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KONTROL INTENSIVE PASIEN TRANSPLANTASI GINJAL

Nama Pasien :
Hari / Tanggal :
Output Input
JAM TD Nadi RR T CVP
Muntah Urin BAB Encer Drain Infus Cairan Obat
07.00
08.00
09.00
10.00
11.00
12.00
13.00
14.00
15.00
16.00
17.00
18.00
19.00
20.00
21.00
22.00
23.00
00.00
01.00
02.00
03.00
04.00
05.00
06.00
07.00
TOTAL

INPUT :
OUTOUT :
BALANCE:
t
Oral
FOLLOW UP LABORATORIUM PASIEN TRANSPLANTASI

NAMA PASIEN :
No Jenis 1 2 3 4 5 6 7 8 9

A Darah :
Hb
Leukosit
Ht
Trombosit
Hitung Jenis
LED
PT
APTT
INR
Ureum
Kreatinin
Calcium
Natrium
Kalium
Clorida
SGOT
SGPT
Albumin
Globulin
Total Kholesterol
LDL-C
HDL-C
Trigliserida
B Tacrolimus
C AGD :

pH
pCO2
pO2
HCO3-
BE
SO2
Lactat
D Urinalisa
Warna
pH
BJ
protein
Glukosa
Leukosit
Eritrosit
Epitel
Bakteri
Silinder
Kristal
10

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