BAPTIS KEDIRI
PRODI KEPERAWATAN PROGRAM SARJANA
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FORMAT PENGKAJIAN ASUHAN KEPERAWATAN MATERNITAS II
(PADA KASUS GINEKOLOGY)
NAMA MAHASISWA :
NIM :
RUANG :
Tanggal masuk RS :
Nomor Rekam Medis :
Diagnosa masuk :
Tanggal Pengkajian :
Jam :
I. PENGKAJIAN
A. Data Subyektif IDENTITAS (BIODATA)
k. Integumen
a) Turgor kulit : ..................................................................................................
b) Warna kulit : ..................................................................................................
c) Kesulitan dalam pergerakan: ..............................................................................
d) Lainnya sebutkan: capillary refill time (CRT): .............. detik
l. Ektremitas
a) Tangan kiri : ..................................................................................................
b) Tangan kanan : ..................................................................................................
c) Kaki kiri : ..................................................................................................
d) Kaki kanan : ..................................................................................................
6. Pemeriksaan Penunjang
a. Laboratorium:
Hb : ....... gr/dl
Leukosit : .........
Hematokrit : .........
Netrofil : ...........
Limfosit : .............
b. Terapi yang didapat:
............................................................................................................................... .
..............................................................................................................................
............................................................................................................................... .
..............................................................................................................................
Kediri, ..........................................
Mahasiswa
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