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FLACC Pain Assesment Tool

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Academic year: 2023

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Face, Legs, Activity, Cry and Consolability (FLACC) scala adalah intrumen pengkajian nyeri yang baik digunakan pada anak usia 2-7 tahun. Skala ini terdiri dari 5 penilaian dengan skor total 0 (tidak nyeri) dan 10 (nyeri hebat). Hsil skor perilakunya adalah 0 (rileks dan nyaman), 1-3 (nyeri ringan/ketidaknyamanan ringan, 4-6 nyeri sedang, 7-10 nyeri hebat/ketidaknyamanan berat.

FLACC Pain Assesment Tool

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o Kategori

Skor Total

0 1 2

1 Face (wajah)

Tidak ade ekspresi khusus, senyum

Terkadang meringis/mena rik diri

Sering

menggertaka n dagu dan mengatupka n rahang

2 Leg (kaki) Normal,

rileks Gelisah, tegang

Menendang, kaki

tertekuk, melengkungk an punggung

3 Acitivity (aktivitas)

Berbarin g

tenang, posisi normal, mudah bergera k

Menggeliat, tidak bisa diam, kaku

mengerang Kaku atau menghentak

4 Cry

(menangis)

Tidak menangi s

Merintih, merengek, kadang-kadang mengeluh

Terus menangis, berteriak, sering mengeluh

5

Consability (konstability

) Rileks

Dapat

ditenangkan dengan sentuhan, pelukan,

bujukan, dapat

diahlihkan Sulit dibujuk Skor total

Sumber:

(2)

 Mini Riset Fatria Irawan Maku dengan Judul Gambaran Intensitas Nyeri Menggunakan FLACC Scale tahun 2019

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