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Gordon’s 11 Functional Health Patterns Assessment Questions

Health Perception-Health Management Pattern.

In general, how is the family’shealth?

What do you do to stay healthy? Do you drink alcohol or use tobacco products?

Do you have regular check-ups with your physician and/or specialists (Pediatrician,Ob/Gyn, Cardiologist,
etc.)? Do you listen to and follow any suggestions made by yourhealth care providers?

Nutritional-Metabolic Pattern

Describe your
Family’stypical daily food intake? Do you consider your family healthy eaters?

Describe yourfamily’stypical daily fluid intake? Do you drink alcohol?

Does anyone consider themselves over or under weight? Is there any unexplained weight gain or loss?

Elimination Pattern

Describe your family’sregular bowel elimination pattern? Frequency? Character?Discomfort? Difficulty?.

Describe your family’sregular urinary elimination pattern? Frequency? Discomfort?Problems with


control?

Activity-Exercise Pattern.

Do you exercise? What type? How often? If not, why?.

What do you like to do in your spare time? What sports do you participate in?5

Sleep-Rest Pattern

Do you feel that you are generally well rested and able to perform your daily activities?

How well do you fall asleep? Stay asleep? Do you use any aids to help you sleep?

Do you awaken feeling rested and ready to take on the day?


Cognitive-Perceptual Pattern

Does anyone have any difficulty hearing others?

Does anyone have difficulty seeing? Do you have routine eye exams?

How do you learn best? Preference for visual or audio aids? Do you have difficultylearning?

Self-Perception –Self-Concept Pattern

Most of the time, do you feel good about yourself?

Do you ever feel that you have lost hope?

Roles-Relationships Pattern

Who do you live with? Alone, family, others? What was the structure in which you grewup?

Do you belong to social groups? Do you interact with others outside of work or school?

Sexuality-Reproductive Pattern

Parents: How would you describe your sexual relationship? Satisfying? Changes?Problems?

Female: Describe menstruation cycle. Problems? Last menstrual period? Para? Gravida?

Coping-Stress Tolerance Pattern

Any big changes in the past year or two?

Who is most helpful in talking things over? Are the frequently available to you?

Do you use any medications, drugs, or alcohol?

Values-Beliefs Pattern.

Is religion important in your family’s


life? Does this help when you are faced with difficult situations?.

Describe your plans for the future. Do you generally get what you want from life?