Status Cardio
Status Cardio
KARDIORESPIRASI
AKADEMI FISIOTERAPI UNIVERSITAS KRISTEN
INDONESIA
Nama Mahasiswa Nama Pasien
NIM No RM
Kelamin
Kesadaran
TOTAL EWT 0 1 2 3
Subyektifitas:
Keluhan Utama
Pencetus Gejala
Qualitas Gejala
Radiasi/Perluasan Gejala
Skala Gejala
FORM STATUS KLINIK FISIOTERAPI
KARDIORESPIRASI
AKADEMI FISIOTERAPI UNIVERSITAS KRISTEN
INDONESIA
Time/Waktu Munculnya Gejala
Riwayat Penyakit
O2 therapy:
Oedema:
Exposure Abdomen:
Thorax:
Urine Output:
Fluid Balance:
Other losses:
Bowel Function:
Data penunjang
ABG pH: 7,35-7,45 ABG: pH _______,
pCo2: 35-45 mmHg pCO2 _______,
pO2 : 75-100 mmHg pO2 _______,
SaO2: 95-99% SaO2 _______,
HCO3 : 22-26 mEq/l HCO3- _______
Umum Na: 135-145 mEq/l Umum: Na ______,
K: 3.5-5.0 mEq/l K ______,
Urea 8-25 mg/100 ml Urea ______,
Mg 1.5-2.0 mEq/l Mg ______
Ca : 8.2 -10.2 mg/dl Ca ______,
Bilirubin : <1.0 mg/100 ml Bilirubin ______,
BNP < 100 pg/ml BNP _______,
Albumin 3.5-5.5 gr/100 ml Albumin ______,
Lactat: 6-16 mg/dl Lactate _______
Lipid Triglycerides: 50-150 mg/dL Lipid Trigliserida _______
Total cholesterol: 3-5.5 mmol/L Total cholesterol ________
(HDL): 40-80 mg/dL HDL ________,
(LDL): 85-125 mg/dL LDL ________,
Ginjal BUN 8-25 mg/100 ml Ginjal BUN ________,
Creatinin : 0.6-1.3 mg/100 ml Creatinine _______,
Asam urat : 3.0-7.0 mg/100 ml Asam urat ________,
Enzim Jantung Troponin T <0.1 ng/ml Enzim Jantung Troponin T ________,
CPK total < 100 U/l CPK total ________,
CRP <10 mg/l CRP ________,
FBC Hb 12-17 g/dl FBC Hb ______,
Pletelets 150 juta - 450 juta/ mm Platelets ______
WCC 4-11 x 109/l WCC ______,
Neutrophils 54-75% Neutrophils ______,
FORM STATUS KLINIK FISIOTERAPI
KARDIORESPIRASI
AKADEMI FISIOTERAPI UNIVERSITAS KRISTEN
INDONESIA
Clotting INR 10-14 detik Clotting INR _______,
APTT 20-35 detik APTT _______
Kesan lab darah
Hasil radiologi:
Rencana Terapi
FORM STATUS KLINIK FISIOTERAPI
KARDIORESPIRASI
AKADEMI FISIOTERAPI UNIVERSITAS KRISTEN
INDONESIA
Penatalaksanaan Intervensi
Evaluasi:
FORM STATUS KLINIK FISIOTERAPI
KARDIORESPIRASI
AKADEMI FISIOTERAPI UNIVERSITAS KRISTEN
INDONESIA