Patient Interview Paper
ASSESSMENT: NURSING HEALTH HISTORY
COLLECTING AND CLUSTERING SUBJECTIVE DATA (Initial Interview – Comprehensive)
BASED ON GORDON’S FUNCTIONALHEALTH PATTERNS
I. BIOGRAPHIC DATA
Name: ____________________________________________________________
___ Age: _______ Sex: ___________
Address: ____________________________________________________________
Race: ________________________
Marital Status: ___________ Occupation: _________________________ Religious Orientation: ________________
Health care financing and usual source of medical care: ____________________________________________________
II. CHIEF COMPLAINT OR REASON FOR VISIT
What brought you to the clinic or hospital?
____________________________________________________________ …show more content…
What do you do for relaxation? (Watch movie, read, dance, shopping, etc.)
F. Cognitive-perceptual pattern
1. Hearing? Difficulty? Aid?
2. Vision? Wear eyeglasses?
3. Any change in memory lately?
4. Easiest way for you to learn things? Any difficulty learning?
5. Any discomfort? Pain? How do you manage it?
G. Self-perception
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. Changes in way you feel about yourself or your body? (Since illness started)
4. Find things frequently make you angry? Annoyed? Tearful? Anxious? Depressed? What helps?
H. Role-relationship Pattern
1. Live alone? Family? Family structure (diagram)?
2. Any family problems you have difficulty handling? (Nuclear extended)
3. Hoe does family usually handle problems?
4. Family depends on you for things? If appropriate: How managing?
5. If appropriate: How family/others feel about your illness/hospitalization?
6. If appropriate: problems with children? Difficulty handling?
7. Belong to social groups? Close friends? Feel lonely frequently?
8. Things generally go well with you at work.
9. Feel part of (or isolated in) neighborhood where
COLLECTING AND CLUSTERING SUBJECTIVE DATA (Initial Interview – Comprehensive)
BASED ON GORDON’S FUNCTIONALHEALTH PATTERNS
I. BIOGRAPHIC DATA
Name: ____________________________________________________________
___ Age: _______ Sex: ___________
Address: ____________________________________________________________
Race: ________________________
Marital Status: ___________ Occupation: _________________________ Religious Orientation: ________________
Health care financing and usual source of medical care: ____________________________________________________
II. CHIEF COMPLAINT OR REASON FOR VISIT
What brought you to the clinic or hospital?
____________________________________________________________ …show more content…
What do you do for relaxation? (Watch movie, read, dance, shopping, etc.)
F. Cognitive-perceptual pattern
1. Hearing? Difficulty? Aid?
2. Vision? Wear eyeglasses?
3. Any change in memory lately?
4. Easiest way for you to learn things? Any difficulty learning?
5. Any discomfort? Pain? How do you manage it?
G. Self-perception
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. Changes in way you feel about yourself or your body? (Since illness started)
4. Find things frequently make you angry? Annoyed? Tearful? Anxious? Depressed? What helps?
H. Role-relationship Pattern
1. Live alone? Family? Family structure (diagram)?
2. Any family problems you have difficulty handling? (Nuclear extended)
3. Hoe does family usually handle problems?
4. Family depends on you for things? If appropriate: How managing?
5. If appropriate: How family/others feel about your illness/hospitalization?
6. If appropriate: problems with children? Difficulty handling?
7. Belong to social groups? Close friends? Feel lonely frequently?
8. Things generally go well with you at work.
9. Feel part of (or isolated in) neighborhood where