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FORMAT PENGKAJIAN

ASUHAN KEPERAWATAN KELUARGA

Tuan J

PENGKAJIAN

1. Data Umum1. Nama KK : Tn. J2. Usia : ! ta"un#. P$n%i%i&an : SD. P$&$'(aan : P$tani). A*amat : Dsn. +I RT ,,2 D$sa Ta*an- Au'. K/m0/sisi an--/ta &$*ua'-a :

N/ Nama

Inisis*

J$nis

K$*amin

Hu3

%-n KK

TTL4

Umu'

P$n%i%i&

an

P$&$'(aa

n

Status

Imunisas

i1 Tn. J La&i5*a&i K$0a*a

&$*ua'-

a

1!5,65

167

SD P$tani T%&

L$n-&a0

2 N8. A P$'$m0u

an

Ist'i ,25,)5

16!#

SD P$tani T%&

*$n-&a0

G$n/-'am

K$t$'an-an :

: La&i5*a&i : Tin--a* s$'uma"

: P$'$m0uan : M$nin--a*

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!. Ti0$ K$*ua'-a : &$*ua'-a Tn. J m$'u0a&an ti0$ &$*ua'-a Dyad 8aitu

&$*ua'-a 8an- t$'%i'i %a'isuami %an ist'i tan0a ana& 8an- "i%u0 3$'sama %a*am

satu 'uma".7. Su&u : &$*ua'-a Tn. J m$'u0a&an su&u 8an- sama 8aitu su&u O-an.6. A-ama : Tn. J %an ist'in8a 3$'a-ama is*am9 &$*ua'-a m$n(a*an&an i3a%a"

s$suai a(a'ana-ama %an t$'masu& 0$n-aut a-ama 8an- taat. K$*ua'-a Tn. J

m$n(a*an&an i3a%a"s$tia0 "a'i.

1,.Status s/isa* $&/n/mi &$*ua'-a : N8. A m$n-ata&an 0$n-"asi*an &$*ua'-a

m$'$&a ti%a& m$n$ntu. P$n-"asi*an m$'$&a 3$'-antun- 0a%a "asi* saa"

8an- %i &$'(a&an. N8. A m$n-ata&an 'ata5'ata 0$n-"asi*an &$*ua'-a

m$'$&a s$3$sa' R0 7,,.,,,4 3u*an. N8. A m$n-ata&an 0$n-"asi*an

m$'$&a ;u&u0 untu& m$m$nu"i &$3utu"an s$"a'i5"a'i a*au0un

s$a%an8a.11.A&ti

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1.Ka'at$'isti& 'uma" t$'masu& %$na" 'uma":a. K$0$mi*i&an 'uma" : Ruma" 8an- %i t$m0ati /*$" &$*ua'-a ini

m$'u0a&an 'uma" /'an- tua %a'i Tn. J.3. Luas =an-unan :;. J$nis =an-unan : Ka8u9 *antai 0a0an 9 ata0 s$n- %an *an-it5*an-it

t$'0a*.%. Sa'ana K$s$"atan Lin-&un-an:

Sumu' %an &/n%isi ai' : ti%a& m$mi*i&i sumu'9 sum3$' ai' %a'i

sun-ai. K/n%isi ai' 3$'3au %an 3$'a'na &$"i(auan.W>4Jam3an : ti%a& a%a W>4(am3an. K$*ua'-a M>K &$ sun-ai.

T$m0at sam0a" : ti%a& a%a9 &a*au a%a sam0a" %i3a&a' %i3$*a&an-

'uma".J$n%$*a : %i&ama' a%a ($n%$*a &$;i*9 %i'uan-an tamu s$&*i-us

&$*ua'-a (u-a t$'%a0at ($n%$*a.P$n;a"a8aan %i'uan- t$n-a" %isian- "a'i t$'an- %an ma*am "a'i

m$n--una&an *ist'i& PLN.$. D$na" Ruma" :

1!.Ka'at$'isti& t$tan--a %an &/munitasK$*ua'-a tin--a* %i *in-&un-an 8an- 0a%at %an ;u&u0 'a0i. T$'%a0at 0/"/n

0isan- %i %$0an 'uma"9 umun8a t$tan--a a%a*a" su&u /-an9 ti%a& a%a

&$su*itan %a*am &$"i%u0an s$"a'i5"a'i9 "u3un-an %$n-an t$tan--a 3ai&9

&$*ua'-a (u-a a&ti? %a*am &$-iatan 0$n-a(ian. N8. A m$n-ata&an (a'an-

3$'&um0u* %$n-an t$tan--a (i&a ti%a& a%a &$-iatan t$'t$ntu9 &a'$na

&$3iasaan /'an-5/'an- %it$m0at tin--a* N8. A si3u& %i'uma" masin-5

masin-.17.M/3i*itas -$/-'a@s &$*ua'-a:

K$*ua'-a su%a" tin--a* %i *in-&un-an &/munitas s$(a& m$ni&a". Tn. J

&$*ua' 'uma" 3$'an-&at 3$&$'(a 0u&u* ,!. ,, 0a-i %an 0u*an- &$'uma"

0u&u* 1.,, s/'$. N8. A &$*ua' 'uma" 0a-i %an s/'$ &$ sun-ai untu& man%i.Ka%an-5&a%an- N8. A &$ 0asa' untu& m$m3$*i &$3utu"an %a0u' %an

m$n(ua* s/n-&$t "asi* t$nunann8a.16.P$'&um0u*an &$*ua'-a %an int$'a&si %$n-an ma8a'a&at:

N8. A m$n($*as&an &u'an- a&ti? %an (a'an- 3$'&um0u* %$n-an mas8a'a&at

%is$&ita'9 s$0$'ti PKK %an 0$n-a(ian. Tn. J s$3a-ian 3$sa' m$n-"a3is&an

a&tun8a %i saa"9 s$%an-&an N8.A %i 'uma" m$masa&9 m$n-u'us 'uma"

%an m$n$nun. K$*ua'-a &a%an-5&a%an- 3$'&um0u* %$n-an &$*ua'-a 3$sa'

(i&a a%a a;a'a t$'t$ntu sa(a s$0$'ti s8u&u'an90$sta %an *$3a'an.

2,.Sist$m 0$n%u&un- &$*ua'-a : &$-i-i"an %an &$'(a &$'as Tn. J 3$&$'(a untu&

m$n;u&u0i &$3utu"an "i%u0 &$*ua'-a %an %u&un-an %a'i ist'i N8. A. S$&a*i5

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s$&a*i t$'(a%i 0$'s$*isi"an anta'a N. A %an Tn. J m$n-$nai 3$*um a%an8a

ana& %it$n-a" &$*ua'-a m$'$&a9 N8. A m$n%a0at %u&un-an %a'i /'an- tua

%an sau%a'a N8. A s$n%i'i. K$*ua'-a ini ti%a& m$mi*i&i W> %an &$n%a'aan.

Ji&a an--/ta &$*ua'-a sa&it9 m$'$&a 3$'/3at &$ 0us&$smas %$n-an (a*an

&a&i.

I+. St'u&tu' &$*ua'-a

21.P/*a &/muni&asi &$*ua'-a : &$*ua'-a 3$'&/muni&asi %$n-an 3a"asa %a$'a"

Ta*an- Au'. K$*ua'-a 3$'&/muni&asi s$;a'a *an-sun- &a'$na &$*ua'-a ini

ti%a& m$mi*i&i a*at &/muni&asi handphone.