Format LK Jikom (1) - 1-1

PRAKTEK PROFESI KEPERAWATAN JIWA
FAKULTAS KEPERAWATAN UNAND

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PENGKAJIAN KEPERAWATAN KESEHATAN JIWA
PENGKAJIAN
Wilayah Kerja :………………………………………………
Nama Perawat :……………………………………………….
I. IDENTITAS KLIEN
Inisial Klien : …………………………………………………………………
Umur : …………………………………………………………………
Tanggal Pengkajian : …………………………………………………………………
Informan : …………………………………………………………………
Alamat Lengkap : …………………………………………………………………
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II. RIWAYAT KESEHATAN

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III. FAKTOR PREDISPOSISI

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IV. PemeriksaanFisik
Tenda Vital : TD : ………………mmHg N : ………. S : ……… P : …………
Ukuran : TB : ………cm BB : ……….kg
KeluhanFisik :
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Masalah Keperawatan : ……………………………………………………………….
V. PSIKOSOSIAL
a. Genogram
= Laki-laki = Klien
= Perempuan = Hubungan Keluarga
= Meninggal = Tinggal Serumah
Keterangan:…………………………………………………………………………………
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Masalah Keperawatan : …………………………………………………………………
b. Konsep Diri
 Citra Tubuh
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 Identitas Diri
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 Peran Diri
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 Ideal Diri
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 Harga Diri
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Masalah Keperawatan :………………………………………………………………….
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c. Hubungan Sosial
 Orang Terdekat
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 Peran serta dalam kegiatan kelompok/masyarakat

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 Hambatan dalam berhubungan dengan orang lain/tingkat keterlibatan klien

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d. Spiritual
 Nilai dan Keyakinan
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 Kegiatan Ibadah
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VI. STATUS MENTAL

a. Penampilan
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Masalah Keperawatan : ………………………………………………………....
b. Pembicaraan
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c. Aktivitas Motorik
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d. Alam Perasaan
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e. Afek
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f. Interaksi Selama Wawancara

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g. Persepsi
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h. Proses Pikir
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i. Isi Pikir
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j. Tingkat Kesadaran
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k. Memori
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l. Tingkat Konsentrasi dan Berhitung

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m. Kemampuan Penilaian
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n. Daya Tilik Diri

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VII. KEBUTUHAN PERSIAPAN PULANG

a. Makan
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b. BAB / BAK
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c. Mandi
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d. Berpakaian / Berhias
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e. Istirahat dan Tidur

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f. Penggunaan Obat
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g. Pemeliharaan Kesehatan
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h. Kegiatan di Dalam Rumah

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i. Kegiatan / Aktivitas di LuarRumah

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VIII. MEKANISME KOPING

a. Koping Adaptif
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b. Koping Maladaptif
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IX. MASALAH PSIKOSOSIAL DAN LINGKUNGAN

a. Masalah dengan dukungan kelompok
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b. Masalah dengan lingkungan
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c. Masalah dengan pendidikan
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d. Masalah dengan pekerjaan
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e. Masalah dengan perumahan
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f. Masalah dengan ekonomi

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g. Masalah dengan pelayanan kesehatan
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X. PENGETAHUAN
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XI. ASPEK MEDIK

Diagnosa Medik :………………………………………………………………………….
Terapik Medik :…………………………………………………………………………
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XII. ANALISA DATA

DATA MASALAH
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XIII. DAFTAR MASALAH KEPERAWATAN

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XIV. POHON MASALAH
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XV. DIAGNOSA KEPERAWATAN

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Padang, Februari 2018
( )
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PRAKTEK PROFESI KEPERAWATAN JIWA

FAKULTAS KEPERAWATAN UNAND

PENGKAJIAN KEPERAWATAN KESEHATAN JIWA

Wilayah Kerja :………………………………………………

Nama Perawat :……………………………………………….

II. RIWAYAT KESEHATAN

III. FAKTOR PREDISPOSISI

Suci rahma yuni

= Perempuan = Hubungan Keluarga

= Meninggal = Tinggal Serumah

Suci rahma yuni

Masalah Keperawatan :………………………………………………………………….

Suci rahma yuni

 Peran serta dalam kegiatan kelompok/masyarakat

 Hambatan dalam berhubungan dengan orang lain/tingkat keterlibatan klien

Masalah Keperawatan :………………………………………………………………….

Suci rahma yuni

Masalah Keperawatan :………………………………………………………………….

VI. STATUS MENTAL

Suci rahma yuni

f. Interaksi Selama Wawancara

Suci rahma yuni

l. Tingkat Konsentrasi dan Berhitung

n. Daya Tilik Diri

Suci rahma yuni

VII. KEBUTUHAN PERSIAPAN PULANG

e. Istirahat dan Tidur

Suci rahma yuni

h. Kegiatan di Dalam Rumah

i. Kegiatan / Aktivitas di LuarRumah

VIII. MEKANISME KOPING

Suci rahma yuni

IX. MASALAH PSIKOSOSIAL DAN LINGKUNGAN

Suci rahma yuni

f. Masalah dengan ekonomi

Masalah Keperawatan : …………………………………………………………………

XI. ASPEK MEDIK

Suci rahma yuni

XII. ANALISA DATA

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XIII. DAFTAR MASALAH KEPERAWATAN

XIV. POHON MASALAH

Suci rahma yuni

XV. DIAGNOSA KEPERAWATAN

Padang, Februari 2018

Suci rahma yuni

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