LAPORAN RESUME

Nama Mahasiswa :
NIM :
Kelompok :

I. IDENTITAS DATA
Nama :..............................................................................................
Umur :..............................................................................................
Nama Ayah/lbu :..............................................................................................
Pekerjaan Ayah/Ibu :..............................................................................................
Pendidikan Ayah/Ibu :..............................................................................................
Alamat / No. Telpon :..............................................................................................
Suku :..............................................................................................
Agama :..............................................................................................
Ruangan :..............................................................................................
Diagnosa Medis :..............................................................................................

II. ALASAN MASUK

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III. RIWAYAT PENYAKIT

a. Keluhan Utama
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b. Riwayat Penyakit Sekarang
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 c. Riwayat Penyakit Dahulu
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d. Riwayat Penyakit Keluarga

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IV. DATA FOKUS

Inspeksi :

Palpasi :

Perkusi :

Auskultasi:

V. DATA TAMBAHAN
BB =…………………………………………………………………………………
TB =…………………………………………………………………………………
LK =…………………………………………………………………………………
LLA =…………………………………………………………………………………
VI. DATA PENUNJANG
NCHS
a. BB/U
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b. TB/U
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c. BB/TB
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VII. ANALISA DATA
 DATA ETIOLOGI MASALAH
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VIII. RENCANA ASKEP

1. Diagnosa Keperawatan :………………………………………………............
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2. Tujuan : ……………………………………………………………..
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3. Kriteria Hasil : ……………………………………………………………..
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4. Intervensi : ……………………………………………………………..
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5. Implementasi : ……………………………………………………………..
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6. Evaluasi
S :…………………………………………………………………………………
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O :…………………………………………………………………………………
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