RM 026

RUMAH SAKIT UMUM KASIH INSANI

JL.BESAR Jl. NAMORAMBE NO.10 – 15 Deli Tua Deli Serdang Tlp. 061-42675288/42071766

OBSERVASI RECOVERY ROOM (RR)

Nama Pasien: R N TD
240

39 220

TGL .Lahir: 32 200

28 180

No.MR: 24 160

20 180 140

Catatan lain: 16 160 120

12 140 100

8 120 80

6 100 60

80 40

60 20

40 0
ALDRERE SCORE
SCORE
RECOVERY ROOM (RR) PINDAH KERUANGAN
MOTORIK
Gerakan ke 4 ektremitas sesuai dengan perintah 2 :............................................... ..............................................
Gerakan ke 2 ektremitas sesuai dengan perintah 1 :............................................... ..............................................
Tidak bergerak 0 :............................................... .............................................
RESPIRASI
Nafas dalam dan reflek batuk 2 :.............................................. .............................................
Dispenu, hipoventilasi 1 :.............................................. .............................................
Apneu 0 :.............................................. .............................................
SIRKULASI
TD sistolik + 20% dari TD sistolik pre anestesi 2 :............................................. .............................................
TD sistolik 20% - 50% dari sistolik pre anestesi 1 :............................................. .............................................
TD sistolik 50% dari TD sistolik 0 :............................................. .............................................
KESADARAN
Sadar penih 2 :............................................. .............................................
Tidur tapi dapat di bangunkan 1 :............................................. .............................................
Tidak respon 0 :............................................. .............................................
EKSTREMITAS
Merah muda 2 :............................................. .............................................
Pucat 1 :............................................. ............................................
Sianosis 0 :............................................ ............................................

Jumlah
Waktu
jam jam
INTRUKSI DI RUANGAN :
□ ICU □ Ruangan ..................
-AWASI TD : NADI : PERNAPASAN TIAP 15 M3NIT

- Kesakitan di berikan :...........................................................................................................

- Mual muntah di berikan :...........................................................................................................

- Perogram catatan :...........................................................................................................

- Kusus :...........................................................................................................

Ahli Anestesi Perawat Anestesi Yang Menerima

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FORMULIR OBSERVASI RECOVERY ROOM (RR)