LEMBAR MONITORING PASIEN

Nama Pasien = Jenis Ventilasi : 1. SP Kesadaran : 1. CM Gban EKG : 1. PVC

No RM = 2. ETT 2. Apatis 2. JR
Tgl Lahir = 3. Asisst 3. Somnolen 3. VT
Dx Medis = 4. SIMV 4. Sopor 4. ST
Tanggal = Stikes Muhammadiyah Klaten 5. CMV 5. Sopor coma 5. AV
Jenis Kelamin 6. CPAP 6. Coma 6. VF
7 8 9 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 1 2 3 4 5 6 7. SVES
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
8. VES
41 Co
280
VITAL

Simbol : 260
40o C 240 Besar Pupil :
Sistole = ^ 220 2
Diastole = v 3
39o C 200
Nadi = ●
Temp. = ▲ 180
38o C 160 4
140 5
37o C 120
100 6
36o C 80
60
7
40
20
10
0o C 0
G
BREATHIN

Jenis Ventilasi
PEEP/CPAP
Resp Rate
Tidal Volume
FiO2
Sensitivity
N
LATIO

SaO2
CIRCU

Gb EKG
CVP

Kesadaran
DISABILITY

Besar Pupil
Reaksi Pupil
Glasgow E
coma V
Scale M
Reflek Path +/-
1.
2.
3.
Kekuatan Otot
 7 8 9 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 1 2 3 4 5 6
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4

Makan/Minum
NGT
Infus : Sisa Sisa Sisa
INTAKE

1.
2.
3.
4.
5.
Jumlah
24 Jam
Total

Urine
NGT
OUT PUT

BAB
Drain/Darah :
1.
2.
Muntah
IWL Jumlah
24 Jam
Total

PaO2/PaCO2 Balance
pH/HCO3 -
Hb/Ht
Leucocyt
DATA LABORATORIUM

LED
Thrombocyt
Deff. Count
GD Puasa
GD 2 J PP
GD Sewaktu
Na/ K
Cl/Ca
Mg
Ureum/BUN
Creatinin
LDH
Cholesterol
Trigliserida
CKMB
Troponin
SGOT/SGPT
Albumin
Globulin