RESUME RUANG HEMODIALISA

I. IDENTITAS
Nama :
Jenis kelamin :
Umur :
Alamat :
Diagnosa medis :
Tanggal pengkajian :

II. ANALISA DATA

DATA PENYEBAB MASALAH
III. PERENCANAAN
DIAGNOSA TUJUAN RENCANA RASIONAL
TINDAKAN

IV. IMPLEMENTASI
NO. TANGGAL IMPLEMENTASI RESPON KLIEN

V. EVALUASI
TANGGAL EVALUASI PARAF
1. Data Pre HD
Keluhan :
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2. Pemeriksaan Fisik
a. Tanda – tanda vital : TD ........MmHg Nadi .....X/menit Rr
.....X/menit S .....ºC
b. Respiratory : normal dyspnea Ronchi Wheezing
c. Oedema : tidakada ekstremitas wajah acites
d. Data BB : BB kering ......... Kg BB pra HD .......Kg
e. Tipe akses vaskuler : AV Fistula Femolaris Double
Luman
3. Data Dializer
Luas membrane : ............... M² low flux High flux
Jenis Dializer : Baru Reuse, ke .......... Volume Priming ......... mL
Hasil tes sisa renalin ( khusus dializer reuse ) 0 1 3
Parameter mesin : alarm Test tidak Ya Conductivity : .......
º
suhu mesin .......... ºC
C
Anticoagulan : Tepi Continue Free Heparin
º º
Dosis Awal : ........ Unit Dosis Pemeliharaan : ........ Unit/jam Total
C C
: ........ Unit
Jam Masalah keperawatan Jam masalah keperawatan
Pola nafas tidak efektif
Gangguan kelebihan
volume cairan
Syok hipovolemik
Gangguan rasa nyaman
nyeri

Jam Pasien mesin Masalah/tindakan

petugas
TD Nadi QB VP UF UF UF
GOAL RATE REMOVED
4. Data Post HD
Keluhan :
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Keadaan Umum :
TD : ...........MmHg Nadi : .........X/Mnt P : ......X/Mnt Suhu : .....
ºC BB Post HD : ........Kg

Cairan Yang masuk selama HD

Sisa Priming : ...........................mL
Transfusi : ................................mL
Wash Out : .................................mL
Minum : .....................................mL
Jumlah : ....................................mL
Nama petugas yang melakukan fungsi : .................................
Nama petugas yang mengakhiri dialysis : .............................
perawat