Nursing Gordons Functional Pattern

Nursing Gordons Functional Pattern

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Nursing Diagnoses Arranged by Gordon’s Health Patterns

Marjorie Gordon (1987) proposed functional health patterns as a guide for establishing a comprehensive nursing data base. These 11 categories make possible a systematic and standardized approach to data collection, and enable the nurse to determine aspects of health and human function:

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Under each health pattern is a partial list of NANDA (North American Nursing Diagnosis Association) nursing diagnoses arranged by health patterns identified as taxonomy by Gordon (2000). It is intended to assist you in implementing the nursing process. You can find these and other nursing diagnoses in your Carpenito text from your sophomore year. These are examples you may find helpful when organizing and evaluating care for your patients. It will also be useful for your academic care plans.

Important Note: Each area must be addressed for each patient. If it truly doesn’t apply, then right a brief explanation of your reasoning (i.e. Newborn and sexuality). A nursing diagnosis could fit under many different health patterns. For example: Breast feeding: Ineffective could fit under almost every category as could fear or lack of knowledge! Where you chose to place it would depend on your assessment while caring for the patient. This combines the science and art of nursing! Have fun with it. This is designed as a creative way for you to get a complete picture of your patient (that is the reason for the concept map format).

Health Perception – Health Management Pattern

This pattern is related to the client’s perceived pattern of health and or well-being, knowledge of lifestyle and the relationship to health, knowledge of preventive health practices and adherence to medical and nursing prescriptions. Data collection is focused on the person’s perceived level of health and well-being, and on practices for maintaining health. Habits that may be detrimental to health are also evaluated, including smoking and alcohol or drug use. Actual or potential problems related to safety and health management may be identified as well as needs for modifications in the home or needs for continued care in the home.

Associated Nursing Diagnoses 

Nursing Gordons Functional Pattern

Energy Field disturbance: A disruption of the flow of energy surrounding a person’s being, which results in a disharmony of mind and spirit.

Growth and Development, Delayed: Altered physical growth, delay or difficulty in exercising skills (motor, social expressive) typical of age group; inability to perform self-care or self-control activities appropriate for age; flat affect; listlessness; decreased responses.

Health Maintenance, Ineffective: Inability to identify, manage, or seek out help to maintain health.

Health Seeking Behaviors; Active seeking (by individual in stable heath) of ways to alter personal health habits and/or environment to move toward higher level of health.

Injury, Risk for (falls, trauma, poisoning, suffocation, aspiration): A risk of injury as a result of the interaction of environmental conditions interacting with the individual’s adaptive and defensive resources

Management of Therapeutic Regimen, Ineffective (individual, family, community): Pattern of regulating and integrating into daily living a program for treatment of illness and its sequelae that is unsatisfactory for meeting specific health goals.

Coping, Defensive

Disturbed Body Image: State in which a person experiences or is at risk to experience a disruption in the way (s)he perceives one’s body. Negative response to actual or perceived change in structure and/or function.

Gordon’s Functional Health Patterns

See Rubric for grading

 

Student name: __________________________________

Patient’s Initials:

Age:

 

Medical Diagnoses (must have 2) See Rubric:

 

 

Past Medical History:

 

 

 

 

Family Medical History (parents/grandparents/siblings):

            Mother:

            Father:

            Maternal Grandmother:

            Maternal Grandfather:

            Paternal Grandmother:

            Paternal Grandfather:

            Siblings:

 

Health Perception/Management Pattern

(Describes patient’s perceived pattern of health and how health is managed.)

 

What is your biggest health challenge?

(Chief Complaint)

 

 

 

How would you describe your health?

 

 

 

What do you know about your present illness (can pt describe their main diagnosis)?

 

 

Factors that aggravate or relieve symptoms

 

If painful, note location, onset, quality, severity, duration, frequency

 

 

Allergies – drugs, dye, iodine, latex, tape, food

Describe reactions:

 

Health Perception/Management Pattern cont.

 

Are you taking any medications either prescribed by the doctor or OTC?  Get mg of each medication and how often they are taken.

 

 

 

 

Herbal remedies?

 

Caffeine consumption/type?

How many cups per day?

 

Tobacco use?

Type:

Frequency?

 

Alcohol use?

Type, amount, frequency?

 

Recreational drugs?

Type? How often?

 

 

 

 

 

Nutritional/Metabolic Pattern

(Describe pattern of food and fluid intake relative to metabolic need.)

 

Does the patient seem to be well-nourished and well-developed in general appearance?

 

Describe typical daily food (list last day’s meals) and fluid intake (amount) per day.

 

 

 

 

 

 

Are you on a special diet?

 

 

What is your height and weight?

Is this your typical weight?

 

Do you have any difficulty swallowing or chewing?

 

Nutritional Metabolic Pattern cont.

 

Do you have any skin problems such as lesions or dryness?

 

 

Do you have any dental problems?  Dentures? Bridges?  Missing teeth?

 

 

Elimination Pattern

(Describe patterns of excretory function.)

 

What is your normal bowel pattern? (frequency, consistency, color)

 

 

Do you ever experience constipation or diarrhea? (frequency)

 

 

Do you use laxatives or other aids?  What kind?  How often?

 

 

 

Describe your usual pattern of urination.

 

 

Have you had any changes in your pattern?

 

 

Do you have a history of bowel or bladder problems? (Bleeding?)

 

 

 

Activity/Exercise Pattern

(Describe pattern of exercise, activity, leisure and recreation that requires energy expenditure.)

 

Describe your normal daily activity.

 

 

Do you feel you have enough energy to do these activities?

 

 

Do you notice a change in your breathing with activities?

 

Can you move about freely without discomfort?

 

 

Do you exercise regularly?

 

 

Sleep/Rest Pattern

 

How many hours do you usually sleep each night?

 

Do you feel rested when you wake up?

 

 

Do you have difficulty falling asleep?  If yes, why do you think?

 

 

Are you able to sleep through the night? If no, why not?

 

 

Do you take anything to help you sleep?

 

 

Cognitive/Perceptual Pattern

(Describes patient’s language, memory, decision-making and sensory abilities.)

 

Do you have any difficulty with vision?

 

 

Do you need glasses for reading or distance vision?

 

 

Do you have difficulty with hearing?  Do you use a hearing aid?

 

 

Are you able to smell odors, taste food?

 

 

Are you having any pain? Describe (location, quality, severity (0-10 scale), onset, duration, frequency).

 

 

How is your memory?  Have you seen any changes recently?

 

 

What is your name? (just tell me if they answered correctly)

 

What day is it? (just tell me if they answered correctly)

 

Where do you live or can you tell me where you are? (just tell me if they answered correctly)

 

 

 

 

 

Self Perception/Self Concept Pattern

(Describes how the person views him/herself)

 

How would you describe yourself?

 

 

 

 

How is your main health issue impacting or affecting you?

 

 

 

 

 

How do you feel about yourself since you’ve been had this issue?

 

 

Role Relationship Pattern

(Describes the patient’s perception of family and social roles.)

 

Who do you consider is important in your life for support?

 

 

 

Who do you live with?

 

How would your family manage if you are in the hospital?

 

 

 

What is your occupation?  If retired, what was your occupatioin?

 

 

How is this affected by your health issues?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sexuality/Reproductive Pattern

 

Describe your menstrual cycle. # of days.

(LMP)

 

Do you examine your breast regularly (men and women)?

 

Do you examine your testes regularly?

 

Are you sexually active?

 

Do you use any form of contraceptive?

 

Do you have children?            Number of pregnancies:

 

 

Would disruption of your sexual relationship be a factor in making a decision about having surgery (taking medication)?

 

 

Coping/Stress Tolerance Pattern

 

How are you managing your current health problem or situation?

 

 

Have you talked to your significant other about the (current situation)?

 

 

Have you informed your family and friends about your (current situation)?

 

 

How would you characterize the level of stress in your life over the past year?

 

 

 

 

How do you handle stress?  Coping mechanisms?

 

 

 

 

 

 

 

 

 

 

 

 

Value/Belief Pattern

 

Describe the things that you value in life.

 

 

 

Do you have any religious practices that will be interfered with if you were hospitalized?

 

 

 

If hospitalized, would you want to see a minister/priest/rabbi?

 

 

 

Will you require a special diet?

 

 

Other

 

 

Any cultural considerations that we have not covered?

 

 

Are there any other things that we have not talked about that you would like to mention?

 

 

 

 

 

You do not need to discuss these with the patient.  Formulate your nursing thoughts here.

 

Identify any health risks that you noted. (should list 3 – see Rubric)

 

 

 

 

Identify any teaching that would benefit the patient. (should list 3 – see Rubric)

 

 

 

 

 

If this patient was in your care at the hospital, what is a nursing intervention you would need to do based on their history? (should list 3 – see Rubric)

 

 

 

Gordon Health Assessment
Criteria Ratings Pts
This criterion is linked to a Learning

Outcome:

Completeness

20 pts

Excellent

All questions answered on assessment.

15 pts

Satisfactory

Few questions not answered on the assessment.

10 pts

Unsatisfactory

Greater than 10 questions not answered in assessment.

20 pts
This criterion is linked to a Learning Outcome Medical Diagnosis, Past Medical History, Family Medical History
20 pts

Excellent

Interviewee has 2 medical diagnosis. Past medical history and family history completed.

15 pts

Satisfactory

Interviewee has 1 medical diagnosis. Past Medical history not addressed. Some parts of the family medical history are missing.

10 pts

Needs Improvement

Interviewee has no medical diagnosis in the history. Past medical history not addressed. Many parts of family are missing.

0 pts

Unsatisfactory

Interviewee has no medical diagnosis in the history. Past medical history not addressed. Family medical history is missing.

20 pts
This criterion is linked to a Learning Outcome

Identify any health risks

20 pts

Excellent

Lists at least 3 health risks noted during the interview.

15 pts

Satisfactory

List at least 2 health risks noted during the interview.

10 pts

Unsatisfactory

Only one health risk noted during the interview.

20 pts
This criterion is linked to a Learning Outcome Identify any teaching that would benefit the patient.
20 pts

Excellent

List at least 3 topics that could be taught to the patient.

15 pts

Satisfactory

List at least 2 topics that could be taught to the patient.

10 pts

Okay

Listed only 1 topic that could be taught to the patient.

20 pts
This criterion is linked to a Learning Outcome Nursing Interventions if pt is hospitalized.
20 pts

Excellent

List at least 3 nursing interventions that were identified in the history.

15 pts

Satisfactory

List at least 2 nursing interventions that were identified in the history.

10 pts

Okay

Listed only 1 nursing interventions that were identified in the history.

20 pts
Total Points: 100

 

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