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Jam

Perawat Pengkaji

Status Fungsional

Keluhan Utama

Riwayat Alergi

Riwayat Penyakit

Riwayat Kebiasaan

JUDUL PRIMARY

AIRWAY

BREATHING

JUDUL CIRCULATION

Denyut Nadi

CRT

Warna Kulit

Pendarahan

Turgor kulit

JUDUL DISABILITY/NEUROLOGICAL

Respon

Pupil

Pupil :

GCS

Judul Secondary Survey

TD

Midriasis Reflek Cahaya

Nadi :

Pernafasan

Suhu

BB :

TB/PB

Penandaan Lokasi

Kondisi

Luka

Judul Penilaian Nyeri

Nyeri

Faktor-Faktor Pemicu

Faktor-Faktor Mengurangi Nyeri

Frekuensi

Lokasi

Menjalar

Lama Nyeri

Skala Nyeri

Tools :

Lama Nyeri

Judul Terapy Yang Digunakan

Skala Nyeri CRIES

CRIES (Usia < 2 Bulan)

<table class="MsoTableGrid" border="1" cellspacing="0" cellpadding="0" style="border: none;">
 <tbody><tr>
 <td width="156" valign="top" style="width:116.85pt;border:solid windowtext 1.0pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Kategori<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.85pt;border:solid windowtext 1.0pt;
 border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:
 solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 0<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border:solid windowtext 1.0pt;
 border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:
 solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 1<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border:solid windowtext 1.0pt;
 border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:
 solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 2<o:p></o:p>
 </td>
 </tr>
 <tr>
 <td width="156" valign="top" style="width:116.85pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 Crying (Menangis)<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.85pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Tidak Ada<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Menangis kuat dapat dihibur<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Menangis kuat tidak dapat dihibur<o:p></o:p>
 </td>
 </tr>
 <tr>
 <td width="156" valign="top" style="width:116.85pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 Requires O2 for oxygen
 saturation > 95% (Membutuhkan O2 untuk saturasi oksigen >
 95%)<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.85pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Tidak Ada<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 < 30%<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 > 30%<o:p></o:p>
 </td>
 </tr>
 <tr>
 <td width="156" valign="top" style="width:116.85pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 Increases Vital Sign (Tanda Vital Meningkat)<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.85pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Nadi dan tekanan darah = atau <
 nilai dasar<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Nadi dan tekanan darah < 20 % nilai
 dasar<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Nadi dan tekanan darah > 20 % nilai
 dasar<o:p></o:p>
 </td>
 </tr>
 <tr>
 <td width="156" valign="top" style="width:116.85pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 Expression (Ekspresi)<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.85pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Tidak ada<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Meringis/menyeringai<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Meringis/menyeringai +
 Mendengkur/Mengorok<o:p></o:p>
 </td>
 </tr>
 <tr>
 <td width="156" valign="top" style="width:116.85pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 Sleeplessness (Sulit Tidur)<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.85pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Tidak ada<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Bayi terbangun pada rentang yang sering<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Bayi terjaga terus menerus<o:p></o:p>
 </td>
 </tr>
</tbody></table>

Skala Nyeri FLACC

FLACC (Usia 2 Bulan - 10 Tahun)

<table class="MsoTableGrid" border="1" cellspacing="0" cellpadding="0" style="border: none;">
 <tbody><tr>
 <td width="156" valign="top" style="width:116.85pt;border:solid windowtext 1.0pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Kategori<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.85pt;border:solid windowtext 1.0pt;
 border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:
 solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 0<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border:solid windowtext 1.0pt;
 border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:
 solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 1<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border:solid windowtext 1.0pt;
 border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:
 solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 2<o:p></o:p>
 </td>
 </tr>
 <tr>
 <td width="156" valign="top" style="width:116.85pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 Face (Wajah)<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.85pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Tidak ada ekspresi tertentu atau senyum<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Sesekali meringis atau mengerutkan
 kening, menarik diri, tidak tertarik<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Sering/selalu mengerutkan kening,
 rahang mengatup, dagu gemetaran<o:p></o:p>
 </td>
 </tr>
 <tr>
 <td width="156" valign="top" style="width:116.85pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 Legs (Kaki)<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.85pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Posisi normal dan rileks<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Cemas, gelisah, Tegang<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Menendang/menarik kaki<o:p></o:p>
 </td>
 </tr>
 <tr>
 <td width="156" valign="top" style="width:116.85pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 Activities (Aktifitas)<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.85pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Berbaring tenang, posisi normal
 bergerak dengan mudah<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Menggeliat, mondar mandir, tegang<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Meringkuk, kaku atau menyentak<o:p></o:p>
 </td>
 </tr>
 <tr>
 <td width="156" valign="top" style="width:116.85pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 Crying (Menangis)<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.85pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Tidak menangis (Bangun atau tidur)<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Mengerang/merintih, sesekali mengeluh<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Menangis terus menerus,
 berteriak/terisak sering mengeluh<o:p></o:p>
 </td>
 </tr>
 <tr>
 <td width="156" valign="top" style="width:116.85pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 Consolability (penghiburan)<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.85pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Puas/senang, rileks/santai<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Sesekali diyakinkan dengan sentuhan,
 pelukan atau diajak berbicara, dialihkan<o:p></o:p>
 </td>
 <td width="156" valign="top" style="width:116.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 Sulit untuk dihibur atau dibuat nyaman<o:p></o:p>
 </td>
 </tr>
</tbody></table>

Wong Baker Faces (Dewasa dan Anak lebih dari 3 Tahun)

Skala Nyeri Numerik

Numerik (Usia 10 Tahun Keatas)

Skala Nyeri CPOT

CPOT (Pasien Tidak Sadar)

<table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0" width="682" style="width: 511.8pt;">
 <tbody><tr style="mso-yfti-irow:0;mso-yfti-firstrow:yes;height:14.4pt;mso-row-margin-right:
 1.8pt">
 <td width="192" nowrap="" valign="bottom" style="width:144.0pt;border:solid windowtext 1.0pt;
 border-right:solid black 1.0pt;mso-border-alt:solid windowtext .5pt;
 mso-border-right-alt:solid black .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Indikator<o:p></o:p>
 </td>
 <td width="95" nowrap="" valign="bottom" style="width:71.0pt;border:solid windowtext 1.0pt;
 border-left:none;mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:
 solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:
 .75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Kondisi<o:p></o:p>
 </td>
 <td width="63" nowrap="" valign="bottom" style="width:47.0pt;border:solid windowtext 1.0pt;
 border-left:none;mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:
 solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:
 .75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Skor<o:p></o:p>
 </td>
 <td width="331" nowrap="" valign="bottom" style="width:248.0pt;border:solid windowtext 1.0pt;
 border-left:none;mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:
 solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:
 .75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">KETERANGAN<o:p></o:p>
 </td>
 <td style="mso-cell-special:placeholder;border:none;padding:0cm 0cm 0cm 0cm" width="2"> </td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:1;height:20.4pt;mso-row-margin-right:1.8pt">
 <td width="192" rowspan="3" style="width:144.0pt;border-top:none;border-left:
 solid windowtext 1.0pt;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-top-alt:windowtext;
 mso-border-left-alt:windowtext;mso-border-bottom-alt:black;mso-border-right-alt:
 black;mso-border-style-alt:solid;mso-border-width-alt:.5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:20.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:"Times New Roman";
 mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;color:black;
 mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:EN-ID">Ekspresi
 Wajah<o:p></o:p>
 </td>
 <td width="95" nowrap="" rowspan="3" style="width:71.0pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:20.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Rilek<o:p></o:p>
 </td>
 <td width="63" rowspan="3" style="width:47.0pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:20.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">0<o:p></o:p>
 </td>
 <td width="331" rowspan="3" style="width:248.0pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:20.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Tidak ada ketegangan otot yang terihat<o:p></o:p>
 </td>
 <td style="mso-cell-special:placeholder;border:none;padding:0cm 0cm 0cm 0cm" width="2"> </td>
 
 <td style="height:20.4pt;border:none" width="0" height="34"></td>
 
 </tr>
 <tr style="mso-yfti-irow:2;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:3;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:4;height:14.4pt">
 <td width="192" rowspan="5" style="width:144.0pt;border-top:none;border-left:
 solid windowtext 1.0pt;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-top-alt:windowtext;
 mso-border-left-alt:windowtext;mso-border-bottom-alt:black;mso-border-right-alt:
 black;mso-border-style-alt:solid;mso-border-width-alt:.5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID"> <o:p></o:p>
 </td>
 <td width="95" nowrap="" rowspan="5" style="width:71.0pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Kaku<o:p></o:p>
 </td>
 <td width="63" nowrap="" rowspan="5" style="width:47.0pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">1<o:p></o:p>
 </td>
 <td width="331" rowspan="5" style="width:248.0pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Merengut alis menurun, orbit mengang dan terdapat kerutan levator atau
 perubahan lainnya (misalnya membuka mata atau menangis selama prosedur
 nosineptif)<o:p></o:p>
 </td>
 <td width="2" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:5;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:6;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:7;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:8;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:9;height:72.0pt">
 <td width="192" rowspan="4" style="width:144.0pt;border-top:none;border-left:
 solid windowtext 1.0pt;border-bottom:solid black 1.0pt;border-right:solid black 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-top-alt:windowtext;
 mso-border-left-alt:windowtext;mso-border-bottom-alt:black;mso-border-right-alt:
 black;mso-border-style-alt:solid;mso-border-width-alt:.5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:72.0pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID"> <o:p></o:p>
 </td>
 <td width="95" rowspan="4" style="width:71.0pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:72.0pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Meringis<o:p></o:p>
 </td>
 <td width="63" rowspan="4" style="width:47.0pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:72.0pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">2<o:p></o:p>
 </td>
 <td width="331" rowspan="4" style="width:248.0pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:72.0pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Semua gerakan wajah sebelumnya ditambah kelopak mata tertutup rapat
 (pasien dapat mengalami mulut terbuka atau mengigit tabung endotrakeal)<o:p></o:p>
 </td>
 <td width="2" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;height:72.0pt"></td>
 
 <td style="height:72.0pt;border:none" width="0" height="120"></td>
 
 </tr>
 <tr style="mso-yfti-irow:10;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:11;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:12;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:13;height:14.4pt">
 <td width="192" nowrap="" rowspan="4" style="width:144.0pt;border-top:none;
 border-left:solid windowtext 1.0pt;border-bottom:solid black 1.0pt;
 border-right:solid black 1.0pt;mso-border-top-alt:solid windowtext .5pt;
 mso-border-top-alt:windowtext;mso-border-left-alt:windowtext;mso-border-bottom-alt:
 black;mso-border-right-alt:black;mso-border-style-alt:solid;mso-border-width-alt:
 .5pt;padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Gerakan Tubuh<o:p></o:p>
 </td>
 <td width="95" rowspan="4" style="width:71.0pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Tidak ada gerakan abnormal<o:p></o:p>
 </td>
 <td width="63" nowrap="" rowspan="4" style="width:47.0pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">0<o:p></o:p>
 </td>
 <td width="331" rowspan="4" valign="bottom" style="width:248.0pt;border-top:none;
 border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Tidak bergerak sama sekali (tidak berarti tidak adanya rasa sakit atau
 posisi normal (gerakan tidak dilakukan terhadap bagian yang terasa nyeri atau
 tidak dilakukan untuk tujuan perlindungan)<o:p></o:p>
 </td>
 <td width="2" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:14;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:15;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:16;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:17;height:14.4pt">
 <td width="192" nowrap="" rowspan="5" style="width:144.0pt;border-top:none;
 border-left:solid windowtext 1.0pt;border-bottom:solid black 1.0pt;
 border-right:solid black 1.0pt;mso-border-top-alt:solid windowtext .5pt;
 mso-border-top-alt:windowtext;mso-border-left-alt:windowtext;mso-border-bottom-alt:
 black;mso-border-right-alt:black;mso-border-style-alt:solid;mso-border-width-alt:
 .5pt;padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID"> <o:p></o:p>
 </td>
 <td width="95" rowspan="5" style="width:71.0pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Lokalisasi Nyeri<o:p></o:p>
 </td>
 <td width="63" rowspan="5" style="width:47.0pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">1<o:p></o:p>
 </td>
 <td width="331" rowspan="5" style="width:248.0pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Lambat gerakan hati-hati menyentuh atau menggosok bagian yang nyeri,
 mencari perhatian melalui gerakan<o:p></o:p>
 </td>
 <td width="2" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:18;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:19;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:20;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:21;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:22;height:14.4pt">
 <td width="192" nowrap="" rowspan="5" valign="bottom" style="width:144.0pt;border:
 solid windowtext 1.0pt;border-top:none;mso-border-top-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID"> <o:p></o:p>
 </td>
 <td width="95" nowrap="" rowspan="5" style="width:71.0pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Gelisah<o:p></o:p>
 </td>
 <td width="63" nowrap="" rowspan="5" style="width:47.0pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">2<o:p></o:p>
 </td>
 <td width="331" rowspan="5" style="width:248.0pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Menarik tabung , mencoba untuk duduk, menggerakkan tungkai /
 meronta-ronta, tidak mengikuti perintah menyerang staf, mencoba turun dari
 tempat tidur<o:p></o:p>
 </td>
 <td width="2" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:23;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:24;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:25;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:26;mso-yfti-lastrow:yes;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
</tbody></table>

<o:p> </o:p><table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0" width="680" style="width: 510pt;">
 <tbody><tr style="mso-yfti-irow:0;mso-yfti-firstrow:yes;height:14.4pt;mso-row-margin-right:
 1.8pt">
 <td width="192" nowrap="" valign="bottom" style="width:144.0pt;border:solid windowtext 1.0pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Indikator<o:p></o:p>
 </td>
 <td width="160" nowrap="" style="width:120.3pt;border:solid windowtext 1.0pt;
 border-left:none;mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:
 solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:
 .75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Kondisi<o:p></o:p>
 </td>
 <td width="64" nowrap="" valign="bottom" style="width:48.0pt;border:solid windowtext 1.0pt;
 border-left:none;mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:
 solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:
 .75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Skor<o:p></o:p>
 </td>
 <td width="261" style="width:195.9pt;border:solid windowtext 1.0pt;border-left:
 none;mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:solid windowtext .5pt;
 mso-border-right-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Keterangan<o:p></o:p>
 </td>
 <td style="mso-cell-special:placeholder;border:none;padding:0cm 0cm 0cm 0cm" width="2"> </td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:1;height:20.4pt;mso-row-margin-right:1.8pt">
 <td width="192" rowspan="5" style="width:144.0pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:20.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Aktivitasi Alarm Ventilator Mekanik<o:p></o:p>
 </td>
 <td width="160" rowspan="5" style="width:120.3pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:20.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Pasien kooperatif terhadap kerja ventilator mekanik<o:p></o:p>
 </td>
 <td width="64" nowrap="" rowspan="5" style="width:48.0pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:20.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">0<o:p></o:p>
 </td>
 <td width="261" nowrap="" rowspan="5" style="width:195.9pt;border-top:none;
 border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:20.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Alarm tidak berbunyi, ventilasi mudah<o:p></o:p>
 </td>
 <td style="mso-cell-special:placeholder;border:none;padding:0cm 0cm 0cm 0cm" width="2"> </td>
 
 <td style="height:20.4pt;border:none" width="0" height="34"></td>
 
 </tr>
 <tr style="mso-yfti-irow:2;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:3;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:4;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:5;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:6;height:14.4pt">
 <td width="192" nowrap="" rowspan="5" valign="bottom" style="width:144.0pt;border:
 solid windowtext 1.0pt;border-top:none;mso-border-top-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID"> <o:p></o:p>
 </td>
 <td width="160" rowspan="5" style="width:120.3pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Alaram aktif tapi mati<o:p></o:p>
 </td>
 <td width="64" nowrap="" rowspan="5" style="width:48.0pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">1<o:p></o:p>
 </td>
 <td width="261" rowspan="5" style="width:195.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Batuk, alaram berbunyi tetapi berhenti secara spontan<o:p></o:p>
 </td>
 <td width="2" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:7;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:8;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:9;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:10;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:11;height:14.4pt">
 <td width="192" rowspan="3" style="width:144.0pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID"> <o:p></o:p>
 </td>
 <td width="160" rowspan="3" style="width:120.3pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Alaram selalu aktif<o:p></o:p>
 </td>
 <td width="64" rowspan="3" style="width:48.0pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">2<o:p></o:p>
 </td>
 <td width="261" rowspan="3" style="width:195.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Alaram sering berbunyi<o:p></o:p>
 </td>
 <td width="2" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:12;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:13;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:14;height:14.4pt">
 <td width="192" rowspan="4" style="width:144.0pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Berbicara jika pasien diekstubasi<o:p></o:p>
 </td>
 <td width="160" rowspan="4" style="width:120.3pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Berbicara dalam nada normal atau tidak ada suara<o:p></o:p>
 </td>
 <td width="64" rowspan="4" style="width:48.0pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">0<o:p></o:p>
 </td>
 <td width="261" nowrap="" rowspan="4" valign="bottom" style="width:195.9pt;border-top:
 none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Berbicara dengan nada pelan<o:p></o:p>
 </td>
 <td width="2" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:15;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:16;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:17;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:18;height:14.4pt">
 <td width="192" rowspan="3" style="width:144.0pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID"> <o:p></o:p>
 </td>
 <td width="160" rowspan="3" style="width:120.3pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Mendesah mengerang<o:p></o:p>
 </td>
 <td width="64" rowspan="3" style="width:48.0pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">1<o:p></o:p>
 </td>
 <td width="261" rowspan="3" style="width:195.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Mendesah mengerang<o:p></o:p>
 </td>
 <td width="2" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:19;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:20;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:21;height:14.4pt">
 <td width="192" rowspan="3" style="width:144.0pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID"> <o:p></o:p>
 </td>
 <td width="160" rowspan="3" style="width:120.3pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Menangis<o:p></o:p>
 </td>
 <td width="64" rowspan="3" style="width:48.0pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">2<o:p></o:p>
 </td>
 <td width="261" rowspan="3" style="width:195.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Menangis berteriak<o:p></o:p>
 </td>
 <td width="2" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:22;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:23;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:24;height:14.4pt">
 <td width="192" nowrap="" rowspan="2" style="width:144.0pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Ketegangan otot<o:p></o:p>
 </td>
 <td width="160" nowrap="" rowspan="2" style="width:120.3pt;border-top:none;
 border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Tidak ada ketegangan otot<o:p></o:p>
 </td>
 <td width="64" rowspan="2" style="width:48.0pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">0<o:p></o:p>
 </td>
 <td width="261" rowspan="2" style="width:195.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Tidak ada ketegangan otot<o:p></o:p>
 </td>
 <td width="2" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:25;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:26;height:14.4pt">
 <td width="192" rowspan="2" style="width:144.0pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID"> <o:p></o:p>
 </td>
 <td width="160" nowrap="" rowspan="2" valign="bottom" style="width:120.3pt;border-top:
 none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Tegang,kaku<o:p></o:p>
 </td>
 <td width="64" rowspan="2" style="width:48.0pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">1<o:p></o:p>
 </td>
 <td width="261" rowspan="2" style="width:195.9pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;
 padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt">
 <span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:
 "Times New Roman";mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri;
 color:black;mso-font-kerning:0pt;mso-ligatures:none;mso-fareast-language:
 EN-ID">Gerakan oto pasif<o:p></o:p>
 </td>
 <td width="2" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
 <tr style="mso-yfti-irow:27;mso-yfti-lastrow:yes;height:14.4pt">
 <td width="2" nowrap="" valign="bottom" style="width:1.8pt;padding:.75pt 5.4pt 0cm 5.4pt;
 height:14.4pt"></td>
 
 <td style="height:14.4pt;border:none" width="0" height="24"></td>
 
 </tr>
</tbody></table>

<o:p> </o:p>

Judul Penilaian Resiko Jatuh

Tools

Resiko Jatuh

Judul Skrining Gizi

USIA SKRINING GIZI

Total Score STRONG Kids

Total Score PYMS

Total Score MUST

Judul Rumus IMT

IMT

JUDUL KEBUTUHAN EDUKASI

Apakah dibutuhkan penerjemah

Sebutkan :

Apakah Pasien Memerlukan Edukasi

Jika ya, kebutuhan edukasi yang diperlukan:

Perawatan Diri

Defisit perawatan diri:

DIAGNOSA KEPERAWATAN GAWAT DARURAT

RENCANA KEPERAWATAN GAWAT DARURAT

MONITORING OBSERVASI PASIEN DI INSTALASI GAWAT DARURAT

<table class="MsoTableGrid" border="1" cellspacing="0" cellpadding="0" style="border: none;">
 <tbody><tr>
 <td width="89" rowspan="2" valign="top" style="width:66.6pt;border:solid windowtext 1.0pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 KONDISI PASIEN<o:p></o:p>
 </td>
 <td width="535" colspan="6" style="width:400.9pt;border:solid windowtext 1.0pt;
 border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:
 solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 JAM
 PEMERIKSAAN<o:p></o:p>
 </td>
 </tr>
 <tr>
 <td width="91" valign="top" style="width:68.2pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.5pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.55pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.55pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.55pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.55pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 </tr>
 <tr>
 <td width="89" valign="top" style="width:66.6pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 Kondisi Umum<o:p></o:p>
 </td>
 <td width="91" valign="top" style="width:68.2pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.5pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.55pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.55pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.55pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.55pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 </tr>
 <tr>
 <td width="89" valign="top" style="width:66.6pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 Kesadaran<o:p></o:p>
 </td>
 <td width="91" valign="top" style="width:68.2pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.5pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.55pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.55pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.55pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.55pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 </tr>
 <tr>
 <td width="89" valign="top" style="width:66.6pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 Tanda Vital<o:p></o:p>
 TD<o:p></o:p>
 Denyut<o:p></o:p>
 Nadi<o:p></o:p>
 RR<o:p></o:p>
 Temp<o:p></o:p>
 Nyeri<o:p></o:p>
 </td>
 <td width="91" valign="top" style="width:68.2pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.5pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.55pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.55pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.55pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.55pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 </tr>
 <tr>
 <td width="89" valign="top" style="width:66.6pt;border:solid windowtext 1.0pt;
 border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;
 padding:0cm 5.4pt 0cm 5.4pt">
 Catatan Hal Penting<o:p></o:p>
 </td>
 <td width="91" valign="top" style="width:68.2pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.5pt;border-top:none;border-left:none;
 border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.55pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.55pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.55pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 <td width="89" valign="top" style="width:66.55pt;border-top:none;border-left:
 none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
 mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
 mso-border-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.4pt">
 <o:p> </o:p>
 </td>
 </tr>
</tbody></table>

Judul Kondisi Pasien Saat Pindah/Keluar dari IGD

Jam

Metode Pemindahan Pasien

Peralatan yang Menyertai Saat Pindah

Kebutuhan O2 (Jika menggunakan O2)

Peralatan Lain

Pasien di Transfer ke

Pasien Keluar dari IGD

Transportasi Saat Keluar IGD

Follow UP

CATATAN LAIN

PENGKAJIAN KEPERAWATAN GAWAT DARURAT