form laporan Gawat Darurat

LAPORAN INSTALASI GAWAT DARURAT

Nama Mahasiswa :
NIM :
RUANGAN :

A. IDENTITAS KLIEN

Nama :
Umur :
Alamat :
Diagnosis Medis :
Tanggal Pengkajian :

B. PRIMARY SURVEY

1. Airway :






2. Breathing :







3. Circulation :








4. Disability :










C. SECONDARY SURVEY
1. Riwayat keadaan sekarang





2. Riwayat penyakit dahulu





3. Riwayat keluarga






4. Pemeriksaan Fisik
a. Kepala :



b. Leher :



c. Dada :



d. Abdomen :



e. Ekstrimitas atas :



f. Ekstrimitas bawah :



g. Genitalia :



h. Data Penunjang lainnya :








D. ANALISA DATA

No
Data
Masalah
Penyebab












E. RENCANA ASUHAN KEPERAWATAN
1. Tujuan :
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2. Kriteria Evaluasi:
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3. Implementasi:
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4. Evaluasi
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Pembimbing praktek

(………………………………)
NIP :
Sampit, …………………………….
Mahasiswa

(…………………………….)
NIM :