MANILA DOCTORS COLLEGE PDMB AVENUE, METROPOLITAN PARK, PASAY CITY COLLEGE OF NURSING GORDONS 11 FUNCTIONAL HEALTH PATTERNS

A. HEALTH PERCEPTION AND HEALTH MANAGEMENT PATTERN 1. How has the general health been? How do you rate your own health? 2. What do you consider healthy about you? What are your health goals? 3. What are traditional concepts of health and illness? Beliefs and practices? 4. Do you have routine physical examination? If yes how often? 5. Perform self-breast examination? (female) 6. In the past year how many times have you seen a health care provider? For what reasons? 7. In the past, has it been easy to find ways to follow things nurses/doctors suggest? 8. What safety practices do you follow? 9. Most important things to keep health? You think these things will make a difference to health/ (include family/folk remedies if appropriate). 10.Personal hygienic practices: Describe how do you take care of your body? Bath, hand washing, trimming of fingernails, wearing of slippers, use of deodorant/cologne, brush teeth, flossing, dental visits? 11.Substance abuse: Use of cigarette, alcohol, drugs? Kind, amount, frequency? Reasons? Aware of effects? Passive smoking? 12.Environmental condition: adequacy of lighting, and ventilation. 13.Environmental sanitation practices: water supply, toilet facilities, waste management, food preparation, presence of vectors, health hazards.

B. NUTRITIONAL AND METABOLIC PATTERN 1. Typical daily food intake? Describe. Supplements? -include 3 day diet recall 2. Typical daily fluid intake? Describe. 3. What is your knowledge of proper nutrition? 4. Food likes and dislikes? 5. Food preparation? 6. Where do you eat?

7. Whom do you eat with? 8. Food budgeting? 9. Weight loss? Weight gain? Amount? 10.Appetite? 11.Food or eating discomforts? Diet restrictions? 12.Heal well or poorly? 13.Skin problems? Lesions? Dryness? 14.Dental problems?

C. ELIMINATION PATTERN 1. Bowel elimination pattern. Describe. Frequency? Characteristics (color and consistency)? Discomfort/pain? 2. Urinary elimination pattern. Describe. Frequency? Characteristics (color, clarity, odor)? Discomfort/pain? Problem in control? 3. Practices to achieve normal elimination pattern. 4. Excess perspiration? Odor problems?

D. ACTIVITY-EXERCISE PATTERN 1. Describe your usual activities in a day (or week). 2. Kind of physical activity do you engage in? Exercise pattern? Type? Regularity? Frequency, Intensity, Duration? 3. Are you satisfied with the amount of exercise do you get? 4. What type of work do you do for a living? 5. Sufficient energy for completing desired required activities? 6. Spare time (leisure activities) enough resources for leisure activities? Satisfaction?

E. SLEEP-REST PATTERN 1. Describe sleep pattern: Number of hours, continuity, satisfied? 2. Usual time of sleep? Usual time of waking up? Do you wake up at night? 3. Do you feel refreshed when you wake up? 4. Describe sleeping environment. Any problems? Concerns?

5. Describe bed time routine? 6. Any problem falling asleep? 7. What helps you sleep? (Back rub, music, or warm milk? Do you take sleep medications? 8. Take naps? When (morning/afternoon)? 9. What do you do for relaxation? (Watch movie, read, dance, shopping etc.)

F. COGNITIVE-PERCEPTUAL PATTERN 1. Can you read and write? 2. How is your hearing? Hearing difficulty? Aid? 3. How is your vision? Wear eyeglasses? Last checked? 4. Any change in the memory lately? 5. Easiest ways to learn things? Any difficulty in learning? 6. Do you have any problem with speaking, reading, or writing? 7. Any changes in smell or taste? 8. How are you doing in school or work?

G. SELF-PERCEPTION AND SELF-CONCEPT PATTERN 1. How do you describe yourself? Most of the time, feel good (not so good) about yourself? 2. Changes in your body or the things you can do? Problem to you? 3. Any physical alterations? Changes in way you feel about yourself or your body? Difficulty in acceptance of changes? How it affects the relationship between you and your family, friends and how you see yourself? 4. How do you see yourself in relation to other people? (better than, equal to, or less than) 5. How do you express your thoughts and feelings to others? 6. What are your goals in the next five years? How do you plan to achieve them? 7. Describe characteristics of type of person you would most like to be. Do you see yourself as that person? 8. What type of mood you are usually in? (calm, depressed, pleasant, happy, excited, agitated)

9. Find things that make you angry? Annoyed? Tearful? Anxious? Depressed? What helps? 10.How do you express yourself during mood changes? Do your relations with others change your moods? How? 11.Are you satisfied with your usual mood? Why?

H. ROLE-RELATIONSHIP PATTERN 1. Live alone? Family structure? Significant people in life? 2. Describe relationship to each other member of the family. 3. Role assumed in the family. Fulfilled? Why? 4. Any family problems you have difficulty handling? (nuclear/extended) 5. How does your family usually handle problems? 6. Family dependent on you for things? If appropriate? How manage? 7. What do you think of voicing opinions to family? Friends? 8. Who initiates activities with family or friends? 9. What are usual family activities? 10.Belong to social groups? Close friends? Feel lonely frequently? 11.How do you express your feelings or thoughts to others? 12.Are things generally goes well with you at work? (School/college)? Are there any problems in work/school that influence health? 13.Income/allowance sufficient for needs? Any financial problems or concerns? 14.Feel part of (or isolated) in neighborhood where living?

I. SEXUALITY-REPRODUCTIVE PATTERN 1. How do you express yourself as a man/woman? Any difficulty or problems in expressing ones sexuality? 2. How do you show affection to others? How do you want others to show affection? 3. Any concerns regarding fertility or family planning?

4. Do you engage in high risk sexual practice? 5. If appropriate: any changes or problems in sexual relations? 6. If appropriate: use of contraceptives? Problems? 7. Female: when was menstruation started? Last menstrual period? Menstrual problems?

J. COPING-STRESS TOLERANCE PATTERN 1. Describe a stressful event to you. 2. How do you handle stress or pressure? Effective? Satisfied? Why/Why not? 3. Tense a lot of time? What helps? Use of any medicine? Drugs? Alcohol? 4. Whos most helpful in talking things over? Available to you now? 5. Any big changes in your life in the last year or two? 6. When (if) you have big problems (any problems) in your life, how do you handle them? 7. Most of the time, is this (are) way(s) successful?

H. VALUE-BELIEF PATTERN 1. What makes a person healthy? 2. How important is health to you? 3. Any spiritual or religious practices important to you relevance to health? 4. Do you generally get things you like out of your life? Most important things to you? 5. Is religion important in your life? Does this help when difficulties arise? 6. What social values you were brought up with? Which ones important to you now? 7. How do you see yourself in relation to society?

I. OTHERS 1. Any other things that we havent talked about that youd like to mention? Questions?