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1) Data Umum

a. Nama : Fadlib. Umur : 23 tahunc. Tempat, Tanggallahir : Jember, 24 April 1991d. Pendidian : !"A#$e. Jeni%elamin : #aiai'. !uubang%a : (nd)ne%iag. Agama : (%lam

h. Alamat : *eda+ung

Daftar Nama Anggota Keluarga

No. Nama L/P Hubungan Usia Pendidika

n

Agama

1. Alm. mi%tum # Aah !"A (%lam2. -ainiah P (bu !"A (%lam

I. Genogram

Keterangan

Perem!uan

Laki"laki

#eninggal

$%A' P(NGKAIAN

P*L P(&A+A'AN PA,I(N D(NGAN K(*U'UHAN KHU,U,

P,IK UNI-(&,I'A, (#*(& '.A 10/1


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((. &i2a3at ke4amilan dan kela4irana. Prenatal :

b. Natal :c. P)%tnatal :

I. &i2a3at dan 'a4a! Perkembangan Keluarga

1. Tahap perembangan eluarga %aat ini................................................................................................................. .................

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..........................................2. Tuga% perembangan eluarga ang belum terpenuhi

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..........................................3. /i+aat eluarga inti

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..........................................4. /i+aat eluarga %ebelumna

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(((. &i2a3at masa lalua. Penait +atu ecil :

b. Pernah dira+at di /! : &c. 0bat&)batan ang digunaan : &d. Tindaan )pera%i :e. Alergi :'. *ecelaaan : pernah mengalami ecelaan nai

m)t)r %aat berumur tahung. (muni%a%i :

(. &i2a3at kese4atan keluarga


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a. Penait ang pernah diderita angg)ta eluarga :

b. Penait ang %edang diderita angg)ta eluarga :

. Kebutu4an dasar1. "aanan ang di%uai 5 tida di%uai :

Na%i g)reng

2. P)la tidur :Tidur malam 6am 27.77 8($

$angun 6am 7.77 8($

3. "andi :"andi 2 %ehari pagi dan %)re hari

4. Ati'ita% bermain :Jalan 6alan ber%ama teman teman dan bermain $)la

. ;limina%i :

. Nilai dan eainan/a6in mela%anaan %h)lat +atu

II. ,truktur Keluarga

1. P)la )munia%i eluarga.....................................................................................................................................

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...........................................2. P)la euatan eluarga

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...........................................3. P)la peran eluarga

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...........................................4. Nilai dan n)rma budaa

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III. $ungsi Keluarga

1. Fung%i a'eti' dan )ping.....................................................................................................................................

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...........................................2. Fung%i %)%iali%a%i

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...........................................3. Fung%i repr)du%i

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...........................................4. Fung%i e)n)mi

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............................................ Fung%i 'i%i dan pera+atan eluarga

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...........................................I-. ,tress dan Ko!ing Keluarga

1. !tre%%)r 6anga pende.....................................................................................................................................

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...........................................2. *emauan eluarga bere%p)n terhadap ma%alah

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...........................................3. !trategi )ping ang dilauan

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...........................................4. !trategi adapta%i di%'ung%i)nal

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) Data ,ubsistem

a. #ingungan 'i%i1 *)ndi%i %e)lah

a *)ndi%i gedung


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7/11

c *amar mandi5+c

*epemilian:


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!#$ bint)r) merupaan %alah %atu !#$ inlu%i di daerah bint)r) ec.Patrang,

dan terleta di dataran tinggi, cuup deat dengan )ta ang mudah untu

menga%e%na, dan mempunai %arana pra%aranaan pembela6aran ang cuup.

b. Peman'aatan pelaanan e%ehatan1 Pelaanan e%ehatana Pelaanan e%ehatan terdeat

Pu%e%ma% /umah prati %+a%ta $alai Peng)batan /umah %ait lainna %ebutan

b Jara pelaanan e%ehatan/umah %ait > m %5d 17 m ? 17 mPu%e%ma%

> m %5d 17 m ? 17 m

2 Pelaanan %)%ial

c. ;)n)mi1 Peer6aan )rang tua murid

a Jeni% peer6aan )rang tua : Pen6ahitb Pengha%ilan rata&rata dalam%ebulan

i. *urang dari /p. 77.777,& < ii. /p. 77.777,& %5d 1.777.777,&

iii. #ebih dari/p. 1.777.777,& 2 Pengeluaran rata&rata tiap bulan

i. *urangdari/p. 77.777,& ii. /p. 77.777,& %5d 1.777.777,&

iii. #ebihdari/p. 1.777.777,& 3 A%uran%i ang dimiliii. A%e%

ii. A%e%in iii. Jam%)%te i@. Tidapuna

d. *eamanan dan tran%p)rta%i1 *eamanan

a Petuga% eamanan

ada


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ada


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%eni lainna

!ebutan

g. /erea%i1 Jeni% atau %arana rerea%i :2 Tempat rerea%i :3 8atu rerea%i :4 Pembiaaan : Bara ana mengi%i +atu luang :

-. Hara!an Keluarga 'er4ada! Asu4an Ke!era2atan Keluarga

=iharapan bagi ana trutama dapat berembang %e%uai emampuan ana ter%ebut

untu mencapai eterampilan dan meningatan emampuan )n%entra%i dan

emandirian ana %e%uai dengan emampuan berembang ana ter%ebut.

Nama "aha%i%+a : ". NurhamCah FahiDi

Tanda Tangan :

A. Analisa Data

N) =ata "a%alah Penebab1 =0: guru pa%ien mengataan

pa%ien e%uitan dalam mengingat

=!: pa%ien terlihat lupa %aat

dinaan

Penurunan daa

ingat

*. Inter5ensi

N)

=Tu6uan

*riteria

Ea%il!tandart (nter@en%i

=

1

1. meningatan')u% dan

)n%entra%i padaana

!etelah

dilauan

pera+atan

melatih %enam

)ta $rian m2. bela6ar dengan


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2. meningatan*emampuan

ber)munia%idan memberire%p)n meningat

%elama 4

6am ana

dapat

melauan

%enam

)ta $rain

m

dengan

tehni bermain3. memberian

in')rma%i dengan

nada rendah.

6. Im!lementasi dan (5aluasi

Tanggal N) = (mplementa%i Tanda Tangan ;@alua%i

29 )t)ber2714

1 "elatih %enam )ta $rian m

! : ana Fmengataan

%enang untu

melauan

geraan %enam

)ta

0 : )pperati'

dalam mengiutilatihan %enam

)ta

A : ma%alah

belum terata%i

P : inte@en%i

dilan6utan.

D. &en7ana 'indak Lan8ut

*etia pera+at haru% mulai meninggalan eluarga, ada beberapa rencana tinda lan6ut

ang haru% diberian )leh pera+at epada eluarga, aitu:1. *eluarga dapat melatih ana dengan menga6aran %enam )ta2. *eluarga dapat membimbing anana.

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