PENGKAJIAN
I. IDENTITAS KLIEN
N a m a Inisial : .........................................................................
Umur : .........................................................................
No RM : ………………………………………………….
C. Pernah melakukan/mengalami/menyaksikan:
V. STATUS PSIKOSOSIAL
A. Genogram (gambar dan jelaskan isi genogram)
Jelaskan :
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
B. Konsep diri
1. Gambaran diri :
..............................................................................................................................
..............................................................................................................................
..............................................................................................................................
2. Identitas diri :
..............................................................................................................................
..............................................................................................................................
3. Peran diri :
..............................................................................................................................
..............................................................................................................................
..............................................................................................................................
4. Ideal diri :
G. Persepsi : Halusinasi
□ Pendengaran □ Penglihatan □ Perabaan
□ Pengecapan □ Penghiduan
Jelaskan :
□ Masalahdengandukungankelompok
……………………………………………………………………………………………….
□ Masalahdenganpendidikan
……………………………………………………………………………………………….
…………………………………………………………………………………………………
□ Masalahdenganperumahan
…………………………………………………………………………………………………
□ Masalahdenganekonomi
…………………………………………………………………………………………………
□ Masalahdenganpelayanankesehatan
……………………………………………………………………………………………….
Masalah keperawatan :
..........................................................................................................................................
..........................................................................................................................................
..........................................................................................................................................
X. DATA MEDIK
1. Diagnosa Medik :
....................................................................................................................................
2. Therapi Medik :
(_______________________)