III. Current Assessment (Before and

III. Current Assessment (Before and after admission)
1. Perception and health maintenance:
________________________________________________________________
2. Nutritional metabolic pattern:
a. Hospital dietary
______________________________________________________________
b. Food intake
______________________________________________________________
c. Liquid intake
______________________________________________________________
3. Elimination Pattern
a. Bowel movement
______________________________________________________________
b. Bladder
______________________________________________________________
4. Activity and exercise pattern:
Self Care 0 1 2 3 4
Eat/ Drink
Take a bath
Toileting
Get dress
Bed mobilization
Movement
Body alignment and range of motion

*Note: 0: independent, 1: using aid, 2: dependent, 3: dependent and using aid, 4:
depend on oxygen
5. Sleeping and Resting Pattern
________________________________________________________________
6. Perceptual Pattern
1. Vision
_____________________________________________________________
2. Hearing
_____________________________________________________________
3. Taste
_____________________________________________________________
4. Sensation
_____________________________________________________________
7. Relationship Pattern
(Communication, relationship with others, financial support)
________________________________________________________________
________________________________________________________________

Hasil (Bahasa Indonesia) 1:

III. arus penilaian (sebelum dan setelah masuk)1. persepsi dan kesehatan pemeliharaan:________________________________________________________________2. nutrisi pola metabolik:a. hospital Diet______________________________________________________________b. asupan makanan______________________________________________________________c. asupan cairan______________________________________________________________3. penghapusan polaa. buang______________________________________________________________b. kandung kemih______________________________________________________________4. kegiatan dan latihan pola:Self perawatan 0 1 2 3 4Makan / minum Mandi Pergi ke toilet Mendapatkan gaun Tidur mobilisasi Gerakan Tubuh alignment dan jangkauan gerak * Catatan: 0: independen, 1: menggunakan bantuan, 2: tergantung, 3: tergantung dan menggunakan bantuan, 4:tergantung pada oksigen5. tidur dan istirahat pola________________________________________________________________6. perceptual pola1. visi_____________________________________________________________2. mendengar_____________________________________________________________3. taste_____________________________________________________________4. sensasi_____________________________________________________________7. hubungan pola(Komunikasi, hubungan dengan orang lain, dukungan keuangan)________________________________________________________________________________________________________________________________

Hasil (Bahasa Indonesia) 2:

AKU AKU AKU. Penilaian saat ini (Sebelum dan setelah masuk)
1. Persepsi dan pemeliharaan kesehatan:
________________________________________________________________
2. Pola metabolik gizi:
a. Diet rumah sakit
______________________________________________________________
b. Asupan makanan
______________________________________________________________
c. Asupan cairan
______________________________________________________________
3. Eliminasi Pola
a. Buang air besar
______________________________________________________________
b. Kandung kemih
______________________________________________________________
4. Aktivitas dan latihan pola:
Self Care 0 1 2 3 4
Makan / Minum
Mandi
toileting
Dapatkan dress
B mobilisasi
Gerakan
keselarasan tubuh dan rentang gerak

* Catatan: 0: mandiri, 1: menggunakan bantuan, 2: tergantung, 3: tergantung dan menggunakan bantuan, 4:
tergantung pada oksigen
5. Tidur dan Pola Istirahat
________________________________________________________________
6. Pola persepsi
1. Visi
_____________________________________________________________
2. Mendengar
_____________________________________________________________
3. Taste
_____________________________________________________________
4. Sensasi
_____________________________________________________________
7. Pola hubungan
(Komunikasi, hubungan dengan orang lain, dukungan keuangan)
________________________________________________________________
________________________________________________________________