PEMERINTAH PROVINSI NUSA TENGGARA BARAT

DINAS KESEHATAN
AKADEMI PERAWAT KESEHATAN
Jl. Soekarno Hatta Telpon.(0376) 22722 Fax. 22722
SAKRA – LOMBOK TIMUR
Kode Pos : 83671

FORMAT RESUME KEPERAWATAN JIWA

1. Identikas Klien
Nama :………………………………………………………………………………………….
Jenis Kelamin :…………………………………………………………………………………………
Tempat, Tanggal Lahir :………………………………………………………………………………………….
Suku :…………………………………………………………………………………………
Bangsa : …………………………………………………………………………………………
alamat :…………………………………………………………………………………………
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2. Keluhan Utama :
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3. Riwayat Penyakit Sekarang :

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4. Factor Predisposisi dan presipitasi

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5. Data tambahan
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6. Analisa data:

No Data focus Masalah

7. Diagnosa Keperawatan
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 Rencana Keperawatan (1 diagnosa Keperawatan)
No Diagnosa Tujuan Intervensi
Keperawatan

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 Tindakan Keperawatan Catatan Keperawatan
Tgl/Hr/Waktu Catatan Perkembangan Evaluasi
Data Subyektif :
- ........................................................... S:
- ...........................................................
- ...........................................................
O:
Data Obyektif :
- ........................................................... A:
- ...........................................................
- ...........................................................
P:
Kemampuan:

Dianosa Keperawatan :

Tindakan Keperawatan :

Rencana tindak Lanjut:

Mataram, Desember 2018

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