Pengkajian Awalpmberian Antibiotik

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Pengkajian Awalpmberian Antibiotik

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PENGKAJIAN AWALPMBERIAN ANTIBIOTIK

IDENTITAS PASIEN

Nama : …………………………………………………………………………………………………………………………

Umur : …………………………………………………………………………………………………………………………

Jenis Kelamin : …………………………………………………………………………………………………………………………

Tanggal Masuk : …………………………………………………………………………………………………………………………

No. RM : …………………………………………………………………………………………………………………………

Klinis : …………………………………………………………………………………………………………………………

DATA PENUNJANG

DL : Leukosit : …………………………………………………………………………………………………

Diffcount : …………………………………………………………………………………………………

LED : …………………………………………………………………………………………………

Urine : Leukosit : …………………………………………………………………………………………………

Nitrit : …………………………………………………………………………………………………

Sedimen : …………………………………………………………………………………………………

Feses : Bakteri : …………………………………………………………………………………………………

BTA : ………………………………………………………………………………………………………………………….

Kultur : ………………………………………………………………………………………………………………………….

Radiologi : Rontgen : …………………………………………………………………………………………………

USG : …………………………………………………………………………………………………

CT Scan : …………………………………………………………………………………………………

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