Functional health assessment

Functional Health Pattern
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 the
following aspects of health
and human function:

Health Perception and
Health Management.
Data collection is focused on the
person's perceived level of
health and well-being, and on
practices for maintaining health.
Habits evaluated includes 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.

Client’sgeneral health?
Anycoldsin pastyear?
If appropriate:anyabsences fromwork/school?
Most importantthings youdo tokeep healthy?
Use ofcigarettes,alcohol, drugs?
Performself exams,i.e. Breast/testicularself-
examination?
Accidentsathome,work,school,driving?
In past,hasitbeen easytofindwaysto carryout
doctor’sor nurse’ssuggestions?
(If appropriate)Whatdoyouthinkcausedcurrent
illness?
Whatactionshaveyoutakensincesymptomsstarted?
Have youractionshelped?
(If appropriate)Whatthings aremostimportantto
yourhealth?
How canwebemost helpful?
Howoftendoyouexercise?

Nutrition and Metabolism
Assessment is focused on the
pattern of food and fluid
consumption relative to
metabolic need.
The adequacy of local nutrient
supplies is evaluated.
Actual or potential problems
related to fluid balance,
tissue integrity, and host
defenses may be identified
as well as problems with
the gastrointestinal system.

History (subjective data):
Typical daily food intake? (Describe)
Use of supplements, vitamins, types of
snacks?
Typical daily fluid intake? (Describe)
Weight loss/gain? Height loss/gain?
Appetite?
Breastfeeding? Infant feeding?
Food or eating: Discomfort, swallowing
difficulties, diet restrictions, able to follow?
Healing – any problems?
Skin problems: lesions? Dryness?
Dental problems?

Examination (examples of
objective data):
Skin assessment, oral mucous
membranes, teeth, actual
weight/height, temperature.
Abdominal assessment.

Elimination.
Data collection is focused
on excretory patterns
(bowel, bladder, skin).
Excretory problems
such as incontinence,
constipation, diarrhea,
and urinary retention
may be identified.

Bowel elimination pattern
(describe)
Frequency, character, discomfort,
problem with bowel control, use of
laxatives (i.e. type, frequency),
etc.?
Urinary elimination pattern
(describe)
Frequency, problem with bladder
control?
Excess perspiration? Odour
problems?
Body cavity drainage, suction,
etc.?

Examination (examples ofobjective
data):
If indicated, examineexcretions or
drainage for characteristics, colour, and
consistency.
Abdominal assessment.

Activity and Exercise.
activities of daily living
requiring energy
expenditure, including self-
care activities, exercise, and
leisure activities.
The status of major body
systems involved with
activity and exercise is
evaluated, including the
respiratory, cardiovascular,
and musculoskeletal
systems.

Sufficient energyfor desired and/or
required activities?
Exercise pattern? Type? regularity?
Sparetime (leisure) activities?
Child-play activities?
Perceivedability for feeding,
grooming, bathing, general
mobility, toileting, home
maintenance, bed mobility,
dressing and shopping?

Examination (examples ofobjective
data):
Demonstrate ability for above criteria.
Gait.
Posture.
Absent body part.
Range of motion (ROM) joints.
Hand grip - can pick up pencil?
Respiration. Blood pressure.
General appearance.
Musculoskeletal, cardiacand respiratory
assessments.

Cognition and Perception.
ability to comprehend and
use information and on the
sensory functions.
Data pertaining to neurologic
functions are collected to
aid this process.
Sensory experiences such as
pain and altered sensory
input may be identified and
further evaluated.

History(subjective data):
Hearing difficulty?
Hearing aid?
Vision?
Wears glasses? Last checked?When last changed?
Anychangein memory?Concentration?
Importantdecisions easy/difficult to make?
Easiest way for youto learn things? Anydifficulty?
Anydiscomfort? Pain? Ifappropriate – PQRST
questions PQRST P – Palliative, Provocative Q -
Quality or quantityR – Regionor radiation S -
Severity or scale T -Timing(Morton, 1977)
COLDSPA C-CharacterO -Onset L -Location D -
Duration S – SeverityP -Pattern A -Associated
factors (Weber, 2003)

objective data):
Orientation.
Hears whispers?
Reads newsprint?
Grasps ideas and questions
(abstract, concrete)?
Language spoken.
Vocabulary level.
Attention span.

Sleep and Rest.
person's sleep, rest, and
relaxation practices.
Dysfunctional sleep patterns,
fatigue, and responses to
sleep deprivation may be
identified.

Generally rested and ready
for activity after sleep?
Sleep onset problems? Aids?
Dreams (nightmares), early
awakening?
Rest / relaxationperiods?
Sleep routine?
Sleep apnea symptoms?

Examination (examplesof
objectivedata):
Observe sleep pattern and
rest pattern.

Self-Perception and Self-
Concept.
Assessment is focused
on the person's
attitudes toward self,
including identity,
body image, and sense
of self-worth.
The person's level of
self-esteem and
response to threats to
his or her self-concept
may be identified.

Howdo youdescribe yourself?
Most of the time, feel good (ornot so
good) about self?
Changes in body or things you can do?
Problems for you?
Changes in the way you feel about self
orbody (generally orsince illness
started)?
Things frequently make you angry?
Annoyed? Fearful? Anxious? Depressed?
Not able to control things? What helps?
Everfeel you lose hope?

objective data):
Eye contact.
Attention span (distraction?).
Voice and speech pattern.
Body posture.
Client nervous (5) or relaxed (1)
(rate scale1-5) Client assertive (5) or
passive (1) (rate scale1-5)

Roles and Relationships.
person's roles in the world
and relationships with
others.
Satisfaction with roles, role
strain, or dysfunctional
relationships may be further
evaluated.

Livealone?Family?
Family structure?
Anyfamilyproblemsyouhavedifficultyhandling
(nuclear/extendedfamily)?
Family orothersdependon youforthings?
How well areyoumanaging?
If appropriate–How families/othersfeel about
yourillness?
Problemswith children?
Belong tosocial groups?Closefriends? Feel lonely?
(Frequency)
Things generally gowellatwork/ school?
If appropriate–income sufficientforneeds?
Feel partof(orisolatedin) yourneighbourhood?

Examination (examplesof
objectivedata):
Interactionwithfamily
members or others if
present.

Sexuality and Reproduction.
Assessment is focused on
the person's
satisfaction or
dissatisfaction with
sexuality patterns and
reproductive functions.
Concerns with sexuality
may he identified.

If appropriate to age and situation –
Sexual relationships satisfying?
Changes? Problems?
If appropriate –Use of contraceptives?
Problems? Female–when did
menstruation begin? Last menstrual
period (LMP)? Any menstrual problems?
(Gravida/Para if appropriate)

objective data):
None unless a problem is identified
or a pelvic examinationis warranted
aspart of full physicalassessment
(advanced nursing skill).

Coping and Stress Tolerance.
person's perception of
stress and on his or her
coping strategies
Support systems are
evaluated, and symptoms of
stress are noted.
The effectiveness of a person's
coping strategies in terms of
stress tolerance may be
further evaluated.

Any big changes in your life in last year or
two?
Crisis? Who is most helpful in talking things
over?Available to you now?
Tense orrelaxed most of the time?
When tense, what helps?
Useany medications, drugs, alcohol to
relax?
When (if)there are big problems in your life,
howdo you handle them?
Most of the time, are these ways successful?

Values and Belief.
Assessment is focused on
the person's values and
beliefs (including
spiritual beliefs), or on
the goals that guide his
or her choices or
decisions.

Generally get things you want from
life?
Important plans for future?
Religion important to you?
If appropriate -Does this help
when difficulties arise?
If appropriate – willbeing here
interfere with any religious
practices?

APGAR SCORE
The test is generally done at
one and five minutes after
birth, and may be
repeated later if the score
is and remains low. Scores
7 and above are generally
normal, 4 to 6 fairly low,
and 3 and below are
generally regarded as
critically low.
Appearance (skin color),
Pulse (heart rate),
Grimace(reflex irritability),
Activity (muscle tone), and
Respiration

Newborn Screening
RepublicAct 9288
Newborn screening (NBS) is a public health program aimed at the early
identification of infants who are affected by certain genetic/metabolic/
infectious conditions. Earlyidentification and timely intervention can lead to
significantreduction of morbidity, mortality, and associated disabilities in
affected infants. NBS in the Philippines started in June 1996 and was integrated
into the public healthdelivery system with the enactment of the Newborn
Screening Actof 2004 (Republic Act 9288). From 1996 to December 2010, the
program hassaved 45 283 patients. Five conditions are currently screened:
Congenital Hypothyroidism, Congenital Adrenal Hyperplasia, Phenylketonuria,
Galactosemia, and Glucose-6-Phosphate Dehydrogenase Deficiency.

ASSESSMENT OF
INFANT AND CHILDREN

Height and Length
Growth is not only a
result of nutrition but also
a result of inherited
factors. Ethnicitycan
influence a child’s growth
patterns, and so some
countries have their own
growth charts.

How to take measurements
Typical measurements taken for children 0-
24 months include:
Head circumference
Length
Weight

Measurements should be taken at regular
intervals in order to observe reliable
trends. Recommendations for
measurement intervals include:
Infants (0-12 months): every 2 months
Young Children: at 15, 18, 24 and 30
months
Ages 3+: every year

Growth Charts
Module_Branded
Measurement Schedule
handout.pdf

Head Circumference
Head circumference is a measurement
taken around the largest part of a child’s
head. This measurement is typically
taken with children ages 0-3 years old.
The measurement should be taken with a measuring tape
that cannot be stretched. This is typically a flexible,
metal measuring tape. To measure, securely wrap the
tape around the widest possible circumference of the
head. Typically, this is from 1-2 finger-widths above
the eyebrow on the forehead to the most prominent
part of the back of the head. Take the measurement
three times and select the largest measurement to the
nearest 0.1cm.

cht_hcfa_boys_z_0_2.pdf
cht_hcfa_girls_z_0_2.pdf

Height
- it is good determination of health and
normal nutrition as weight
-male infant is an average of 2-3cm longer
than of female at birth
-During first year of the life the infant HT
should increase by 25-30 cm
- by age 2 yrs , the child will be an average of
12.5 cm taller -most toddlers have reached
approximately 12 of their adult height.
-AT birth: 46-56cm , average( 50cm)

Length
Length is the linear measurement for
infants up to 24 months. Length
measurements (instead of height) are
also taken for children 24 to 36 months
who cannot stand without assistance.

Length
Length is measured when children are in a
recumbent (lying down) position. The
most accurate way to measure length is
by using a calibrated length board.
Length boards should have a fixed
headpiece and a moveable foot piece
perpendicular to the surface of the
board.
To measure, lay the child on the board with their head against the fixed
headpiece. Make sure the child is not wearing shoes or a hairpiece. An
assistant may be helpful to hold the child still and centered on the
board. Straighten the child’s legs and adjust the moveable foot piece
so the soles of the feet are against the foot piece. Record the length
to the nearest 0.1 cm.

cht_lfa_boys_z_0_2.pdf
cht_lfa_girls_z_0_2.pdf

Weight
Weight is a measurement taken throughout
the lifespan to help determine trends
and current nutritional status.

Weight
Infant weight can be accurately measured using one
of several different pieces of equipment. If
available, a pan-type pediatric scale allows a
child to be weighed while lying down. These
pediatric scales are either electronic or beam
scales with non-detachable weights, and are
accurate to the nearest 10 gram. Another option
is a hanging scale. A hanging scale needs to be
attached to a sturdy structure (e.g. building
rafter, door frame) and the child is suspended
from the scale in weighing pants.

Weight
To measure, make sure the child is wearing
as little clothing as possible and that no
one is touching the child. Read the scale
at eye-level and record weight to the
nearest 10 gram. Repeat the
measurement three times, exclude
values that appear skewed, and find the
average.

In the event a baby scale is unavailable, an
adult standing scale can be used to
measure infant weight. Weigh an adult
first, and then weigh the same adult
while holding a child. Find the difference
between the two weights – this is the
infant’s weight.
Weight-for-age is an important indicator of
a child’s nutritional status over time,
such as trends in underweight.

Weight:
Average newborn boy weight=3400g,
and girl= 3200g
- infant lose 5-10% of birth weight at
age 3-4 days to gain it back in 2
weeks with a steady growth rate.
infant double birth Wight by 6 month
they triple the body weight by 12
month= 10 kg.

Chest, and
abdominal
circumference.
Whaley and Wong

Abdominal Girth
Abdominal girth should be
measured over the umbilicus
Whenever possible.

head circumference and chest circumference :
Measure at birth and routinely until age 3 yrs.
HC measures directly skeletal growth (skull),
and indirectly cerebral growth.
Measurement at birth = 33-35 cm
Chest circumference : CC = 31-33 cm at birth
Ratio of head to chest circumference:
birth : HC is larger than CC2 cm
1 yrs-18 month : HC=CC
2-3 yrs HC slightly smaller than CC
> 3 yrs :HC is smaller than CC by 5-7 cm

Metro Manila Development Screening
Test (MMDST)
Developed for health professionals (MDs,
RNs, etc)
It is not an intelligence test
It is a screening instrument to determine if
child’s development is within normal
Children 6 ½ years and below

Purposes
Measures developmental delays
Evaluates 4 aspects of development
Metro Manila Development Screening
Test (MMDST)

4 sectors of development
Personal-Social – tasks which indicate
the child’s ability to get along with
people and to take care of himself
Fine-Motor Adaptive – tasks which
indicate the child’s ability to see and use
his hands to pick up objects and to draw
Language – tasks which indicate the
child’s ability to hear, follow directions
and to speak
Gross-Motor – tasks which indicate the
child’s ability to sit, walk and jump

MMDST KIT.
Preparation for test administration involves the nurse ensuring
the completeness of the test materials contained in the
MMDST Kit. These materials should be followed as specified:
MMDST manual
test Form
bright red yarn pom-pom
rattle with narrow handle
eight 1-inch colored wooden blocks (red, yellow, blue green)
small clear glass/bottle with 5/8 inch opening
small bell with 2 ½ inch-diameter mouth
rubber ball 12 ½ inches in circumference
cheese curls
pencil

EXPLAINING THE PROCEDURE.
AGE & THE AGE LINE.
TEST ITEMS.
SCORING.

What is the Barthel Index?
The Barthel Index consists of 10 items that
measure a person's daily functioning
specifically the activities of daily living
and mobility. The items include feeding,
moving from wheelchair to bed and
return, grooming, transferring to and
from a toilet, bathing, walking on level
surface, going up and down stairs,
dressing, continence of bowels and
bladder.

How is the Barthel Index used?
The assessment can be used to determine a baseline level
of functioning and can be used to monitor
improvement in activities of daily living over time. The
items are weighted according to a scheme developed
by the authors. The person receives a score based on
whether they have received help while doing the task.
The scores for each of the items are summed to create
a total score. The higher the score the more
"independent" the person. Independence means that
the person needs no assistance at any part of the
task. If a persons does about 50% independently
then the "middle" score would apply.

KATZ INDEX
WHY: Normal aging changes and health problems
frequently show themselves as declines in the
functional status of older adults. Decline may
place the older adult on a spiral of iatrogenesis
leading to further health problems. One of the
best ways to evaluate the health status of older
adults is through functional assessment which
provides objective data that may indicate future
decline or improvement in health status,
allowing the nurse to plan and intervene
appropriately.

BEST TOOL: The Katz Index of Independence in Activities of Daily
Living, commonly referred to as the Katz ADL, is the most
appropriate instrument to assess functional status as a
measurement of the client’s ability to perform activities of
daily living independently. Clinicians typically use the tool to
detect problems in performing activities of daily living and to
plan care accordingly. The Index ranks adequacy of
performance in the six functions of bathing, dressing,
toileting, transferring, continence, and feeding. Clients are
scored yes/no for independence in each of the six functions.
A score of 6 indicates full function, 4 indicates moderate
impairment, and 2 or less indicates severe functional
impairment.

BMI
Your BMI is based on your height and
weight. It's one way to see if you're at a
healthy weight.
Underweight: Your BMI is less than 18
Healthy weight: Your BMI is 18.5 to 24.9
Overweight: Your BMI is 25 to 29.9
Obese: Your BMI is 30 or higher

HOW TO CALCULATE YOUR BODY
MASS INDEX OR BMI
BMI is your weight (in kilograms) over your
height squared (in centimeters). Let’s
calculate, however, using pounds and
inches.
For instance, the BMI of a person who is
5’3" and weighs 125 lbs is calculated as
follows:

1. Multiply the weight in pounds by
0.45 (the metric conversion factor)
125 X 0.45 = 56.25 kg
2. Multiply the height in inches by
0.025 (the metric conversion factor)
63 X 0.025 = 1.575 m

3. Square the answer from step 2
1.575 X 1.575 = 2.480625
4.Divide the answer from step 1 by
the answer from step 3
56.25 : 2.480625 = 22.7
•1.575 X 1.575 = 2.480625

The BMI for a person who is 5’3"
and weighs 125 lbs is 22.7 or
practically, 23

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Functional health assessment

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