KEPERAWATAN MEDIKAL BEDAH

PROGRAM STUDI SARJANA KEPERAWATAN DAN PROFESI

NERS FAKULTAS KEDOKTERAN UNIVERSITAS UDAYANA

LAPORAN ASUHAN KEPERAWATAN PERIOPERATIVE

NAMA MAHASISWA : ………………………….....................................

NIM : ………………………….....................................
TANGGAL PRAKTIK : ………………………….....................................
ASUHAN KEPERAWATAN
A. Asuhan Keperawatan Preoperatif
1. Identitas
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Agama : ………………………….....................................
Tanggal masuk : ………………………….....................................
Tanggal pengkajian : ………………………….....................................
Sumber informasi : ………………………….....................................

2. Pengkajian
A. Riwayat Kesehatan
Dx Medis : ………………………….....................................
Jenis operasi : ………………………….....................................
Jenis anastesi : ………………………….....................................
Keluhan utama :
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RPS:
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RPD:
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Pemeriksaan Laboratorium:
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Persiapan Operasi:
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Persiapan saat di ruang penerimaan:

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Analisa data:
Diagnosa
Data Tujuan Intervensi
Keperawatan
Implementasi dan Evaluasi :

Hari/tgl No dx Implementasi Evaluasi

B. Asuhan Keperawatan Intraoperatif
1. Pengkajian
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2. Persiapan Perawat
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3. Persiapan Pasien
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4. Prosedur Operasi
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Analisa data:
Diagnosa
Data Tujuan Intervensi
Keperawatan
Implementasi dan Evaluasi :
Hari/Tgl No. Dx Implementasi Evaluasi
C. ASUHAN KEPERAWATAN POST OPERATIF
1. Pengkajian
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Analisa Data :
Diagnosa
Data Tujuan Intervensi
Keperawatan
Implementasi Dan Evaluasi :
Hari/Tgl No.Dx Implementasi Evaluasi