Format Pengkajian Adaptasi - Roy
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FORMAT PENGKAJIAN APLIKASI TEORI MODEL KONSEP ADAPTASI ROY STIKES HANG TUAH SURABAYA A. PENGKAJIAN 1. Identitas Klien a. Nama : ................................................... ............................................................. ........ b. Jenis kelamin : L / P c. Umur : .......... tahun d. Agama : .................................................. ............................................................. ......... e. Pendidikan : ................................................ ............................................................. ........... f. Pekerjaan : .................................................. ............................................................. ......... g. Suku : ................................................... ............................................................. ........ h. Alamat : .................................................. ............................................................. ......... 2. Pengkajian Tahap pertama a. Fisiologi 1) Oksigenasi dan ventilasi .......................................................... .......................................................... .......................................................... .......................................................... .................................................. 2) Nutrisi .......................................................... .......................................................... .......................................................... .......................................................... .................................................. 3) Eliminasi .......................................................... ..........................................................
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Transcript of Format Pengkajian Adaptasi - Roy
FORMAT PENGKAJIAN
APLIKASI TEORI MODEL KONSEP ADAPTASI ROY
STIKES HANG TUAH SURABAYA
A. PENGKAJIAN1. Identitas Klien
a. Nama : ........................................................................................................................b. Jenis kelamin : L / Pc. Umur : .......... tahund. Agama: ........................................................................................................................e. Pendidikan : ........................................................................................................................f. Pekerjaan : ........................................................................................................................g. Suku : ........................................................................................................................h. Alamat: ........................................................................................................................
2. Pengkajian Tahap pertamaa. Fisiologi
1) Oksigenasi dan ventilasi..........................................................................................................................................................................................................................................................................................
2) Nutrisi..........................................................................................................................................................................................................................................................................................
3) Eliminasi..........................................................................................................................................................................................................................................................................................
4) Aktivitas..........................................................................................................................................................................................................................................................................................
5) Istirahat..........................................................................................................................................................................................................................................................................................
6) Sense..........................................................................................................................................................................................................................................................................................
7) Cairan, elektrolit, dan keseimbangan asam basa..........................................................................................................................................................................................................................................................................................
8) Fungsi neurologis..........................................................................................................................................................................................................................................................................................
9) Endokrin ..........................................................................................................................................................................................................................................................................................
b. Konsep diri.........................................................................................................................................................................................................................................................................................................................................................................................................................................................
c. Fungsi peran.........................................................................................................................................................................................................................................................................................................................................................................................................................................................
d. Ketergantungan.........................................................................................................................................................................................................................................................................................................................................................................................................................................................
3. Pengkajian Tahap KeduaMode fisiologi
Perilaku klien Stimulus fokal Stimulus kontekstual Stimulus residual
Konsep diriPerilaku klien Stimulus fokal Stimulus kontekstual Stimulus residual
Fungsi PeranPerilaku klien Stimulus fokal Stimulus kontekstual Stimulus residual
InterdependensiPerilaku klien Stimulus fokal Stimulus kontekstual Stimulus residual
B. DIAGNOSA KEPERAWATAN......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
RENCANA DAN TINDAKAN KEPERAWATANNo. Dx Tujuan Intervensi
IMPLEMENTASI DAN EVALUASINo. Dx Implementasi Evaluasi
