SIX MINUTES WALKING TEST

Nama Pasien : Lumongga Michaela

Tanggal Lahir : 07 Juni 2008
No. RM : 21056544
Diagnosis Kerja : Post Mitral Valve Replacement with Bioprosthetic Valve et causa Severe
Mitral Regurgitation et causa Penyakit Jantung Rematik, Moderate
Tricuspid Regurgitation, Enuresis Nokturnal, Overweight
Tanggal Pemeriksaan : ...................................................................................................................

Hemodinamik

Baseline : TD : ..............mmHg

HR : ..............kali/menit

RR : ..............kali/menit

SpO2 : ..............%

Post-test : TD : ..............mmHg

HR : ..............kali/menit

RR : ..............kali/men

SpO2 : ..............%

Keluhan : ...................................................................................................................

...................................................................................................................

Jarak Tempuh : ............................................meter, ............................................... METs

Anjuran Latihan : Tipe : ..................................................................................

Intensitas/Waktu : ..................................................................................

Frekuensi : ..................................................................................