CLINCAL PATHWAYS

SMF Peny.Saraf RSUD ZAINOEL ABIDIN 2011

MENINGITIS PURULENTA

Nama Pasien Umur Berat Badan Tinggi Badan Nomor Rekam Medik
................................... ...................... .................. Kg ................ cm ..................................
Diagnosis Awal : Kode ICD 10 : Rencana Rawat : 21 hari
Aktivitas Ruang Rawat Tgl/Jam masuk Tgl/Jam Keluar Lama Rawatan Kelas Tarif/hr (Rp) Biaya (Rp)
Pelayanan
....................... ....................... ....................... 21 hari ..................... ....................... ............................
HR1 HR2 HR3 HR4 HR HR HR HR HR14
Penyakit
▪Diagnosis
Utama
:Meningitis
purulenta ....................... ....................... ....................... ....................... ................... ................... ................... ................... ...................
▪ Penyakit
Penyerta ....................... ....................... ....................... ....................... ................... ................... ................... ................... ...................
OMSK,Caries
dentis,pharingiti
s,sinusitis

▪ Komplikasi ....................... ....................... ....................... ....................... ................... ................... ................... ................... ...................
∙ Hidrosefalus
∙ Sepsis

∙ Pneumonia
∙ decubitus
∙ plebitis
infark serebri

Asessmen Klinis
▪Pemeriksaan
Dokter ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-)
▪ Konsultasi ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-) ▫ (+) ▫ (-)
∙ Bedah Saraf
∙ Rehab Medik

Darah lengkap
(DR,GDS,Ur/Cr
,Lipid
Pemeriksaan Penunjang
Profile,SGOT/S
GPT) (+)
Foto Thoraks (+)
EEG (+)/(-)
EKG (+)

CT-scan Kepala
(+)
Lumbal punksi (+)
Analisa LCS (+)
funduskopi (+)

Tindakan
Oksigen (+)/(-)
IVFD (+)
Catheter (+)/(-)
NGT (+)/(-)
Obat-obatan
Ceftriaxone (+) (+) (+) (+) (+) (+) (+) (+) (+)
Metronidazole (+) (+) (+) (+) (+) (+) (+) (+) (+)
Roborantia (+) (+) (+)
Kortikosteroid (+)/(-)
Diet TKTP (+)

Mobilisasi .....(+)..........
Hasil
(outcome)
▪ GCS ............... ............... ............... ............... ............... ............... ............... ...............
paresis
n.cranialis
▪ Motorik
▪ Kejang
Pemulangan Penjelasan Penyakit Nasehat berobat
teratur
VarianJumlah .................. .................. .................. .................. .................. .................. .................. ..................
Biaya:
Tgl dirawat Diagnosa Akhir : ICD 10 Jenis ICD 9-CM
............. Tindakan :
Tgl Pulang ▪ Utama Visite/konsul : Anamnesis 89.0
.......... ▪ Penyerta ...................... ................ Visite/konsul P. Neurologi 89.7
Lama Rawatan .................
...................... ................ Pemeriksaan
Foto Thorak Mikroskop Darah 90.5
14 hari ▪ Komplikasi .................
...................... ................ PA 87.44
.................
...................... ................ EKG
CT-scan
.................
...................... ................ Kepala
................. Lumbal punksi
Analisa LCS
Sputum BTA
Kultur
Darah & LCS
funduskopi
Oksigen
Pasang
IVFD/Inj 99.2
Catheter 93.96
Nama NGT
Pelaksana Nama Dokter Nama
Verifikasi Perawat
................... ...................... ..................
................... ...................... ..................
....... . .........
 Biaya (Rp)
....................
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