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LAMPIRAN 1 PEMANTAUAN TERAP! OBAT DATA PASIEN: Nama:_to. se. QP), Tol. Lair za sqyover aos Bi cm ‘Alamat: ree hei aon No. Telp: Tol. Masue RS: Gen nis) Ruang Rawat aie i ot — sn acon tt) KELUHAN UTAMA: on de etrevAan desi pnale_dendian Yelvhon_lemos ori Tetihab, bis bee 09 Yetoven ko] Bie don GAB | RIWAYAT PENYAKIT SEKARANG: iS 4 vk on CD behesis denon Wiferalkeni RIWAYAT PENYAKIT TERDAHULU: Gi ie RIWAYAT KELUARGA: RIWAYAT SOSIAL: RIWAYAT PENGGUNAAN ODAT = _ Nama Obat Dosis Frekuenst Rate Pemberian | Neto bicarhenal Tam Seems [7/24 Jom oral ‘Bcherret Tate 10 ws a4 Orel [Gtos Tae fee mt Zo tan ‘rel Force “Tate 400 wea B_ Jor bral Hoversfa_ fen ieelY ut BW ZE jan se Forosenid Tae om (24 \ere Oval Gadtiorton 7 tes 224 i ora a - HASIL PEMERIKSAAN FISIK: Pemeriksaan | Nilai Tal. Co) | Tgl. Cee) [Tgl. Geo) [Tgl. Ceo) | Tol. Ue normal _| +9/er /act2 | 02 far/2et2 |sbér roe (tal e/erhuslite| is hanlovt) Reramsen [tara0x (reall 32x Avot [14x fey | sex Avent | 4 X/nent | 314/renb Medi De (went [iWin merit | ger /nent | 126% fours | tx Auer 7. ne /B> mata [it Ait mens |b go minty | 192/95 mata |. Ze wal W/m oil 505 ari | aay % 6% Ges lantesmenss | Pats - 7 fued Ferd Burn : Suns wine [eae = = = HASIL PEMERIKSAAN LABORATORIUM: Pemeriksaan | Ni Tol. sor | Toles) | Tal-Cves) | Tal. (ie) | Tal Clea) Normal__|e9(or/yer |oter/on los lor new |we/e/a | wlrhon Catal Pr it : 5 2 < [Conteot Aver | 24-s0dets| 29,7 = = z z [ Henestain [isco sellin. 7A | vr oom WA 97a | 3 $a Levgesit —_ove-wew wnt | 24 tpomamt | 1tee wed Wie wat Hemabohei weer | 4h 45% wk | Trempost __|eere-Awomel aetcoome® [hws a? re ee Bosefl A% ° © z a = esiefil Pav ‘ 2 zi = > [Neto gt wateal —so8 22] 30 z = = HevtreRt comenl sp-jore [ah “| 7 = ee Lanfesit as=40% ee Tak E 2 Moness Vee 3% Ev Z = : Ve RACE el] bed or z = [Sue wine | awe | wae | ware = of parts | wn | = fos SIA tamly | anor wats ib awh] ed nol > Os that | Pret tenth] td mi] Soturen [rerrrd bil Ah WE . Heo ie ad masgye | Mem fat 1 -_] a 18 net er = Gos tie oof | 49 : = - = Chet dart, [00-eemet| U9 | =| went eeu en ne/A | 4 =| = = eae] Gene ais refa | aee of : = 23 -9/ | Hobewwee able | tt | ae | te ee] eee] nt om et meta | Ff “| sa | ap wars | ate | AD nm tetve Ouride ssi eat | OF 7 Taetyi] 96 wer | ot my = 108 tt Nese ag HASIL PEMERIKSAAN MIKROBIOLOGI: Eryibramgian, Caenocn, lvetixecin, flora, Clndanen, Conjanycin CRetibent) Chisramfentcol, unt atid CrensitF) Cotmmoxarote. Cinterneciet) DIAGNOSIS: Sere 4CED, tests dendan hterstibemi PENGGUNAAN OBAT SAAT INI: ‘A. Non Parenteral ‘Nama Obat Regimen ndikast__ epee fratcium bacrol | froma /p Sam asidesig vie mioguitel fae [ime aujon | Merrion |? | Golds bot so /B jem rent fv To fee dob Anes 6 ee | wncesaies || Bafort toe asm (3H jon | Kigewesi |e |e [enrdeacet tae ms Lasiten [aap etateut [se [Se ashe Bow etnies [Se | $e Sie seeP I {recksorten_jeto | [e tel sion ok eI Erhon dae 3s ‘Acwylerstene fee TT Begg fe 2pe9 /24 Jor = Ager ba 303 [tn | WPL aowe Varaagat Y taturan Fatah Ga (obeitins Ut See (2) Se: Oban Fekat Sere Cite) P saturn Paka; fea (oteo) A ten Ponet eenaoe) B. Parenteral PENGGUNAAN OBAT SAAT INI: r Nama Obat Regimen Tndikast ze Crstearel if | demo Zn dom [toe wots | == tT eT od Furosenid tng Top / on Jee | Hipesensi Wee et ele Zentt Zu4 Jem | Anbivost —|- |-l ele le le le bes in fer / Bien | porpabe Wetted ole Sieee [ro wen 7 | htatnse 1 Sloe [ee Le Lo Tiel} eet 7) om = [vey = Nib tes Jong {8 Jom Vheem 7d eS 0 Rseoe Trowenanat | tps 0s / Por | werspaoye | {~| | -| -| | jenticrece vo} 9 fer Kb eletete G Cetin ee aoe [eee ek | tl tlle Yi aS 2 fon Preaacees (sel ei— 1-1-1 1= PEMANTAUAN P.A.M A. Problem = lemes (Ga faa ban = Tewhel Seagal Stich = Tat nwam\ung defen berticora = Teeonan crow 41991 = RerncRagen Cad = Neat Cetab - Marsa Rerngtaten Parla Gula Dero Seentty = vrormatitos Rada hermatotens Cuevbotl, Limit) = Mivormavies Pack Fina Gel (Kekon arch, uve, Leran, Haksom hate Pde) ____DRP ‘Adaltidak | __ Keterangan—_ [Ado shero¥si_Obeh | Ade Sere + auatenn [ Ada dives Jepari febt_delerts mot Penbenan cbot dor \ndites [ray Pewitinan obet You Fedak betel Tide | Dosis fertoty $99. | ride [ Deres fertaty cerca Telok Pears: obot Yong [lat dwtinton rice. Na. Gcarbenal ate nentees cidegg petensVe ,Saasgy ager olbat clam Prgoveben Wigrtaimn fe on don ghd ois trot 3. poping . Deapaan dasam GeEdnhen Serarben ATLAKE Seok chan refnfeks (Out ed 194, hal. 24) Dens eral © lems fra 3 Gm Bite! 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Sengaver Lambs Lise vet.¥y steal 9) Bens 1-3 bee ; kde bali Seber 13 onePrazet Weak (ambund, uitss Auclenion cepite erfasvs Cige ve 44, Lal SOM ) Rus ime re 14 Foresemid Iricertens, edema Yang disetebean geu Persstit Janted POs vk Yong Ie Reropemem ny Arkib Atteall Prevmonia, infers Cat tenih, Pris for my -tem Ad bap Bane Te Inslin AP dra Setestar Anes deatoabes dete J 1Pecis eet umd /at Com ed ry telson) 1 Viena & Feasermton Ardara ben 055 Oring tm Cie ei Ng, el td) \O Gahan Brevtesthome deine sf Mlecnory liste Qe. sd kav toh vel C80 yet 9, trol. 464) “4b semmedibs con Setheensa (iso vetY9, te 78u) 20 AS. srntuanel, Tegal Weeatdabh, meeey WKVan Renchanten Gite Vel bal 29? Des lea bate Grune aye = send 2 eveflercein inf Aasbiobh chiam Progetaten smariky, tafever Pertal, Trecmone, Mlvgr beht Cie Wt 49 Valu) Dots me me stk bal Rha TA Oveetm Vevitwaen Keane vans diserdar fenvmn Seewal (fe ytig tat 20) Vests ap mem Ini ww WHTERASL_OFAT 0. Ma. Bicarherah 4 Alivfurins| —* Ne. vicorhenal menmuekan Kadler allsprire| dengan merguantoat Pryeraman fade Gl To Perwatian /meniter, de gumoian dengan Jee wath) 2 Jam b. cetedageel + Astlel A MENMDEHLAN fovnsisee lain derdon finteBe Farvatednome Tete Remontesan car moniter Yand kehak derhadef pader Fre tetrombin C. No-Bicarbenad 4 APU Weems ewemmgick inl Pasi atiay pentng taken Vader Saleitat reenngtay nce AOE sedan, kadlor Salis Mensron Qocla ders bene Ceatak meningtotian esters ainfe dacs asaen Soksiick arg tele bavbot) d- ASpIEIN ¢ ASoen felak(enition Joe ASPArin daPot menurunkan kaclar atom felel dendan menghambot aspid) Pergerapon dv 61-9 moor 1E Montens piece boral dan pilvgurine) diberi Sede Unk 3. Jam, Rell» Pemantavan Ane ie = Yacle Rerggucen No. = UML femetaian Submigal chbert Sele Uatly Asem dengan froggmaen ovat [ain = Persguncon cletidegrel don AEBIC , Periv tmoniforing ack hewabotrit , karen adasya resthe Rendlarean Feragunaan Ya. bccerbonak clan ASpiitt » Pere Remarkauen Pada FNsst inkl Fergpunaan ASPieh clan oben ctibert eda wetly pematsian Wawaan Pengealion derbadag deroRs ‘

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