You are on page 1of 2

DATA PENGKAJIAN KEPERAWATAN SISWA

MAN INSAN CENDIKIA HALMAHERA BARAT

Tanggal Masuk :

Ruang/Kelas :

Nomor Kamar :

IDENTITAS

Nama :

Umur :

Jenis Kelamin : (PRIA) (WANITA)

Berat Badan/Tinggi Badan :

Riawayat Alergi : (TIDAK) ( IYA)

Alergi Obat :
……………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………
Alergi Makanan :
……………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………

TD : NADI :

RR : SB :

Keluhan Utama :
……………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………

Riwayat Penyakit Dahulu


……………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………………………………

Terapi Pemberian Obat/Cairan

Oral : 1)
…………………………………………………………………………………………………………………………………………………………………………2)
…………………………………………………………………………………………………………………………………………………………………………3)
…………………………………………………………………………………………………………………………………………………………………………4)
…………………………………………………………………………………………………………………………………………………………………………
Injeksi (IV) (IM) (IC) (SC) 1)
…………………………………………………………………………………………………………………………………………………………………………2)
…………………………………………………………………………………………………………………………………………………………………………3)
…………………………………………………………………………………………………………………………………………………………………………4)
…………………………………………………………………………………………………………………………………………………………………………

You might also like