Question

Discuss how functional patterns help a nurse understand the current and past state of health for a patient. Using a condition or disease associated with an elimination complexity, provide an example.

Answer 1

Ans) Functional nursing: an assessment that focuses on the functional patterns that all humans share; health perception and health management, activity and exercise, nutrition and metabolism, elimination, sleep and rest, cognition and perception, self-perception and self-concept, roles and relationships, coping and stress tolerance, sexuality and reproduction, and values and beliefs.

- Functional health patterns: Gordon's (1987) approach to assessment that addresses each of the domains of a patient's quality of life and functional status.

- The formats for assessment that follow are designed to elicit information in a systematic manner. They are screening formats for the collection of a basic nursing database in any specialty, for any age group, and at any point in the wellness-illness continuum. Questions and examination items tap into areas of all current nursing diagnoses. If data indicate that a problem or potential problem (dysfunctional pattern) may be present, diagnostic hypotheses (nursing diagnoses) should be generated to direct further information collection. This directs the search for the diagnostic or critical characteristics of each possibility.

- Nurses practicing in a specialty area may desire in-depth assessments of certain patterns. Both the history (subjective data) and the examination (objective data) can be expanded relative to disease, disability, age, and other client-specific factors. For example, a client’s activity-exercise pattern requires an in-depth assessment when the client has a disease that affects this pattern.

- Diagnoses are grouped under the same pattern areas as they are in the assessment guidelines and are used to label tentative judgments in a pattern area.

- Assessment using questions for examples:

HEALTH-PERCEPTION-HEALTH-MANAGEMENT PATTERN
How has general health been?
Any colds in the past year? If appropriate, absences from work/school?
Most important things done to keep healthy? Did these things make a difference to health (include family folk remedies, if appropriate)? Breast self-examination? Use cigarettes? Drugs? Ever had a drinking problem? When was your last drink?
Accidents (home, work, driving)? Falls?
In past, easy to find ways to follow suggestions of doctors or nurses?
If appropriate, what do you think caused this illness? Action taken when symptoms perceived? Results of action?
If appropriate, what is important to you while you are here? How can we be most helpful?

2. NUTRITIONAL-METABOLIC PATTERN
Typical daily food intake? Describe. Supplements?
Typical daily fluid intake? Describe.
Weight loss/gain? Amount? Height loss/gain? Amount?
Appetite?
Food or eating discomfort? Swallowing? Diet restrictions? If appropriate, breastfeeding? Problems with breastfeeding?
Heal well or poorly?
Skin problems, such as lesions, dryness?
Dental problems?

3. ELIMINATION PATTERN
Bowel elimination pattern? Describe. Frequency? Character? Discomfort? Problem in control? Laxatives?
Urinary elimination pattern? Describe. Frequency? Discomfort? Problem in control?
Excess perspiration? Odor problems?

4. ACTIVITY-EXERCISE PATTERN
Sufficient energy for desired/required activities?
Exercise pattern? Type? Regularity?
Spare time (leisure) activities? Child’s play activities?
Perceived ability for the following (code level according to Functional Levels Code below)
Feeding

Grooming

Bathing

General mobility

Toileting

Cooking

Bed mobility

Home maintenance

Dressing

Shopping

Functional Levels Code
Level 0: Full self-care
Level I: Requires use of equipment or device
Level II: Requires assistance or supervision of another person
Level III: Requires assistance or supervision of another person and equipment or device
Level IV: Is dependent and does not participate

5. SLEEP-REST PATTERN
Generally rested and ready for daily activities after sleep?
Sleep-onset problems? Aids? Dreams (nightmares)? Early awakening?
Rest/relaxation periods?

6. COGNITIVE-PERCEPTUAL PATTERN
Hearing difficulty? Aid?
Vision? Wear glasses? Last checked?
Any change in memory lately?
Easy/difficult to make decisions?
Easiest way for you to learn things? Any difficulty learning?
Any discomfort? Pain? How do you manage it?

7. SELF-PERCEPTION-SELF-CONCEPT PATTERN
How would you describe yourself? Most of the time, do you feel good (not so good) about yourself?
Changes in your body or the things you can do? Are these problematic for you?
Changes in way you feel about yourself or your body (since illness started)?
Find things frequently make you angry? Annoyed? Fearful? Anxious? Depressed? What helps?
Ever feel you lose hope? Not able to control things in life? What helps?

8. ROLE-RELATIONSHIP PATTERN
Live alone? Family? Family structure? Draw diagram.
Any family problems you have difficulty handling (nuclear/extended)?
How does the family usually handle problems?
Family depend on you for things? How are you managing?
If appropriate, how do family/others feel about your illness/hospitalization?
If appropriate, problems with children? Difficulty handling?
Belong to social groups? Close friends? Feel lonely (frequency)?
Things generally go well for you at work? School? If appropriate, income sufficient for needs?
Feel part of (or isolated in) neighborhood where living?

9. SEXUALITY-REPRODUCTIVE PATTERN
If appropriate to age/situation, sexual relationships satisfying? Changes? Problems?
If appropriate, use of contraceptives? Problems?
For females, when menstruation started? Last menstrual period? Menstrual problems? Para? Gravida?

10. COPING-STRESS-TOLERANCE PATTERN
Any big changes in your life in the last year or two? Crisis?
Who’s most helpful in talking things over? Available to you now?
Tense a lot of the time? What helps? Use any medicines, drugs, alcohol?
When (if) problems occur in your life, how do you handle them?
Most of the time, is this way(s) successful?

11. VALUE-BELIEF PATTERN
Generally get things you want out of life? Important plans for the future?
Religion important in your life? If appropriate, does this help when difficulties arise?
If appropriate, will being here interfere with any religious practices?

12. OTHER
Any other things that we have not talked about that you would like to mention?
Questions?