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PROGRAM PENDIDIKAN S1 KEPERAWATAN

STIKes NURUL JADID


PAITON PROBOLINGGO
2016
FORMAT RESUM POLI THT

Nama Mahasiswa : ..........................................


NIM : ..........................................
Tempat Praktek : ..........................................

A. Identitas Klien
1. Nama : .......................................................
2. Tempat tgl lahir ( usia ) : .......................................................
3. Jenis kelamin : .......................................................
4. Agama : .......................................................
5. Pendidikan : .......................................................
6. Alamat : .......................................................
7. Tgl masuk : .......................................................
8. Tgl pengkajian : .......................................................
9. Diagnosa medik : .......................................................
10. Sumber Informasi : .......................................................

B. Riwayat Penyakit
1. Keluhan Utama : .......................................................................................................

2. Riwayat Penyakit Sekarang : .......................................................................................................

3. Riwayat Penyakit Dahulu : .......................................................................................................

4. Riwayat Penyakit Keluarga : .......................................................................................................

C. Pemeriksaan Fisik
1. Keadaan Umum : ...................................................................................................................

2. Tanda – Tanda Vital


a. Tekanan Darah : ........./......... mmhg
b. Suhu : ............. O C
c. Nadi : ............ X / Menit
d. RR : ............ X / Menit

3. a. Berat Badan : .......... kg


b Tinggi Badan : .......... cm

4. Telinga, Hidung, Tenggorokan


a. Inspeksi : ...................................................................................................................

b. Palpasi : ...................................................................................................................