FORMAT PENGKAJIAN KEPERAWATAN GAWAT DARURAT DAN KRITIS

I. Identitas Mahasiswa
Nama :
NIM :
II. Identitas Klien
Nama :
Umur :
No MR :
Jenis Kelamin :
Tanggal :
BB :
Agama :
Status :
Pendidikan :
Pekerjaan :
Alamat rumah :
Diagnosa medis :

III. Keluhan utama

a. Saat MRS (Tgl..................Jam....................)
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b. Saat Pengkajian (Tgl……..Jam…………….)
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IV. Primary Survey
Air way :
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Breathing :
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Circulation :
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Fluid :
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V. Secondary Survey

1) Brain
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2) Breathing
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3) Blood
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4) Bladder
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5) Bowel
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6) bone
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VI. Pemeriksaan penunjang