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ASUHAN KEPERAWATAN

PADA ........ DENGAN ..................................................


DI RUANG INSTALASI GAWAT DARURAT
RSUP Dr. KARIADI SEMARANG
Pembimbing Klinik :

Pembimbing Akademik :
Ns. Dody Setyawan, S.Kep., M.Kep.

Oleh :
..........................................................................
..

PROGRAM PENDIDIKAN PROFESI KEPERAWATAN


JURUSAN KEPERAWATAN
FAKULTAS KEDOKTERAN
UNIVERSITAS DIPONEGORO
SEMARANG
2016

A. PENGKAJIAN KEPERAWATAN
Tanggal masuk IGD : .
Tanggal pengkajian : .
1.

Identitas
a. Identitas Pasien
Nama
Usia
No Register
Jenis Kelamin
Agama
Suku/Bangsa
Pekerjaan
Status Perkawinan
Alamat
Pendidikan Terakhir

:
:
:
:
:
:
:
:
:

..
..
..
..
..
..
..
..
..
:

..
Diagnosa Medis

..
b. Identitas Penanggungjawab
Nama
: ..
Umur
: ..
Jenis Kelamin
: ..
Alamat
: ..
Hubungan dengan klien
:
..

2.

Pengkajian Primer

3.

Pemeriksaan Penunjang

....

....

....

4.

Terapi
Nama
Obat

Dosis

Rut

Indikasi

Efek samping

B. ANALISA DATA
Nama
: ..
No Register : ..
N

Kontraindikasi

Data Fokus

Usia
Tanggal
Masalah

Etiologi

: ..
: ..
Dx Keperawatan

TTD

C. RENCANA TINDAKAN KEPERAWATAN


Nama
: ..
No Register : ..
No

Dx

Tujuan dan Kriteria

Dx

Keperawatan

Hasil

Usia
Tanggal

: ..
: ..

Intervensi

TTD

D. IMPLEMENTASI KEPERAWATAN

Nama
No Register

: ..
: ..

Tanggal/J

No.

am

Dx

Implementasi

Usia
Tanggal

: ..
: ..

Evaluasi Formatif

TTD

E. EVALUASI SUMATIF
Nama
: ..
No Register : ..
No

Tanggal/Ja

Diagnosa

Dx

Keperawatan

Usia
Tanggal

: ..
: ..

Evaluasi Sumatif

TTD

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