Escolar Documentos
Profissional Documentos
Cultura Documentos
FORMAT PENGKAJIAN
AKTIVITAS DAN MOBILITAS
Minum
Frekuensi ............................... ................................
Jenis ............................... ................................
Jumlah ............................... ................................
Keluhan ............................... .................................
c. Pola Eliminasi
Kebiasaan BAB
Keterangan Sebelum Sakit Saat Sakit
e. Pola Istirahat-Tidur
Keterangan Sebelum Sakit Saat Sakit
Lama tidur siang
Lama tidur malam
Pengantar tidur
Gangguan tidur
3 RR .......................................... ..................................
TB :................................cm
BB saat ini :................................Kg
BB Ideal :.................................Kg
2. Kepala
Rambut :………………………………………………………………………….......
Wajah : ……………………………………………………………………….........
Mata : ……………………………………………………………………….........
Hidung :………………………………………………………………………….......
Mulut :………………………………………………………………………….......
Gigi :………………………………………………………………………….......
Telinga :………………………………………………………………………….....
3. Leher
I.........................................................................................................................................
P........................................................................................................................................
5. Dada
Paru-Paru
I……………………………………………………………………………………………………
P........................................................................................................................................
P........................................................................................................................................
A………………………………………………………………………………………………….
Jantung
I……………………………………………………………………………………………………
P........................................................................................................................................
P........................................................................................................................................
A………………………………………………………………………………………………….
6. Abdomen
I…………………………………………………………………………………………………..
A…………………………………………………………………………………………………
P…………………………………………………………………………………………………
P………………………………………………………………………………………………….
7. Ekstremitas
Atas
I…………………………………………………………………………………………………..
P………………………………………………………………………………………………….
Gerakan Sendi…………………………………………………………………………………
…………………………………………………………………………………………………….
Kekuatan Otot…………………………………………………………………………………
Bawah
I………………………………………………………………………………………………….
P…………………………………………………………………………………………………
Gerakan Sendi………………………………………………………………………………..
………………………………………………………………………………………………….
Kekuatan Otot…………………………………………………………………………………
9. Anus – Genetalia
……………………………………………………………………………………………………..
……………………………………………………………………………………………………..
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Mahasiswa
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NIM…………………………