format askep stroke fix

7/24/2019 Format Askep Stroke Fix

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ASUHAN KEPERAWATAN PADA PASIEN Mc

DENGAN DIAGNOSA STROKE HEMORAGI

DI RUANG NAGASARI RSUP SANGLAH DENPASAR

TANGGAL 1 FEBRUARI s.d 3 FEBRUARI 2016

N! M"s#s$ % N# Kd&' A(#)s*+*#

T&!,* P(*&' % R+- Ns(# RSUP S-/" D&-,s(

T-/ P&-'#- % 1 F&(+(# 2016

I. Identitas Diri Klien

N! % Mc

T-/ Ms+' RS %

T&!,*T-/ L"#( %

U!+( %

A! %

&-#s K&/!#- %

S**+s P&('$#-- %P&-d#d#'- %

S + ' + %

P&'&(- %

L! B&'&( %

A/!* %

D#-4s M&d#s %

S+!&( I-54(!s# %

KELUHAN UTAMA%

RIWAAT PENAKIT%


2/26

1. K&/+( *&(d&'* )- d,* d#"++-# 7 4(-*+8 $/#8 s+!#8 #s*(#8 d- /#-9/#-:

P&'&(- % P&-d#d#'- %

A/!* %

2. A/&(# %

T#,& %

R&'s# %

T#-d'- %

3. Ks- % !&(4'4' '4,# 4* /'4"4/ /#-9/#-

#' ) &/s'-

;. P4/ P&(-,s-

K&s+/#*- &(-5s % d*#d'

K&s+/#*- d#(s'- % !&-(#'!&-&/+('- -5s

K&/+"- )- d#(s'-%

#'

= > s&d-8 /s- % !+/!+-*"s(#$-d//

= > '+(-8 /s- % !+/!+-*"s(#$-d//

P&(+"- BB 3 +/- *&('"#( %

= > &(*!" '

= > *&*,

= > &('+(- '

6. P4/ &/#!#-s#

. B+- #( &s( %

F(&'+&-s# % W'*+ %,#s#-s4(&!/!

W(- % K4-s#s*&-s# %


3/26

P&-+-- P&-c"( %

. B+- #( '&c#/ %

F(&'+&-s# % W(- %

B+ %

?. P4/ *#d+( d- #s*#("* %

W'*+ *#d+( 7!: %

L! *#d+("(# %

Ks- ,&--*( *#d+( %

Ks- s* *#d+( %

K&s+/#*- d/! "/ *#d+( % = > !&-&/- *#d+(

= > s&(#-!+d" *&(-+-

= > !&(s *#d' ,+s s&*&/" -+- *#d+(

@. P4/ &(' d- '*##*s

c. K*- d/! ,&'&(- %

d. O/" ( %

&. K*- d# $'*+ /+- %

5. K&s+/#*-'&/+"- d/! "/ #-# % = > ,&(&('- *++"=> &(s4/&'

= > !-d#8 &("* = > !+d" !&(s '&/&/"-

= > !&-&-'- ,'#- = > s&s' -5s s&*&/" !&-d'- '*##*s

. P4/ K&(

. &-#s ,&'&(- %

. +!/" ! '&( %

c. d$/ ! '&( %

d. L#-9/#- 7s&+*'- : %

II. Riwayat KekuargaG&-4(! %


4/26

III. Riwayat Lingkungan

1. K&&(s#"- L#-'+-- %

2. B") %

3. P4/+s# %

IV. Aspek Psikososial

1. P4/ ,#'#( d- ,&(s&,s#

. A/* -*+ )- d#+-'- %

= > 'c !* = > /* -*+ ,&-d&-(-

. K&s+/#*- )- d#/!# %

= > s&(#-,+s#-

= > !&-+(+--)s&-s#*#5#*s*&("d,,-sd#-#-

= > !&!c!&-+/#s2. P&(s&,s# d#(#

H/ )- d#,#'#('- s* #-# %

H(,- s&*&/" !&-/-# ,&($*- %

P&(+"- )- d#(s'- s&*&/" s'#* %

3. S+s- "*# %

;. H++--'4!+-#'s# %

. B#c(

= > &/s "s +*! %

= > (&/&- "s d&(" %

= > !!,+ !&-&'s,(&s#'-

= > !!,+ !&-&(*# 4(- /#-

. T&!,* *#-/

= > s&-d#(#

= > &(s! 4(- /#-8 )#*+

c. K&"#d+,- '&/+(

- Ad* #s*#d* )- d#-+* %

- P&!+*- '&,+*+s- d/! '&/+( %

- P4/ '4!+-#'s# %

-K&+-- % = > !&!d# = > '+(-

d. K&s+/#*- d/! '&/+(


5/26

= > "++-- d&-- 4(- *+

= > "++-- d&-- s-' '&/+(

= > "++-- d&-- s+!##s*(#

s&-d#(#

= >d#-*+ 4(- /#-C s&+*'-

. - d#s+'# *&-*- d#(# s&-d#(# %

c. - #-#- d#(+" d(# '&"#d+,- %

d. - d#/'+'- #' s&d- s*(&ss %

= > ,&!&c"- !s/" = > c(# ,&(*4/4--

= > !'- = > !'- 4*

= > *#d+(

= > /#-9/#- 7!#s/-) !("8 d#! d//: s&+*'-

?. S#s*&! -#/# '&,&(c)-

. S#, *+ , )- !&-d# s+!&( '&'+*- %

. A,'" T+"-8 A!8 K&,&(c)- ,&-*#- +-*+' -d %

= > ) = > *#d'

c. K*- A! *+ K&,&(c)- )- d#/'+'- 7!c! d- 5(&'+&-s#:

S&+*'- %

d. K*- A! *+ K&,&(c)- )- #-#- d#/'+'- s&/! d#

(+!" s'#*8


6/26

S&+*'-%

V. Pengkajian Fisik

A. #*/ S#-

T&'--d(" %

S+"+ %

Nd# %

P&(-5s- %

B. K&sd(- % GS %

E)& %

&(/ %

M4*4(#' %

. K&d- +!+! %

S'#* -)&(# % 1. (#-- 2. s&d- 3. &(*

S'/ -)&(# %

N)&(# d# d&(" %

S**+s ## % 1. &!+' 2. -4(!/ 3. '+(+s

BB % TB %

S#', % 1. *&-- 2. &/#s" 3. !&-"--)&(#

P&(s4-/ ")#&-& % 1. &(s#" 2. '4*4( 3. /#-9/#-.

O(#&-*s#$'*+ *&!,* 4(- % 1. #' 2. *&(-+

D. P&!&(#'s-F#s#' H&d T4 T4&

1. K&,/ B&-*+' % 1. !&s4c"&,/& 2. !#'(4c"&,/&

3. "#d(4c"&,/& ;. /#-9 /#-

L&s# /+' % 1. "&!*4! 2. ,&(d("- 3. /+' s4&'

;. /#-9/#-.

2. R!+*

W(- %

K&/#-- % (4-*4' d//.3. M*


7/26

P&-/#"*- % 1. -4(!/ 2. 'c !* /&-s 3. /#-9/#-.

S'/&( % 1. #'*&(#' 2. *#d'#'*&(#'

K4-+-*# % 1. -&!#s 2. *#d'-&!#s

P+,#/ % 1. #s4'4( 2.-#s4'4( 3. !#d(#s#s ;. '*('

K&/#-- % '&+*-'-''#(#.

D* *!"-.

;. H#d+-

P&-"#d+ % 1. -4(!/ 2. d-+-

S&'(&* d(" ,4/#, % .

T(#'-c,#-"#d+- % 1. ) 2. *#d'


8/26

;. *+' % ) *#d'


9/26

13. D* ,&!&(#'s- 5#s#' -&+(4/4#s

VI. Data Penunjang

a. Pemeriksaan Penunjang; Laboratorium dll.

b. Program !erapi


10/26

A. A"ALI#A DA!A

DA!A F$% A"ALI#I# 'A#ALA( 'A#ALA(

DS %

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12/26

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13/26

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14/26

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15/26

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16/26

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17/26

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). DIA*"$#A K+P+RA,A!A" DA" PRI$RI!A# 'A#ALA(

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18/26

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19/26

%. P+R+"%A"AA" K+P+RA,A!A"

"

$ DIA*"$#A

R+"%A"A K+P+RA,A!A"

!&-&A" I"!+RV+"#I RA#I$"AL

" DIA*"$#A R+"%A"A K+P+RA,A!A"


20/26

$ !&-&A" I"!+RV+"#I RA#I$"AL

"

$ DIA*"$#A

R+"%A"A K+P+RA,A!A"

!&-&A" I"!+RV+"#I RA#I$"AL


21/26

D. I'PL+'+"!A#I K+P+RA,A!A"

" !*L "$. I'PL+'+"!A#I R+#P$" PARAF


22/26

$ -A' D

"

$

!*L

-A'

"$.

DI'PL+'+"!A#I R+#P$" PARAF


23/26

"

$

!*L

-A'

"$.



24/26

"

$

!*L

-A'

"$.



25/26

+. +VAL&A#I K+P+RA,A!A"

"$!*L/-A

'%A!A!A" P+RK+')A"*A" PARAF

S %


26/26

O %

A %

P %

format askep stroke fix

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