Format Discharge Planning
Format Discharge Planning
No. MR : Alamat :
Nama : Ruang Rawat :
Jenis Kelamin :
IGD Poli................................
0
Suhu : C, Nadi: x/menit, RR: x/menit, TD: / mmHg
2. Diagnosa medis :
Ruangan............................
1. Keadaan umum :
0
Suhu : C, Nadi: x/menit, RR: x/menit, TD: / mmHg
2. Masalah selama dirawat
Perubahan nutrisi kurang dari kebutuhan Perubahan perfusi jaringan
Anietas Intoleransi aktifitas
Nyeri Gangguan pola tidur
Gangguan keseimbangan cairan Resiko infeksi
Dan elektrolit Resiko cedera
Perubahan persepsi sensori Lain –lain .....
Kerusakan komunikasi verbal
Ketidak efektifan bersihan jalan nafas
Catatan :
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III. Pasien Keluar Rumah Sakit
1. Keadaan umum :
0
Suhu : C, Nadi: x/menit, RR: x/menit, TD: / mmHg
2. Dipulangkan dari RS dengan keadaan :
b. Tempat :
4. Lanjutan perawatan di rumah ( luka operasi, pemasangan gift, pengobatan, dan lain-lain )
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5. Aturan diet/Nutrisi
Bebas Cair Rendah Garam
Catatan :
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6. Obat-obatan yang masih diminum dan jumlahnya:
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7. Aktivitas dan Istirahat :
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8. Bawaan pulang pasien ( Hasil Lab, Foto, EGC, obat, dan lain-lainnya ) :
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9. Lain-lain
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Palangka Raya.................................................
Pasien/Keluarga Perawat
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