PROGRAM STUDI ILMU KEPERAWATAN UNIVERSITAS JEMBER

FORMAT PENGKAJIAN KEPERAWATAN GAWAT DARURAT

(INSTALASI GAWAT DARURAT)

Nama Mahasiswa :
NIM :
Tempat Pengkajian :
Tanggal :

I. Identitas Klien
1. Nama :
2. No. RM :
3. Tanggal lahir/ Umur :
4. Alasan masuk RS :

5. Diagnosa medis :

II. Pengkajian
A. Primary Survey
1. Respon
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2. Airway
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3. Breathing
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4. Circulation
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5. Disability
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6. Exposure
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B. Secondary Survey
1. Riwayat Penyakit Sekarang
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2. Riwayat Kesehatan Terdahulu :
a. Penyakit yang pernah dialami
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b. Alergi (Obat, Makanan, dll).
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c. Obat-obat yang digunakan
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3. Pengkajian Head To Toe
Keadaan Umum
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Tanda-tanda Vital & Nyeri
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a. Kepala
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b. Leher
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c. Dada
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d. Abdomen
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e. Urogenital
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f. Ekstremitas
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g. Punggung
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h. Keadaan lokal
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7. Tindakan Pre-Hospital
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8. Pemeriksaan Penunjang
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Pengambil data,
…...……………………….2019

( )
NIM.
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