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Format Pengkajian Proses keperawatan Jiwa

Di Unit Rawat Jalan

I. Data Demografi
Initial Pasien

:.........................................

Usia

: .........................................

Jenis Kelamin

: .........................................

Agama : .........................................

Pendidikan

: .........................................

No CM: .........................................

Tanggal MRS

: .........................................

Sistem Pembayaran: ....................................

Penanggung Jawab

: ....................................................................................................................

Alamat

:.....................................................................................................................

II. Status Mental


A. Pengkajian pada pasien
a. Alasan MRS :
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b. Stressor
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c. Respon terhadap stressor
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d. Faktor Pedisposisi
i.

Herediter

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ii.

Pola asuh

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iii.

Pengalaman traumatis

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e. Evaluasi dan Validasi


i. Kemampuan ADL
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ii. Kemampuan bersosialisasi


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iii. Penanganan masalah


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iv. Kepatuhan terhadap minum obat


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b. Hambatan yang dihadapi pasien


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B. Pengkajian pada keluarga


a. Persepsi terhadap masalah
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b.Koping keluarga terhadap masalah
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c. Kemampuan merawat penderita


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d.Kemampuan memanfaatkan sumber pelayanan kesehatan
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C.

ANALISA DATA :

NO
1.

DATA

DIAGNOSA KEPERAWATAN

DS:

DO:

D.

DAFTAR DIAGNOSA KEPERAWATAN


1. ..
2. ..
3. ..

E.

PRIORITAS DIAGNOSA KEPERAWATAN


1. ..
2. ..
3. ..

Mengetahui
Perawat Jaga

Malang, .
Perawat yang mengkaji

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NIP...............

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NIM...............