Ardew_ASKEP SNH Nagasari

8/17/2019 Ardew_ASKEP SNH Nagasari

1/31

ASUHAN KEPERAWATAN PASIEN NY. S

DENGAN STROKE NON HEMORAGIC (SNH)

DI RUANG STROKE UNIT NAGASARI RSUP SANGLAH

DARI HARI KAMIS TANGGAL 4 s/d SABTU, 6 FEBRUARI !"6

N#$# M#%#s&s'# I Gs*& A+ A& D-'&

T-$#* P#*- R#01 N#1#s#& RSUP S#012#% D-0#s#

T#011#2 P-01#3 K#$&s, 4 F-#& !"6

I. Identitas Diri Klien

N#$# N+. S

T#011#2 M#s RS 5 F-#& !"6

T-$#*/T#011#2 L#%& -$#0#, ! 0& "74!

S$- I089$#s& #s&-0, -2#1# #s&-0, d#0 RM 09$9 !"57!6:7

U$ ;: *#%0 ; 2#0 ": %#&

A1#$# H&0d

-0&s K-2#$&0 P--$#0

S*#*s P-#'&0#0 K#'&0P-0d&d&#0 SMA

S B#2&

P--3##0 P-0s&0#0

L#$# B--3# <

A2#$#* B#03# -9 B#3#, T##0#0

Dms# M-d&s ss. SNH dd/ SH

KELUHAN UTAMA

K-2-$#%#0 #d# s-#% *% &&.

RIWAYAT PENYAKIT

P#s&-0 d#*#01 - I0*#2#s& R#'#* D##* RSUP S#012#% #d# 2 ";.!! WITA d-01#0

-2%#0 s-#% *% && d&#s##0 2-$#s. P#s&-0 d#0 -2#1# $-01#*##0 #%'#

2-$#s0+# s-#% *% #s&-0 +#01 && sd#% d&#s##0 s-3# %#& +#01 2#2.

D&#*##0 #%'# %#& +#01 2#2 #s&-0 $-01#*##0 *#01#0 %&011# *01#& #1


2/31

&&0+# 2-$#s s-s##* s-*-2#% #010 *&d, %#0+# d##* d&1-s- d#0 *&d# d##* d#*,

0#$0 $-$#& #d# --s9#0 %#&0+# d&*0d#& d-01#0 #s&-0 d##* $-01#01#*

*#01#00+# d-01#0 -2#%#0. K#-0# -#d##0 #s&-0 +#01 $-0-*# s--*& &* $##

-2#1# $-$*s#0 0* $-$#'# #s&-0 - $#% s#&*. S-2#&0 &*, -2#1#

$-01#*##0 #%'# #s&-0 *&d# d##* $##0 #-0# $#2 $0*#% d#0 s## -29 d&s-*#&

&& $-0=901 - #0#0. P#s&-0 *&d# $-$&2&& &'#+#* *#$# -#2#, *&d# $-#s##0

*-#2 d& s-3 *%, BAB d#0 BAK 09$#2.

". K-2#1# *-d-#* +#01 d##* d&%01& #d#2#% #0#0+#

P--3##0 PNS P-0d&d&#0 S"

A2#$#* B#03# -9 B#3#, T##0#0

. A2-1& <T&- <

R-#s& <

T&0d##0 <

5. K-s##0 $-99/ 9& / 9#* / #29%92 / 2#&0


3/31

P-#%#0 BB 5 2#0 *-#%& -#01 ± 5 1

;. P92# -2&$&0#s&

#. B#01 #& -s#

F--0s& %#& s-#2& W#* #1&

W#0# 0&01 09$#2 K90s&s*-0s& #d#* 09$#2

P-0110##0 P-0=#%# <

. B#01 #& -=&2

F--0s& 5 > 4 #2& s-%#& W#0# 0&01 09$#2

B# %#s 09$#2

?. P92# *&d d#0 &s*&#%#*

W#* *&d (3#$) 2 .!! d& $#2#$ %#& d#0 "4.!! d& s %#&

L#$# *&d/%#& ± "! 3#$

K-s##0 -01#0*# *&d <

K-s##0 s##* *&d <

K-s2&*#0 d#2#$ %#2 *&d <

7. P92# 1-# d#0 #*&@&*#s

#. K-1*#0 d#2#$ --3##0 #s&-0 %#0+# -d$ d&& d& $#%

. O2#% #1# #s&-0 *&d# $#$ $-2##0 92#%#1#

=. K-1*#0 d& '#* 2#01 <

d. K-s2&*#0/-2%#0 d#2#$ %#2 &0& -1-##0 *%, $d#% $-#s# -2-2#%#0

"!. P92# K-3#

#. -0&s --3##0 <

. $2#% 3#$ -3# <=. #d'#2 3#$ -3#


4/31

II. Riwayat Keluarga

G-091#$

K-*-#01#0

2#&


5/31

IV. Aspek Psikososial

". P92# && d#0 -s-s&

#. A2#* #0* +#01 d&10##0 <

. K-s2&*#0 +#01 d#$& <

. P-s-s& d&&

H#2 +#01 d&&&#0 s##* &0& #s&-0 $-$&&#0 -0+#&* +#01 d#$&0+#

H###0 s-*-2#% $-03#2#0& -#'#*#0 #s&-0 -%## d##* $-011-##0 #0119*#

*%0+# +#01 2-$#s s--*& s-d#2#

P-#%#0 +#01 d&#s##0 s-*-2#% s#&* #s&-0 *&d# $-#s##0 -#%#0 ##0 d#&

-s-s&0+#

5. S#s#0# %#*& s#s#0# %#*& #s&-0 *-0#01

4. H01#0/9$0&#s& ..........................................................................

........................

#. B&=##

( √ ) 3-2#s #%#s# *#$# I0d90-s

( √ ) -2-@#0 #%#s# d#-#% B#2&

( √ ) $#$ $-01-s-s&#0

( √ ) $#$ $-01-*& 9#01 2#&0

. T-$#* *&011#2

( √ ) -s#$# 9#01 2#&0, +#&* #0#0+#

=. K-%&d#0 -2#1#

- Ad#* &s*d#* +#01 d* d#-#% B#3# T##0#0

- P-$#*#0 -*s#0 d#2#$ -2#1# -d#s##0 s## *-#0+#

- P92# 9$0&#s& %9&90*#2

- K-#01#0 ( √

) $-$#d#&

d. K-s2&*#0 d#2#$ -2#1# <

:. K-s##0 s-s#2

#. G#011#0 %01#0 s-s#2 d&s-##0 90d&s& s-#1#& -&*


6/31

. P-$#%#$#0 *-%#d# 801s& s-s#2 <

6. P-*#%#0#0 9&01

#. P-01#$&2#0 -*s#0 d&#0* 9#01 2#&0 #0# --=#+##0

#. S# #*# ## +#01 $-03#d& s$- -#*#0

H01#0 d-01#0 T%#0

. A##% T%#0, A1#$#, K--=#+##0 -0*&01 0* #0d#

( √ ) +# *&d#

=. K-1*#0 A1#$# #*# K--=#+##0 +#01 d&2##0 ($#=#$ d#0 8--0s&)

S-*#0 s-$#%+#01 $-0* %#& d#0 -0#011#2#0

d. K-1*#0 A1#$# #*# K--=#+##0 +#01 &01&0 d&2##0 s-2#$# d&

$#% s#&*,

S-*#0 -d9# 0* -s-$%#00+#

V. Pengkajian Fisik

A. &*#2 S&10

T-#0#0 d##% 7!/6! $$H1

S% 56 ℃

N#d& ?4 /$-0&*

P-0#8#s#0 "? /$-0&*

B. K-s#d##0 =9$9s $-0*&s GCS ": (E+- 4 -#2 : M9*9& 6)

C. K-#d##0 $$

S#&*/ 0+-& s-d#01

S#2# 0+-& 4

N+-& d& d#-#% -* #0#0 #'#% %&011# - &011#01

S*#*s 1&& 09$#2

BB 6! K1 TB "6! =$

S&# *-0#01


7/31

P-s90#2 %+1&-0- = -s&%

O&-0*#s& '#*/ *-$#*/ 9#01 #&

D. P-$-&s##0 F&s& H-#d T9 T9-". K-#2#

B-0* $-s9=%-#2

L-s&/ 2# <

. R#$*

W#0# %&*#$ -*&%#0 (#0)

K-2#&0#0 90*9

5. M#*#

P-012&%#*#0 09$#2

S2-# *&d# &*-&

K90301*&@# #0-$&s

P&2 &s99

K-2#&0#0 <

4. H&d01

P-01%&d 09$#2

S--*/ d##%/ 92& <

T#&#0 =#&01 %&d01 T&d#

:. T-2&01#

P-0d-01##0 ". 09$#2

S-*/ =#&#0/ d##% *&d#

6. M2* D#0 G&1&

B&& -&01

M2* d#0 *-01199#0 09$#2

G&1& 9$901 #d# 1-#%#$ #*#s #0#0


8/31

;. L-%-

P-$-s##0 *+9&d *&d#

L-s& *&d# N#d& #9*&s *-##

P-$-s##0 2&$89&d *&d#

?. T%9#

#0*01 ". 0#d& ?4 / $-0&*, . -#*#0 #*

5. &#$# *-#*

P# ". 8-'-0s& 0#8#s *-#*

. '#2&*#s 09$#2

5. s## 0#8#s @-s&2-

4. #* *&d#

:. s$#*#0 3#2#0 0#8#s <

R-*#s& d#d# *&d# #d#

7. Ad9$-0

P-&s*#2*& ss #d# ? /$-0&*

K-$01 *&d#

N+-& *-#0 +# d& #d#0 ; /#1 *-01#% s#* - #0#0 %&011#

- &011#01

As=&*-s *&d# #d#

"!.G-0-*#2

P&$9s&s <

A2#* B#0* <

K-2#&0#0 <

"". K2&*

T19 -&01


9/31

L#s-#s& <

W#0# 2&* ". 09$#2 (s#'9 $#*#01)

".Es*&$&*#s K-#*#0 9*9*

::: 444

::: 444

R O M *-#*#s

H-$&2-1&/#-s- +#, &&

A#2 %#01#*

C#&22#+ -8&22 *&$- 5 d-*&

Ed-$# *&d# #d#

"5. D#*# -$-&s##0 8&s& 0-9291&s

- K#0&$ (I0-s&, P#2#s&, P-s&, As2*#s&, T#0s&2$&0#s&, d22) d#2#$

#*#s 09$#2

-K9s -*-# (I0-s&, P#2#s&, P-s&, M9&2&*#s, d22) d#2#$ #*#s

09$#2

Tanda-tanda perangsangan selaput otak

- K# d ( &&) s-*#01

P-1-##0 92# $#*# (#0#0 > &&) 09$#2 - s-1#2# ##%

N&s*#1$s (#0#0 > &&) *&d# #d#

C-2#% $#*# (#0#0 > &&) 09$#2P*9s&s (#0#0 > &&) *&d# #d#


10/31

P&2

R-82-s =#%#+# 2#01s01 (#0#0 > &&) 9s&*&8

R-82-s =#%#+# 90s-0s&2 (#0#0 > &&) 9s&*&8

R-82-s =#%#+# 90@-1-0s& (#0#0 > &&) 9s&*&8

R-82-s &2 M#=s &&) 0-1#*&8

T-s W#*-0-1 (#0#0 > &&) 0-1#*&8

- N-@s

M9*9& (#0#0 > &&) 09$#2

S-0s&&2&*#s (#0#0 > &&) 09$#2

R-82-s 90-# (#0#0 > &&) 9s&*&8

R-82-s $#s-*- (#0#0 > &&) 0-1#*&8

T&s$s (#0#0 > &&) *&d# #d#

N+-& *-#0 (#0#0 > &&) *&d# #d#

- N-@s II

O*9* '#3#% s##* &s*&#%#* (#0#0 > &&) *#$# s&s 0#s92#&sM-01-*#0 d#%& (#0#0 > &&) && 2-&% d#*#

M-0* $#*# (#0#0 > &&) s&$-*&s

M-&01&s (#0#0 > &&) sd* && *-*#& - #0#0

M-0== (#0#0 > &&) sd* && *-d9901 - &&

G-###0 &0@920*-- (#0#0 > &&) *&d# #d#

I0d# -01-=# (#0#0 > &&) 09$#2

S--s& #& $#*# (#0#0 > &&) 09$#2

H&-#s&s (#0#0 > &&) 09$#2

T#0d# C%@9s*- (#0#0 > &&) *&d# #d#

- N-@s III

M-0d-01##0 s## (#0#0 > &&) 09$#2

- N-@s IJ, J, JI, JII

L#01&* &&) s&$-*&s

M-0-2#0 (#0#0 > &&) 09$#2

D&s#s*& (#0#0 > &&) #d#

D&s890 (#0#0 > &&) *&d# #d#

R-82-s $0*#% (#0#0 > &&) 9s&*&8

"otorik (*-0#1#, *90s, 99d&0#s&, 1-##0 &0@920*--, 2#01#% d#0 1#+# 3#2#0)- T-0#1#

::: 444

::: 444

- T90s

N9$

#2

M-0

0


11/31

N9$

#2

M-0

0

Releks #8&s&9291&, #*9291&)

-R. F&s&9291&s

B&s-s (#0#0 && )

T&s-s (#0#0 && )

R#d&s (#0#0 &&


12/31

4. P91#$ T-#&

- IFD N#C2 !,7 ! *$

- C&*&=92&0 :!! $1 I. I0d&#s& 0-99*-&0

- S&$@#s*#*&0 "4! $1 IO. I0d&#s& #0*&&082#$#s&

-B&s99292 " : $1 IO.

- As-*9s#2 "!! $1 IO. I0d&#s& A0*-1#s& 2#*-2-*

- As#$ 892#* $1 IO. I0d&#s& A0*&%9$9s&s*-&0


13/31

A. A$ALISA DATA

". D#*# P-*#$#

#. D#*# S3-*&8

- P#s&-0 $-01#*##0 s-#% #d#0 #1 &&0+# 2-$#s s-3# %#& +#01 2#2.

P#s&-0 $-01#*##0 *&d# d##* $-01#01#* *#01#0 %&011# *01#& &&0+#,

%#0+# d##* $-011-s-


14/31

- T90s 9*9* -s*-$&*#s #*#s d#0 #'#% #1 && $-01#2#$& -00#0

- R-82-s 8&s&9291&s 9*9* &s-s, *&s-s, 20#, d#0 #d&s && 0-1#*&8

- S##* $-01-*#0 d#%&, #1 && 2-&% d#*#

=. A0#2&s&s d#*#

T9$s/-$92& d#2#$ d##% d& 3#&01#0 =--#2↓

P-0+-$&*#0 #2&#0 d##% - 9*# ↓

D&s801s& N-@s F#s&s (II) ← P-00#0 s2#& d##% d#0 O - 9*#

↓ ↓

K-2-$#%#0 $-011-##0 9*9* '#3#% D&s801s& N-@s As-s9&s (JI)

↓

H-$&s8- #0#0

↓

K-*&d#$#$#0 $-011-##0 -s*-$&*#s #*#s d#0 #'#% #1 &&↓

H#$#*#0 $9&2&*#s 8&s&

d. M#s#2#%

H#$#*#0 M9&2&*#s F&s&

5. D#*# -*&1#

#. D#*# s3-*&8

- P#s&-0 d#0 -2#1# $-01#*##0 #%'# #s&-0 -s2&*#0 s##* -&=##

- P#s&-0 $-01#*##0 2&d#%0+# *-#s# -2/*-*#& - d#2#$

- P#s&-0 $-01#*##0 #%'# d&&0+# $-#s# &&0+# $-0=901 - #0#0

. D#*# 93-*&8

- T#$# #s&-0 -s2&*#0 s##* -&=## d-01#0 9s&s& 2&d#% +#01 *-*#& -

-2##01- Sd* && #s&-0 *-*#& - #0#0

=. A0#2&s&s d#*#

T9$s/-$92& d#2#$ d##% d& 3#&01#0 =--#2↓

P-0+-$&*#0 #2&#0 d##% - 9*# ↓

P-00#0 s2#& d##% d#0 O - 9*#↓

D&s801s& N-@s F#s&s (II) d#0 G29s98#&01-s (IJ)


15/31

↓

K-*&d#$#$#0 $-0190*92 9*9* $9*9& '#3#% d#0 #%#01↓

K-s##0 9$0&#s& @-#2d. M#s#2#%

K-s##0 K9$0&#s& -#2

4. D#*# --$#*

#. D#*# s3-*&8

- P#s&-0 $-01#*##0 *&d# d##* $-0-2#0 $##0#0

- P#s&-0 $-01#*##0 s-&01 $#2 d#0 $0*#%

- P#s&-0 $-01#*##0 2-$#s d#0 2## 0#$0 *&d# &s#/d##* $##0

. D#*# 93-*&8

- P#s&-0 *#$# 2-$#% #-0# 0*&s& +#01 $#s *&d# #d-#*

-P#s&-0 %#0+# d##* $-01%#&s#0 "/? #1 9s& $##0#0 +#01 d&s-d#0

d-01#0 *&d# $-$##0 2# +#01 -#s d#0 %#0+# $-01&s& $##0#0 d-01#0

#%

- P#s&-0 *#$# -ss#%#0 s##* $-010+#% d#0 $-0-2#0 $##0#0

=. A0#2&s&s d#*#

T9$s/-$92& d#2#$ d##% d& 3#&01#0 =--#2↓

P-0+-$&*#0 #2&#0 d##% - 9*# ↓

P-00#0 s2#& d##% d#0 O - 9*#↓

D&s801s& N-@s #1s (J) d#0 G29s98#&01-s (IJ)

↓

R-82-s $-0-2#0 *&d# -8-*&8 ↓

D&s8#1

↓

A09-↓

K-*&d#s-&$#01#0 0*&s& #01 d#& -*%#0

d. M#s#2#%

K-*&d#s-&$#01#0 0*&s& #01 d#& -*%#0

:. D#*# -2&$#

#. D#*# s3-*&8

-

P#s&-0 $-01#*##0 *&d# d##* $-2##0 #*&@&*#s0+# s-0d&&- P#s&-0 $-01#*##0 2-$#s d#0 *&d# d##* #010 d#& *-$#* *&d


16/31

- P#s&-0 $-01#*##0 *&d# d##* $-2##0 #*&@&*#s $#0d& s-0d&&

. D#*# 93-*&8

- P#s&-0 *#$# 2-$#% d#0 *-2-0*#01 d& *-$#* *&d

- P#s&-0 %#0+# d##* $9&2&s#s& d& *-$#* *&d s#3#

- ADL d&#0* -0%

=. A0#2&s&s d#*#T-3#d& -00#0 s2#& O - 9*#

↓

D01s& d& --## 0-@s↓

A09$#2&*#s $9*9& 9*9*↓

O*9* 2-$#% d#0 *&d# d##* $-2##0 #*&@&*#s s--*& s#↓

ADL d&#0* -0%↓

D-8&s&* -#'#*#0 d&& $#0d&

d. M#s#2#%

D-8&s&* -#'#*0 d&& $#0d&


17/31

%. DIA&$!SA K'P'RA(ATA$ DA$ PRI!RITAS "ASALA)

". K-*&d#-8-*&8#0 -8s& 3#&01#0 - 9*# /d -00#0 s2#& d##% d#0 O -

9*# d/d P#s&-0 $-01#*##0 s-#% #d#0 #1 &&0+# 2-$#s s-3# %#& +#01

2#2. P#s&-0 d#0 -2#1# $-01#*##0 #%'# #s&-0 #1# -s2&*#0 s##* -&=##

(&&0+# *-*#& - sd* #0#0), T#01#0 %&011# *01#& && #s&-0 *#$#

2-$#%, #s&-0 *&d# d##* $-01#01#* #1 *-s-*, S##* -&=##, && #s&-0

*#$# *-*#& - #0#0 d#0 #s&-0 *#$# -s2&*#0 s##* -&=##, T-#0#0

d##% #s&-0 7!/6! $$H1, d#0 S#*#s& O 75.

. K-*&d#s-&$#01#0 0*&s& #01 d#& -*%#0 /d -*&d#$#$#0 $-0=-0#

$##0#0 d/d P#s&-0 $-01#*##0 *&d# d##* $-0-2#0 $##0#0, s-&01 $#2 d#0

$0*#%, 2-$#s d#0 2## 0#$0 *&d# &s#/d##* $##0. P#s&-0 *#$# 2-$#%

#-0# 0*&s& +#01 $#s *&d# #d-#*, P#s&-0 %#0+# d##* $-01%#&s#0 "/? #1 9s& $##0#0 +#01 d&s-d#0 d-01#0 *&d# $-$##0 2# +#01 -#s

d#0 %#0+# $-01&s& $##0#0 d-01#0 #% d#0 P#s&-0 *#$# -ss#%#0 s##*

$-010+#% d#0 $-0-2#0 $##0#0

5. H#$#*#0 $9&2&*#s 8&s& /d %-$&##s- && d/d P#s&-0 $-01#*##0 1-#0+#

*-%#$#* #-0# 2-$#s #d# s-#% #d#0 #1 &&, *&d# d##* $-2##0

#*&@&*#s0+# *#0# #0*#0 9#01 2#&0. P#s&-0 *#$# $-01#2#$& -00#0

801s& $9*9& d#0 $s29s-2-*#2, K-#*#0 9*9* -s*-$&*#s #*#s d#0 #'#%

#1 && #d#2#% 444, T90s 9*9* -s*-$&*#s #*#s d#0 #'#% #1 &&

$-01#2#$& -00#0, d#0 S##* $-01-*#0 d#%&, #1 && 2-&% d#*#

4. K-s##0 9$0&#s& @-#2 /d -00#0 801s& 9*9* 8#= d#0 9#2 d/d P#s&-0

d#0 -2#1# $-01#*##0 #%'# #s&-0 -s2&*#0 s##* -&=##, 2&d#%0+# *-#s#

-2/*-*#& - d#2#$, d#0 d&&0+# $-#s# &&0+# $-0=901 - #0#0. T#$#

#s&-0 -s2&*#0 s##* -&=## d-01#0 9s&s& 2&d#% +#01 *-*#& - -2##01 d#0

Sd* && #s&-0 *-*#& - #0#0

:. D-8&s&* -#'#*#0 d&& $#0d& /d -2-$#%#0 9*9* #&#* %-$&##s- d/d P#s&-0

$-01#*##0 *&d# d##* $-2##0 #*&@&*#s0+# s-0d&&, 2-$#s d#0 *&d# d##*

#010 d#& *-$#* *&d, *&d# d##* $-2##0 #*&@&*#s $#0d& s-0d&&. P#s&-0

*#$# 2-$#% d#0 *-2-0*#01 d& *-$#* *&d, P#s&-0 %#0+# d##* $9&2&s#s& d&

*-$#* *&d s#3#, d#0 ADL d&#0* -0%


18/31

*. P'R'$*A$AA$ K'P'RA(ATA$

$! DIA&$!SAR'$*A$A K'P'RA(ATA$

T+,+A$ I$T'RV'$SI RASI!$AL

K-*&d#-8-*&8#0 -8s& 3#&01#0 -

9*# /d -00#0

s2#& d##% d#0 O

- 9*# d/d P#s&-0

$-01#*##0 s-#%

#d#0 #1 &&0+#

2-$#s s-3# %#&

+#01 2#2. P#s&-0d#0 -2#1#

$-01#*##0 #%'#

#s&-0 #1#

-s2&*#0 s##*

-&=## (&&0+#

*-*#& - sd*

#0#0), T#01#0

%&011# *01#& &&

#s&-0 *#$#

2-$#%, #s&-0 *&d#

d##* $-01#01#*

#1 *-s-*, S##*

-&=##, &&

#s&-0 *#$#

*-*#& - #0#0 d#0

#s&-0 *#$#

-s2&*#0 s##*

-&=##, T-#0#0

d##% #s&-0 7!/6!

$$H1, d#0 S#*#s&

O 75.

Tujuan #$!* /

s-*-2#% d&-&#0 #s%#0

--#'#*#0 s-2#$# 4

3#$ $##

G#011#0 -8s& 3#&01#0

d##* *-=##& s-=##

9*&$#2

Kriteria 0asil /

• M#$$-$-*#%#0#0

*&01#* -s#d##0

• F01s& s-0s9& d#0

$9*9& $-$#&

Inter1ensi #$I*

. P#0*# TT *

3#$ d#0 =#*#*

%#s&20+#

2. K#3& -s90

$9*9& *-%#d#

-&0*#% s-d-%#0#

3. P#0*# s*#*s

0-9291&s s-=##

*-#*

4. D9901 2#*&%#0

*#01#0 d#0 #&

#*&8/ #s&8 5. K92#9#s&

-$- 9#*

s-s#& &0d&#s&

. P-0&01#*#0 *-#0#0

d##% s&s*-$& +#01

d&&*& d-01#0

-00#0 *-#0#0

d##% ds*92&

$-##0 *#0d#

-0&01#*#0 TIK.

N##s *&d# *-#*

$-003#0 #d#0+#

-0&01#*#0 TIK

2. M#$ $-01-*#%&

*&01#* -s90 $9*9&

#s&-0

3. M-0=-1#%/$-00#

0 #*-2-=*#s&s

4. M-00#0 s*#*&s

@-0#

5. M-00#0 -s&9

*-3#d&0+# 9$2&#s&

2 K-*&d#s-&$#01#0

0*&s& #01 d#&

-*%#0 /d

-*&d#$#$#0

Tujuan #$!* /

s-*-2#% d&-&#0 #s%#0

--#'#*#0 s-2#$# 4

3#$ $##

Inte1ensi #$I* /

". P-01-292##0

1#011#0

$##0#0

. P-01-22##0


19/31

$-0=-0# $##0#0

d/d P#s&-0

$-01#*##0 *&d#

d##* $-0-2#0

$##0#0, s-&01

$#2 d#0 $0*#%,

2-$#s d#0 2##

0#$0 *&d#

&s#/d##* $##0.

P#s&-0 *#$#

2-$#% #-0# 0*&s&

+#01 $#s *&d#

#d-#*, P#s&-0

%#0+# d##*

$-01%#&s#0 "/?

#1 9s&

$##0#0 +#01

d&s-d#0 d-01#0

*&d# $-$##0 2#

+#01 -#s d#0

%#0+# $-01&s&

$##0#0 d-01#0

#% d#0 P#s&-0

*#$# -ss#%#0

s##* $-010+#% d#0

$-0-2#0 $##0#0

". S*#*s 1&&

. As#0 $##0#0

5. C#&#0 d#0 #* 1&&

Kritria e1aluasi/

". M-03-2#s#0

9$90-0 -d-#*#0

d&-*

. N&2#& 2#9#*9&$

($&s,*0s8-&0,#2$&0,

d#0 -2-*92&*)

5. M-2#9#0

-#d-#*#0 *&01#*

1&&

4. N&2#& 2#9#*9&$($&s*#s8-&0,#29$-0

d#0 -2-*92&*

:. T92-#0s& *-%#d# 1&&

+#01 d#0.

0*&s&

5. B#0*#0

$-0#&#0 BB

Akti1itas

keperawatan /

. T-0*#0 $9*&@#s&2&-0 0*

$-01#%

-s##0 $##0

2. K-*#%& $##0#0

-s##0 2&-0

3. B#0* $##0

s-s#& d-01#0

-*%#0 2&-0

4. C&*##0

2&0101#0 +#01

$-0+-0#01#0

0* $##0

". M9*&@#s& 2&-0

$-$-01#%& d#2#$

-#%#0 0*&s&

. M##0#0 -s##0 2&-0

0* $-$-$d#%

-$- 0*&s&

5. M-$#0* $##0 0*

$-01-*#%& -#%#0

0*&s& s-*# 0*

-01#3

4. M-0=&*##0

2&0101#0 0*

-0+#$#0#0 &s*&#%#*

2&-0 s-*# *

-*-0#01#0 d#2#$

#01#0/#$#.

3 H#$#*#0 $9&2&*#s

8&s& /d %-$&##s-

&& d/d P#s&-0

$-01#*##0

1-#0+# *-%#$#*

#-0# 2-$#s #d#

s-#% #d#0

#1 &&, *&d#

d##* $-2##0

#*&@&*#s0+# *#0#

#0*#0 9#01 2#&0.

Tujuan #$!*/

s-*-2#% d&-&#0 #s%#0

--#'#*#0 s-2#$# 4

3#$ $##

K2&-0 d&$&0*#

$-003#0 *&01#*

$9&2&*#s, d&*#0d#& d-01#0

&0d&#*9 -&* (s-*#0

0&2#&0+# " < :

-*-1#0*01#0 (*&d#

-#*&s&#s&)

$-$*%#0 #0*#0

Inte1ensi #$I* /

T-#&

#*&@&*#s,

#$2#s&

T-#&

#*&@&*#s,

$9&2&*#s

s-0d&.

P-#%#0. M-01#3##0 2&-0


20/31

P#s&-0 *#$#

$-01#2#$&

-00#0 801s&

$9*9& d#0

$s29s-2-*#2,

K-#*#0 9*9*

-s*-$&*#s #*#s d#0

#'#% #1 &&

#d#2#% 444, T90s

9*9* -s*-$&*#s #*#s

d#0 #'#% #1

&& $-01#2#$&

-00#0, d#0 S##*

$-01-*#0 d#%&,

#1 && 2-&%

d#*#

9#01 2#&0 #*# #2#*

$-$*%#0 #0*#0

9#01 2#&0, $#0d&& d-01#0

-*92901#0 #2#* #0* #*#

$#0d&& -0%).

Kriteria '1aluasi /

. M-003#0

-0110##0 #2#* #0*

s-=## -0# d-01#0

-01#'#s#0.

2. M-$&0*# #0*#0 0*

-#*&@&*#s $9&2&s#s&

3&# d&-2#0.

3. M-0+#011# BAB

4. M-0110##0 s&

9d# s-=## -8-*&8.

9s&s&

Akti1itas

Keperawatan /

. A3##0 2&-0

*-0*#01 d#0 #0*#

-0110##0 #2#*

#0* $9&2&*#s.

2. A3##0 d#0 #0*

2&-0 d#2#$ 9s-s

-&0d#%#0.

3. B-&#0 -01#*#0

9s&*&8 s-2#$#

-#*&@&*#s.

4. D01 *-0& 2#*&%#0 ROM

5. K92#9#s& d-01#0

*&$ $-d&s *-0*#01

$9&2&*#s 2&-0

*-0*#01 d#0 #0*#

-0110##0 #2#* #0*

$9&2&*#s 2&-0 2-&%

$d#%.

2. M-$#0* 2&-0 d#2#$

9s-s -&0d#%#0 ##0

$-$#0* 2&-0 2#*&%#0

d-01#0 =## *-s-*.

3. P-$- -01#*#0

9s&*&8 s-2#$# #*&@&*#s

##0 $-$#0* 2&-0

s-$#01#* d#2#$ 2#*&%#0.

4. M-$-=-#* 2&-0

d#2#$ $9&2&s#s& d#0

$-01-0d9#0 9*9*


21/31

- d#2#$, d#0

d&&0+# $-#s#

&&0+# $-0=901

- #0#0. T#$#

#s&-0 -s2&*#0 s##*

-&=## d-01#0

9s&s& 2&d#% +#01

*-*#& - -2##01

d#0 Sd* &&

#s&-0 *-*#& -

#0#0

#. K2&-0 d##*

$-01-s-s&#0

-#s##0

. M-$#%#$& $#sd

d#0 -$&=###0 9#01

2#&0

=. P-$&=###0 #s&-0

d##* d&#%#$&

5. B-d&& d& d-#0

2##01 #0d#01

#s&-0 #d# s##*

&=##

4. L#*&% 9*9* &=##

s-=## 9*&$#2

:. L&#*#0 -2#1#

d#2#$ $-2#*&%

9$0&#s& @-#2

#d# #s&-0

6. K92#9#s& d-01#0

#%2& *-#& '&=##

2&-0 *s

5. M-01-*#%& d-#3#*

*&01#*#0 -$#$#0

-9$0&#s& 2&-0

4. M-00#0 *-3#d&0+#

9$2&#s& 2#03*#0

:. K-2#1# $-01-*#%&

$#$

$-0d-$90s*#s&#0 =##

$-2#*&% 9$0&#s&

@-#2d 2&-0 *#0#

#0*#0 -#'#*

6. M-01-*#%&

--$#01#0

9$0&#s& @-#2 2&-0

5 D-8&s&* -#'#*#0

d&& $#0d& /d

-2-$#%#0 9*9*

#&#* %-$&##s-

d/d P#s&-0

$-01#*##0 *&d#

d##* $-2##0

#*&@&*#s0+# s-0d&&,

2-$#s d#0 *&d#

d##* #010 d#&

*-$#* *&d, *&d#

d##* $-2##0#*&@&*#s $#0d&

s-0d&&. P#s&-0

*#$# 2-$#% d#0

*-2-0*#01 d& *-$#*

*&d, P#s&-0 %#0+#

d##* $9&2&s#s& d&

*-$#* *&d s#3#,

d#0 ADL d&#0*

-0%

Tujuan #$!*

s-*-2#% d&-&#0 #s%#0

--#'#*#0 s-2#$# 4

3#$ $##

I0*92-#0=- #=*&@&*+

M9&2&*+ %+s&=#2

&$#&-d

S-28 =#- d-8&s&* %+1&-0-

S-0s9+ -=-*&90,

#d&*9+ d&s*-d

Kriteria 0asil

Ο P-#'#*#0 d&&

$#0d& $#$

0*

$-$-s&%#0

*% s-0d&&

s-=## $#0d&&

d-01#0 #*# *#0#

#2#* #0*.

Ο M#$

$-$-*#%##0

$9&2&*#s -

#$# $#0d&

Ο M-$-s&%#0d&& d#0

Inter1ension #$I*

S-28 C#- #ss&s*#0-

ADLs

". M90&*9

-$-$#0 2&-00* -#'#*#0

d&& +#01 $#0d&&.

. M90&*9 -*%#0

2&-0 0* #2#*<

#2#* #0* 0*

--s&%#0 d&&,

-##,

-%s, *9&2-*&01

d#0 $##0.

5. S-d#0 #0*#0

s#$#& 2&-0

$#$ s-=## *%

0* $-2##0

s-28


22/31

$-01-&01#0

*%

Ο M-2##0

-#'#*#0 %+1&-0-

9#2

$-0d9901

-$#0d&, 0*

$-$-&#0

#0*#0 %#0+# 3&#

#s&-0 *&d#

$#$ 0*

$-2##00+#.

6. P-*&$#01#0 s

2&-0 3&#

$-0d9901

-2#s#0##0

#*&@&*#s s-%#&<

%#&.

6. M-2&%#* s #s&-0 d#0

$-0+-s#&#0 *-%#d#

2#*&%#0 $#0

-s##0 ## +#01

=9=9 s-s#& s+#.


23/31

D. I"PL'"'$TASI K'P'RA(ATA$

$

!

T&L6

,A"

$!.

D7I"PL'"'$TASI R'SP!$ PARAF

"


24/31

WITA4.

4.5

#s&-0 $-0d-01##0 d-01#0

s-s#$# d#0 -#d# d& d-#0

2##01 #0d#01 #s&-0 -*&#

-&=##

#2&$#* +#01 #01 3-2#s, *#$#

sd* && *-*#& - #0#0, d#0

#s&-0 -s2&*#0 d#2#$

$-01=##0 --## %8#-0# 2&d#%0+# -2.

4.4M-2#*&% 9*9* &=## s-=##

9*&$#2

P#s&-0 d##* $-01&*& &0*s&

d#& -#'#* s-2#$# 2#*&%#0

$-2-$#s#0 9*9*


25/31

."

M-0-0*#0 $9*&@#s& 2&-0

0* $-01#% -s##0

$##0

P#s&-0 $-01#*##0 $-#s# $#2

&2# $##0 *-2#2 #0+#. T-#s#

*&d# -0# #d# 2 %#*&. P#s&-0

d##* $##0 &2# 2#0+#d&=&0=#01/d&9*901 -=&2


26/31

!7.!!

WITA".

M-01#3& -s90 $9*9&

*-%#d# -&0*#% s-d-%#0#

P#s&-0 *&d# d##* $-01&*&

-&0*#% 0* $-0#&#0 *#01#0

%&011# *01#& &&0+#

".4

5.4

M-0d9901 2#*&%#0 *#01#0 d#0

#& #*&8 (ROM)

A03#0 #s&-0 0*

$-2##0 $9&2&s#s& d& *-$#*

*&d s-* 3#$.

P#s&-0 $-01&*& -2#*&%#0 ROM

d-01#0 #0*ss. P#s&-0 $-#s#

*-#0* d-01#0 #d#0+# 2#*&%#0.

P#s&-0 $-01#*##0 *#01#00+#

sd#% &2-s d#0 2-$#s s-%&011#

d##* d#* s--0*#


27/31

WITA5.:

4.6

s-s#& &0d&#s&

C#*9&2 :! $1 IO*#0# $-$0*#%#00+#.

"6.!!

WITA"." M-$#0*# TT #s&-0

S 56,! ℃ N ?! /$-0&* TD

"!/?! $$H1 RR ! /$-0&*SPO 7;

";.!!

WITA:.:

M-01#3##0 -2#1# 0*

$-$#0d&#0 s&-0

K-2#1# &* s-*# $-$#0d&#0

#s&-0 -s#$# -#'#*

"?.!!

WITA.5

M-$#0* #s&-0 0* $##0

$#2#$

M##0#0 +#01 d&%#&s#0 +#&*

± "/5 9s&

."

M-0-0*#0 $9*&@#s& 2&-0

0* $-01#% -s##0

$##0

P#s&-0 d##* $##0 d-01#0 9s&

%#&s +#01 -*#$#% 0#$0

s-d&&* d-$& s-d&&*

"7.!!

WITA

".:

5.:

4.6

K92#9#s& -$- 9#*

s-s#& &0d&#s&

C#*9&2 :! $1 IO

As#$ 892#* IO

O#* d##* d&$&0$ 92-% #s&-0

*#0# $-$0*#%#00+#.

".!!

WITA

4.:

M-2&#*#0 -2#1# d#2#$

$-2#*&% 9$0&#s& @-#2

#s&-0

K-2#1# sd#% *-s $-01#3#

#s&-0 -&0=#01


28/31

#s&-0 $##0.


29/31

'. 'VAL+ASI K'P'RA(ATA$

$!

D8

T&L9,A

"*ATATA$ P'RK'"%A$&A$ PARAF

" 6


30/31

$!D8

T&L9,A"

*ATATA$ P'RK'"%A$&A$ PARAF

5 6


31/31

$!

D8

T&L9,A

"*ATATA$ P'RK'"%A$&A$ PARAF

: 6

Ardew_ASKEP SNH Nagasari

Documents

Transcript of Ardew_ASKEP SNH Nagasari