Nama :

STIKes Hafshawaty NIM :

Zainul Hasan Genggong Probolinggo Poli :

RESUME KEPERAWATAN
Pada Tn/Ny/Sdr.........Dengan Kasus .....................
(Format Pengkajian Poli Bedah dan THT)

Data diambil tanggal :……………………. Jam………

No. Rekam Medik :…………………….

I. IDENTITAS KLIEN
Nama :……………………………………………………………………..
Umur :…………………………………………………………………….
Jenis Kelamin :…………………………………………………………………….
Suku / Bangsa :………………………………………………………………………
AgamaPekerjaan :………………………………………………………………………
Pendidikan :………………………………………………………………………
Alamat :………………………………………………………………………
No. Register :…………………………………………………………………….
Tanggal MRS :………………………………………………..............................
Diagnosa Medis :………………………………………………..............................
Sumber Informasi :………………………………………………..............................
Penanggung : Askes / Astek / Jamsostek / JPS / Sendiri

II. KELUHAN UTAMA

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III. KRONOLOGIS PENYAKIT SEKARANG

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IV. PEMERIKSAAN FISIK YANG BERHUBUNGAN DENGAN KASUS
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V. PEMERIKSAAN DIAGNOSTIK DAN PENATALAKSANAAN
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VI. ANALISA DATA

a. Data
Subyektif : ..........................................................................................................................................
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b. Data
Obyektif : ...........................................................................................................................................
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VII. DIAGNOSA KEPERAWATAN

1. .........................................................................................................................................................
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1
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3. .........................................................................................................................................................
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4. Dst…

VIII. INTERVENSI KEPERAWATAN/RENCANA TINDAKAN KEPERAWATAN

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IX. IMPLEMENTASI KEPERAWATAN
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X. EVALUASI
S : .......................................................................................................................................................................................
O : .......................................................................................................................................................................................
A : .......................................................................................................................................................................................
P : .......................................................................................................................................................................................

Surabaya, ..............................20.....
Mahasiswa,

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