FORMAT PENGKAJIAN
Keluhan:
- Mual
- Muntah(..x/hari,...cc)
- Sariawan
- Masalah mengunyah
- Kesulitan menelan
- ................................
3. Pola Eliminasi
a. Eliminasi Urine
Keterangan Sebelum Sakit Saat Sakit
Frekuensi
Jumlah
Warna
Bau.
b. Eliminasi Alvi
Keterangan Sebelum Sakit Saat Sakit
Frekuensi
Konsistensi
Warna
Bau
2. Kepala
Rambut : ……………………………………………………………………………….....
Wajah : ……………………………………………………………………………….....
Mata : ……………………………………………………………………………….....
Hidung : ……………………………………………………………………………….....
Mulut : ……………………………………………………………………………….....
Gigi : ……………………………………………………………………………….....
Telinga : ……………………………………………………………………………….....
3. Leher
I.............................................................................................................................................
P...........................................................................................................................................
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…………………………………………………………………………………….
P……………………………………………………………………………………………………..
9. Anus – Genetalia
……………………………………………………………………………………………………..
……………………………………………………………………………………………………..
………………,…………20........
Mahasiswa
(
) NIM…………………………