ASUHAN KEPERAWATAN KRITIS

Nama : ………………………………………………………….....
NIM : …………………………………………………………….
TempatPraktek : …………………………………………………………….
Mingguke-/Tanggal : …………………………………………………………….

Nama : …………………………………………………………….
Usia : …………………………………………………………….
Alamat : …………………………………………………………….
No. Register : …………………………………………………………….
KriteriaKlien : …………………………………………………………….
Tanggal MRS : ………………………………………………………….....
TanggalPengkajian : …………………………………………………………….

I. PENGKAJIAN
1. Riwayat Penyakit
a. Riwayat Penyakit Sekarang
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
…………………………………………………………………………………..

b. Riwayat Penyakit Dahulu

……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
…………………………………………………………………………………..
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
…………………………………………………………………………………..

c. RiwayatPenyakitKeluarga
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………

d. DiagnosaMedis
……………………………………………………………………………………
……………………………………………………………………………………

2. Secondary Survey
a. B1 (Breath)
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
…………………………………………………………………………………..

b. B2 (Blood)
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
c. B3 (Brain)
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………

d. B4 (Bowel)
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………

e. B5 (Bladder)
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………

f. B6 (Bone)
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
3. Pemeriksaan Penunjang
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
…………………………………………………………………………………..
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
…………………………………………………………………………………..
4. Terapi Farmakologi
NO Nama Obat Dosis Indikasi Kontraindikasi Efek Samping
1

4
5

8
9

10
II. ANALISA DATA
No. Data (Symptom) Penyebab (Etiologi) Masalah (Problem)
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
 ....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
No. Data (Symptom) Penyebab (Etiologi) Masalah (Problem)
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
....................................................................... .................................................. .........................................................................
. . .
III. PRIORITAS DIAGNOSA KEPERAWATAN
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
IV. RENCANA KEPERAWATAN
No. DiagnosaKeperawatan TujuandanKriteriaHasil Intervensi
............................................................... .............................................................. ..............................................................................
. .............................................................. .
............................................................... .............................................................. ..............................................................................
. .............................................................. .
............................................................... .............................................................. ..............................................................................
. .............................................................. .
............................................................... .............................................................. ..............................................................................
. .............................................................. .
............................................................... .............................................................. ..............................................................................
. .............................................................. .
............................................................... .............................................................. ..............................................................................
. .............................................................. .
............................................................... .............................................................. ..............................................................................
. .............................................................. .
............................................................... .............................................................. ..............................................................................
. .............................................................. .
............................................................... .............................................................. ..............................................................................
. .............................................................. .
............................................................... .............................................................. ..............................................................................
. .............................................................. .
............................................................... .............................................................. ..............................................................................
. .............................................................. .
............................................................... .............................................................. ..............................................................................
. .............................................................. .
 ............................................................... ..............................................................................
. .
............................................................... ..............................................................................
. .
............................................................... ..............................................................................
. .
............................................................... ..............................................................................
. .
............................................................... ..............................................................................
. .
............................................................... ..............................................................................
. .
............................................................... ..............................................................................
. .
............................................................... ..............................................................................
. .
............................................................... ..............................................................................
. .
............................................................... ..............................................................................
. .
............................................................... ..............................................................................
. .
............................................................. ..............................................................................
.

V. IMPLEMENTASI
No Tanggal/Jam TindakanKeperawatan Paraf
.
……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
 ……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
……………………….. ……………………………………………………………………………………
. …
VI. EVALUASI
No DiagnosaKeperawatan Tanggal/Jam Evaluasi (SOAP)
.
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… ……………………..
. .
………………………… ……………………..
. .
 ………………………… ……………………..
. .
………………………… ……………………..
. .
………………………… ……………………..
. .
………………………… ……………………..
. .
………………………… ……………………..
. .
………………………… ……………………..
. .
………………………… ……………………..
. .
………………………… ……………………..
. .
………………………… ……………………..
. .
………………………… ……………………..
. .
VII. CATATAN OBSERVASI
No DiagnosaKeperawatan Tanggal/Jam CatatanObservasi (SOAPIE)
.
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… …………………….. …………………………………………………………………………………….
. . …………………………………………………………………………………….
………………………… ……………………..
. .
………………………… ……………………..
. .
………………………… ……………………..
. .
………………………… ……………………..
. .
………………………… ……………………..
. .
………………………… ……………………..
. .
………………………… ……………………..
. .
………………………… ……………………..
. .
………………………… ……………………..
. .
………………………… ……………………..
. .
………………………… ……………………..
. .
………………………… ……………………..
. .