This document provides guidelines for assessing patients using Gordon's 11 functional health patterns. The summaries are: 1. The health perception-health management pattern assessment focuses on a patient's perceived health and well-being as well as health practices. Subjective questions examine health habits and compliance with treatments. 2. The nutritional-metabolic pattern assessment examines dietary habits and metabolic needs. Subjective questions cover diet, fluid intake, and condition of skin, hair and nails. 3. The elimination pattern assessment focuses on bowel and bladder function. Subjective questions examine bowel and urinary habits and routines.

1. Advanced Nursing Health Assessments
Tigistu G, (MSc, Ass.
Prof)

2. Approaches to Nursing Health Assessments
 Functional Health Assessment Pattern Approach
 Medical Health Assessment Approach

3. Gordon’s functional health pattern
Marjorie Gordon (1987) proposed 11 functional health patterns
as a guide for establishing a comprehensive nursing data base.
These categories make possible a systematic and standardized
approach to data collection,

4. Functional Health Assessment Pattern
Health Perception-Health management pattern
Nutritional-Metabolic Pattern
Elimination Pattern
Activity-Exercise Pattern
Sexuality-Reproduction Pattern
Sleep-Rest Pattern

5. Functional …
 Sensory-Perceptual Pattern
 Cognitive Pattern
 Role-Relationship Pattern
 Self-Perception-Self- Concept Pattern
 Coping-Stress Tolerance Pattern
 Value-Belief Pattern

6. Biographic data

7. 1. Health Perception-
Health Management
Pattern:
Data collection is focused on the person's perceived level
of health and well-being, and on practices for maintaining
health.
Purpose:
• To determine how the client perceives and manage
current and past nursing and, medical
recommendations.
• The client's ability to perceive the relationship between
activities of daily living and health.

8. Subjective Data
Guideline Questions Client
perception of health:
Describe your health.
Ask
• How would you rate your health on a scale of 1 to 10
(10 is excellent) now, 5 years ago, and 5 years ahead?
Client perception of illness. Ask client to describe illness or current health
problem.
• How has this affected the normal daily activities?
• How do you feel your current daily activities have
affected your Health?
• What do the client feel caused the illness?
• What course do client predict your illness will take?
• How do you feel your illness should be treated?
• Do you have or anticipate any difficulties in caring for
Yourself or others at home? If yes, explain.

9. Subjective cont’d
Health management and
habits:
• Tell me what you do when you have a health problem.
• When do you seek nursing or medical advice?
• How often do you go for professional exams (dental, Pap
Smears, breast, BP)?
• What activities do you feel keep you healthy?
• Contribute to illness?
• Do you perform self-exams (blood pressure, breast,
testicular)?
• When were your last immunizations?
• Are they up to date?
• Do you use alcohol, tobacco, drugs?
• Are you exposed to pollutants or toxins?

10. Subjective cont’d
Compliance With Prescribed
Medications and Treatments
• Have you been able to take your prescribed
medications?
• If not, what caused your inability to do so?
• Have you been able to follow through with your
prescribed nursing and medical treatment (e.g.,
diet, exercise)?
• If not, what caused your inability to do so?

11. Objective Data
Objective • Refer to General Physical Survey
Associated Nursing
Diagnoses Categories to
Consider
• Health Seeking Behaviors Effective Management of Therapeutic
Regimen
• Risk for Injury
• Risk for Suffocation
• Risk for Poisoning
• Risk for Trauma
• Risk for Peri-operative Positioning Injury
Actual Diagnoses • Energy Field Disturbance.
• Altered Growth and Development.
• Altered Health Maintenance.
• Ineffective Management of Therapeutic Regimen:
• Individual; Ineffective Management of Therapeutic Regimen:
• Family; Ineffective Management of Therapeutic Regime:
• Community Non compliance

12. 2 Nutritional-
Metabolic Pattern
Assessment is focused on the pattern of food and fluid
consumption relative to metabolic need
Purpose:
• To determine the client dietary habits and metabolic needs.
• The conditions of hair, skin, nails, teeth and mucous
membranes are assessed

13. Subjective Data
.
Guideline Questions Dietary
and Fluid Intake
• Describe the type and amount of food you eat at breakfast,
lunch, and supper on an average day
• Do you follow any certain type of diet? Explain.
• What time do you usually eat your meals?
• Do you find it difficult to eat meals on time? Explain.
• What types of snacks do you eat? How often?
• Do you take any vitamin supplements? Describe.
• Do you consider your diet high in fat? Sugar? Salt?

14. Subjective
Guideline Questions
Dietary and Fluid coni’d
• Do you find it difficult to tolerate certain foods? Specify.
• What kind of fluids do you usually drink?
• How much per day?
• Do you have difficulty chewing or swallowing food?
• When was your last dental exam? What were the result?
• Do you ever experience sore throat, sore tongue, sore gums?
Describe
• Do you ever experience nausea and vomiting? Describe
• Do you ever experience abdominal pains? Describe.
• Do you use antacids? How often? What kind?

15. Condition of Skin • Describe the condition of your skin.
• How well and how quickly does your skin heal?
• Do you have any skin lesions? Describe-
• Do you have excessive oily or dry skin?
• Do you have any itching? What do you do for relief?
Condition of Hair, Nails • Describe the condition of your hair, nails
• Do you have excessively oily or dry hair?
• Have you had difficulty with scalp itching or sores?
• Do you use any special hair or scalp care products?
• Have you noticed any changes in your nails? Color Cracking?
Shape? Lines?
Subjective

16. Subjective
Metabolism • What would you consider to be your "ideal weight"?
• Have you had any recent weight gains or losses?
• Have you used any measures to gain or lose weight? Describe.
• Do you have any intolerance to heat or cold?
• Have you noted any changes in your eating or drinking
habits? Explain.
• Have you noticed any voice changes?
• Have you had difficulty with nervousness?

17. Objective Data
Assess the client's temperature, pulse, respirations, and height and weight.
Wellness Diagnoses • Opportunity to enhance nutritional metabolic pattern
• Opportunity to enhance effective breast feeding
• Opportunity to enhance skin integrity
Actual Diagnoses • Decreased Adaptive Capacity: Intracranial.
• Ineffective Thermo regulation.
• Fluid Volume Deficit
• Fluid Volume Excess
• Altered Nutrition: Less than body requirements
• Altered Nutrition: More than body requirements
• Ineffective Breastfeeding
• Interrupted Breastfeeding
• Ineffective Infant Feeding Pattern
• Impaired Swallowing
• Altered Protection Impaired Tissue Integrity
• Altered Oral Mucous Membrane Impaired Skin Integrity.

18. 3. Elimination
Pattern
Data collection is focused on excretory patterns (bowel, bladder, skin).
Excretory problems such as incontinence, constipation, diarrhea, and
urinary retention.
Purpose:
• To determine the adequacy of function of the client's bowel and
bladder for elimination.
• The client's bowel and urinary routines and habits are assessed.
• In addition, any bowel or urinary problems and use of urinary or
bowel elimination devices are examined.

19. Subjective Data
Guidelines Questions Bowel Habits Bladder Habits
• Describe your bowel pattern.
• Have there been any recent changes?
• How frequent are your bowel movements?
• What is the color and consistency of your
stools?
• Do you use laxatives? What kind and how
often do you use them?
• Do you use enemas? How often and what kind?
• Do you use suppositories? How often and what
kind?
• Do you have any discomfort with your bowel
movements? Describe.
• Have you ever had bowel surgery? What type?
Ileostomy? Colostomy
• Describe your urinary habits.
• How frequently do you urinate?
• What is the amount and color of your urine?
• Do you have any of the following problems with
urinating:. Pain? Blood in urine?
• Difficulty starting a stream? Incontinence? Voiding
frequently at night? Voiding frequently during day?
Bladder infections?
• Have you ever had bladder surgery? Describe.
• Have you ever had a urinary catheter? Describe.
When? How long?

20. Objective Data
Associated nursing-Diagnoses Categories to Consider
Wellness Diagnoses • Opportunity to enhance adequate bowel elimination pattern
• Opportunity to enhance adequate urinary elimination pattern
Risk Diagnoses • Risk for constipation, - Risk for altered urinary elimination
Actual Diagnoses • Altered Bowel Elimination
• Constipation
• Colonic constipation
• Perceived constipation
• Diarrhea
• Bowel Incontinence
• Altered Urinary Elimination Patterns of Urinary Retention
• Total Incontinence
• Functional Incontinence
• Reflex Incontinence Urge Incontinence
• Stress Incontinence
Refer to Abdominal Assessment and the rectal assessment.

21. 4. Activity-
Exercise Pattern
Assessment is focused on the activities of daily living
requiring energy expenditure, including self-care activities,
exercise, leisure activities respiratory and cardiac system
Purpose:
• To determine the client's activities of daily living, including
routines of exercise, leisure, and recreation.
• This includes activities necessary for personal hygiene,
cooking, shopping eating, maintaining the home, and
working.
• An assessment is made of any factors that affect or
interfere with the client's routine activities of daily living.
• Activities are evaluated in reference to the client's
perception of their significance in his or her life.

22. Subjective Data
Guideline Questions
Activities of Daily Lining
• Describe your activities on a normal day. (Including hygiene, activities, cooking
activities, shopping activities, eating activities, house and yard activities, other self-
care activities.)
• How satisfied are you with these activities?
• Do you have difficulty with any of these self-care activities? Explain.
• Does anyone help you with these activities? How?
• Do you use any special devices to help you with your activities?
• Does your current physical health affect any of these activities e.g. dyspnea, shortness
of breath, palpations, chest pain. stiffness, weakness)? Explain.
Leisure Activities: • Describe the leisure activities you enjoy.
• Has your health affected your ability to enjoy your leisure? Explain.
• Do you have time for leisure activities?
• Describe any hobbies you have.
• Exercise Routine: Describe those activities that you feel give you exercise.
• How often are you able to do this type of exercise?
• Has your health interfered with your exercise routine?

23. Occupational
Activities:
• Describe what you do to make a living.
• How satisfied are you with this job?
• Do you feel it has affected your health?
• How has your health affected your ability to work?
Objective Data
Refer to :-
• Thoracic and Lung Assessment
• Cardiac Assessment
• Peripheral Vascular Assessment and
• Musculoskeletal Assessment
Associated Nursing
Diagnoses
Wellness diagnosis
• Opportunity to enhance effective cardiac output
• Opportunity to enhance effective diversional activity pattern
• Opportunity to enhance effective activity-exercise pattern
• Opportunity to enhance effective home maintenance management

24. Associated Nursing
Diagnoses
Wellness diagnosis
• Opportunity to enhance effective self-care activities
• Opportunity to enhance adequate tissue perfusion
• Opportunity to enhance effective breathing pattern
Risk Diagnoses • Risk for Disorganized Infant Behavior
• Risk for Peripheral Neurovascular Dysfunction
• Risk for altered respiratory function
Actual Diagnoses • Activity Intolerance
• Impaired Gas Exchange
• Ineffective Airway Clearance
• Ineffective Breathing Pattern
• Decreased Adaptive Intracranial Capacity
• Decreased Cardiac Output
• Disuse syndrome
• Diversional Activity Deficit
• Impaired Home Maintenance Management

25. 5. Sexuality-
Reproduction Pattern
• Assessment is focused on the person's satisfaction or
dissatisfaction with sexuality patterns and reproductive
functions
Purpose:
• To determine the client’s fulfillment of sexual needs and
perceived level of satisfaction.
• The reproductive pattern and developmental level of the client
is determined.
• Perceived problems related to sexual activities, relationships,
or self-concept are elicited.
• The physical and psychological effects of the client's current
health status, on sexuality or sexual expression are examined.

26. Subjective Data
Guideline Questions for Female
Menstrual history: • How old were you when you began menstruating?
• On what date did your last cycle begin?
• How many days dose your cycle normally last?
• How many days elapse from the beginning of one cycle until the
beginning of another?
• Have you noticed any change in your menstrual cycle?
• Have you noticed any bleeding between your menstrual cycles?
• Do you experience episodes of flushing; chilling, or intolerance to
temperature change?
• Describe any mood changes or discomfort before, during, or after
your cycle.

27. Subjective
Guideline Questions for Female
Obstetric history: • How many times have you been pregnant?
• Describe the outcome of each pregnancies if you have children?
• What are the ages and sex of each?
• Describe your feelings with each pregnancy.
• Explain any health problems or concerns you had with each
pregnancy.
• If pregnant now, Was this a planned or unexpected pregnancy?
• Describe your feelings about this pregnancy.
• What changes in your life-style do you anticipate with this
Pregnancy?
• Describe any difficulties or discomfort you have had with this
Pregnancy.
• How can I help you meet your needs during this pregnancy?

28. Subjective
Guideline Questions for Male/Female considerations:
Contraception: • What do you or your partner do to prevent pregnancy?
• How acceptable is this method to both of you?
• Do this means of birth control affect your enjoyment of sexual
relations?
• Describe any discomfort or undesirable effects of this method
produces.
• Have you had any difficulty with fertility? Explain.
• Has infertility affected your relationship with your partner? Explain.

29. Subjective
Perception of sexual
activities:
• Describe you sexual feelings.
• How comfortable are you with your feelings of
femininity/masculinity?
• Describe your level of satisfaction from your sexual relationship (s)
on scale of 1 to 10(with 10 being very satisfying).
• Explain any changes in your sexual relationship (s) that you Would
like to make.
• Describe any pain or discomfort you have during intercourse
• Have you (your partner) experienced any difficulty achieving an
orgasm or maintaining an erection?
• If so, how has this – affected your relationship?

30. Subjective
Concerns related
to illness:
• How has your illness affected your sexual relationships?
• How comfortable are you discussing sexual problems with your
partner?
• Who would you seek help from for sexual concerns?
Special problems: • Do you have or have you ever had a sexually transmitted disease?
Describe.
• What method do you use to prevent contracting a sexually
transmitted disease?
• Describe any pain, burning, or discomfort you have while voiding.
• Describe any discharge or unusual odor you have from your
penis/vagina.
• What is the date of your last Pap smear?

31. Subjective
History of sexual
abuse:
• Describe the time and place the incident occurred.
• Explain the type of sexual contact that occurred.
• Describe the person who assaulted you.
• Identify any witnesses present.
• Describe your feelings about this incident.
• Describe your feelings about this incident.
• Have you had any difficulty sleeping, eating, or working since the
incident occurred?
Objective Data
Refer to:
• Breast Assessment,
• Abdominal Assessment,
• Urinary-Reproductive Assessment

32. Associated nursing Diagnoses Categories to Consider
Wellness
Diagnoses:
• Opportunity to enhance sexuality patterns
Risk- Diagnoses: • Risk for altered sexuality pattern
Actual Diagnoses: • Sexual Dysfunction,
• Altered Sexuality Patterns

33. 6. Sleep-Rest
Pattern
• Assessment is focused on the person's sleep, rest, and relaxation
practices.
• Dysfunctional sleep patterns, fatigue, and responses to sleep
deprivation may be identified.
Purpose:
• To determine the client perception of the quality of his or her
relaxation and energy levels
• Methods used to promote relaxation and sleep is also assessed.

34. Subjective Data
Guideline Questions:
Sleep Habits: • Describe your usual sleeping time at home.
• How would you rate the quality of your sleep?
Special Problems: • Do you ever experience difficulty with falling asleep?
• Remaining asleep?
• Do you ever feel fatigued after a sleep period?
• Has your current health altered your normal sleep habits? Explain.
• Do you feel your sleep habits have contributed to your current
Illness? Explain.
Sleeping Aids: • What helps you to fall asleep?
• Medications?
• Reading?
• Relaxation technique?
• Watching TV?
• Listening to music?

35. Objective Data
Observe
appearance
• Pale
• Puffy eyes with dark circles
Observe behavior
• Yawning
• Dozing during day
• Irritability
• Short attention span

36. Associated nursing Diagnoses Category to Consider
Wellness Diagnoses: • Opportunity to enhance sleep
Risk Diagnoses: • Risk for sleep pattern disturbance
Actual Diagnosis: • sleeps Pattern Disturbance

37. 7. Sensory-
Perceptual and
Cognitive Pattern
•Assessment is focused on sensory functions and,
ability to thinking, decision making, and problem
solving.
Purpose:
• To determine the functioning status of five senses: vision,
hearing, smelling, taste and touch, (including pain perception)
• Devices and methods used to assist the client with deficits in
any of these five senses are assessed.
• To determine the client’s ability to understand, communicate,
remember, and make decision.

38. Subjective Data
Guideline Questions
Perception of Senses: • Describe your ability to see, hear, feel, taste, and smell.
• Describe any difficulty you have with your vision, hearing, and
ability to feel (e.g., touch, pain, heat, cold), taste (salty, sweet,
bitter, sour), or smell.
Pain Assessment: • Describe any pain you have now.
• What brings it on?
• What relieves it?
• When does it occur and How often?
• How long does it last?
• Show me where you have pain.
• Rate your pain on a scale of 1 to 10, with 10 being the most
severe Pain.
• How has your pain affected your activities of daily living?

39. Subjective
Guideline Questions
Special Aids: • What devices (e.g., glasses, contact lenses, hearing aids) or
methods do you use to help you with any of the above
problems?
• Describe any medications you take to help you with these
problems.
Objective Data
Refer to the section
on:
• Nose,
• Sinus,
• Eye, and
• Ear Assessment.

40. Associated Nursing Diagnoses Categories to Consider
Wellness Diagnosis:
Risk Diagnoses:
• Opportunity to enhance comfort level
• Risk for pain,
• Risk for Aspiration
Actual Diagnoses: • Pain,
• Chronic Pain and
• Dysreflexia.

41. Guideline Questions to cognitive
Ability to Understand: • Explain what your doctor has told you about your health
• Do you feel you understand your illness and prescribed care?
• What is the best way for you to learn something new (read,
watch TV, etc.)?
Ability to
Communicate:
Ability to Remember:
Ability to Make
Decisions:
• Can you tell me how you feel about your current state of
health?
• Are you able to ask questions about your treatments,
medications, and so forth?
• Do you ever have difficulty expressing yourself or explaining
things to others?
• Are you able to remember recent event and events of long years
ago? Explain.
• Describe how you feel when faced with a decision.
• What assists you in making decisions?
• Do you find decision making difficult, fairly easy, or variable?
Subjective Data

42. Objective Data
• Refer to the Mental Status Assessment
Associated Nursing Diagnoses Categories to Consider
Wellness Diagnosis:
Risk Diagnoses:
• Opportunity to enhance cognition
• Risk for altered thought processes
Actual Diagnoses: Acute confusion Chronic Confusion
Decisional Conflict Impaired
Environmental Interpretation Syndrome Knowledge Deficit
(Specify)
Altered Thought Processes Impaired Memory

43. 8. Role-Relationship
Pattern:
Assessment is focused on the person's roles in the family and
relationships with others.
Purpose:
• To determine the client’s perceptions of responsibilities and
roles in the family, at work, and in social life.
• The client's level of satisfaction with these is assessed.
• In addition, any difficulties in the client's relationships and
interactions with others are examined.

44. Subjective Data
Guideline Questions:
Perception of Major Roles
and Responsibilities in
Family:
• Describe your family.
• Do you live with your family? alone?
• How does your family get along?
• Who makes the major decisions in your family?
• Who is the main financial supporter of your family?
• How do you feel about your family?
• What is your role in your family?
• Is this an important role?
• What is your major responsibility in your family?
• How do you feel about this responsibility?
• How does your family deal with problems?
• Are there any major problems now? Who is the person you feel
closest to in your family?

45. Subjective Data
Guideline Questions:
Perception of Major Roles
and Responsibilities at Work:
Describe your occupation.
What is your major responsibility at work?
How do you feel about those you work with?
What would you change if you could about your work?
Are there any major problems you have at work?
Perception of Major Social
Roles and Responsibilities :
Who is the most important person in your life? Explain.
Describe your neighborhood and the community in which you live.
How do you feel about the people in your community?
Do you participate in any social groups or neighborhood activities?
What do you see as your contribution to society?
What about your community would you change if you could?

46. Objective Data
• Outline a family genogram for your client.
• Observe your client's family members.
• How do they communicate with each other?
• How do they respond to the client?
• Do they visit, and how long do they stay with the client?
Associated Nursing Diagnoses Categories to Consider
Wellness
Diagnoses:
Opportunity to enhance effective relationships
Opportunity to enhance effective parenting
Opportunity to enhance effective role performance
Opportunity to enhance effective communication
Opportunity to enhance effective social interaction.
Opportunity to enhance effective caregiver and grieving role

47. Associated nursing Diagnoses Categories to Consider cont’d
Risk- Diagnoses: • Risk for dysfunctional grieving,
• High risk for Loneliness.
• Risk for Altered Parent/Infant/Child Attachment
Actual Diagnoses: • Impaired Verbal Communication
• Altered Family Processes
• Alcoholism Anticipatory Grieving
• Dysfunctional Grieving?
• Altered Parenting
• Parental Role Conflict
• Altered Role Performance Impaired Social Interaction:
• Social Isolation

48. 9.. Self-Perception-
Self-Concept Pattern:
Assessment is focused on the person's attitudes toward self,
including identity, body image, and sense of self-worth.
Purpose:
• To determine the client’s perception of identity, abilities,
body image, and self worth.
• The client's behavior attitude, and emotional patterns are also
assessed

49. Subjective Data
Guideline Questions Perception of Identity:
Describe yourself: • Perception of Abilities and Self-Worth:
• What do you consider to be your strengths? Weaknesses?
• How do you feel about yourself?
• How does your family feel about you and your illness?
Body Image: • How do you feel about your appearance?
• Has this changed since your illness? Explain.
• How would you change your appearance if you could?
• How do you feel about other people with disabilities?
Objective data Refer to the procedures for observing appearance, mood under
Mental Status assessment.

50. Associated Nursing Diagnoses Categories to Consider
Wellness Diagnoses: • Opportunity to enhance self-perception
• Opportunity to enhance self-concept
Risk Diagnoses: • Risk for hopelessness
• Risk for body image disturbance
• Risk for low self esteem
Actual Diagnoses: • Anxiety fatigue –
• Fear - Hopelessness-
• Powerlessness-
• Personal Identity Disturbance
• Body Image Disturbance
• Self Esteem Disturbance.

51. 10. Coping-Stress
Tolerance Pattern
Assessment is focused on the person's perception of stress and
on his or her coping strategies Support systems are evaluated,
and symptoms of stress are noted.
Purpose:
• To determine the areas and amount of stress in a client’s life
and the effectiveness if coping methods used to deal with it.
• Availability and use of support systems such as family,
friends, and religious believes are assessed.

52. Subjective Data
Guideline Questions Perception of Stress and Problems in Life:
Perception of Stress
Problems in Life
Describe what you believe to be the most stressful situation in your
life.
How has your illness affected the stress you feel?
How do you feel stress has affected your illness?
A personal loss or major change in your life over the last year?
Explain.
What has helped you to cope with this change or loss?
Coping Methods and
Support Systems:
What do you usually do first when faced with a problem?
What helps you to relieve stress and tension?
To whom do you usually turn when you have a problem or feel under
pressure?
How do you usually deal with problems?
Do you use medication, drugs, or alcohol to help relieve stress?
Explain

53. Associated nursing Diagnoses Categories to Consider:
Wellness Diagnoses: Opportunity to enhance effective individual coping.
•Opportunity to enhance family coping
•Potential for Enhanced Spiritual Well Being.
•Potential for Enhanced Community coping.
Risk Diagnoses: Risk for ineffective coping (individual, family, or community)
• Risk for self-harm Risk for self- abuse.
• Risk for Self-Mutilation
• Risk for suicide
• Risk for Violence; Self- directed or directed at others
Actual Diagnoses: • Impaired Adjustment
• Ineffective Individual Coping
• Ineffective Family Coping
• Disabling Ineffective Family Coping
Objective Data
• Refer to the Mental Status Assessment.

54. 11. Value-Belief
Pattern:
Assessment is focused on the person's values and beliefs (including
spiritual beliefs).
Purpose:
• To determine the client’s life values and goals, philosophical,
religious beliefs, and spiritual beliefs that influence choices and
decisions.
• Conflicts between these values, goals, beliefs, and expectations
that are related to health are assessed.

55. Subjective Data
Guideline Questions Values Goals and Philosophical beliefs;
Goals • What is most important to you in Life?
• What do you hope to accomplish in your life?
• What is the major influencing factor that helps you make decisions?
• What is your major source of hope and strength in life?
Religious and
Spiritual Beliefs:
• Do you have a religious affiliation?
• Is this important to you?
• Are there certain health practices or restrictions that are important for you to follow
while you are ill or hospitalized? Explain.
• Is there a significant person (e.g., minister, priest) from your religious denomination
whom you want to be contacted?
• Would you like the hospital chaplain to visit?
• Are there certain practices (e.g., prayer, reading scripture) that are important to you?
• Is a relationship with God an important part of your life? Explain.
• Do you have another source of strength that is important to you?
• How can I help you continue with this source of spiritual strength while you are ill in
the hospital?

56. Objective Data
Observe religious
practices
• Presence of religious articles in room (e.g., Bible, cards, medals,
Statues)
• Visits from clergy Religious actions of client: prayer, visit to chapel,
request for clergy, watching of religious TV programs or listening to
religious radio stations
• Observe client's behavior for signs of spiritual distress.
• Anxiety, Anger, Depression, Doubt Hopelessness, Powerlessness…
Associated Nursing Diagnoses Category to Consider
Wellness Diagnosis: • Potential for Enhanced Spiritual Well- Being
Risk diagnosis: Risk for spiritual distress
Actual Diagnosis: Spiritual disturbance (distress of the human spirit).

57. Medical approach to Health Assessment

58. Medical approach to Health Assessment
Holistic approach:
1. The interview
2. Psychosocial assessment
3. Nutritional assessment
4. Assessment of sleep-wakefulness patterns
5. The health history.

59. The Interview
Definition:
 Communication process focuses on the client's development of psychological,
physiological, socio-cultural, and spiritual responses, that can be treated with
nursing & collaborative interventions

60. Major purpose:
 To obtain health history, elicit symptoms and the time course of their
development.
 Interview is conducted before the physical examination.
Phases of nursing interview
1. Introductory phase
2. Working phase
3. Termination phase

61. 1. Introductory phase:
 Introduce yourself and explains the purpose of the interview to the client.
 Before asking questions, Let client to feel Comfort, Privacy and
Confidentiality
2.Working phase:
 The nurse must listen and observe cues in addition to using critical thinking
skills to validate information received from the client.
 The nurse identifies client's problems and goals.

62. Termination phase:
1.Summarizes information obtained during the working phase
2. Validates problems and goals with the client.
3. Making plans to resolve the problems (nursing diagnosis and collaborative
problems are identified and discussed with the client)

63. Communications techniques during interview
. Types of questions :
Begin with open ended questions to assess client's feelings e.g. “what,
how, which”
Use closed ended question to obtain facts e.g." when, did…etc
Use list to obtain specific answers e.g. "is pain sever, dull sharp
Explore all data that deviate from normal e.g. “increase or decrease the
problem

64. Health History
Definition:
Systematic collection of subjective data stated by the client, and objective
data which observed by the nurse that is used to determine a client’s
functional health pattern status.
Taking Health History
Two phases:-
The interview phase which elicits the information (primary sources)
The recording phase (secondary sources).

65. Guidelines for Taking Nursing History
Private, comfortable, and quiet environment.
Review information about past health history before starting interview.
Allow the client to state problems and expectations for the interview.
Orient the client the structure, purposes, and expectations of the history taking.
Communicate and negotiate priorities with the client
Listen more than talk.

66. Guidelines for Taking Nursing History cont’d..
Observe non verbal communications e.g. "body language, voice tone, and
appearance".
Balance between allowing a client to talk in an unstructured manner and the
need to structure requested information.
Clarify the client's definitions (terms & descriptors)
Avoid yes or no question (when detailed information is desired).
Write adequate notes of the health history for recording soon after interview

67. Nursing Health History can be:
Complete health history: taken on initial visits to health care facilities.
Interval health history: collect information in visits following the initial
data base is collected.
Problem- focused health history: collect data about a specific problem

68. Components of Health History
1-Biographical Data: This includes
Full name
Address and telephone numbers
Birth date and birth place.
Sex
Religion and race.
Marital status.
Social security number.
Occupation (usual and present)
Source of referral.
Usual source of healthcare
Source and reliability of information.
Date of interview.

69. 2- Chief Complaint: “Reason For Hospitalization ”
Examples of chief complaints:
Chest pain for 3 days.
Swollen ankles for 2 weeks.
Fever and headache for 24 hours.
Pap smear needed.
Physical examination needed for camp.

70. Symptom analysis
P Q R S T
A. Provocative or Palliative
First occurrence :
What were you doing when you first experienced or noticed the symptom?
What triggers it ? stress? Position?, activity?
What seems to cause it or make it worse? For a psychological symptom .
What relieves the symptom : change diet? Change position ? Take medication
? Being active?
Aggravation: what makes the symptom worse?

71. Symptom ana…
P Q R S T
B. Quality Or Quantity
QUALITY:
 How would you describe the symptom- how it feels, looks, or sounds?
QUANTITY:
 How much are you experiencing now?
 Is it so much that it prevents you from performing any activity?

72. Symptom Ana…
P Q R S T
C. Region/Radiation
Region :
Location: Where does the symptom occur?
Radiation :
Does it travel down your back or arm, up your neck or down your legs?

73. Symptom Anal…
P Q R S T
D. Severity scale
Severity
How bad is symptom at its worst?
Course
Does the symptom seem to be getting better, getting worse?

74. Symptom Anal….
P Q R S T
E. Timing
Onset : On what date did the symptom first occur
Type of onset :
How did the symptom start sudden? Gradually?
Frequency :
How often do you experience the symptom ; hourly ? Daily ? Weekly?
monthly
Duration :
 How long does an episode of the symptom last

75. 3-History of present illness
Gathering relevant information
- Chief complaint,
- Client's problem, including
* Essential and relevant data, and
* Self medical treatment.

76. Component of Present Illness
Introduction: "client's summary and usual health".
Investigation of symptoms: "onset, date, gradual or sudden, duration,
frequency, location, quality, and alleviating or aggravating factors".
Negative information.
Relevant family information.
Disability "affected the client's total life".

77. 4- Past Health History:
The purpose:
To identify all major past health problems of the client
This includes:
Childhood illness e.g. history of rheumatic fever.
History of accidents and disabling injuries
History of hospitalization (time of admission, date, admitting complaint, discharge
diagnosis & follow up care.
History of operations "how and why this done"
History of immunizations and allergies.
Physical examinations and diagnostic tests.

78. 5-Family History
The purpose: to learn about the general health of the client's blood relatives, spouse, and
children and to identify any illness of environmental genetic, or familiar nature that might
have implications for the client's health problems.
Family history of communicable diseases.
Heredity factors associated with causes of some diseases.
Strong family history of certain problems.
Health of family members "maternal, parents, siblings, aunts, etc.".
Cause of death of family members "immediate and extended family".

79. 6-Environmental History:
Purpose
“To gather information about surroundings of the client", including
physical, psychological, social environment, and presence of hazards,
pollutants and safety measures."

80. 7- Current Health Information
The purpose is to record major current health related information.
Allergies: environmental, ingestion, drug, other.
Habits "alcohol, tobacco, drug, caffeine"
Medications taken regularly "by doctor or self prescription
Exercise patterns.
Sleep patterns (daily routine).
The pattern life (sedentary or active)

81. 8- Psychosocial History:
Includes:
How client and his family cope with disease or stress, and how they
respond to illness and health.
You can assess if there is psychological or social problem that affects the
general health of the client.

82. 9- Review of Systems (ROS)
 This may identify hidden problems and provides an opportunity to indicate
client strength and disabilities
 Collection of data about the past and the present of each of the client
systems.
 Review of the client’s physical, sociologic, and psychological health status.

83. Physical Systems P/E
Which includes assessment of:-
General review of skin, hair, head, face, eyes, ears, nose, sinuses, mouth, throat,
neck nodes and breasts.
Assessment of respiratory and cardiovascular system.
Assessment of gastrointestinal system.
Assessment of urinary system.
Assessment of genital system.
Assessment of extremities and musculoskeletal system.
Assessment of endocrine system.
Assessment of heamatologic system.

84. 10. Nutritional assessment
Major goals of nutritional assessment is: to detect malnutrition including
over consumption, under nutrition and optimal nutritional status.
Components of Nutritional Assessment: Anthropometric measurement,
Biochemical measurement, Clinical examination and Dietary analysis.

85. Physical Assessment/Examination

86. Indications for the Physical Exam
 Routine screening
 Eligibility prerequisite for health insurance, military service, job, sports,
school
 Admission to a hospital or long term care facility

87. STEPS OF ASSESSMENT
 Think
 Organize
 Don’t forget…Nutrition / Height & Weight
 Environment:
 Accommodate special needs (cultural sensitivity)
 Equipment - clean surface & clean equipment Room - quiet, warm & well
lighting
 Maintain privacy
 Observe & Listen

88. Physical Assessment
There are four techniques to use in performing physical assessment:
1.Inspection
2. Palpation
3. Percussion
4. Auscultation
Note: there is 5th additional skill known as olfaction

89. 1. Inspection:
 Inspection is defined as “the use of the senses of vision, to observe the
normal condition or any deviations from normal of various body parts.”
 The nurse inspects or looks body parts to detect normal characteristics or
significant physical sings.
 Inspection helps to know normal characteristics before trying to distinguish
abnormal findings in different ages.
 The quality of an inspection depends on the nurse's willingness to spend time
doing a thorough job.

90. Principles of Accurate Inspection
 Good lightening either day light or artificial light is suitable.
 Expose body parts being observed only.
 Look before touching.
 warm room for examination of the client “not cold not hot".
 Observe for color, size, location, texture, symmetry, odors,
and sounds.
 Compare each area inspected with the opposite side of body
if possible.
 Use pen light to inspect body cavities.

91. Palpation
 Touch & feel with hands to determine:
 Texture – use fingertips (roughness, smoothness).
 Temperature – use back of hand (warm, hot, cold).
 Moisture (dry, wet, or moist).
 Organ location and size
 Consistency of structure (solid, fluid filled)
 Slow and systematic
 Light to deep
 Light palpation (tenderness)
 Deep palpation (abdominal organs/masses)

92. Principles for Accurate Palpation
 Examiner finger nails should be short.
 Use sensitive part of the hand.
 Light Palpation precedes deep palpation.
 Start with light then deep palpation
 Tender area are palpated last
 Tell client to take slow deep breath to enhance muscle relaxation.
 Examine condition of the abdominal organs
 Depressed areas must be approximately “2cm”
 Assess turger of skin measured by lightly grasping the body part with finger
tips.

93. Light palpation

94. Deep palpation

95. Percussion
 Tap a portion of the body to elicit tenderness that varies with the
density of underlying structures.
 Percussion denotes location, size and density of underlying
structures, percussion requires dexterity.
Methods of percussion:
Direct method: involving striking the body surface directly
with one or two fingers.
Indirect method: performed by placing the middle finger of the
examiner’s non dominant hand “pleximeter hand” firmly against the
body surface with palm and fingers remaining off the skin, and the tip
of the middle finger of the dominant hand “plexor” strikes the base of
the distal joint of the pleximeter. Use a quick & sharp stroke

96. Indirect Percussion

97. Description of sounds
 Sound produced by the body is characterized by intensity, frequency,
duration and quality.
 Intensity, or loudness, associated with physiologic sound is low; thus, the
use of the stethoscope is needed.
 Frequency, or pitch, of physiologic sound is in reality “noise”.
 Duration relates to the time elapsed from the beginning of the sound till the
end of the sound.
 Quality of sound relates to overtones that allow one to distinguish between
different sounds.

98. Five percussion sounds produced in different body regions
1. Resonant – normal lung
2. Hyper resonant: it’s a louder and lower pitched than resonant sounds. Normally
heard in children and very thin adults , and abnormally in emphysema
3. Tympany : A hollow drum-like sound produced when a gas-containing cavity is
tapped sharply. Tympany is heard if the chest contains free air (pneumothorax) or
the abdomen is distended with gas air filled (stomach)
4. Dull sounds are normally heard over dense areas such as the heart or liver.
Dullness replaces resonance when fluid replaces air-containing lung tissues, such as
occurs with pneumonia, pleural effusions, or tumors
5. Flat: shown in no air areas such as thigh muscle, bone and tumor

99. Auscultation
“To listen for various breath, heart, and bowel sounds”
Direct or immediate auscultation is accomplished by the unassisted ear that
is without amplifying device.
 This form of auscultation often involves the application of the ear directly
to a body surface where the sound is most prominent.
Mediate auscultation: the use of sound augmentation device such as a
stethoscope in the detection of body sounds.

100. Auscultation
 Listening to body sounds
 Movement of air (lungs)
 Blood flow (heart)
 Fluid & gas movement (bowels)
 Remember the sound changes in the
abdomen…

101. HOW TO BEGIN…
 Positions for physical exam
 Using a stethoscope:
 Longer the tube – more sound has to travel
 Hold diaphragm firmly against client’s skin (NOT THROUGH CLOTHING)
 If using bell – less pressure
 Warm in your hands first!
 Listen / Concentrate on the sounds

102. Olfaction
Another skill that used during assessment, certain alteration in body function
create characteristic body odors, smelling can detect abnormalities that
unrecognized by other means.
Assessment of characteristic odors:
 Alcohol odor from oral cavity means ingestion of alcohol.
 Ammonia from urine means urinary tract infection.
 Body odor from skin, particularly in areas where body parts rub together

103.  Feces odor from wound site means wound abscess, but if this odor from
vomitus this means bowel obstruction, and if the odor from rectal area this
means fecal incontinence.
 Foul–smelling stools in infant from stool means mal absorption syndrome.
 Halitosis from oral cavity means poor dental and oral hygiene, gum disease.
 Sweat, fruity ketones from oral cavity may be from diabetic acidosis.
 Musty odor from casted body part means infection inside cast.
 Fetid odor from tracheostomy or mucous secretions means infection of
bronchial tree (pseudomonas bact).

104. Basic Guidelines for physical Assessment
1. Obtain a nursing history and survey
2. Maintain privacy.
3. Explain the procedure
4. Always inspect, palpate, percuss, and then auscultate except abdominal start with
auscultation
5. Compare symmetrical sides
6. If abnormality (Symptom analysis )
7. Client teaching
8. Allow time for client’s questions.
"Remember: the most important guideline for adequate physical assessment is
conscious, continuous practice of physical assessment skills".

105. Variation in physical assessment of the
pediatric client.
 Sequence of physical assessment is dependent upon the developmental
level of the client.
 Allowing time for interaction with the child prior to beginning the
examination helps to reduce fears.
 In certain age groups, portions of assessment will require physical restraint
of the client with the help of another adult.
 Distraction and play should be intermingled throughout the examination to
assist in maintaining rapport with the pediatric client.

106.  Involving assistance from the child’s significant caregiver may
facilitate a more meaningful examination of the younger client.
 The examiner should be prepared to alter the order of the
assessment and approach to the child based on the child’s
response.
 Protest or an uncooperative attitude toward the examiner is a
normal finding in children from birth to early adolescence,
throughout parts or even all the assessment process.

107. Variations for physical assessment of the geriatric
client.
Remember: normal variation related to aging may be observed in all parts of the
physical examination.
 Dividing the physical assessment into parts in order to avoid fatigue in the
older client.
 Provide room with comfortable temperature and no drafts.
 Allow sufficient time for client to respond to directions.
 If possible assess the elderly clients in a setting where they have an
opportunity to perform normal activities of daily living in order to determine
the client’s optimum potential.

108. General Survey

109. Introduction
 General Survey begins with the first moment of the encounter with the
patient and continues throughout the health history.
 First component of the assessment Contributes to formation of global
impression of the person.
 This Includes physical appearance, body structure, mobility, and behavior
 Assess Physical appearance Overall appearance

110. General Survey
Observe the general state of health:
 Posture (straight or stopped)
 Motor activity
 Gait
 Dress, grooming and personal hygiene (hair, oral, hygiene, nails, any
odors of body or breath)
 Patient’s facial expression (manner and reaction to the persons and
things in the environment)
 Listen to the speech
 Anxiety, depression, uncooperativeness, anger, suspiciousness
 Weigh, height
 Vision

111. Integument (skin)
o Color general pigmentation (areas of hypo-pigmentation or hyper-
pigmentation; redness, pallor, cyanosis and yellowish of skin) around the
fingernails, lips and mucous membranes of mouth, conjunctivae
(Anaemia)
o Palpate skin for temperature, moisture, edema, mobility and turgor (speed
with which it returns into place- sign of dehydration)
o Skin lesion
o Inspect and palpate the nails for shape, consistency and color

112. Vital Signs
o Assess and record:
o Radial pulse- assess for its rate, rhythm (regularity), force (weak, absent,
full) and elasticity
o Respirations- normally it is relaxed, regular, automatic and silent
o Blood pressure
o Temperature

113.  It begins during interview phase of health assessment.
 Health history collected
 Nursing observations
 Initial impression development
 Data collection plan formulation
 Vital signs: include Temperature, Pulse, Respirations, Blood pressure and
Pain are important indicators of patient’s physiological status, response to
the environment

114. Urgent Assessment
 Indicators of an urgent situation : Extreme anxiety; acute distress Pallor;
cyanosis; mental status change
 Interventions begin while continuing the assessment.
 Rapid response team may be called for An acute change in mental status changes,
Stridor, Respirations <10 or >32 breaths/min.
 Increasing effort to breathe is necessary when Oxygen saturation <92%, Pulse <55
beats/min or >120 beats/min, Systolic BP <100 mm Hg or >170 mm Hg,
Temperature <35°C or >39.5°C, New onset chest pain Agitation and Restlessness.

115.  Anthropometric Measurements: Height; weight Calculation of BMI Vital
signs measurement reflects health status; cardiopulmonary, overall body
function.
 Normal range of Body Temperature dependent upon route: Rectal,
temporal artery measurements are 0.4° to 0.5°C (0.7° to 1°F) > oral
measurements Axillary measurement averages 0.5°C (1°F ) < oral
temperatures.
 Diurnal cycle Thermometer types: electronic; disposable; tympanic;
temporal artery.
 Appropriate route selection is critical
 Documentation

116.  Pulse: palpated over peripheral artery, auscultated over cardiac apex Palpate
arterial pulse points,
 Rate; rhythm; amplitude;
 Abnormal findings Tachycardia; bradycardia; asystole Sinus arrhythmia; pulse
deficit.
 Respirations Act of breathing:
 Inspiration + Expiration = One respiration
 Respiratory rate: 12 to 20 breaths/min, regular (adult)
 Dependent upon various factors Eupnea
 Abnormal findings: dyspnea Bradypnea; tachypnea; apnea

117.  Oxygen Saturation Percentage to which hemoglobin is filled with O2
 Normal pulse oximetry (SpO2): 92% to 100% SpO2
 < 85%: inadequate oxygenation; possible emergency
 SpO2 of 85% to 89%: possibly acceptable for patients with specific chronic
conditions Emphysema.

118.  Blood Pressure: Measurement of force exerted by blood flow against arterial
walls.
 Systolic blood pressure (SBP) results from left ventricular contraction
(maximum pressure)
 Diastolic blood pressure (DBP) results from left ventricular relaxation
(minimum pressure)
 Factors contributing to BP Cardiac output; peripheral vascular resistance
Circulating blood volume; viscosity Vessel wall elasticity

119.  Variations occur normally:
 Influencing factors Age; gender; ethnicity; weight; diurnal cycle, position;
exercise; emotions; stress, medications; smoking
 Abnormal findings:
- Hypertension (elevated BP)
- Hypotension (lower than normal limits BP.

120. Cultural Variations
 Mexican American patients -expect nurses to show warmth to patients and
family.
 Asian cultures- spoken and written order of the name is last name, first name.
 Southeast Asian patients: “krun” (translated as fever, but can mean “feeling
ill”)
 Arab cultures don’t disclose personal or sexual information
 East African - skin decorations with henna; black henna causes errors in O2
sat readings.

121. Nutritional assessment

122. Nutritional assessment
Introduction:
 Nutritional assessment is the interpretation of anthropometric, biochemical
(laboratory), clinical and dietary data to determine whether a person or groups
of people are well nourished or malnourished (over-nourished or under-
nourished).
 Nutrition plays a major role in the way an individual looks, feels,& behaves
 The body ability to fight disease greatly depends on the individual's
nutritional status.

123. Major goals of nutritional assessment
1. Identification of malnutrition.
2. Identification of over consumption
3. Identification of optimal nutritional status.
 Nutritional assessment can be done using the ABCD methods.
 These refer to the following: A. Anthropometry B. Biochemical/biophysical methods
C. Clinical methods D. Dietary methods.
Components of Nutritional Assessment
1. Anthropometric measurement.
2. Biochemical measurement.
3. Clinical examination.
4. Dietary analysis

124. A. Anthropometric measurement
 A: Anthropometry • anthropometry - Anthropo means ‘human’ and metry
means ‘measurement’.
• It uses several different measurements including length, height, weight and
head circumference.
Measurement of size, weight, & proportions of human body.
Measurement includes: height, weight, skin fold thickness, and circumference
of various body parts, including the head, chest, and arm.

125. Anthropometric cont’d…
 Assess body mass index (BMI) to shows a direct and continuous relationship to
morbidity and mortality in studies of large populations.
 High ratios of waist to hip circumference are associated with higher risk for
illness & decreased life span.
BMI = (Wt. in kilograms) = 60 = 60 = 23.4
(High in meters) 2 (1.6)2 2.56

126. BMI RANGE
Condition
Rang kg/m2
Very thin
less than 16.0
Thin
16.0 - 18.4
Average
18.5- 24.9
Overweight
25–29.9
Obese
30-34.9
Highly obese
≥ 35
An indicator is an index (for example, a scale showing weight for age, or weight for
height) combined with specific cut-off values help determine whether a person is
underweight or malnourished.

127. B. Biochemical Measurement
Useful in indicating malnutrition or the development of diseases as a result
of over consumption of nutrients.
Serum and urine are commonly used for biochemical assessment..
Common tests in assessment of malnutrition include, :
- Total lymphocyte count,
- Albumin,
- Serum transferrin,
- Hemoglobin, and
- Hematocrit …etc.

128. Biochemical….
These values taken with anthropometric measurements, give a good overall picture of an
individual's skeletal and visceral protein status as well as fat reserves and immunologic
response
C. Clinical examination:
Involves:
 Close physical evaluation and may reveal signs suggesting malnutrition or over
consumption of nutrients.
 Checking signs of deficiency at specific places on the body.
 Asking the patient whether they have any symptoms that might suggest nutrient
deficiency from the patient

129. Clinical cont’d…
Although examination alone doesn't permit definitive diagnosis of
nutritional problem, it should not be overlooked in nutritional assessment
Signs of nutrient deficiency include:
Pallor on the palm of the hand or the conjunctiva of the eye
Bitot’s spots on the eyes ('foamy' appearing lesions located on the nasal
and temporal conjunctiva).
Pitting oedema
Goitre and severe visible wasting

130. Nutritional assessment technique for clinical examination
 A. Types of information needed
 Diet: Describe the type: regular or not, special, "e.g. teeth problem,
sensitive mouth.
 Usual mealtimes: How many meals a day: when? Which are heavy
meals?
 Appetite: "Good, fair, poor, too good".
 Weight: stable? How has it changed?

131.  Food preferences: e.g." prefers beef to other meats"
 Food dislike: What & Why? Culture related?
 Usual eating places: Home, snack shops, restaurants.
 Ability to eat: describe inabilities, dental problems: "ill fitting dentures,
difficulties with chewing or swallowing
 Elimination" urine & stool: nature, frequency problems
 Exercise & physical activity: how extensive or deficient
Nutritional assessment technique …

132.  Psycho social - cultural factors: Review any thing which can affect on proper nutrition
 Taking Medications which affect the eating habits
 Laboratory determinations e.g.: “Hemoglobin, protein, albumin, cholesterol, urinalyses"
 Height, weight, body type "small, medium, large"
After obtaining information, summarize your findings and determine the nutritional diagnosis
and nutritional plan of care.
Imbalanced nutrition: Less than body requirements, related to lack of
knowledge and inadequate food intake
Risk for infection, related to protein-calorie malnutrition

133. B. Signs & symptoms of malnutrition
Dry and thin hair
Yellowish lump around eye, white rings around both eyes, and pale
conjunctiva
Redness & swelling of lips especially corners of mouth
Teeth caries & abnormal missing of it
Dryness of skin (xerosis): sandpaper feels of skin
Spoon shaped Nails " Koilonychia “ anemia
Tachycardia, elevated blood pressure due to excessive sodium intake
and excessive cholesterol, fat, or caloric intake
Muscle weakness and growth retardation

135. D. Dietary analysis
Food represent cultural and ethnic background and socio- economic
status and have many emotional and psychological meaning
Assessment includes usual foods consumed & habits of food
The nurse ask the client to recall every thing consumed within the past
24 hour including all foods, fluid, vitamins, minerals or other
supplements to identify the optimal meals
 Should not bias the client's response to question based on the
interviewer's personal habits or knowledge of recommended food
consumption

136. Diseases affected by nutritional problems
1- Obesity: excess of body fat.
2- Diabetes mellitus.
3- Hypertension.
4- Coronary heart disease.
5- Cancer.

137. Assessment of sleep habits
Let the client record the times of going to sleep and awakening periods,
including naps.
Allow clients to describe their sleep habits in their own words
You can ask the following questions:
- How have you been sleeping?‖
- Can you tell me about your sleeping habits?"
- Are you getting enough rest?"
- Tell me about your sleep problem"
Good History includes: a general sleep history, psychological history, and a drug
history

138. THANK YOU