1. PENGKAJIAN A. IDENTITAS KLIEN Nama (Inisial) : L/P : Umur : Alamat : Pendidikan : Agama : No. RM : Tgl Pengkajian : B. ALASAN MASUK ....................................................................................................................................... ....................................................................................................................................... ........................................................................................................................ C. PEMERIKSAAN FISIK Keadaan umum : TD : Nadi : Respirasi : Suhu : Keluhan fisik : D. DATA FOKUS DATA SUBYEKTIF DATA OBYEKTIF
E. ANALISA DATA N o 1.
DATA
ETIOLOGI
Subyektif .
Obyektif
2.
Subyektif .
Obyektif
PROBLEM
F. DAFTAR DIAGNOSA KEPERAWATAN (PRIORITAS)
1. ............................................................................................................................ 2. ............................................................................................................................ G. RENCANA INTERVENSI KEPERAWATAN NO TGL/JA M