FORMAT PENGKAJIAN

APLIKASI TEORI MODEL SELF CARE OREM

STIKES HANG TUAH SURABAYA

A. PENGKAJIAN1. Universal Self Care

a. Kebutuhan oksigen......................................................................................................................................................................................................................................................................................................

b. Kebutuhan Cairan......................................................................................................................................................................................................................................................................................................

c. Kebutuhan Nutrisi......................................................................................................................................................................................................................................................................................................

d. Kebutuhan Eliminasi......................................................................................................................................................................................................................................................................................................

e. Interaksi Sosial......................................................................................................................................................................................................................................................................................................

f. Istirahat dan Tidur......................................................................................................................................................................................................................................................................................................

g. Konsep Diri......................................................................................................................................................................................................................................................................................................

2. Development Self Carea. Identitas Anggota kelompok

1) Usia : .......... tahun2) Jenis kelamin : L / P3) Pendidikan : .................................................................................................................4) Agama: .................................................................................................................5) Pekerjaaan : .................................................................................................................6) Suku : .................................................................................................................

b. Penyakit Keturunan......................................................................................................................................................................................................................................................................................................

c. Persepsi terhadap penyakitnya......................................................................................................................................................................................................................................................................................................

d. Pengetahuan Terhadap Penyakit......................................................................................................................................................................................................................................................................................................

3. Health Deviationa. Tindakan preventif yang dilakukan untuk mengatasi masalah

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...................................................................................................................................................b. Halangan untuk melakukan tindakan preventif

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B. DIAGNOSA KEPERAWATAN......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

RENCANA KEPERAWATANNo dx Penuh/wholly Sebagian/partial Supportif Edukatif

IMPLEMENTASI DAN EVALUASINo. Dx Implementasi Evaluasi