FORMAT UJIAN KGD PROFESI FKP-UNRI

I. PENGKAJIAN
A. IDENTITAS
1. Identitas Klien
Nama :
Umur :
Agama :
Pendidikan :
Pekerjaan :
Suku/bangsa :
Diagnosa Medis :
Tanggal masuk RS :
Tanggal Pengkajian :
No. MR :
Alamat :

2. Identitas Penanggung jawab

Nama :
Umur :
Agama :
Pendidikan :
Pekerjaan :
Suku/bangsa :
Hubungan dengan klien :
Alamat :

B. KELUHAN UTAMA
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PENGKAJIAN PRIMER
Airway : ...............................................................................................................
Breathing : ...............................................................................................................
Circulation : ...............................................................................................................
Disability : ...............................................................................................................
Exposure : ...............................................................................................................
Foley Cateter : ...............................................................................................................
Gastric Tube : ...............................................................................................................
Heart Monitor: ..............................................................................................................
C. PENGKAJIAN TERFOKUS (SISTEM YANG TERGANGGU)
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PATOFISIOLOGI PENYAKIT
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D. DIAGNOSA KEPERAWATAN, DATA PENUNJANG, TINDAKAN DAN RASIONAL
1. Diagnosa keperawatan
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Data Penunjang:
DS:
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DO:
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Intervensi:
a. ............................................................................................................................
b. ............................................................................................................................
c. ............................................................................................................................
d. ............................................................................................................................
e. ............................................................................................................................
f. ............................................................................................................................

2. Diagnosa keperawatan
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Data Penunjang:
DS:
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DO:
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Intervensi:
a. ............................................................................................................................
b. ............................................................................................................................
c. ............................................................................................................................
d. ............................................................................................................................
e. ............................................................................................................................
f. ............................................................................................................................
3. Diagnosa keperawatan
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Data Penunjang:
DS:
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DO:
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Intervensi:
a. ............................................................................................................................
b. ............................................................................................................................
c. ............................................................................................................................
d. ............................................................................................................................
e. ............................................................................................................................
f. ............................................................................................................................

4. Diagnosa keperawatan
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Data Penunjang:
DS:
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DO:
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Intervensi:
a. ............................................................................................................................
b. ............................................................................................................................
c. ............................................................................................................................
d. ............................................................................................................................
e. ............................................................................................................................
f. ............................................................................................................................

Pekanbaru, ............................................
Mahasiswa, ............................................