Gordons Functional Health Patterns Questionnaire
Gordons Functional Health Patterns Questionnaire
Appendix Gordon’s Functional Health Patterns Assessment Values/Health Perception 1. Explore attitudes and beliefs about the healthcare system 2. Follow medical advice when given it? 3. Acceptance of blood products or vaccinations due to religious views Nutrition 1. Typical daily food intake? (Describe.) Supplements (vitamins, type of snacks)? 2. Weight loss or gain? (Amount/BMI) Height loss or gain? (Amount) 3. Skin problems: Lesions? Dryness? Sleep/Rest 1. Generally rested and ready for daily activities after sleep? 2. Sleep problems? Aids? Dreams (nightmares)? Early awakening? 3. Rest-relaxation periods? Elimination 1. Bowel elimination pattern? (Describe) Frequency? Character? Discomfort? Problem in control? Laxatives? 2. Urinary elimination pattern? (Describe.) Frequency? Problem in control? 3. Excessive perspiration? Odor problems? Activity/Exercise 1. Exercise pattern? Type? Regularity? 2. Spare-time (leisure) activities? Child: play activities? 3. Sufficient energy for desired or required activities? Cognitive 1. Describe any changes in memory 2.
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Important decision easy or difficult to make? 3. Easiest way for you to learn things? Any difficulty? Sensory-Perception 1. Does the family have a history of sensory deficits and how are they being treated? 2. When was the last time anyone visited an optometrist or audiologist and what were the results? 3. Self-Perception 1. How would you describe your self-worth/self-image on a daily basis? 2. Any disturbances in self-esteem and feeling of powerlessness? Depression? Describe. 3. Has anyone in the family expressed being uncomfortable with their general appearance? Role Relationship 1. How does the family support each other in making decisions? 2. Describe any relationships that are not as strong as should be. Any parental or marital differences? 3. How would you describe the roles (and respect of one another) in the family? Sexuality 1. Explain in your own words preventive health practices (breast and testicular exam, papanicolau, contraception, etc.) 2. Are there any difficulties with reproduction in the family? 3. Coping 1. How have you dealt with stress in the past? 2. What are the main areas of stress experienced? 3.
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