and Undesirable side effects
• Problems with sexual activities

… • Effect of illness on sexual activities- like Pain, Burning,

Discomfort during intercourse
• STDs; Discharge.
• Male: Testicular self examination:- Annual/Monthly
Screening Exams
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 • Breasts examination: Inspections: Palpation

• Male genitalia; Female genitalia examination by

Inspections; Palpation
Objective
Data

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 • Wellness Diagnosis: Opportunity to enhance
sexuality patterns

• Risk-Diagnosis: Risk for altered sexuality pattern

Possible NDx • Actual Diagnoses: Sexual Dysfunction, Altered
Sexuality Patterns, Ineffective Health Maintenance

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 7 • Describes sensory, perceptual, and cognitive
pattern
COGNITIVE Cognitive
-
PERCEPTUAL • Subjective data

• Educational status/Academic standing/rank

• Language: Speaking, Reading, and Writing.

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 • LOC (alert, lethargy/drowsey, comatose), Glasgow Coma
Scale

• Orientation to TPP

Objective • Mood: Happy/pleasant, Euphoria, Depression/Sadness,

data Irritable, Labile(reactive), Flat

• Memory and Language: Aphasia, Short-term memory,

Long-term memory, Judgment

• Thought process: orientation, confusion, comprehension

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 Subjective data

• Visual problems: Aids of vision

• Hearing problems: Aids for hearing

• Taste; Smell; Touch Sensation

II. Sensory Objective data
Function • Visual acuity: OD, OS, OU; Visual field, EOMs; PERRLA

• Fundoscopic examinations

• Test, smell and touch sensation examination

• Hearing: Weber, Rinne; Cranial nerves examination

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 Subjective Data

• Any pain/discomfort

• Assess for character using COLDSPA method for Pain

Assessment -Onset, Location, Duration, Severity, Pattern
III. Pain and Associated Factors (COLDSPA of pain)

• Any pharmacology and non-pharmacology treatments

• Aggravating & Alleviating Factors

• Any pain Lasting Longer than six months? Yes or no

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Quality Pharmacologic Non pharmacologic Side Effects Indicators of Pain

1. Aching 1. PCA (Patient- 1. Massage 1. Sedation 1. Tearful

2. Burning Controlled 2. Distraction 2. Constipation 2. Moaning, Crying

3. Cramping Analgesia Pump) 3. Music 3. Hypotension 3. Rigid Posture

4. Sharp 2. Epidural 4. Positioning 4. Nausea & V 4. Guarding

5. Shooting 3. IV NSAID 5. Heat/cold 5. Itching 5. Restlessness

6. Dull 4. PO Opioid 6. Other 6. Ur. Retention 6. Withdrawal

7. Spasm 5. PO NSAID 7. Num. & Tingling 7. Elevated Vital Signs

8. Throbbing 6. IM/SQ Med 8. Other 8. Other

9. Other 7. Other Meds Used:

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 • Acute pain: Diaphoresis, Body position,
Grimacing, Guarding, Refusal to move body part,
rubbing body part
Objective
data • Chronic pain: flat facial expression, Dull eye
appearance, Fatigue, Crying, Moaning, yelling

• Desired Pain Score (0-10) _______

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 • Confusion Acute; Confusion Chronic

• Impaired Memory

• Acute Pain; Chronic Pain

• Disturbed Sensory Perceptual;

Possible NDx
• Disturbed Thought Processes, Impaired Environmental
Interpretation Syndrome

• Impaired Verbal Communication; Ineffective Protection

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 8 • Describes pattern of role, engagements and
relationships
ROLE
- • Perception of major roles and responsibilities in
RELATIONSHIP Family and at work.

• Perception of major social roles and

responsibilities

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 • Marital status: single, married, separated

• Primary role at home; Living arrangement; Family

structure

Subjective • Source of Income

data • Employment, Retired, Disabled, Primary role at work.

• Dependants:- Source of help; Identified Support Systems

• Belong to social group/close friends

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 • Problems affecting health at work or home

• Changes in life roles/relationships:

• Verbalized Fear of Violence; History of conflicts with

… other’s

• Objective data

• Interaction with family members and significant others

• Visitor’s flow

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 • Wellness Diagnoses: Opportunity to enhance effective
relationships; Opportunity to enhance effective
communication
• Risk Diagnoses: High risk for Loneliness; Risk for Altered
Parent/Infant/Child attachment
Possible NDx
• Actual Diagnoses:
• Impaired Verbal Communication
• Impaired Social Interaction: Social Isolation; Grieving; Loneliness;
Ineffective Role Performance; Risk for Caregiver Role Strain

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 9 • Describes self-concept and perceptions of self (body
comfort, image, feeling state)

Self- Subjective Data

perception • Self-description
–
• Feeling differently because of illness
Self-concept
• Things frequently make you angry, Annoyed, Fearful,
Anxious, Depressed

• Ever feel you lose hope

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 • Eye contact

• Posture

• Expression: Voice and speech pattern

Objective • Is there Identified/ Verbalized Major Losses or Life

Data Changes: Emotional/Behavioral State: sad, agitated,
anxious, depressed, happy

• Nursing Diagnoses: Impaired Adjustment; Hopelessness;

Risk Powerlessness; Grieving
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 10 • Describes general coping patterns and effectiveness of the
pattern in terms of stress tolerance.
• Subjective Data
COPING
- • Perception of Stress and Problems in Life

STRESS • Tense or relaxed most of the time?

TOLERANCE • Describe what you believe to be the most stressful situation in
your Life. Or Any big changes in your life?
• Crisis, Stressors, Recent stress
• How has your illness affected the stress you feel?
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Coping Methods and Support Systems:

• What do you usually do first when faced with a problem?

• When tense, what helps to relieve stress and tension? Do

you use medication, drugs, or alcohol to relieve stress?

• Who is most helpful in talking things ever

• When (if) there are big problems in your life, how do you
handle them

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 • Mental Status Assessment.
Objective
Data

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 • Wellness Diagnoses : Opportunity to enhance
effective individual coping; Opportunity to enhance
family coping

NDx • Risk Diagnoses: Risk for self-harm; Risk for suicide

• Actual Diagnoses: Ineffective Individual Coping;

Ineffective Family Coping: Disabling, Impaired
Adjustment; Ineffective Coping; Ineffective Denial
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 11 • Describes pattern of values and beliefs, including spiritual
and /or goals that guide choices or decisions.

Value Subjective Data

– • Religion
Belief
• Most valued in life, Goals, and Philosophical Beliefs
Pattern
• Verbalization of self as a spiritual or religious person

• Request for spiritual support while hospitalized

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Religious and Spiritual Beliefs: Are there certain health practices
or restrictions that are important for you to follow while you are
ill or hospitalized?
• Behavioral/ Verbalized Cues of Spiritual Distress
Objective Data
• Environmental spiritual cues: if any
• Observe religious practices: Bible; Visits from clergy
• Observe client's behavior for signs of spiritual distress: Anxiety,
Anger , Depression , Doubt, Hopelessness and Powerlessness
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 Wellness Diagnosis: Potential for Enhanced
Spiritual Well-Being.

Risk diagnosis: Risk for spiritual distress

NDx Actual Diagnosis: Spiritual disturbance (distress of
the human spirit).

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