Nama :

STIKES Hafshawaty NIM :

Pesantren Zainul HasanProbolinggo Poli :

RESUME KEPERAWATAN
Pada Tn/Ny/Sdr.........Dengan Kasus .....................
(Format Pengkajian Praktek Komplementer)

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

……………………………………………………………………………………………………………….................……………..
………………………………………………………………………………………………………………………..................…….

III. RIWAYAT PENYAKIT SEKARANG

.............................................................................................................................................................................................
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IV. PEMERIKSAAN FISIK FOKUS PADA KASUS
.............................................................................................................................................................................................
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V. PEMERIKSAAN DIAGNOSTIK DAN PENATALAKSANAAN
.......................................................................................................................................................
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.......................................................................................................................................................
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VI. ANALISA DATA

VII. DIAGNOSA KEPERAWATAN (minimal 2)

1. ....................................................................................................................................................................................
2. ....................................................................................................................................................................................
3. ....................................................................................................................................................................................
4. Dst…

1
VIII. INTERVENSI KEPERAWATAN/RENCANA TINDAKAN KEPERAWATAN (SESUAI NIC NOC DAN
TAMBAHKAN INTERVENSI SESUAI KEPERAWATAN KOMPLEMENTER_
Diagnosa Keperawatan 1
.............................................................................................................................................................................................
.............................................................................................................................................................................................
Diagnosa Keperawatan 2
.............................................................................................................................................................................................
.............................................................................................................................................................................................
IX. IMPLEMENTASI KEPERAWATAN
Diagnosa Keperawatan 1
.............................................................................................................................................................................................
.............................................................................................................................................................................................
Diagnosa Keperawatan 2
.............................................................................................................................................................................................
.............................................................................................................................................................................................

X. EVALUASI (tiap Diagnosa Keperawatan)

S : .......................................................................................................................................................................................
O : .......................................................................................................................................................................................
A : .......................................................................................................................................................................................
P : .......................................................................................................................................................................................

............................, ..............................2020
Mahasiswa,

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