Form-Dorothea Orem

PENGKAJIAN KEPERAWATAN
“DOROTHEA OREM”
1.1 Pemeliharaan Kecukupan Oksigen & Sirkulasi Adequacy of Self-Care
 Adequate
 Inadequate
Unuversal Self Care Rqquisites
1.2 Pemeliharaan Kecukupan Cairan Adequacy of Self-Care
 Adequate
 Inadequate
1.
1.3 Pemeliharaan Kecukupan Nutrisi Adequacy of Self-Care
 Adequate
 Inadequate
1. Unuversal Self Care Rqquisites
1.4 Pemeliharaan Kecukupan Eliminasi Adequacy of Self-Care
 Adequate
 Inadequate
1.5 Pemeliharaan Kecukupan Aktivitas & Istirahat Adequacy of Self-Care
 Adequate
 Inadequate
1.6 Pemeliharaan Keseimbangan antara Isolasi & Interasi Sosial Adequacy of Self-Care
 Adequate
 Inadequate
1. Unuversal Self Care Rqquisites
1.7 Pencegahan Faktor Risiko yang Mengancam Hidup, Fungsi Adequacy of Self-Care
Tubuh, dan Kesehatan
 Adequate
 Inadequate
1.8 Peningkatan Pemeliharaan Fungsi Diri dan Perkembangan Adequacy of Self-Care
dalam Kelompok Sosial
 Adequate
 Inadequate
Perilaku Khusus sesuai Tahap Perkembangan atau Perilaku Adequacy of Self-Care

Baru yang Didapatkan seubungan dengan Perubahan Kondisi
Development Self Care Requisites
 Adequate
 Inadequate
2.
3.1 Perilaku Mencari Bantuan Medis Adequacy of Self-Care

3. Health Deviation Self Care Requisites
 Adequate
 Inadequate
3.2 Kesadaran terhadap Efek dari Kondisi Patologis Adequacy of Self-Care

 Adequate
 Inadequate
3.3 Kepatuhan terhadap Regimen Terapeutik Adequacy of Self-Care
 Adequate
 Inadequate
3.4 Kesadaran terhadap Masalah Ketidaknyamanan terkait Adequacy of Self-Care

3. Health Deviation Self Care Requisites
Regimen Terapeutik
 Adequate
 Inadequate
3.5 Modifikasi Konsep Diri akibat Perubahan Status Kesehatan Adequacy of Self-Care
 Adequate
 Inadequate
3.6 Pengetahuan tentang Efek dari Kondisi Patologis, Diagnosa Adequacy of Self-Care
Medik, dan Pengobatan
 Adequate
 Inadequate
Test Diagnostic:
Terapi:
........................., ..................................................
Perawat yang Mengkaji,
(...................................)
IDENTIFIKASI DIAGNOSA KEPERAWATAN

“NANDA”
Data Etiologi Masalah

Tgl
PRIORITAS DIAGNOSA KEPERAWATAN
DIAGNOSA KEPERAWATAN
No.
........................., ..................................................
Perawat yang Mengkaji,
(...................................)
INTERVENSI KEPERAWATAN
Tgl , Rencana Keperawatan Nama

No. DP Hasil Yang Diharapkan (Guidance, Support, Teaching, Acting, Providing developmental environment) Perawat
Tujuan:
 Promote patient as self-care agent ...............................................................................................................................................
 Meet self-care agent ...............................................................................................................................................
 Decrease self-care deficits ...............................................................................................................................................
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Kriteria Hasil: ...............................................................................................................................................
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Design of Nursing Sistem: ...............................................................................................................................................
 Whooly Compensatory ...............................................................................................................................................
 Partly Compensatory ...............................................................................................................................................
 Supportive-Educative ...............................................................................................................................................
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IMPLEMENTASI & EVALUASI
Nama
Nama Evaluasi Perawat
Tgl. Implementasi
Perawat (efectiveness of nurse-patient action)
Pkl.
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Form-Dorothea Orem

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Form-Dorothea Orem

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PENGKAJIAN KEPERAWATAN

1.1 Pemeliharaan Kecukupan Oksigen & Sirkulasi Adequacy of Self-Care

1.2 Pemeliharaan Kecukupan Cairan Adequacy of Self-Care

1.3 Pemeliharaan Kecukupan Nutrisi Adequacy of Self-Care

1.4 Pemeliharaan Kecukupan Eliminasi Adequacy of Self-Care

Perilaku Khusus sesuai Tahap Perkembangan atau Perilaku Adequacy of Self-Care

3.1 Perilaku Mencari Bantuan Medis Adequacy of Self-Care

3.2 Kesadaran terhadap Efek dari Kondisi Patologis Adequacy of Self-Care

3.3 Kepatuhan terhadap Regimen Terapeutik Adequacy of Self-Care

3.4 Kesadaran terhadap Masalah Ketidaknyamanan terkait Adequacy of Self-Care

IDENTIFIKASI DIAGNOSA KEPERAWATAN

Data Etiologi Masalah

Tgl , Rencana Keperawatan Nama

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