Form KDM Eliminasi
Form KDM Eliminasi
FORMAT PENGKAJIAN
KEBUTUHAN ELIMINASI
Minum
Frekuensi ............................... ................................
Jenis ............................... ................................
c. Pola Eliminasi
Kebiasaan BAB
Karakteristik BAB Sebelum sakit Saat sakit
e. Pola Istirahat-Tidur
Keterangan Sebelum Sakit Saat Sakit
Lama tidur siang
Lama tidur malam
Pengantar tidur
Gangguan tidur
f. Pola Kognitif dan Persepsi Sensori
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3. Leher
I.............................................................................................................................................
P...........................................................................................................................................
5. Dada
Paru-Paru
I……………………………………………………………………………………………………
P...........................................................................................................................................
P...........................................................................................................................................
A………………………………………………………………………………………………….
Jantung
I……………………………………………………………………………………………………..
P..............................................................................................................................................
P..............................................................................................................................................
A…………………………………………………………………………………………………....
6. Abdomen
I………………………………………………………………………………………………………
A…………………………………………………………………………………………………….
P…………………………………………………………………………………………………….
P…………………………………………………………………………………………………….
7. Ekstremitas
Atas
I…………………………………………………………………………………………………….
P……………………………………………………………………………………………………
Gerakan Sendi……………………………………………………………………………………
……………………………………………………………………………………………………..
Kekuatan Otot…………………………………………………………………………………….
Bawah
I………………………………………………………………………………………………………
P……………………………………………………………………………………………………..
Gerakan Sendi…………………………………………………………………………………….
……………………………………………………………………………………………………....
Kekuatan Otot…………………………………………………………………………………….
9. Anus – Genetalia
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………………,…………………..20…..
Mahasiswa
( )
NIM…………………………