Askep Keluarga Tn. M.docx

8/12/2019 Askep Keluarga Tn. M.docx

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ASUHAN KEPERAWATAN KELUARGA

PADA KLIEN TN. M

A. PENGKAJIAN

I. Data Umum

1. Kepala Keluarga : Tn. M (x tahun)

2. Alamat & Telepon : Komp. BLK Bawah RT. 010 No. x

3. Pekerjaan KK : Swasta

4. Pendidikan KK : SD/Madrasah

5. Komposisi Keluarga:

No Nama Jenis

Kelamin

Hubungan

dengan KK

Umur

(tahun)

Pendidikan Status Imunisasi Ket

Polio BCG DPT Hepatitis Cam pak

1 2 3 4 1 2 3 1 2 31 Ny. A Perempuan Isteri

2 Tn. X Laki-laki Orang tua/Ayah

3 An. Laki-laki Anak kandung L

4 An. Perempuan Anak kandung L

5 An. T Perempuan Anak kandung L

6 An. M Perempuan Anak kandung L

7 By. Perempuan Anak kandung

Ket:L = Lengkap

Genogram:


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6. Tipe Keluarga : ......................................................................

7.Suku Bangsa :........................................................................

8. Agama :.......................................................................

9. Status sosial ekonomi : ................................................................................

10. Aktivitas Rekreasi Keluarga: ........................................................................................

II. Riwayat dan Tahap Perkembangan Keluarga

11. Riwayat perkembangan keluarga saat ini .................................................................

12. Tugas Perkembangan keluarga yang belum terpenuhi

.....................................................................................................................................

13. Riwayat Kesehatan Keluarga Inti

AnggotaKeluar

ga

RiwayatKesehatanDahu

lu

RiwayatKesehatansaati

ni

Keteranga

n

14. Riwayat kesehatan keluarga sebelumnya

...............................................................................................................................

...............................................................................................................................

III. Data Lingkungan

15. Karakteristik Rumah

...............................................................................................................................

...............................................................................................................................

Denah Rumah :

16. Karakteristik tetangga dan komunitas

..............................................................................................................................

..............................................................................................................................

17. Mobilitas geografis keluarga

...............................................................................................................................


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...............................................................................................................................

18. Perkumpulan keluarga dan interaksi dengan masyarakat

..............................................................................................................................

..............................................................................................................................

19. Sistem pendukung keluarga

...............................................................................................................................

..............................................................................................................................

IV. Struktur Keluarga

20. Struktur Peran

...............................................................................................................................

...............................................................................................................................

21. Nilai atau norma keluarga

................................................................................................................................

...............................................................................................................................

22. Pola komunikasi keluarga

...............................................................................................................................

...............................................................................................................................

23. Struktur kekuatan keluarga

...............................................................................................................................

...............................................................................................................................

V. Fungsi Keluarga

24. Fungsi Ekonomi

...............................................................................................................................

...............................................................................................................................

25. Fungsi mendapatkan status ekonomi

...............................................................................................................................

..............................................................................................................................

26. Fungsi Pendidikan

...............................................................................................................................

..............................................................................................................................

27. Fungsi Sosialisasi

............................................................................................................................

............................................................................................................................


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28. Fungsi pemenuhan (perawatan/pemeliharaan) kesehatan

a. Mengenal masalah

.........................................................................................................................

.......................................................................................................................

b. Mengambil keputusan mengenai tindakan kesehatan

..........................................................................................................................

.........................................................................................................................

c. Kemampuan merawat anggota keluarga yang sakit

..........................................................................................................................

.....................................................................................................................

d. Kemampuan keluarga memelihara/memodifikasi lingkungan rumah yang

sehat

........................................................................................................................

........................................................................................................................

e. Kemampuan menggunakan fasilitas pelayanan yang sehat

.........................................................................................................................

.........................................................................................................................

29. Fungsi Religius

................................................................................................................................

................................................................................................................................

30. Fungsi Rekreasi

..............................................................................................................................

31. Fungsi Reproduksi

.............................................................................................................................

...........................................................................................................................

32. Fungsi Afeksi

................................................................................................................................

.............................................................................................................................

VII.Stress Koping Keluarga

33. Stressor Jangka pendek dan panjang................................................................................................................................


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............................................................................................................................

34. Kemampuankeluargaberesponterhadap stressor

...............................................................................................................................

...............................................................................................................................

35. Strategi koping yang digunakan

...............................................................................................................................

..............................................................................................................................

36. Strategi adaptasi fungsional

..............................................................................................................................

................................................................................................................................

VII.Pemeriksaan Kesehatan Tiap Individu Anggota Keluarga

.....................................................................................................................................

....................................................................................................................................

....................................................................................................................................

....................................................................................................................................

VIII. Harapan Keluarga

...................................................................................................................................

...................................................................................................................................

...................................................................................................................................

..................................................................................................................................


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B. DIAGNOSA KEPERAWATAN KELUARGA

I. Analisis & Sintesis Data

No Data Masalah Penyebab


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II. Perumusan Diagnosis Keperawatan

No Diagnosa Keperawatan (PES)

1

2

III. Penilaian Skoring & Diagnosis Keperawatan

No.

Diagnosa Kep.

Kriteria Skor

a. Sifat masalah ....................

b. Kemungkinan masalah dapat dirubah

..................................

c. Potensi masalah untuk dicegah

....................................

d.Menonjolnya masalah .........................

....... x 1

3

....... x 1

2

....... x 1

3

........ x 1

2

TOTAL SKOR

IV. Prioritas Diagnosis Keperawatan

Prioritas Diagnosa Keperawatan Skor


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1

2


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C. RENCANA ASUHAN KEPERAWATAN KELUARGA

DxKeperawatan :

................

................................................................................................................................................

................................................................................................................................................

....................

Tujuan Kriteria Hasil/standar Intervensi

D. IMPLEMENTASI

No. Tangal &

Waktu

Dx Keperawatan Implementasi


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E.EVALUASITanggal &

Waktu

No DxKep. Evaluasi

Askep Keluarga Tn. M.docx

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