PENGKAJIAN KEPERAWATAN

KESEHATAN JIWA

Ruang rawat : …………………

Tanggal dirawat : ………................

I. IDENTITAS KLIEN
Inisial : …….. ( L/P )
Umur : ……thn
No. RM : …….
II. ALASAN MASUK/KELUHAN UTAMA
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III.FAKTOR PREDISPOSISI
1. Pernah mengalami gangguan jiwa dimasa lalu ?
 Ya
 Tidak
2. Pengobatan sebelumnya
 Berhasil
 Kurang berhasil
 Tidak berhasil
3. Trauma usia pelaku korban saksi
 Aniaya fisik …… ……. ……. …....
 Aniaya seksual …… ……. …… …….
 Penolakan …… ……. …… ……
 Kekerasan dalam
keluarga …… …… ……. ..…..
 Tindakan criminal …… ……. …… …....
Jelaskan :
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4. Anggota keluarga yang gangguan jiwa ?
  Ada
 Tidak
Kalau ada :
Hubungan keluarga :
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Gejala :
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Riwayat pengobatan :
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5. Pengalaman masa lalu yang tidak menyenangkan :
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h Keperawatan :
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IV. PEMERIKSAAN FISIK

1. TTV : TD : ……….mmHg N : ……X/mnt
S : …….….°C P :……X/mnt
2. Ukur : BB : ……….kg, TB : ……..cm

3. Keluhan fisik :
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V. PSIKOSOSIAL
1. Genogram :
 Jelaskan :
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Masalah Keperawatan :
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2. Konsep diri
a. Citra tubuh :
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b. Identitas :
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c. Peran :
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d. Ideal diri :
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e. Harga diri :
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Masalah Keperawatan :
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3. Hubungan sosial
a. Orang yang berarti :
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b. Peran serta dalam kegiatan kelompok/masyarakat :
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c. Hambatan dalam berhubungan dengan orang lain :
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Masalah Keperawatan :
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4. Spiritual
a. Nilai dan keyakinan
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b. Kegiatan ibadah :
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VI. STATUS MENTAL

1. Penampilan
 Tidak rapi
 Penggunaan pakaian tidak sesuai
 Cara berpakaian tidak seperti biasanya
Jelaskan :
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Masalah Keperawatan :
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2. Pembicaraan
 Cepat
 Keras
 Gagap
 Inkoherensi
 Lambat
 Membisu
 Tidak mampu memulai pembicaraan
Jelaskan :
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Masalah Keperawatan :
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3. Aktivitas Motorik
 Lesu
 Tegang
 Gelisah
 Agitasi
 Tik
 Grimasem
 Tremor
 Kompulsif
Jelaskan :
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Masalah Keperawatan :
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4. Alam perasaan
 Sedih
 Ketakutan
 Putus asa
 Khawatir
 Gembira berlebihan
Jelaskan :
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Masalah Keperawatan :
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5. Afek
 Datar
 Tumpul
 Labil
 Tidak sesuai
 Jelaskan :
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Masalah Keperawatan :
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6. Interaksi selama wawancara
 Bermusuhan
 Tidak kooperatif
 Mudah tersinggung
 Kontak mata kurang
 Defensive
 Curiga
Jelaskan :
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Masalah Keperawatan :
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7. Persepsi
Halusinasi :
  Pendengaran
 Penglihatan
 Perabaan
 Pengecapan
 Penghidu/Penciuman
Jelaskan :
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Masalah Keperawatan :
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8. Isi pikir
 Obsesi
 Phobia
 Hipokondria
 Depersonalisasi
 Ide yang terkait
 Pikiran magis
Waham :
 Agama
 Somatik
 Kebesaran
 Curiga
 Nihilistic
  Sisip pikir
 Siar pikir
 Kontrol pikir
Jelaskan :
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Masalah Keperawatan :
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9. Arus pikir
 Sirkumstansial
 Tangensial
 Kehilangan asosiasi
 Flight of idea
 Blocking
 Pengulangan pembicaraan/perseverasi
Jelaskan :
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10. Tingkat Kesadaran
  Bingung
 Sedasi
 Stupor
 Disorientasi waktu
 Disorientasi orang
 Disorientasi tempat
Jelaskan :
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Masalah Keperawatan :
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11. Memori
 Gangguan daya ingat jangka panjang
 Gangguan daya ingat jangka pendek
 Gangguan daya ingat saat ini
 Konfabulasi
Jelaskan :
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Masalah Keperawatan :
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12. Tingkat konsentrasi dan berhitung
 Mudah beralih
 Tidak mampu berkonsentrasi
 Tidak mampu berhitung sederhana
Jelaskan :
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Masalah Keperawatan :
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13. Kemampuan penilaian
 Gangguan ringan
 Gangguan bermakna
Jelaskan :
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Masalah Keperawatan :
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14. Daya tilik diri

  Mengingkari penyakit yang diderita
 Menyalahkan hal-hal diluar dirinya
Jelaskan :
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Masalah Keperawatan :
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VII. KEBUTUHAN PERENCANAAN PULANG

1. Kemampuan klien memenuhi kebutuhan
Ya Tidak
 Makanan ………. ………
 Keamanan ………. ………
 Perawatan kesehatan ……… ………
 Pakaian ……… ………
 Transportasi ……… ………
 Tempat tinggal ……… ……....
 Uang ……… ……....
Jelaskan :
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Masalah Keperawatan :
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2. Kegiatan hidup sehari-hari
a. Perawatan diri BT BM
 Mandi …… …….
 Kebersihan …… …….
 Makan …… …….
 BAB / BAK …… …….
 Ganti pakaian …… …….
Jelaskan :
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Masalah Keperawatan :
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b. Nutrisi
Apakah anda puas dengan pola makan anda ?
 Ya
 Tidak
Apakah anda memisahkan diri ?
Ya, jelaskan :
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 Tidak
Frekuensi makan sehari: ..................X
Frekuensi kudapan sehari : ..............X
Nafsu makan :
  Meningkat
 Menurun
 Berlebihan
 Sedikit-sedikit
Berat Badan :
 Meningkat
 Menurun
BB terendah : ..............kg BB tertinggi : ...........kg
Jelaskan :
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Masalah Keperawatan :
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c. Tidur
1) Apakah ada masalah tidur ?
2) Apakah merasa segar setelah bangun tidur ?
3) Apakah ada kebiasaan tidur siang ?
4) Lama tidur siang :................jam
5) Apa yang menolong tidur ? .............................
6) Tidur malam jam : ........, bangun jam .............
7) Apakah ada gangguan tidur ?
 Sulit untuk tidur
 Bangun terlalu pagi
 Somnabulisme
 Terbangun saat tidur
 Gelisah saat tidur
  Berbicara saat tidur
Jelaskan :
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Masalah Keperawatan :
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3. Kemampuan klien dalam :
Mengantisipasi kebutuhan sendiri
 Ya
 Tidak
Membuat keputusan berdasarkan keinginan sendiri
 Ya
 Tidak
Mengatur penggunaan obat
 Ya
 Tidak
Melakukan pemeriksaan kesehatan
 Ya
 Tidak
Jelaskan :
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Masalah Keperawatan :
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Klien memiliki sistem pendukung
Keluarga : Ya :........... Tidak :.......
Terapis : Ya : ......... Tidak :.......
Teman sejawat : Ya : .......... Tidak : .......
Kelompok sosial : Ya: .......... Tidak :.........
Jelaskan :
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Masalah Keperawatan :
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Apakah klien menikmati saat bekerja, kegiatan produktif atau hobi ?
 Ya
 Tidak
Jelaskan :
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Masalah Keperawatan :
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VIII. MEKANISME KOPING

Adaptif : Maladaptif :
 Bicara dengan orang lain  Minum alkohol
 Mampu menyelesaikan  Reaksi lambat/ berlebih
masalah  Bekerja berlebihan
 Teknik relokasi  Menghindar
 Aktivitas konstruktif  Mencederai diri
 Olahgara  Lainnya…………………
 Lainnya ……………

IX. MASALAH PSIKOSOSIAL & LINGKUNGAN

 Masalah dengan dukungan kelompok, uraikan
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 Masalah dengan pendidikan, uraikan
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 Masalah dengan pekerjaan, uraikan
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 Masalah dengan perumahan, uraikan
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 Masalah dengan ekonomi, uraikan
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 Masalah dengan pelayanan kesehatan, uraikan
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 Masalah lainnya, uraikan
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Masalah Keperawatan :
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X. KURANG PENGETAHUAN TENTANG

 Penyakit jiwa
 Factor presipitasi
 Koping
 System pendukung
 Penyakit fisik
 Obat-obatan
 Lainnya………………………………….
Masalah Keperawatan :
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XI. ASPEK MEDIK

Diagnosis medik :
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Terapi medik :
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STRATEGI PELAKSANAAN TINDAKAN KEPERAWATAN

A. PROSES KEPERAWATAN
1. Kondisi klien
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2. Diagnosa keperawatan
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3. Tujuan khusus
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4. Tindakan keperawatan
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B. STRATEGI KOMUNIKASI DALAM PELAKSANAAN TINDAKAN
KEPERAWATAN
ORIENTASI :
1. Salam terapeutik
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2. Evaluasi/validasi
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3. Kontrak
Topik
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Waktu
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Tempat : .....................................................................................................
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KERJA : (langkah-langkah tindakan keperawatan)

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TERMINASI :
1. Evaluasi respon klien terhadap tindakan keperawatan
Evaluasi subjektif
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Evaluasi objektif
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2. Rencana tindak lanjut klien
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Kontrak yang akan datang :
Topik
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Waktu
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Tempat : .....................................................................................................
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 JADWAL KEGIATAN HARIAN PASIEN
Nama Pasien : No.RM : Ruangan :
TANGGAL
WAKTU KEGIATAN
 KET : M : Mandiri B : Bantuan T : Tidak Dilakukan

JADWAL KEGIATAN HARIAN PASIEN

Nama Pasien : No.RM : Ruangan :
TANGGAL
WAKTU KEGIATAN
 KET : M : Mandiri B : Bantuan T : Tidak Dilakukan

RENCANA HARIAN PERAWAT

Tanggal :
Nama Perawat :
Ruangan :
Waktu Kegiatan Keterangan
 RENCANA HARIAN PERAWAT
Tanggal :
Nama Perawat :
Ruangan :
Waktu Kegiatan Keterangan
 RENCANA HARIAN PERAWAT
Tanggal :
Nama Perawat :
Ruangan :
Waktu Kegiatan Keterangan
 RENCANA HARIAN PERAWAT
Tanggal :
Nama Perawat :
Ruangan :
Waktu Kegiatan Keterangan
 RENCANA HARIAN PERAWAT
Tanggal :
Nama Perawat :
Ruangan :
Waktu Kegiatan Keterangan
 RENCANA HARIAN PERAWAT
Tanggal :
Nama Perawat :
Ruangan :
Waktu Kegiatan Keterangan
 RENCANA HARIAN PERAWAT
Tanggal :
Nama Perawat :
Ruangan :
Waktu Kegiatan Keterangan
 RENCANA HARIAN PERAWAT
Tanggal :
Nama Perawat :
Ruangan :
Waktu Kegiatan Keterangan
 RENCANA HARIAN PERAWAT
Tanggal :
Nama Perawat :
Ruangan :
Waktu Kegiatan Keterangan
 RENCANA HARIAN PERAWAT
Tanggal :
Nama Perawat :
Ruangan :
Waktu Kegiatan Keterangan
 RENCANA HARIAN PERAWAT
Tanggal :
Nama Perawat :
Ruangan :
Waktu Kegiatan Keterangan
 RENCANA HARIAN PERAWAT
Tanggal :
Nama Perawat :
Ruangan :
Waktu Kegiatan Keterangan