Laporan Kasus

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Oleh:

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SEKOLAH TINGGI ILMU KESEHATAN BULELENG

PROGRAM STUDI PROFESI NERS
2023-2024
 Lembar Pengesahan

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Telah disahkan dan diterima oleh Clinical Instruktur (CI) dan Clinical Teacher (CT)
Praktek Profesi Ners sebagai syarat memperoleh nilai dari Keperawatan Medikal Bedah
Profesi Program Studi Profesi Ners STIKes BULELENG.

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Clinical Instructure (CI) Clinical Teacher (CT)
Ruang ............................. STIKes BULELENG,
RSUP PROF. DR. I. G. N. NGOERAH

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NIP. ...............................................................
NIK.
 Format Analisa Tindakan Keperawatan

Nama :........................................................................

NIM :........................................................................

Jenis Tindakan :........................................................................

1. Identitas pasien

Nama :..........................................................................................................

Umur :..........................................................................................................

Jenis Kelamin :..........................................................................................................

Pekerjaan :..........................................................................................................

Agama :..........................................................................................................

Tanggal masuk :.........................................................................................................

Alasan masuk :.........................................................................................................

Dx Medis :........................................................................................................

2. Tahap Persiapan

Persiapan pasien :.......................................................................................................

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Persiapan :.......................................................................................................
lingkungan .........................................................................................................
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Persiapan Alat :.......................................................................................................

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3. Tahap Pelaksanaan

No Pelaksanaan
4. Tahap Akhir

Terminasi :............................................................................................................
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Evaluasi :............................................................................................................
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Dokumentasi :............................................................................................................
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5. Analisa Materi Tindakan

Pengertian Tindakan :................................................................................................

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Tujuan Tindakan :................................................................................................

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6. Evaluasi Hasil Tindakan

Hasil Tindakan :..........................................................................................................

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7. Evaluasi Diri

Evalauasi Diri :..........................................................................................................

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Singaraja, ........................................2021

Mahasiswa,

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NIM.......................................

Menyetujui,

Clinical Instruktur (CI) Clinical Teacher (CT)

Ruang ............... STIKes Buleleng

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NIP....................................................... NIK...............................................