RESUME HEMODIALISA

PENGKAJIAN
Hari/Tanggal : ............................................................................................
Ruang : ............................................................................................
Nama Perceptee :............................................................................................
NIM : ............................................................................................

A. Identitas Pasien
Nama :............................................................................................
Umur : ............................................................................................
No. RM :.............................................................................................
Jenis kelamin : ............................................................................................
Alamat : ............................................................................................
Pekerjaan : ............................................................................................
Diagnosa Medis : ............................................................................................
Tanggal masuk : ............................................................................................
B. Penanggung Jawab
Nama : ............................................................................................
Umur :............................................................................................
Alamat : ............................................................................................
Hubungan dg klien : ............................................................................................

PRE HEMODIALISA
1. Keluhan Klien
Data Subyektif
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2. Riwayat penyakit sekarang / dahulu
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3. Riwayat penyakit keluarga

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C. Tanda-tanda Vital :
TD :.................................................................
 Nadi :.................................................................
RR :.................................................................
Suhu :.................................................................
Kesadaran:................................................................
Berat Badan :........................................................(Kg)
D. Pemeriksaan Fisik (IPPA & Data Fokus)
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E. Data Penunjang / Laboratorium
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F. Masalah Keperawatan
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 G. INTERVENSI KEPERAWATAN (Pre Hemodialisa)
NO Diagnosa Tujuan dan Kriteria Intervensi Implementasi Evaluasi
Keperawatan Hasil
INTRA HEMODIALISA
A.Keluhan Klien
Data Subyektif
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B. Persiapan Mesin dan Alat Hemodialisa
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C.Tindakan Keperawatan yang dilakukan selama Hemodialisa
1. Obersevasi
Jam TTV Keluhan Saat HD
HD ke
I TD :
NADI :
RR :
SUHU :
II TD :
NADI :
RR :
SUHU :
III TD :
NADI :
RR :
SUHU :
IV TD :
NADI :
RR :
SUHU :
V TD :
NADI :
RR :
SUHU :

2. Pengobatan selama HD
Obat yang diberikan Dosis

3. Penyulit selama HD (beri tanda (√))

Shunt problem Koma
Perdarahan Sakit dada
Mual muntah Gatal-gatal
Kejang Hypotensi
Kram Hypertensi
Panas/ Menggigil Alergi Dializer

Lain-lain ………………………………
POST HEMODIALISA
A. Analisa Data
Data Subyektif
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Data Obyektif (data focus)
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B. Tanda-tanda Vital :
TD :.................................................................
Nadi :.................................................................
RR :.................................................................
Suhu :.................................................................
Berat Badan :........................................................(Kg)

C. Discharge Planning
Edukasi
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