Format Orem
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FORMAT PENGKAJIAN APLIKASI TEORI MODEL SELF CARE OREM
A. PENGKAJIAN 1. 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 Care a. Identitas Anggota kelompok 1) Usia : .......... tahun 2) Jenis kelamin : L / P 3) Pendidikan : ................................................................................................................. 4) Agama : ................................................................................................................. 5) Pekerjaaan : ................................................................................................................. 6) Suku : ................................................................................................................. b. Catatan Kesehatan Kesehataan Saat ini ................................................................................................................................................... ................................................................................................................................................... Kesehatan Masa Lalu ................................................................................................................................................... ................................................................................................................................................... Penyakit Keturunan ................................................................................................................................................... ................................................................................................................................................... Persepsi terhadap penyakitnya ................................................................................................................................................... ................................................................................................................................................... Pengetahuan Terhadap Penyakit (Kognitif) ................................................................................................................................................... ................................................................................................................................................... 3. Health Deviation a. Tindakan preventif yang dilakukan untuk mengatasi masalah
................................................................................................................................................... ................................................................................................................................................... b. Halangan untuk melakukan tindakan preventif ................................................................................................................................................... ...................................................................................................................................................
B. DIAGNOSA KEPERAWATAN ............................................................................................................................................................... ............................................................................................................................................................... ............................................................................................................................................................... ............................................................................................................................................................... ............................................................................................................................................................... ............................................................................................................................................................... ............................................................................................................................................................... ............................................................................................................................................................... ............................................................................................................................................................... ...............................................................................................................................................................
No dx
Penuh/wholly
RENCANA KEPERAWATAN Sebagian/partial
Supportif Edukatif
IMPLEMENTASI DAN EVALUASI No. Dx
Implementasi
Evaluasi
A. PENGKAJIAN 1. 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 Care a. Identitas Anggota kelompok 1) Usia : .......... tahun 2) Jenis kelamin : L / P 3) Pendidikan : ................................................................................................................. 4) Agama : ................................................................................................................. 5) Pekerjaaan : ................................................................................................................. 6) Suku : ................................................................................................................. b. Catatan Kesehatan Kesehataan Saat ini ................................................................................................................................................... ................................................................................................................................................... Kesehatan Masa Lalu ................................................................................................................................................... ................................................................................................................................................... Penyakit Keturunan ................................................................................................................................................... ................................................................................................................................................... Persepsi terhadap penyakitnya ................................................................................................................................................... ................................................................................................................................................... Pengetahuan Terhadap Penyakit (Kognitif) ................................................................................................................................................... ................................................................................................................................................... 3. Health Deviation a. Tindakan preventif yang dilakukan untuk mengatasi masalah
................................................................................................................................................... ................................................................................................................................................... b. Halangan untuk melakukan tindakan preventif ................................................................................................................................................... ...................................................................................................................................................
B. DIAGNOSA KEPERAWATAN ............................................................................................................................................................... ............................................................................................................................................................... ............................................................................................................................................................... ............................................................................................................................................................... ............................................................................................................................................................... ............................................................................................................................................................... ............................................................................................................................................................... ............................................................................................................................................................... ............................................................................................................................................................... ...............................................................................................................................................................
No dx
Penuh/wholly
RENCANA KEPERAWATAN Sebagian/partial
Supportif Edukatif
IMPLEMENTASI DAN EVALUASI No. Dx
Implementasi
Evaluasi
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