Lampiran 6

FORMAT LAPORAN RESUME

ASUHAN KEPERAWATAN
A. Identitas Pasien
Nama Pasien : .......................................................................................................
Tempat tanggal lahir : .......................................................................................................
Umur : .......................................................................................................
Agama : .......................................................................................................
Alamat : .......................................................................................................
Pekerjaan : .......................................................................................................
Jenis kelamin : .......................................................................................................
Diagnosa Medis : .......................................................................................................
Tanggal Masuk RS : .......................................................................................................
Tanggal pengkajian : .......................................................................................................
Nama Penanggung jawab : ...........................................................................................
Hubungan dengan pasien : ...........................................................................................

B. Data Fokus
DS :
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
DO :
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
Riwayat Penyakit Sekarang
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
Riwayat Penyakit Dahulu
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
C. Terapi medis

No Nama Obat Dosis Fungsi Rute

D. Data Penunjang
1. Laboratorium

Hari/
tanggal/ Jenis Pemeriksaan Hasil Nilai Normal Interpretasi
jam
 2. Radiologi
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
3. EEG, USG, MRI, EKG
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
.........................................................................................................................................................
4. Scanning
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
.........................................................................................................................................................
E. Diagnosa Keperawatan
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
F. Tujuan
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
G. Intervensi
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
H. Implementasi
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
I. Evaluasi
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................