Form Pengkajian Stase KDP
Form Pengkajian Stase KDP
Nama Mahasiswa :
NIM :
Kelompok :
Tanggal Praktik/Minggu ke :
Tempat Praktik :
Identitas Pasien
Nama :
Umur :
Jenis Kelamin :
Alamat :
Pendidikan Terakhir :
Suku :
Agama :
Status Perkawinan :
Pekerjaan :
No. Rekam Medik :
Diagnosis :
Keadaan Umum : ..........................................................................................................
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Keluhan Utama : .........................................................................................................
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Minuman Minuman
Muntah Muntah
Keluhan/ masalah yang memengaruhi Keluhan/ masalah yang memengaruhi
asupan nutrisi : asupan nutrisi
3. Pola Eliminasi
Tanggal defekasi terakhir : ................................................................................................
Frekuensi defekasi : ...........................................................................................................
Konsistensi : ......................................................................................................................
Warna : ..............................................................................................................................
Masalah defekasi : .............................................................................................................
Penggunaan alat bantu (laksatif/ pispot) : .........................................................................
Bising usus : ......................................................................................................................
Struktur abdomen :
I : ..................................................................................................................................
A : ................................................................................................................................
P : .................................................................................................................................
P : .................................................................................................................................
Distensi : ............................................................................................................................
Nyeri tekan : ......................................................................................................................
Lain-lain : ..........................................................................................................................
............................................................................................................................................
Frekuensi berkemih : .........................................................................................................
Jumlah : .............................................................................................................................
Warna : ..............................................................................................................................
Penggunaan alat bantu berkemih : ....................................................................................
Keluhan /masalah berkemih : ............................................................................................
Sakit pinggang : .................................................................................................................
Palpasi ginjal : ...................................................................................................................
Perkusi ginjal : ...................................................................................................................
Kondisi blast : ....................................................................................................................
Lain-lain ……………………………………………………………………………….....
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Diagnosis Keperawatan :
Tanggal Paraf
No. Masalah Keperawatan
Ditemukan Teratasi (Nama Perawat)
RENCANA KEPERAWATAN