FORMAT PENGKAJIAN ASUHAN KEPERAWATAN SISTEM

PERKEMIHAN

Nama Kelompok : .........................................

Tanggal : .........................................

I. Identitas diri pasien

Nama : ........................................ Pendidikan : ..........................................
Umur : ........................................ Pekerjaan : ..........................................
Jenis Kelamin : ........................................
Alamat : .......................................
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Status Perkawinan :.................................. Tanggal Masuk RS :...............................
Agama :.................................. Tanggal Pengkajian :...............................

II. Riwayat Penyakit

1. Keluhan utama saat masuk RS
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2. Riwayat penyakit sekarang
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3. Riwayat penyakit dahulu
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III. Pengkajian saat ini

1. Pola nutrisi / metabolik

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a.Intake makanan
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b. Intake minuman
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2. Pola eliminasi
a. Buang air besar
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 b. Buang air kecil
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3. Pola tidur dan istirahat

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IV. Pemeriksaan Fisik
Keluhan yang dirasakan saat ini
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TD: mmHg P: x/menit N: x/menit S:
0
C
BB/TB: ......................................................................

Abdomen :
 Inspeksi
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 Palpasi
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 Auskultasi
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Ekstrimitas
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Program terapi
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 Hasil Pemeriksaan Penunjang dan laboratorium

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