PENGKAJIAN KEPERAWATAN

KESEHATAN JIWA

Tanggal MRS
Tanggal Pengkajian
Ruang Rawat
I.

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IDENTITAS KLIEN
Inisial
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Pendidikan
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Pekerjaan
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II.

ALASAN MASUK
a. Data Primer
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b. Data Sekunder
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III.

RIWAYAT PENYAKIT SEKARANG DAN FACTOR PRESIPITASI

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IV.

FACTOR PREDISPOSISI
1. Pernah mengalami gangguan jiwa dimasa lalu?

Ya

Tidak
Jika Ya, Jelaskan:
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2. Pengobatan sebelumnya
Berhasil
Kurang Berhasil
Tidak berhasil
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3. a. Pernah mengalami penyakit fisik (Termasuk gangguan tumbuh kembang)
Ya
Tidak
b. Pernah ada riwayat NAPZA
Narkotika
Penyalagunaan psikotropika
Zat aditif: kafein, nikotin, alkohol
DLL
c. Riwayat trauma
Usia

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1. Aniaya fisik

Pelaku

Korban Pelaku
Saksi Korban
Usia

Saksi

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seksual
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3. Penolakan

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4. Kekerasan
dalam keluarga

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5. Tindakan
kriminal ..............

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6. Usaha bunuh diri

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2. Aniaya

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Jelaskan:
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