B,-0 K-K

K -K*
* -
K5
*67K, B580K* ,0K ,,,
 -9*W %,K 

FORMAT
FORMAT ASESMEN NYERI
NYER I LANJUT
L ANJUTAN
AN

Bila intensitas nyeri ≥ 4 dilanjutkan dengan melakukan tatalaksana nyeri :

1. Lokasi dan penyebaran

penyebaran nyeri nyeri
: ....................................................................................................................
..........................................................................................................................
..............................

2. Kualitas dan atau penjalaran / penyebaran nyeri

: ....................................................................................................................
..........................................................................................................................
..............................

3. Waktu durasi dan !aktor pemi"u nyeri

  : ...................................................................................................................
..........................................................................................................................
...............................

4. #aktor yang memperberat dan yang yang meringankan

nyeri : ...............................................................................................................
..........................................................................................................................
...................................

$. %engaru& nyeri ter&adap ter&adap akti'itas

akti'itas se&ari(&ari
se&ari(&ari
: ....................................................................................................................
..........................................................................................................................
..............................

). *i+ayat
*i+ayat penanganan
penanganan nyeri sebelumnya
sebelumnya dan e!ekti'itasn
e!ekti'itasnya
ya :
 ..........................................................................................................................
..........................................................................................................................
........................

. 0ejala lain yang menyertai

: ....................................................................................................................
..........................................................................................................................
..............................

%ontianak..............................
...

%etugas yang mengkaji

;.............................................
.<

anda tangan = nama

 jelas