Lampiran Buku Panduan

Program Pendidikan Profesi Ners

Stase Keperawatan Medikal Bedah

Untuk Mahasiswa S1 Keperawatan Program Pendidikan Profesi Ners dan

Pembimbing Klinik

Penyusun:

TIM Keperawatan Medikal Bedah

PSIK ITKES Wiyata Husada Samarinda

PROGRAM STUDI ILMU KEPERAWATAN

ITKES WIYATA HUSADA
SAMARINDA
2021
 Identitas Mahasiswa

Paspoto
4x6

Nama :

NIM :

Jalur :

Kelompok :

Periode Praktik :

Alamat :

HP :

Panduan Penyusunan Laporan & Penilaian 2

Kinerja
Lampiran-Lampiran

1. Format Pengkajian Keperawatan

2. Format Rencana Asuhan Keperawatan
3. Format Catatan Keperawatan
4. Format Subjektif, Objektif, Analisis, Planning (SOAP)
5. Format Analisa Keterampilan Tindakan Keperawatan
6. Format Evaluasi Kinerja klinik
7. Format Penilain Ujian Praktik
8. Format Daftar Topik Diskusi
9. Ketentuan Presentasi Analisa Jurnal
10. Format Penilaian LP dan Kasus Kelolaan
11. Format Pergantian Jadwal Dinas
12. Daftar Kehadiran Mahasiswa
13. Lembar Bukti Pengumpulan Tugas
14. Jadwal Praktik Stase KMB
 FORMAT ASUHAN KEPERAWATAN KEPERAWATAN MEDIKAL BEDAH
PSIK STIKES WIYATA HUSADA SAMARINDA

Nama mahasiswa : .........................................................

Tempat praktek : ……………………………………

Tanggal : ……………………………………

I. Identitas diri klien

Nama : .......................................... Suku : …………………………………............

Umur : .......................................... Pendidikan :..........................................................

Jemis kelamin :........................................... Pekerjaan :..........................................................

Alamat :........................................... Lama bekerja :..........................................................

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

…………………………………………………....................... Tanggal masuk RS :........................................

Status perkawinan .......................................................... Tanggal Pengkajian : ……………………...........

Agama: ................................................................................ Sumber Informasi : ……………………….......

II. Riwayat penyakit

1. Keluhan utama saat masuk RS:

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2. Riwayat penyakit sekarang:

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3. Riwayat Penyakit Dahulu

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Genogram:
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4. Diagnosa medik pada saat MRS, pemeriksaan penunjang dan tindakan yang telah dilakukan:
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III. Pengkajian saat ini (mulai hari pertama saudara merawat klien)

1. Persepsi dan pemeliharaan kesehatan

Pengetahuan tentang penyakit/perawatan
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2. Pola nutrisi/metabolic
Program diit RS:

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Intake makanan:
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Intake cairan:
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3. Pola eliminasi

a. Buang air besar

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b. Buang air kecil

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4. Pola aktifitas dan latihan:

Kemampuan perawatan diri 0 1 2 3 4

Makan/minum
Mandi

Toileting
Berpakaian

Mobilitas di tempat tidur

Berpindah
Ambulasi/ROM
0: mandiri, 1: alat Bantu, 2: dibantu orang lain, 3: dibantu orang lain dan alat, 4: tergantung total
Oksigenasi:

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5. Pola tidur dan istirahat

(lama tidur, gangguan tidur, perawasan saat bangun tidur)

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6. Pola persepsual
(penglihatan, pendengaran, pengecap, sensasi):

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7. Pola persepsi diri

(pandangan klien tentang sakitnya, kecemasan, konsep diri)

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 8. Pola seksualitas dan reproduksi

(fertilitas, libido, menstuasi, kontrasepsi, dll.)

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9. Pola peran hubungan

(komunikasi, hubungan dengan orang lain, kemampuan keuangan):

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10. Pola managemen koping-stess

(perubahan terbesar dalam hidup pada akhir-akhir ini):

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11. Sistem nilai dan keyakinan

(pandangan klien tentang agama, kegiatan keagamaan, dll)

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IV. Pemeriksaan fisik

(cephalocaudal) yang meliputi : Inspeksi, Palpasi, Perkusi dan Auskultasi
keluhan yang dirasakan saat ini

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TD: mm/H P: x/m N: x/m S: o

C

BB/TB…………………………………………
 Kepala:

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Mata dan Telinga (Penglihatan dan pendengaran)

a. Penglihatan

 Berkurang  Ganda  Kabur  Buta/ gelap

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 Visus: dioptri
 Sklera ikterik : (ya/tidak)

 Konjungtiva : (anemis/ tidak anemis)

 Nyeri : (ya/tidak), intensitas :

 Kornea : jernih/keruh/berbintik
 Alat bantu : tidak ada/lensa kontak/kaca mata

b. Pendengaran
 Normal  Berdengung  Berkurang  Alat bantu  Tuli

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Keluhan lain:

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Hidung:
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a. Dada :
Mulut/Gigi/Lidah:
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Leher :
b. Batuk : ya/tidak; produktif/tidak produktif
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Karakteristik Sputum................................................................................................................................
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c. Napas bunyi : vesikuler/lainnya, jelaskan
Respiratori
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 Sesak napas saat :
 Ekspirasi  Inspirasi  Istirahat  Aktivitas
 .......

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Tipe pernapasan :

 Perut  Dada  Biot

 Kussmaul  Cynestokes  Lainnya

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Frekuensi nafas : x/mnt

Penggunaan otot-otot asesori: (ya/tidak), Napas Cuping Hidung: .....................................

Fremitus:....................................................................................................................................................

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Sianosis : (ya/ tidak)

 Keluhan Lain:

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Kardiovaskular
Riwayat Hipertensi: .............................................................. Masalah jantung……………..
Demam Rematik: ..................................................................

Bunyi Jantung: Frekuensi:................................................. Irama………………….

 Kualitas……………………………….. Murmur ………………………..

 Nyeri dada, Intensitas : Palpitasi

 Pusing  Cianosis
 Capillary refill :

 Riwayat Keluhan lainnya

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 Edema, lokasi : grade :

 Hematoma, lokasi :

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Neurologis
Rasa ingin pingsan/ pusing: ......................................................................................................................

Sakit Kepla: Lokasi nyeri ...................................................................... Frekuensi...................................

 GCS : Eye = Verbal = Motorik =

 Pupil : isokor/unisokor
 Reflek cahaya :

 Sinistra : +/- cepat/lambat

 Dextra : +/- cepat/lambat

 Bicara :
 Komunikatif  Aphasia  Pelo 

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 Keluhan lain :

 Kesemutan  Bingung  Tremor  Gelisah  Kejang

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 Koordinasi ekastemitas

 Normal  Paralisis, Lokasi :  Plegia, Lokasi :

  Keluhan lain:
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Integumen

 Warna kulit

 Kemerahan  Pucat  Sianosis  Jaundice  Normal

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 Kelembaban :

 Lembab  Kering

 Turgor : elastis / tidak elastic

 > 2 detik  <2

detik Keluhan lain :

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Abdomen
Nyeri Tekan: .......................................................................................................................................................

Lunak/keras: .......................................................................................................................................................

Massa:……………………………..ukuran/ Lingkar Perut:................................................................................

Bising usus: .........................................................................................................................................................
Asites : ..................................................................................................................................................................

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Keluhan lain:.......................................................................................................................................................

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 Muskuloskeletal

 Nyeri otot/tulang, lokasi : intensitas :

 Kaku sendi, lokasi :

 Bengkak sendi, lokasi :

 Fraktur (terbuka/tertutup), lokasi :

 Alat bantu, jelaskan :

 Pergerakan terbatas, jelaskan :

 Keluhan lain, jelaskan :

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Seksualitas

Aktif melakukan hubungan seksual: ................................................................................................................

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Penggunaan alat kontrasepsi: ............................................................................................................................
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Masalah/kesulitan seksual: ..................................................................................................................................

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Perubahan terakhir dalam frekuensi:...............................................................................................................
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Wanita:

Usia Menarche :…………… lamanya siklus:……………..durasi:………………..

Periode menstruasi terakhir:……………………..Menopouse:……………………

Melakukan pemeriksaan payudara sendiri:...................................................................................................

PAP smear terakhir:................................................................................................................................................

Pria
Rabas penis :……………………….Gangguan prostat:……………………………

Sirkumsisi :…………………………Vasektomi:…………………………………..

Impoten :…………………………….Ejakulasi dini:………………………………

V. Program terapi:

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Hasil Pemeriksaan Penunjang dan Laboratorium

(dimulai saat anda mengambil sebagai kasus kelolaan, cantumkan tanggal pemeriksaan,
dan kesimpulan hasilnya)
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Samarinda,............2019
Perawat

(....................................)
VI. Analisa Data

No Data Penunjang Kemungkinan Penyebab Masalah

1. Data Subjektif :
dst

Data Objektif :

VII. Diagnosa Keperawatan

1. …………………………………………………………………………………………………………………………………………………………

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2. …………………………………………………………………………………………………………………………………………………………

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4. …………………………………………………………………………………………………………………………………………………………

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 RENCANA KEPERAWATAN

DIAGNOSA KEPERAWATAN
NO TUJUAN (NOC)/ (SLKI) INTERVENSI (NIC)/ (SIKI)
/MASALAH KOLABORASI

Dst

Panduan Penyusunan Laporan & Penilaian Kinerja 16

 Catatan Perkembangan

Nama Klien : Umur :

No RM : Ruang :

Hari/Tgl No. Dx Implementasi Evaluasi Paraf

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Panduan Penyusunan Laporan & Penilaian 17

Kinerja
 PENILAIAN PROSES PRAKTIK KLINIK/ PERILAKU PROFESIONAL
KEPERAWATAN MEDIKAL BEDAH TAHAP PROFESI

Nama Mahasiswa/ NIM :……………………../……………………………

Ruangan :…………………………………………………...

Nilai
Komponen Penilaian
1 2 3 4 5

A. Proses Keperawatan (20%), mahasiswa mampu:

1. Melakukan pengkajian keperawatan secara Bio Psiko Sosio
Kultural Spiritual

2. Melakukan pengkajian secara akurat

3. Mengembangkan diagnose keperawatan dengan tepat dan

benar
(PES sesuai dengan data penunjang)
4. Mengidentifikasi masalah keperawatan yang aktual dan resiko
5. Menerapkan prioritas keperawatan

6. Menetapkan tujuan yang realistis

7. Mengidentifikasi tindakan keperawatan mandiri dan kolaborasi
8. Melakukan evaluasi SOAP setiap hari
9. Memodifikasi recana sesuai evaluasi

10. Mendokumentasikan rencana keperawatan dengan benar

B. Komunikasi (15%), Mahasiswa mampu:
1. Menciptakan interaksi dengan klien dan keluarga dengan
percaya
diri
2. Menggunakan komunikasi nonverbal dan verbal yang efektif
dalam merespon klien dan keluarga

3. Melakukan komunikasi yang efektif dengan tim kesehatan lain

4. Menuliskan laporan dengan padat, tepat, ringkas dan akurat

C. Perilaku Profesional (15%), mahasiswa mampu

1. Menampilkan sikap baik dan sopan
2. Mempertahankan privasi dan kerahasiaan klien

Panduan Penyusunan Laporan & Penilaian 1

Kinerja 8
3. Mengambil inisiatif dalam situasi belajar
4. Memperlihatkan sikap selalu tepat waktu
5. Bekerjasama dengan berpartisipasi dalam kegiatan ruangan
6. Memakai seragam sesuai dengan ketentuan

7. Mampu mengidentifikasi kekuatan dan kelemahan diri

8. Menerapkan teori dan konsep keperawatan dalam memberikan
asuhan keperawatan

D. Keterampilan dasar (20%), mahasiswa mampu:

1. Melakukan pengkajian (anamnesis dan pemeriksaan fisik)
2. Melakukan tindakan yang sudah direncanakan sesuai dengan
prosedur

3. Melakukan tindakan pencegahan terhadap infeksi

4. Menciptakan keamanan dan kenyamanan

5. Menggunakan alat secara tepat guna

6. Mengkaji dan memenuhi (jika diperlukan) kebutuhan dasar

klien
7. Membantu klien dalam proses duka cita dan berkabung

8. Memberikan pendidikan Kesehatan

E. Memenuhi objektif (15%), mahasiswa mampu: memberikan
asuhan keperawatan pada klien yang mengalami gangguan
sistem tertentu di ruang masing-masing sesuai dengan objektif

1. Menghubungkan tanda-tanda klinis dengan patofisiologi yang

terjadi

2. Menganalisis data-data penunjang sesuai dengan kasus

3. Menjelaskan rasional tindakan keperawatan
4. Menjelaskan tujuan kolaborasi
F. Analisa data dan pemecahan masalah selama diskusi, mahasiswa
mampu:

1. Memperlihatkan kesiapan diri untuk melakukan praktek klinik

dengan menyampaikan hasil bacaan materi kasus yang terkait

2. Menyampaikan ide yang bermanfaat

3. Mempresentasikan masalah secara sistematis

4. Merespon pertanyaan dari pembimbing dengan tepat
5. Merujuk pada referensi dalam menyampaikan ide
JUMLAH

Penilaian = jumlah total nilai yang diperoleh

2
Pengesahan Penilai:

Komentar mahasiswa :

Samarinda, 2021

Preceptor

(……………………………………………)
 FORMAT ANALISA KETERAMPILAN

PSIK ITKES WHS

ANALISIS KETERAMPILAN TINDAKAN KEPERAWATAN

HANA TRIAYU GASPAR NIM

PROGRAM STUDI ILMU KEPERAWATAN STIKES WHS
DI RSU Dr. Abdul Wahad Sjahranie Samarinda
 LAPORAN ANALISIS TINDAKAN KEPERAWATAN

(KEPERAWATAN MEDIKAL BEDAH)

Nama Mahasiswa : Hana Tanggal:

NIM : Tempat :
1. Tindakan keperawatan yang
dilakukan Memberikan nutrisi enteral
Nama Pasien : Nutrisi enteral merupakan terapi pemberian nutrien
Diagnosa Medis : melalui saluran cerna dengan menggunakan slang/kateter
Tanggal Tindakan : (feeding tube) (Andry H, 2006).

2. Diagnosa keperawatan Risiko ketidakseimbangan nutrisi kurang dari kebutuhan

tubuh b.d perubahan kemampuan mencerna nutrien
(penurunan kesadaran).
3. Tujuan tindakan
4. Prinsip-prinsip tindakan dan a. Jenis Formula dasar yang dapat diberikan melalui NGT
rasional :
b. Prinsip tindakan
5. Bahaya-bahaya yang mungkin a. Aspirasi (Penejelasan/ hasil analisis)
terjadi akibat tindakan tersebut b. Mual muntah
dan cara pencegahan c. Kelebihan cairan
d. Alergi
e. Iritasi, peradangan, infeksi, ulkus dan abses.

6. Hasil yang didapat dan makna Tidak terdapat residu saat dilakukan pengecekan, hal
ini terjadi akibat pasien telah dipuasakan untuk tes
diagnostik, bising usus (+), makanan masuk dengan
lancar tanpa
adanya aspirasi, mual muntah dan tidak ada respon
alergi.
7. Identifikasi tindakan keperawatan a. Auskultasi bising usus, catat adanya penurunan
lainnya yang dapat dilakukan atau suara yang hiperaktif
untuk mengatasi b. Dan lainnya
masalah/diagnosa tersebut.

8. Evaluasi diri tentang pelaksanaan Praktikan dapat memberikan nutrisi enteral dengan
tindakan tersebut memperhatikan prinsip – prinsip, serta mengobservasi
bahaya yang kemungkinan terjadi akibat pemberian nutrisi
enteral.

Point 6 & 7 disesuikan dengan Kondisi (diutamakan saat

luring) REFERENSI
Refleksi

Refleksi merupakan salah satu langkah sebagai upaya pengembangan kemampuan profesional
tenaga kesehatan. Refleksi ini dilakukan 1 kali per mahasiswa di minggu terakhir setiap stase.
Proses pembelajaran dengan jalan merefleksikan pengalaman tentang kasus yang pernah
ditangani dan dianggap menarik/menyentuh perasaan ko-ners yang sesuai dengan
kompetensi untuk mempelajari berbagai aspek yang terkait dalam penanganan pasien
misalnya aspek medis, legal, sosial, psikologi, budaya, ekonomi, etika, kebijakan pemerintah,
sistem kesehatan, perundangan dan lain sebagainya.

Pengalaman tersebut mendiskripsikan tentang situasi yang dialami dan orang-orang yang
terlibat dalam situasi tersebut. Ners muda melakukan eksplorasi perasaan terhadap kejadian
tersebut serta melakukan analisis untuk tujuan pembelajaran serta melakukan perencanaan
kedepan apabila kejadian dialami kembali.
Adapun langkah-langkah refleksi sebagai berikut:

1. Diskripsi kejadian
2. Perasaan saat menghadapi kasus tersebut

3. Evaluasi: Sisi Negatif dan positif dari kasus/kejadian

4. Analisis:

a. Mengapa kasus tersebut menarik?

b. Mengapa bisa terjadi?

c. Bagaimana hubungannya dengan kompetensi Ners?

d. Analisis dapat dilihat dari berbagai aspek seperti aspek etik, moral, budaya, sosial, ekonomi,
komunikasi, hukum, kebijakan dan lain-lain sesuai dengan kejadian yang dihadapi.
5. Kesimpulan dari kasus tersebut
6. Action Plan: Seandainya ke depan kasus tersebut terjadi lagi, rencana apa yang akan
dilakukan.
 PROGRAM PROFESI NERS STASE KEPERAWATAN
MEDIKAL BEDAH STIKES WIYATA HUSADA
SAMARINDA EVALUASI
KLINIK

Laporan
Pendahuluan
NAMA MAHASISWA :
TEMPAT PRAKTEK :
TANGGAL :

NO ASPE NILAI
K MAKS SKOR
1 Teori tentang penyakit
(definisi, patofisiologi, tanda
20
pemeriksaan
komplikasi)
2 Ketepatan rumusan 20
diagnosa keperawatan
3 Prioritas diagnosa 5
4 Ketepatan rumusan tujuan 10
5 Perencanaan tindaka
20
keperawatan
6 Rasionalisasi tindaka
10
keperawatan
7 Daftar Pustaka 5
8 Penampilan laporan 10
TOTAL

Keterangan :

Nilai :
A = > 81
B = 70 – 80
Penilai, C = 60 – 69,9

(…………………………………)
 PROGRAM PROFESI NERS STASE KEPERAWATAN
MEDIKAL BEDAH STIKES WIYATA HUSADA
SAMARINDA
EVALUASI KLINIK

Kasus kelolaan
NAMA MAHASISWA
: TEMPAT PRAKTEK
:
TANGGAL :

NO ASPE NILAI
K MAKS SKOR
1 Ketepatan pengumpulan 20
2 Kelengkapan data / 20
3 Identifikasi diagnosa
keperawatan/ masala 5
kolaborasi
4 Ketepatan rumusan 15
diagnosa keperawatan
5 Ketepatan rumusan tujuan 10
6 Ketepatan tindaka
15
keperawatan
7 Evaluasi 10
8 Penampilan laporan 5
TOTAL NILAI

Keterangan :

Nilai :
A = > 81
B = 70 – 80
Penilai, C = 60 – 69,9

(……………………………….)

Panduan Penyusunan Laporan & Penilaian 2

Kinerja 5
 Penilaian Direct Observasional of Preocedure Skill (DOPS

Nama Mahasiswa : ……………………………………………. NIM : …………………………………………….

Inisial Pasien : ……………………………………………. Dx Medis : …………………………………………….
Usia : ……………………………………………. Jenis Kelamin : …………………………………………….
Ketergantungan : ……………………………………………. Dx : …………………………………………….
Keperawatan
Tempat : ……………………………………………. Tanggal : …………………………………………….
Jenis : …………………………………………….
Keterampilan

No Komponen Bobot Nilai

1 Indikasi, kontraindikasi prosedur 10
2 Kemampuan anatomi dan fisiologi yang sesuai dengan 10
prosedur
3 Inform consent 5
4 Persiapan sebelum prosedur 10
5 Keterampilan prosedur 25
6 Universal precaution, teknik aseptik 10
7 Keterampilan komunikasi 10
8 Pencegahan dan manajemen komplikasi 10
9 Manajemen setelah prosedur 10
Total Nilai 100
Komentar: Evaluator

__
 Penilaian Case Test atau Student Oral Case Analysis (SOCA)

Nama Mahasiswa : ……………………………………………. NIM : …………………………………………….

Inisial Pasien : ……………………………………………. Dx Medis : …………………………………………….
Usia : ……………………………………………. Jenis Kelamin : …………………………………………….
Ketergantungan : ……………………………………………. Dx : …………………………………………….
Keperawatan
Tempat : ……………………………………………. Tanggal : …………………………………………….

No Aspek Penilaian Bobot Nilai

1 Review kasus secara umum: fokus penilaian 10
kemampuan mahasiswa dalam menyusun peta konsep
dan menjelaskan hubungan antara diagnosis dengan
kondisi lainnya seperti etiologi, faktor risiko dan faktor
predisposisi)
2 Keterlibatan ilmu-ilmu dasar: menggambarkan 20
keterkaitan ilmu-ilmu dasar dalam patofisiologi dan
pathogenesis terjadinya suatu penyakit/gangguan.
3 Patogenesis: menjelaskan mekanisme terjadinya suatu 20
penyakit dan perubahan berbagai struktur tubuh yang
ditunjukkan dengan berbagai pemeriksaan penunjang.
4 Patofisiologi: menjelaskan setiap mekanisme terjadinya 20
suatu penyakit yang ditandari dengan timbulnya
berbagai gejala dan tanda penyakit.
5 Manajemen atau penatalaksanaan: menjelaskan 10
berbagai jenis intervensi keperawatan berdasarkan pada
diagnosa keperawatan dan perencanaan keperawatan.
6 Komplikasi 5
7 Prognosis 5
8 Penampilan mahasiswa 10
Total Nilai 100
Komentar: Evaluator
 DAFTAR TOPIK DISKUSI

Ruangan:

NO Topik Diskusi Tanggal & paraf pembimbing

Ruangan:

NO Topik Diskusi Tanggal & paraf pembimbing

Ruangan:

NO Topik Diskusi Tanggal & paraf pembimbing

Ruangan:

NO Topik Diskusi Tanggal & paraf pembimbing

 ACTIVITY DAILY LIVING
MAHASISWA STASE KEPERAWATAN DASAR
PROFESI 2020/2021

Hari/tanggal :
Ruang :
No Waktu Kegiatan Ket

Paraf preceptor

(………………………………………)

Hari/tanggal :

Ruang :
No Waktu Kegiatan Ket

Paraf preceptor

(………………………………………)
 DAFTAR TARGET KETERAMPILAN KLINIK KMB

Nama mahasiswa :

NIM :

1. Mahasiswa mampu memperlihatkan keterampilan prosedur dasar di bagian keperawatan dewasa

No Prosedur Tanggal/tempat Paraf pembimbing target

1 Memberikan transfusi darah 5
2 Mempertahankan teknik aseptic pada setiap tindakan 5
3 Mengangkat jahitan luka operasi 3
4 Memberikan pendidikan kesehatan 5
5 Memberikan obat melalui SC, IM, IV 5
6 Melakukan pemasangan infuse 5
7 Melakukan skin test 5
8 Menghitung balans cairan 5
9 Memberikan kompres 5
10 Melatih ROM 5

2. Mahasiswa mampu memperlihatkan keterampilan melakukan prosedur pada klien dengan masalah pada sistem
pernapasan

No Prosedur Tanggal/tempat Paraf pembimbing target

1 Melakukan pengkajian fisik 5
2 Memberikan latihan napas dalam dan batuk efektif 5
3 Mengambil spesimen untuk pemeriksaan BTA 5
4 Melakukan fisoterapi dada (perkusi, vibrasi, postural 5

Panduan Penyusunan Laporan & Penilaian 3

Kinerja 0
 drainage)
5 Memberikan oksigen melalui nasal kanul 5
6 Memberikan oksigen melalui masker 5
7 Memberikan inhalasi 5
3. Mahasiswa mampu memperlihatkan keterampilan prosedur pada klien dengan masalah pada sistem gastrointestinal

No Prosedur Tanggal/tempat Paraf pembimbing target

1 Melakukan pengkajian fisik 5
2 Memberikan makan/ minum melalui oral 5
3 Memberi makan melalui NGT 5
4 Melakukan huknah 3
5 Melakukan perawatan kolostomi/ileostomy 3
6 Melakukan irigasi kolostomi/ ileostomy 3

4. Mahasiswa mampu memperlhatkan keterampilan prosedur pada klien dengan masalah pada sistem perkemihan

No Prosedur Tanggal/tempat Paraf pembimbing target

1 Melakukan pengkajian fisik 5
2 Melakukan kateterisasi urin pada wanita 3
3 Melakukan kateterisasi urin pada pria 3
4 Melakukan irigasi kateter 5
5 Melakukan pemasangan kateter kondom 3
6 Melakukan perawatan kateter 5

5. Mahasiswa mampu memperlihatkan keterampilan prosedur pada klien dengan masalah pada sistem persyarafan

No Prosedur Tanggal/tempat Paraf pembimbing target

1 Melakukan pengkajian fisik 5
2 Memberikan posisi side lying 3
3 Memberikan posisi dengan teknik log roll 4
4 Melakukan perhitungan GCS 5

6. Mahasiswa mampu memperlihatkan keterampilan prosedur pada klien dengan masalah pada sistem muskuloskeletal

No Prosedur Tanggal/tempat Paraf pembimbing target

1 Melakukan pemeriksaan fisik 5
2 Merawat klien yang menggunakan traksi 3
3 Merawat klien yang menggunakan gips 3
4 Melatih menggunakan crutch dan walker 3
5 Memindahlan klien dari tempat tidur ke kursi dan 4
sebaliknya
6 Menggunakan kursi roda 5
7 Mengganti balutan 5
8 Mencegah deformitas pada klien dengan imobilisasi 5
9 Merawat luka Bakar 3
 Lembar Bukti Pengumpulan Tugas

Nama Mahasiswa :

NIM :

Hari/ Tanggal Topik Asuhan Keperawatan Tanda Tangan Tanda Tangan Keterangan
CI PA