B.

ANALISA DATA
No

Tanggal

Data Fokus
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Penyebab/Interpretasi

Masalah

No

Tanggal

Data Fokus
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Penyebab/Interpretasi
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Masalah

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C. DIAGNOSA KEPERAWATAN BERDASARKAN PRIORITAS

No.Dx

Tanggal Muncul

No.Dx

Tanggal Muncul

Diagnosa Keperawatan
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Diagnosa Keperawatan

Tanggal Teratasi

Ttd

Tanggal Teratasi

Ttd

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D. RENCANA KEPERAWATAN

Hari
Tanggal

No.D
x

Tujuan dan Kriteria Hasil

Hari

No.D
Tujuan dan Kriteria Hasil

Rencana Keperawatan
Intervensi

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Rencana Keperawatan
Intervensi

Rasional

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Rasional

Tanggal

E. IMPLEMENTASI

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Hari

No.

Tanggal

Dx

Jam

Tindakan Keperawatan

Respon Klien

Ttd

Evaluasi

Ttd

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Hari/

No.

Tanggal

Dx

Jam

Implementasi

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E. EVALUASI (CATATAN PERKEMBANGAN)

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No

Hari

Jam

Evaluasi

Ttd

Tanggal
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No

Hari

Jam

Evaluasi

Tanggal
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Ttd

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