RM 25-e

PENGKAJIAN KEBUTUHAN EDUKASI

Tanggal Material Intervensi mengatasi
Kebutuhan Edukasi Hambatan
Pengkajian Edukasi hambatan
A. □ Penjelasan penyakit ...…………………….... □ Leaflet □ Tidak ada □ Tidak ada
B. □ Prosedur pemberian …………………………. □ Booklet □ Penglihatan □ Mengulangi materi
obat □ Lembar balik □ Pendengaran □ Melibatkan keluarga
C. □ Program diet / nutrisi ……………………….... □ Audiovisual □ Buta huruf Terdekat
D. □ Manajemen nyeri ……………………….... (CD/VCD) □ Kognitif □ Melakukan pendekatan
E. □ Program rehabilitasi ……………………….... □ Lisan □ Bahasa dengan cara memakai
medik □ Motivasi role
F. □ Prosedur diagnostik ……………………….... □ Emosi model untuk merubah
G. □ Kebersihan diri ……………………….... □ Usia prilak
H. □ Home Care ............................. □ Fisik □ Menyediakan
I. Peralatan khusus : penterjemah
□ Urin kateter ............................. □ Lain-lain (jelaskan)
□ NGT / Sonde ............................. .........................................
□ Trakheostomi ............................. .........................................
□ Lain-lain : ........................ ............................. .........................................
J. Lain-lain : .........................................
□ ......................................... .........................................
□ ........................................
MASALAH KEPERAWATAN RENCANA KEPERAWATAN
□ Nutrisi, skor ...................................... ................................................................................................
□ Alergi ................................................ ................................................................................................
□ Risiko jatuh, skor ............................. ................................................................................................
□ Nyeri, skor ....................................... ................................................................................................
□ Fungsional, skor .............................. ................................................................................................
□ Pola pernafasan yang tidak efektif ................................................................................................
□ Ketidakefektifan bersihan jalan nafas ................................................................................................
□ Gangguan pertukaran gas ................................................................................................
□ Tidak toleransi beraktifitas ................................................................................................
□ Perubahan perfusi jaringan ................................................................................................
□ Penurunan curah jantung ................................................................................................
□ Nyeri dada ................................................................................................
□ Risiko cedera ................................................................................................
□ Gangguan pola tidur ................................................................................................
□ Gangguan integritas kulit ................................................................................................
□ Risiko infeksi ................................................................................................
□ Gangguan komunikasi verbal ................................................................................................
□ Gangguan interaksi sosial ................................................................................................
□ Kecemasan ................................................................................................
□ Diare ................................................................................................
□ Konstipasi ................................................................................................
□ Perubahan pola eliminasi urine ................................................................................................
□ Retensi Urine ................................................................................................
□ Lain lain :………………...............................................… ................................................................................................
PERAWAT PENANGGUNG JAWAB
Tanggal / Waktu selesai pengkajian : Nama & tanda tangan Perawat : Verifikasi DPJP :

................................... / Pukul : ........ ................................. ................................

RM 25-e/RI/R2/2022 Hal. 4 dari 4

RM 25-e

RM 25-e/RI/R2/2022 Hal. 4 dari 4