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  • Form Nic Noc

    Diunggah oleh

    Shella Syarief
    11 tayangan9 halaman

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    11 tayangan9 halaman

    Form Nic Noc

    Diunggah oleh

    Shella Syarief

    Hak Cipta:

    © All Rights Reserved
    Unduh sebagai DOC, PDF, TXT atau baca online dari Scribd
    Tandai sebagai konten tidak pantas
    dari 9

    ANALISA DATA

    Nama Pasien : ........................................................


    Diagnosa : ........................................................

    MASALAH
    NO DATA ETIOLOGI
    KEPERAWATAN

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    DAFTAR DIAGNOSA KEPERAWATAN

    Nama Pasien : ........................................................


    Diagnosa : ........................................................

    No. Dx TANGGAL DIAGNOSA KEPERAWATAN TANGGAL TANDA


    MUNCUL TERATASI TANGAN

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    RENCANA ASUHAN KEPERAWATAN

    Diagnosa Keperawatan: …………………………………………………………………………….............


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    Tujuan: …………………..…………………………………………………………………………….............
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    Kriteria Hasil :
    NOC
    No. Indikator 1 2 3 4 5

    Keterangan Penilaian :
    1 :
    1 :
    2 :
    3 :
    4 :

    NIC :
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    IMPLEMENTASI

    Nama Pasien : ........................................................


    Diagnosa : ........................................................

    TTD &
    No. Dx.
    Tgl Jam Tindakan Keperawatan Respon Klien Nama
    Kep
    Terang

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    CATATAN PERKEMBANGAN (PROGRESS NOTE)

    Diagnosa Keperawatan:
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    …………NOC :
    Tanggal Observasi dan Hasil
    No Indikator
    1 2 3 4 S 1 2 3 4 S 1 2 3 4 S

    Keterangan Penilaian :
    - : tidak sesuai
    + : sesuai yang diharapkan
    S : scoring

    Keterangan Skoring :
    1 :-
    2 : 1+
    3 : 2+
    4 : 3+
    5 : 4+
    EVALUASI
    Hari/
    No Dx Tanda
    Tanggal/ Evaluasi
    tangan
    Jam

    S: ...........................................................................................
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    O:
    NOC:
    Score
    Indikator
    Awl Tgt Akr

    A: Masalah sesuai dengan NOC sudah / belum teratasi


    P: Intervensi dihentikan / dilanjutkan dan didelegasikan
    kepada perawat dinas ……… :
    1. NIC : ……………………………………………………….
    2. NIC : ……………………………………………………….
    *Coret yang tidak perlu
    RESUME KEPERAWATAN
    NAMA KLIEN : ......................................... TANGGAL : .........................................
    DX. MEDIS : ......................................... RUANG : .........................................

    S O A P I E

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