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ASUHAN KEPERAWATAN PADA PASIEN............

DENGAN..............................................................
DI RUANG............................ RSUD KLUNGKUNG
TANGGAL..............................

I. PENGKAJIAN
A. Identitas Pasien
Nama :
No RM :
Umur :
Jenis Kelamin :
Pekerjaan :
Agama :
Status :
Tanggal MRS :
Tanggal Pengkajian :
B. Keluhan Utama
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C. Riwayat Kesehatan
1. Riwayat Kesehatan Dahulu
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2. Riwayat Kesehatan Sekarang
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3. Riwayat Kesehatan Keluarga
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II. ANALISA DATA
Ruang :
Nama Pasien :
No. Register :

No. Data Fokus Etiologi Masalah


III. DIAGNOSA KEPERAWATAN
Ruang :
Nama Pasien :
No. Register :
IV. PERENCANAAN / INTERVENSI
Ruang :
Nama Pasien :
No. Register :

Hari, No. Tujuan Intervensi Rasional


Tanggal, Dx
Jam
V. PELAKSAAN / IMPLEMENTASI
Ruang :
Nama Pasien :
No. Register :

No. Hari, No. Implementasi Evaluasi Formatif TTD


Tanggal, Dx
Jam
VI. EVALUASI
Ruang :
Nama Pasien :
No. Register :

No. Hari, No. Evaluasi Sumatif TTD


Tgl,Jam Dx.
Lembaran Pengesahan

Klungkung,……………………

Mengetahui, Mahasiswa
Clinical Instructure/CI

NIP : NIM :
Mengetahui,

Pembimbing Akademik

NIP :

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