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RESUME

Tanggal : ……………………………
Ruang : ……………………………

A. Identitas Pasien
Nama : ………………………. No. RM : …………………….
Umur : ………………………. Tgl MRS : …………………….
Jenis Kelamin : ………………………. Dx Medis : …………………….
Alamat : ……………………….

B. Data Fokus
1. Pre Hemodialisa
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2. Intra Hemodialisa
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Intake Output Ket
Time QB UF TD N S R Nacl Dex Ma
Rate 40% /Mi

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3. Post Hemodialisa
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Intake Output Ket
Time QB UF TD N S R Nacl Dex Ma
Rate 40% /Mi

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C. Diagnosa Keperawatan
1. Pre Hemodialisa
Analisa Data
Data Subyektif Data Obyektif Interpretasi
2. Intra Hemodialisa
Analisa Data
Data Subyektif Data Obyektif Interpretasi

3. Post Hemodialisa
Analisa Data
Data Subyektif Data Obyektif Interpretasi

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