UNIT 1 BUILDING CLINICAL COMPETENCEDimensions of Medical-Surgical NursingFUNCTIONAL HEALTH PATTERN: Health Perception-Health Management

Think about clients with altered health perception or health management for whom you havecared in your clinical experiences.

■ What were the clients’ major medical diagnoses (e.g., hypertension, diabetes mellitus,cancer, chronic obstructive pulmonary disease, stroke, or alcoholism)?

■ What manifestations did each of these clients have? Were these manifestations similar ordifferent?

■ How did the clients’ healthcare behaviors interfere with their health status? Did they haveyearly physical examinations and routine eye examinations? Did they obtain recommendedimmunizations? Did they use preventive measures, such as conducting breast or testicularself-examinations, applying sunscreen, following dietary recommendations, decreasingalcohol intake, stopping smoking, beginning to exercise regularly, practicing safer sex, usingstress reduction activities? Did they achieve developmental tasks appropriate for their age?Did they interact well with family and friends?

The Health Perception-Health Management Pattern includes healthcare behaviors, such ashealth promotion and illness prevention activities, medical treatments, and follow-up care. In-dividuals are at different locations on the illness–wellness continuum at specific points in time.Health perception and health maintenance are affected by factors that influence the individual’shealth status or level of wellness in two primary ways:

■ Factors affecting health that may be altered to prevent disease processes are diet (e.g.,osteoporosis), substance abuse (e.g., alcoholism), smoking (e.g., chronic obstructivepulmonary disease, lung cancer), socioeconomic status (e.g., communicable disease, violenceor abuse), or occupational exposure (e.g., pulmonary disease due to asbestos, tuberculosis).

■ Factors affecting health that cannot be altered and may result in disease processes aregenetics (e.g., sickle cell disease, hemophilia), age (e.g., type 2 diabetes mellitus,myocardial infarction), or race (e.g., hypertension).

A client’s perceived pattern of health and well-being affects how health is managed. Improperhealth management affects the body’s ability to maintain homeostasis, leading to manifesta-tions such as:

■ Vomiting (caused by a variety of factors, including ingestion of chemicals, toxic materials,or infectious materials; chronic liver or kidney disease, and allergic responses tomedications)

■ Bleeding (as from trauma or decreased platelets or deficient clotting factors � resulting inthe delay of activation or inability to activate the clotting pathway � causing loss orleakage of blood)

■ Pain (resulting from many physical factors, including trauma, edema, and changes in pHor inflammatory changes � which may cause tissue damage that stimulates painreceptors � which transmit pain impulses to the brain).

Priority nursing diagnoses within the Health Perception-Health Management functional healthpattern that may be appropriate for clients include:

■ Health-Seeking Behaviors as evidenced by making dietary changes as prescribed,decreasing alcohol intake, stopping smoking, and joining a health club to participate in anexercise program

■ Deficient Knowledge: Healthy Behaviors as evidenced by lack of interest in learningabout health care, inability to understand healthcare teaching (developmental level), andmisinterpretation of healthcare teaching completed

■ Ineffective Health Maintenance as evidenced by smoking, drinking alcohol or othersubstance abuse, sedentary lifestyle, and not seeking routine health care

■ Risk for Injury related to poor hygiene habits, self-treatment of illnesses, not takingprescribed medications, and participating in risk-taking behaviors.

Two nursing diagnoses from other functional health patterns often are of high priority for theclient with deficits in Health Perception-Health Management:

■ Self-Care Deficit (Activity/Exercise)■ Situational Low Self-Esteem (Self-Perception/Self-Concept)

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