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KEMENTRIAN KESEHATAN RI

POLITEKNIK KESEHATAN KEMENKES MALANG


JURUSAN KEPERAWATAN
PROGRAM STUDI D-IV KEPERAWATAN LAWANG

FORMAT LAPORAN PENDAHULUAN

I. DEFINISI

II. PATOFISIOLOGI (POHON MASALAH)

III. ETIOLOGI
IV. GEJALA/ TANDA
V. MASALAH KEPERAWATAN

VI. PEMERIKSAAN PENUNJANG


Pemeriksaan Diagnostik Hasil
1. ………………………………………………… 1. …………………………………………………
2. ………………………………………………… 2. …………………………………………………
3. ………………………………………………… 3. …………………………………………………

VII. PENATALAKSANAAN
a. Penatalaksanan Medis
b. Penatalaksanaan Keperawatan :

VIII. ASUHAN KEPERAWATAN


a. Pengkajian Fokus (sesuai kasus)
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b. Diagnosa yang mungkin muncul
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c. Rencana Keperawatan
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Mahasiswa

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NIM:.....................................

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