PENGKAJIAN
I. IDENTITAS KLIEN
N a m a Inisial : .........................................................................
Umur : .........................................................................
No RM : ………………………………………………….
V. STATUS PSIKOSOSIAL
A. Genogram (gambar dan jelaskan isi genogram)
Jelaskan :
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B. Konsep diri
1. Gambaran
diri : ......................................................................................................................
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2. Identitas diri :
2. Kegiatan ibadah :
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Masalah
keperawatan : ..................................................................................................
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VI. STATUS MENTAL
A. Penampilan
□ Tidak rapih □ Pakaian tidak sesuai □ Cara berpakaian tidak
seperti biasanya
Jelaskan : ...................................................................................................................
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B. Pembicaraan
□ Cepat □ Keras □ Gagap □ Apatis
□ Lambat □ Inkoheren □ Membisu □ Tidak mampu memulai
□ Perseverasi
Jelaskan :
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C. Aktivitas Motorik
□ Lesu □ Tegang □ Gelisah □ Agitasi
□ TIK □ Grimace □ Tremor □ Kompulsif
Jelaskan :
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□ Masalahdengandukungankelompok
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□ Masalahdenganekonomi
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□ Masalahdenganpelayanankesehatan
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Masalah
keperawatan : .................................................................................................................
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X. DATA MEDIK
1. Diagnosa
Medik : .......................................................................................................................
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2. Therapi Medik :
(_______________________)