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

NIM : .............................................
STIKes Hafshawaty
Zainul Hasan Genggong Probolinggo

RESUME KEPERAWATAN
Pada Anak.........Dengan Kasus .....................
(Format Pengkajian Poli Anak)

I. IDENTITAS KLIEN
Nama : …………………..................... Alamat : ………………….....................
Umur : …………………..................... Tanggal Rawat Jalan : ………………….....................
Jenis Kelamin : …………………..................... Tanggal Pengkajian : ………………….....................
Suku / Bangsa : …………………..................... No. Rekam Medik : ………………….....................
Agama : …………………..................... Diagnosa Medis : ………………….....................
Pendidikan : ………………….....................

II. IDENTITAS KELUARGA KLIEN
Nama Ayah : …………………..................... Nama Ibu : ………………….....................
Pendidikan : …………………..................... Pendidikan : ………………….....................
Pekerjaan : …………………..................... Pekerjaan : ………………….....................
Alamat : …………………..................... Alamat : ………………….....................

III. KELUHAN UTAMA
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IV. KRONOLOGIS PENYAKIT SEKARANG
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V. PEMERIKSAAN FISIK YANG BERHUBUNGAN DENGAN KASUS
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VI. PEMERIKSAAN DIAGNOSTIK DAN PENATALAKSANAAN
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VII. ANALISA DATA
a. Data
Subyektif : ..........................................................................................................................................
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b. Data
Obyektif : ...........................................................................................................................................
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VIII. DIAGNOSA KEPERAWATAN
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4. Dst…

IX. INTERVENSI KEPERAWATAN/RENCANA TINDAKAN KEPERAWATAN

........................................................................................................................................................................... .................................................................................................................................................................................... ....................................................................................................... EVALUASI S : ...... Mahasiswa....... ............................. ....................................................................................................................... P : ...................................................................... .................................. X................. IMPLEMENTASI KEPERAWATAN ........................................................................................................ (..... O : ................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................) ......... Surabaya................... A : ................................................................................................ ........................................................................................................................................................ .............................. XI...............................................................................................................................................20.............................. ......................................................................................................................................