A.

Identitas Klien

1. Nama :

2. Jenis Kelamin :

3. Agama :

4. Pendidikan :

5. Pekerjaan :

6. Alamat :

7. Diagnosa Medis :

8. Tanggal masuk RS :

9. Alasan masuk RS :

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10. Riwayat penyakit sebelumnya :

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11. Riwayat penyakit saat ini :

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B. Pengkajian kebutuhan dasar manusia

1. Pola Persepsi-Manajemen Kesehatan

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2. Pola Metabolisme-Nutrisi

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3. Pola Eliminasi

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4. Pola Aktivitas-Latihan

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5. Pola Istirahat-Tidur

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6. Pola Kognitif-Persepsi

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7. Pola Persepsi Diri-Konsep Diri

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8. Pola Hubungan-Peran

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9. Pola Seksual-Reproduksi

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10. Pola Koping-Toleransi Terhadap Stress

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 11. Pola Nilai-Kepercayaan

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C. Analisa Data

DATA ETIOLOGI PROBLEM

D. Perencanaan

DIAGNOSA TUJUAN INTERVENSI

KEPERAWATAN
E. Implementasi

DIAGNOSA IMPLEMENTASI EVALUASI

KEPERAWATAN