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Follow Up

Tanggal S O A P
01/01/201 Pasien KU sedang, CM B. Diges B. Diges
9 Vital Sign: - Tumor colon - Pro laparotomy
mengeluh
(DPH 3) TD 120/70 mmHg ascendent K/P
nyeri perut HR 82x - Cholelitiasis Hemicolectomy
RR 16x - Nefrolitiasis (D)
T 36,7oC - Pro Preparasi
St Lokalis: Colon

St Lokalis:
R. Abdomen
I: Distended (-)
A: BU (+)
P : timpani
P : NT (+)
02/01/201 Pasien KU sedang, CM B. Diges B. Diges
9 Vital Sign: - Tumor colon - Pro laparotomy
mengeluh
(DPH 4) TD 120/70 mmHg ascendent K/P
nyeri perut HR 82x - Cholelitiasis Hemicolectomy
RR 16x - Nefrolitiasis (D)
T 36,7oC - Pro Preparasi
St Lokalis: Colon

St Lokalis:
R. Abdomen
I: Distended (-)
A: BU (+)
P : timpani
P : NT (+)

Tanggal S O A P
3/1/2019 - KU sakit sedang, B. Diges B. Diges
(DPH 4) CM  Tumor colon - Pro laparotomy
ascendent K/P
Vital Sign:  Cholelitiasis Hemicolectomy
TD110/70 mmHg  Nefrolitiasis (D)
HR 82x - Pro Preparasi
RR 20x Colon
T 36,7oC
B. Urologi - USG Urologi
St Lokalis:  Adenocarcin - Cek Asam Urat
R. Abdomen oma colon - BNO – IVP
I: Distended descendent
A: BU (+)  Cholelitiasis
P : timpani
P : NT (+)

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