PELATIHAN HEMODIALISA

INSTALASI PELAYANAN DIALISIS

RSUP SANGLAH DENPASAR
TAHUN 2015

LAPORAN UJIAN PRAKTEK PELATIHAN HEMODIALISA

DI INSTALASI PELAYANAN DIALISIS
RS SANGLAH DENPASAR

Nama peserta Pelath. : ……………………………………………………………

Tanggal ujian : ..............................................................................................

A. PENGKAJIAN
1. Identitas pasien
Nama klien : .............................................................................................
No.RM :……………………………………………………………...
Umur/Jenis Kelamin : ..........................................Jenis Kelamin :……………...
Pendidikan :……………………………………………………………...
Pekerjaan :……………………………………………………………...
Dx. Medis :……………………………………………………………...
Mula inisiasi HD :………………………………………………………….......

2. Pengkajian keperawatan
2.1. Data Fokus
 Keluhan utama, keluhan saat dikaji
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 Keadaan umum pasien
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 PELATIHAN HEMODIALISA
INSTALASI PELAYANAN DIALISIS
RSUP SANGLAH DENPASAR
TAHUN 2015

 Tanda Vital : TD :........... HR :.......... RR :........... Temp. :............

2.2. Pemeriksaan fisik ( Data fokus Keperawatan HD)

 Sistem Kardiovaskuler
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 Sistem respirasi
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 Sistem neurologi
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 PELATIHAN HEMODIALISA
INSTALASI PELAYANAN DIALISIS
RSUP SANGLAH DENPASAR
TAHUN 2015

 Sistem gastro intestinal

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 Sistem urinaria
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 Sistem muskuloskeletal
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3. Data hemodialisis
 BB kering :.................................................................................
 BB pra HD :..................................................................................
 Tipe akses vaskuler :..................................................................................
 Frekuensi HD :..................................................................................
 Lama HD :...................................................................................
 Jenis cairan dialisat :..................................................................................
 Metode heparinisasi :..................................................................................
 Dosis Heparin :...................................................................................
 Jenis dializer :............................. Vol priming :...............................
 Nilai konduktivity :.............................. Temp. :.......................................
 PELATIHAN HEMODIALISA
INSTALASI PELAYANAN DIALISIS
RSUP SANGLAH DENPASAR
TAHUN 2015

 Lain-lain
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4. Data laboratorium
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 PELATIHAN HEMODIALISA
INSTALASI PELAYANAN DIALISIS
RSUP SANGLAH DENPASAR
TAHUN 2015

B. DX. KEPERAWATAN/MASALAH KOLABORASI

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3. ...................................................................................................................
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 PELATIHAN HEMODIALISA
INSTALASI PELAYANAN DIALISIS
RSUP SANGLAH DENPASAR
TAHUN 2015

Mengetahui,

Penguji, Peserta ujian,

(.......................................) (......................................)
 PELATIHAN HEMODIALISA
INSTALASI PELAYANAN DIALISIS
RSUP SANGLAH DENPASAR
TAHUN 2015

Resume asuhan keperawatan pada klien......................

Dengan.........................................pada tanggal ...........Oktober 2015
Di Instalasi Pelayanan Dialisis RS Sanglah Denpasar

Nama Peserta :..........................................

INSTALASI PELAYANAN DIALISIS

RSUP SANGLAH DENPASAR
2015