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    Analisa Data (1)

    Data Masalah Keperawatan Etiologi

    DS:

    DO:

    DS:

    DO:

    DS:

    DO:
    Analisa Data (2)
    Data Masalah Keperawatan Etiologi

    DS:

    DO:

    DS:

    DO:

    DS:

    DO:
    Daftar Prioritas Diagnosa Keperawatan

    Tanggal Tanda
    No. Diagnosa Keperawatan
    Muncul Tangan

    1. ................................................................................................
    ................................................................................................
    2. ................................................................................................
    ................................................................................................
    3. ................................................................................................
    ................................................................................................
    4. ................................................................................................
    ................................................................................................
    5. ................................................................................................
    ................................................................................................
    Rencana Asuhan Keperawatan (1)
    TGL NO. DX. TUJUAN INTERVENSI RASIONAL

    ......................................... 1............................................ 1............................................


    ........................................ ............................................. .............................................
    ........................................ 2............................................ 2............................................
    KH: .............................................. ..............................................
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    ........................................ 4............................................ 4............................................
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    ........................................ 5............................................ 5............................................
    ........................................ ............................................. .............................................

    ......................................... 1............................................ 1............................................


    ........................................ ............................................. .............................................
    ........................................ 2............................................ 2............................................
    KH: .............................................. ..............................................
    ......................................... 3............................................ 3............................................
    ........................................ ............................................. .............................................
    ........................................ 4............................................ 4............................................
    ........................................ ............................................. .............................................
    ........................................ 5............................................ 5............................................
    ........................................ ............................................. .............................................

    ......................................... 1............................................ 1............................................


    ........................................ ............................................. .............................................
    ........................................ 2............................................ 2............................................
    KH: .............................................. ..............................................
    ......................................... 3............................................ 3............................................
    ........................................ ............................................. .............................................
    ........................................ 4............................................ 4............................................
    ........................................ ............................................. .............................................
    ........................................ 5............................................ 5............................................
    ........................................ ............................................. .............................................

    ......................................... 1............................................ 1............................................


    ........................................ ............................................. .............................................
    ........................................ 2............................................ 2............................................
    KH: .............................................. ..............................................
    ......................................... 3............................................ 3............................................
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    ........................................ 4............................................ 4............................................
    ........................................ ............................................. .............................................
    ........................................ 5............................................ 5............................................
    ........................................ ............................................. .............................................
    Rencana Asuhan Keperawatan (2)
    TGL NO. DX. TUJUAN INTERVENSI RASIONAL

    ......................................... 1............................................ 1............................................


    ........................................ ............................................. .............................................
    ........................................ 2............................................ 2............................................
    KH: .............................................. ..............................................
    ......................................... 3............................................ 3............................................
    ........................................ ............................................. .............................................
    ........................................ 4............................................ 4............................................
    ........................................ ............................................. .............................................
    ........................................ 5............................................ 5............................................
    ........................................ ............................................. .............................................

    ......................................... 1............................................ 1............................................


    ........................................ ............................................. .............................................
    ........................................ 2............................................ 2............................................
    KH: .............................................. ..............................................
    ......................................... 3............................................ 3............................................
    ........................................ ............................................. .............................................
    ........................................ 4............................................ 4............................................
    ........................................ ............................................. .............................................
    ........................................ 5............................................ 5............................................
    ........................................ ............................................. .............................................

    ......................................... 1............................................ 1............................................


    ........................................ ............................................. .............................................
    ........................................ 2............................................ 2............................................
    KH: .............................................. ..............................................
    ......................................... 3............................................ 3............................................
    ........................................ ............................................. .............................................
    ........................................ 4............................................ 4............................................
    ........................................ ............................................. .............................................
    ........................................ 5............................................ 5............................................
    ........................................ ............................................. .............................................

    ......................................... 1............................................ 1............................................


    ........................................ ............................................. .............................................
    ........................................ 2............................................ 2............................................
    KH: .............................................. ..............................................
    ......................................... 3............................................ 3............................................
    ........................................ ............................................. .............................................
    ........................................ 4............................................ 4............................................
    ........................................ ............................................. .............................................
    ........................................ 5............................................ 5............................................
    ........................................ ............................................. .............................................
    Rencana Asuhan Keperawatan (3)
    TGL NO. DX. TUJUAN INTERVENSI RASIONAL

    ......................................... 1............................................ 1............................................


    ........................................ ............................................. .............................................
    ........................................ 2............................................ 2............................................
    KH: .............................................. ..............................................
    ......................................... 3............................................ 3............................................
    ........................................ ............................................. .............................................
    ........................................ 4............................................ 4............................................
    ........................................ ............................................. .............................................
    ........................................ 5............................................ 5............................................
    ........................................ ............................................. .............................................

    ......................................... 1............................................ 1............................................


    ........................................ ............................................. .............................................
    ........................................ 2............................................ 2............................................
    KH: .............................................. ..............................................
    ......................................... 3............................................ 3............................................
    ........................................ ............................................. .............................................
    ........................................ 4............................................ 4............................................
    ........................................ ............................................. .............................................
    ........................................ 5............................................ 5............................................
    ........................................ ............................................. .............................................

    ......................................... 1............................................ 1............................................


    ........................................ ............................................. .............................................
    ........................................ 2............................................ 2............................................
    KH: .............................................. ..............................................
    ......................................... 3............................................ 3............................................
    ........................................ ............................................. .............................................
    ........................................ 4............................................ 4............................................
    ........................................ ............................................. .............................................
    ........................................ 5............................................ 5............................................
    ........................................ ............................................. .............................................

    ......................................... 1............................................ 1............................................


    ........................................ ............................................. .............................................
    ........................................ 2............................................ 2............................................
    KH: .............................................. ..............................................
    ......................................... 3............................................ 3............................................
    ........................................ ............................................. .............................................
    ........................................ 4............................................ 4............................................
    ........................................ ............................................. .............................................
    ........................................ 5............................................ 5............................................
    ........................................ ............................................. .............................................
    Implementasi Keperawatan (1)
    NO.
    TGL IMPLEMENTASI WAKTU
    DX.

    1................................................................................................. ...........................
    2................................................................................................. ...........................
    3................................................................................................. ...........................
    4................................................................................................. ...........................
    5................................................................................................. ...........................

    1................................................................................................. ............................
    2................................................................................................. ............................
    3................................................................................................. ..............................
    4................................................................................................. ...............................
    5................................................................................................. ...............................

    1................................................................................................. ............................
    2................................................................................................. ............................
    3................................................................................................. ..............................
    4................................................................................................. ...............................
    5................................................................................................. ...............................

    1................................................................................................. ............................
    2................................................................................................. ............................
    3................................................................................................. ..............................
    4................................................................................................. ...............................
    5................................................................................................. ...............................

    1................................................................................................. ............................
    2................................................................................................. ............................
    3................................................................................................. ..............................
    4................................................................................................. ...............................
    5................................................................................................. ...............................
    Implementasi Keperawatan (2)
    NO.
    TGL IMPLEMENTASI WAKTU
    DX.

    1................................................................................................. ...........................
    2................................................................................................. ...........................
    3................................................................................................. ...........................
    4................................................................................................. ...........................
    5................................................................................................. ...........................

    1................................................................................................. ............................
    2................................................................................................. ............................
    3................................................................................................. ..............................
    4................................................................................................. ...............................
    5................................................................................................. ...............................

    1................................................................................................. ............................
    2................................................................................................. ............................
    3................................................................................................. ..............................
    4................................................................................................. ...............................
    5................................................................................................. ...............................

    1................................................................................................. ............................
    2................................................................................................. ............................
    3................................................................................................. ..............................
    4................................................................................................. ...............................
    5................................................................................................. ...............................

    1................................................................................................. ............................
    2................................................................................................. ............................
    3................................................................................................. ..............................
    4................................................................................................. ...............................
    5................................................................................................. ...............................
    Implementasi Keperawatan (3)
    NO.
    TGL IMPLEMENTASI WAKTU
    DX.

    1................................................................................................. ...........................
    2................................................................................................. ...........................
    3................................................................................................. ...........................
    4................................................................................................. ...........................
    5................................................................................................. ...........................

    1................................................................................................. ............................
    2................................................................................................. ............................
    3................................................................................................. ..............................
    4................................................................................................. ...............................
    5................................................................................................. ...............................

    1................................................................................................. ............................
    2................................................................................................. ............................
    3................................................................................................. ..............................
    4................................................................................................. ...............................
    5................................................................................................. ...............................

    1................................................................................................. ............................
    2................................................................................................. ............................
    3................................................................................................. ..............................
    4................................................................................................. ...............................
    5................................................................................................. ...............................

    1................................................................................................. ............................
    2................................................................................................. ............................
    3................................................................................................. ..............................
    4................................................................................................. ...............................
    5................................................................................................. ...............................
    Evaluasi 1 (SOAPIE)
    Nama :............... Usia :.................
    Kasus :.........................................................................................................

    Masalah
    Tanggal Jam Catatan Perkembangan TTD
    Keperawatan

    1.

    2.

    3.
    Evaluasi 2 (SOAPIE)
    Nama :............... Usia :.................
    Kasus :.........................................................................................................

    Masalah
    Tanggal Jam Catatan Perkembangan TTD
    Keperawatan

    4.

    5.

    6.
    Evaluasi 3 (SOAPIE)
    Nama :............... Usia :.................
    Kasus :.........................................................................................................

    Masalah
    Tanggal Jam Catatan Perkembangan TTD
    Keperawatan

    7.

    8.

    9.
    Evaluasi 4 (SOAPIE)
    Nama :............... Usia :.................
    Kasus :.........................................................................................................

    Masalah
    Tanggal Jam Catatan Perkembangan TTD
    Keperawatan

    10.

    11.

    12.

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