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Gordons Assessment Tool
Field Placement EMT (FLPL 108)
Fleming College
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Gordon's Functional Health Patterns Assessment Tool
Student Name Jennah Farnell____ Date(s) cared for _________________________
Client's Initials ____Age ______Dr. ____________Co-assigned nurse ________________
Diagnosis _________________________________________________________________
History ___________________________________________________________
Health Pattern Report Shift Assessment
Health Perception - Health Management:
Allergies Risk for falls Gait/coordination Personal Care Skin condition: wounds/dressing Side rails/call bell
Nutritional - Metabolic:
Diet/fluids/appetite Risk for choking Integrity of mm IV solution/rate/site
Elimination:
Bowels Last BM: colour/consistency Bowel Sounds/continence Laxative use/suppositories Urinary Pattern/freq/amount/colour/clarity Continence Attends/catheter
Activity - Exercise
TPR/B/P/SpO 2 Peripheral pulses/CMS Skin Colour Air entry/adventitious sounds Smoker? Level of activity Assistive Devices Assist with transfers
Sleep - Rest:
Sleep Time Rest Patterns Comfort Pain/VAS
Cognitive - Perception:
Oriented x 3 Cognitive status Visual/hearing aids
Self Perception - Self concept:
Mood Belief system Understanding of illness & treatments Decision making capacity
Role Relationship:
Support systems (family/friends) Ability to communicate Visitors Social activities
Sexuality - Reproductive:
Behavioural issues Expresses/responds to affection
Value - belief:
Personal goals Expression of contentment vs. unfinished business
Coping - Stress Tolerance
Stressors Coping methods Recent trauma/surgery/loss
Other significant data: _______________________________________________________________________ ___________________________________________________________________________________________
Gordon's Assessment Tool 2011
Gordons Assessment Tool
Course: Field Placement EMT (FLPL 108)
University: Fleming College
