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    Ayu Wulandari
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    This clinical pathway document outlines the planned 4-day hospital treatment for a patient diagnosed with diabetes mellitus. It details the patient's name, age, weight, height and medical record number. The diagnosis, treatment plan, room type and costs are specified. Daily activities are documented including assessments, tests, medications, nutrition, mobility and outcomes. The goal is to control the patient's blood sugar levels before discharge with education on managing their condition.

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    This clinical pathway document outlines the planned 4-day hospital treatment for a patient diagnosed with diabetes mellitus. It details the patient's name, age, weight, height and medical record number. The diagnosis, treatment plan, room type and costs are specified. Daily activities are documented including assessments, tests, medications, nutrition, mobility and outcomes. The goal is to control the patient's blood sugar levels before discharge with education on managing their condition.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    17 views2 pages

    Clinical Pathway DM

    Uploaded by

    Ayu Wulandari
    This clinical pathway document outlines the planned 4-day hospital treatment for a patient diagnosed with diabetes mellitus. It details the patient's name, age, weight, height and medical record number. The diagnosis, treatment plan, room type and costs are specified. Daily activities are documented including assessments, tests, medications, nutrition, mobility and outcomes. The goal is to control the patient's blood sugar levels before discharge with education on managing their condition.

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    © All Rights Reserved
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    of 2

    CLINICAL PATHWAY

    RS SURYA ASIH PRINGSEWU


    DIABETES MELITUS
    2022
    Nama Pasien: Umur: Berat badan: Tinggi Badan: Nomor Rekam Medis:
    ........................... .....................tahun ...................K ...................Cm .................................
    g
    Diagnosis Awal:.................. Kode ICD 10: E11 Rencana Rawat Inap: 4 hari Biaya (Rp)
    Ruang Rawat:...................... Kelas: Tarif/hari(Rp) Tgl masuk Lama rawat
    ............ ..................... ................ ..........hari .............
    Aktivitas Hari Rawat 1 2 3 4

    Diagnosis Utama Diabetes mellitus ............ ............ ............ ............


    Penyerta .......................... ............ ............ ............ ............
    Komplikasi ......................... ............ ............ ............ ............
    .........................
    .........................
    .........................
    Asessmen Klinis Visite (+)(-) (+)(-) (+)(-) (+)(-) .........................
    Konsultasi:
    1. ........................
    2.............................. (+)(-) (+)(-) (+)(-) (+)(-) ....................
    3.............................. (+)(-) (+)(-) (+)(-) (+)(-) ....................
    4.......................... (+)(-) (+)(-) (+)(-) (+)(-) ....................
    5......................... (+)(-) (+)(-) (+)(-) (+)(-) ...................
    (+)(-) (+)(-) (+)(-) (+)(-) ....................
    Pemeriksaan Penunjang:
    Darah Lengkap
    (+)(-) (+)(-) (+)(-)
    LED
    (+)(-)
    (+)(-) (+)(-)
    (+)(-)
    (+)(-)
    (+)(-)

     GDA (+)(-)
     GDP (+)(-)
     2 jam pp (+)(-)

     Foto toraks PA (+)(-) (+)(-)


    Tindakan Oksigen...........l/m (+)(-) (+)(-) (+)(-) (+)(-)
    IVFD.............cc/hr (+)(-) (+)(-) (+)(-) (+)(-)
    Injeksi (+)(-) (+)(-) (+)(-) (+)(-)

    (+)(-) (+)(-) (+)(-) (+)(-)

    Obat lain-lain (+)(-) (+)(-) (+)(-) (+)(-)


    penunjang DM
    (+)(-) (+)(-) (+)(-) (+)(-)
    (+)(-) (+)(-) (+)(-) (+)(-)
    (+)(-) (+)(-) (+)(-) (+)(-)
    (+)(-) (+)(-) (+)(-) (+)(-)
    (+)(-) (+)(-) (+)(-) (+)(-)
    (+)(-) (+)(-) (+)(-) (+)(-)
    Nutrisi (jenis Diet)
    Mobilisasi (Bedrest, Duduk, Jalan)
    Hasil Gula darah mencapai (+)(-) (+)(-) (+)(-) (+)(-)
    berdasarkan target
    keluhan (+)(-) (+)(-) (+)(-) (+)(-)
    (Outcome) (+)(-) (+)(-) (+)(-) (+)(-)
    (+)(-) (+)(-) (+)(-) (+)(-)
    (+)(-) (+)(-) (+)(-) (+)(-)
    Pendidikan & rencana pemulangan Penjelasan perjalanan penyakit dan Kontrol poliklinik
    informed consent
    Varians (komplikasi lain yang mungkin
    memerlukan perawatan lebih lama)

    Jumlah Biaya
    Nama perawat : Diagnosis Kode ICD 10 Jenis Tindakan Kode ICD 9 CM
    Utama Diabetes mellitus E11
    ………………………………
    Nama DPJP : Penyerta
    ………………………………

    Nama PPDS :

    ………………………………
    Verifikator Keuangan: Komplikasi

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