Status Psikiatrikus
Status Psikiatrikus
STATUS PSIKIATRIKUS
Nama :
NIM :
Semester :
Tanggal :
Pembimbing :
Kegiatan :
MENGETAHUI
SUPERVISOR
(.......................................)
2
Keadaan Umum
Sensorium :......................... Suhu :................ Berat Badan :...................
Nadi :......................... Pernafasan :................ Tinggi Badan :...................
Tekanan Darah :......................... Turgor :................ Status Gizi :...................
STATUS NEUROLOGIKUS
Darah Rutin..........................................................Khusus......................................................
Urine Rutin...........................................................Khusus......................................................
Tinja Rutin...........................................................Khusus......................................................
Liquor Serebrospinalis (Pungsi Lumbal)...............................................................................
PEMERIKSAAN RADIOLOGI
BRAIN COMPUTERIZED TOMOGRAPHY SCANNING (CT-SCAN OTAK)
HASIL
5
STATUS PSIKIATRIKUS
KEADAAN UMUM
Kesadaran/Sensorium :.......................................................................................................
Perhatian :.......................................................................................................
Sikap :.......................................................................................................
Inisiatif :.......................................................................................................
Tingkah Laku Motorik :.......................................................................................................
Karangan/Tulisan/Gambaran (bila ada lampirkan)................................................................
Ekspresi Fasial :.......................................................................................................
Verbalisasi :...........................................Cara Bicara :.....................................
Kontak Psikis : - Kontak Fisik :........................................................................................
- Kontak Mata :........................................................................................
- Kontak Verbal :........................................................................................
2. Hidup Emosi
Stabilitas :........................................Dalam-dangkal :.....................................
Pengendalian :........................................Adekuat-Inadekuat :.....................................
12
PEMERIKSAAN LAIN-LAIN
FOLLOW UP
16
RESUME
I. IDENTIFIKASI
III.STATUS NEUROLOGIKUS
FORMULASI DIAGNOSTIK
20
DIAGNOSIS MULTIAKSIAL
AKSIS I :............................................................................................................................
AKSIS II :............................................................................................................................
AKSIS III :............................................................................................................................
AKSIS IV :............................................................................................................................
AKSIS V :............................................................................................................................
DIAGNOSIS DIFERENSIAL
TERAPI
PROGNOSIS