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Lampiran 3

STIKES Cahaya Bangsa Banjarmasin

PRE PLANNING (STRATEGI PELAKSANAAN)


TINDAKAN KEPERAWATAN
Hari/Tanggal
Pertemuan ke

:
:

Nama Klien
Nama Mahasiswa

:
:

1. Kondisi Klien :
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2. Diagnosa Keperawatan :
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3. Tujuan Khusus :
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4. Tindakan Keperawatan :
a. ..............................................................................................................................
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b. ..............................................................................................................................
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c. ..............................................................................................................................
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d. Dst
5. Rencana Tindakan :
ORIENTASI
a. Salam Terapeutik :
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b. Validasi :
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Lampiran 3
STIKES Cahaya Bangsa Banjarmasin

c. Kontrak
Topik
: ....................................................................................................
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Waktu
: ....................................................................................................
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Tempat: .........................................................................................................
KERJA
a. ..............................................................................................................................
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b. ..............................................................................................................................
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c. ..............................................................................................................................
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d. ..............................................................................................................................
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e. ..............................................................................................................................
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f. ..............................................................................................................................
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g. ..............................................................................................................................
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h. Dst
TERMINASI
a. Evaluasi Respon Klien Terhadap Tindakan Keperawatan
Evaluasi Klien (Subyektif) :
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Evaluasi Perawat (Obyektif) :
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b. Tindak Lanjut Klien
c. Kontrak Yang Akan Datang
Topik
: ....................................................................................................
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Waktu
: ....................................................................................................
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Tempat: .........................................................................................................

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