Ners
FIK UNIPDU
Jombang
Nama Mahasiswa : _______________________
NIM : _______________________
Ruangan : _______________________
PENGKAJIAN
I. BIODATA
Nama : _________________________________________________
Umur : _________________________________________________
Agama : _________________________________________________
Alamat : ________________________________________________
Pendidikan : ________________________________________________
Pekerjaan : ________________________________________________
Tanggal MRS : _______________________________________________
Diagnosa Medis : _______________________________________________
Nomor Register : _______________________________________________
Tanggal Pengkajian : ______________________________________________
2. Pola Eliminasi :
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3. Pola makan/minum :
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7. Pola Seksual :
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B. Tanda-tanda vital :
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D. Mata :
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E. Hidung :
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G. Mulut :
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H. Integumen :
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I. Thorak/dada :
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J. Abdomen :
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L. Muskuloskeletal :
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M. Neurologi :
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X. PEMERIKSAAN PENUNJANG :
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PERAWAT
( __________________________)
NIM :
Ditemukan Teratasi
DIAGNOSA
NO. SLKI SIKI
KEPERAWATAN