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PROGRAM STUDI NERS TAHAP PROFESI

STIKES CITRA DELIMA BANGKA BELITUNG

FORMAT PENGKAJIAN KEPERAWATAN (RESUME)

Nama Mahasiswa :.........................................................................................................


Stase :.........................................................................................................
Ruangan :.........................................................................................................
Tanggal Pengkajian :.........................................................................................................

DATA KLIEN

A. DATA UMUM
1. Nama inisial klien : .........................................................
2. Umur : .........................................................
3. Alamat : .........................................................
4. Agama : .........................................................
5. Tanggal masuk RS/RB : .........................................................
6. Nomor Rekam Medis : .........................................................
7. Dx Medis : .........................................................
8. Bangsal : .........................................................

B. PENGKAJIAN
ANALISA DATA
Symptom Etiology Problem

Masalah Keperawatan :

Diagnosa Keperawatan :
PROGRAM STUDI NERS TAHAP PROFESI
STIKES CITRA DELIMA BANGKA BELITUNG

Diagnosa
Tanggal/Jam Assessment NOC NIC Implementasi Evaluasi
Keperawatan
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