FORMAT LAPORAN

RESUME KEPERAWATAN JIWA

A. IDENTITAS
Nama (Inisial) : (L/P) Agama :
Umur :........................... No. RM : ...........................
Alamat : Tanggal Pengkajian : ...........................
Pendidikan :...........................

B. ALASAN MASUK
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C. PEMERIKSAAN FISIK
Keadaan Umum :
TD :
Nadi :
Respirasi :
Suhu :
Keluhan Fisik :
D. DATA FOKUS

DATA SUBYEKTIF DATA OBYEKTIF

E. ANALSIS DATA

SYMPTOM ETIOLOGI PROBLEM

Subjektif

Objektif

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F. DAFTAR DIAGNOSA KEPERAWATAN (PRIORITAS)
1. ..............................................................................................................................
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2. ..............................................................................................................................
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3. ..............................................................................................................................
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RENCANA INTERVENSI KEPERAWATAN

NO DIAGNOSA NOC NIC

TGL/JAM KEPERAWATAN
IMPLEMENTASI KEPERAWATAN DAN EVALUASI KEPERAWATAN

NO DIAGNOSA IMPLEMENTASI EVALUASI

TGL/JAM KEPERAWATAN
RENCANA TINDAK LANJUT