Nama Mahasiswa :
NIM :
Tempat Pengkajian :
Tanggal :
IDENTITAS KLIEN
Nama : No. RM :
Umur : Pekerjaan :
Jenis Kelamin : Status Perkawinan :
Agama : Tanggal MRS :
Pendidikan : Tanggal Pengkajian :
Alamat : Sumber Informasi :
Diagnosa :
Medis
PROSES KEPERAWATAN
PRE HEMODIALISA
1) Data Fokus
Data Subjektif:
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
Data Objektif:
BB Pre HD :
Tanda vital:
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
2) Diagnosa Keperawatan
......................................................................................................................................
......................................................................................................................................
3) Intervensi Keperawatan
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
4) Implementasi Keperawatan
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
5) Evaluasi Keperawatan (SOAP)
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
INTRA HEMODIALISA
1) Data Fokus
Data Subjektif:
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
Data Objektif:
Cairan dialisat :
TMP :
Qd :
Qb :
Dosis Heparin :
Tanda vital:
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
2) Diagnosa Keperawatan
......................................................................................................................................
......................................................................................................................................
3) Intervensi Keperawatan
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
4) Implementasi Keperawatan
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
5) Evaluasi Keperawatan (SOAP)
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
POST HEMODIALISA
1) Data Fokus
Data Subjektif:
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
Data Objektif:
BB Post HD :
Tanda vital:
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
......................................................................................................................................
2) Diagnosa Keperawatan
......................................................................................................................................
......................................................................................................................................
3) Intervensi Keperawatan
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
4) Implementasi Keperawatan
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
5) Evaluasi Keperawatan (SOAP)
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
..................., ..............................
(..............................)