Format Pengkajian Keluarga-1
50
ASUHAN KEPERAWATAN KELUARGA PADA KELUARGA ..............................DENGAN ................................ DI..................................................... ........... OLEH:
Transcript of Format Pengkajian Keluarga-1
ASUHAN KEPERAWATAN KELUARGA
PADA KELUARGA ..............................DENGAN ................................
DI................................................................
OLEH:
PROGRAM STUDI S1 KEPERAWATAN NERS
SEKOLAH TINGGI ILMU KESEHATAN (STIKES) BALI
2013
FORMAT ASUHAN KEPERAWATAN KELUARGA
1. PENGKAJIANPengumpulan data dilaksanakan pada hari ……. ….......... pukul …...... wita. Data diperoleh dengan
cara wawancara, observasi, pemeriksaan fisik dan dokumentasi.
a. Data Umum
1) Kepala Keluarga
a. Nama :
b. Umur :
c. Jenis Kelamin :
d. Pendidikan :
e. Pekerjaan :
f. Agama :
g. Suku / Bangsa :
h. Alamat :
i. Tanggal Pengkajian :
2) Komposisi keluarga
Tabel …..Komposisi Keluarga …………………
No Nama L/P Umur Hub dgn
KK
Pendidikan Pekerjaan Keterangan
1
2
3
4
5
6
7
8
9
10
11
12
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14
15
16
3) Genogram
Keterangan:
: Laki-laki
: Anak Kandung: Perempuan
: Laki-laki meninggal: Anak Angkat
: Perempuan Meninggal
: Tinggal serumah
: Abortus: Menikah
: Pisah: Kembar
: Cerai
Penjelasan:
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4) Tipe keluarga
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5) Latar Belakang Budaya (Etnis)
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6) Agama
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7) Status Sosial Ekonomi Keluarga
Tabel ….
Rata-Rata Pendapatan dan Pengeluaran Keluarga
No. Nama Pekerjaan Pendapatan Pengeluaran Keterangan
1
2
3
Penjelasan :
8) Aktivitas rekreasi keluarga atau waktu luang
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……….
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……….
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b. Tahap perkembangan keluarga
1. Tahap perkembangan keluarga saat ini (ditentukan dengan anak tertua):
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2. Tahap perkembangan keluarga yang belum terpenuhi
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3. Riwayat keluarga sebelumnya
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…….
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…….
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c. Data Lingkungan
1. Karakteristik rumah
1). Luas rumah : ....................................................................................................
2). Tipe rumah : ....................................................................................................
3). Kepemilikan : ....................................................................................................
4). Pemanfaatan ruangan
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5). Septic tank: ada/tidak..............letak........................................................................
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6). Sumber air minum
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7). Kamar mandi/WC
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8).Sampah
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limbah RT...............................................................................................................
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9).Kebersihan lingkungan
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10).Denah rumah
2. Karakteristik lingkungan dan komunitas
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3. Mobilitas geografis keluarga
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4. Perkumpulan keluarga dan interaksi dengan masyarakat
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5. Sistem pendukung keluarga
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d. Struktur Keluarga
1) Pola komunikasi keluarga
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2) Struktur kekuasaan
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3) Struktur peran
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4) Nilai dan norma keluarga yang berkaitan dengan kesehatan
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e. Fungsi Keluarga
1) Fungsi afektif
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2) Fungsi Sosialisasi
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3) Fungsi Perawatan Kesehatan
a) Keyakinan, nilai dan prilaku keluarga
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b) Definisi keluarga tentang sehat dan sakit
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c) Status kesehatan dan kerentanan sakit yang dirasakan oleh keluarga
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d) Praktek diet keluarga
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e) Kebiasaan tidur dan istirahat
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f) Latihan dan rekreasi
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g) Kebiasaan menggunakan obat-obatan dalam keluarga
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h) Perawatan diri
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i) Praktek lingkungan
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j) Pemeriksaan kesehatan secara teratur
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k) Kesehatan gigi
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l) Riwayat kesehatan keluarga
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m) Pelayanan perawatan kesehatan yang diterima
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n) Perasaan dan persepsi terhadap pelayanan kesehatan
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o) Sumber pembiayaan pelayanan kesehatan
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p) Logistik untuk mendapatkan perawatan
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f. Pemeriksaan fisik
TABEL ...............PEMERIKSAAN FISIK PADA KELUARGA ...................
No Pemeriksaan Fisik Nama Anggota Keluarga
1 Keadaan Umum
a. Postur tubuh
b. bangun Tubuh
c. Kesadaran
d. TB/BB
2 Gejala Kardinal
a. Suhu
b. Tekanan Darah
c. Nadi
d. Respirasi
1) Data Penunjang
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2) Keadaan fisik klien
a. Kepala : .....................................................................................
b. Mata : .....................................................................................
c. Hidung : .....................................................................................
d. Telinga : .....................................................................................
e. Mulut : .....................................................................................
f. Leher : .....................................................................................
g. Thorak : .....................................................................................
h. Abdomen : .....................................................................................
i. Ekstremitas:
Ekstremitas atas : .....................................................................................
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Ekstremitas bawah: .....................................................................................
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g. Koping keluarga
1) Stressor jangka pendek dan jangka panjang
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2) Kemampuan keluarga untuk berespon terhadap situasi atau stressor
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3) Penggunaan strategi koping
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4) Strategi adaptasi disfungsional
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h. Analisa DataTabel .......
Analisa Data Asuhan ............................................
No. Data Subjektif Data Objektif MasalahKeperawatan
i. Rumusan Masalah
1.
2.
3.
4.
5.
j. Skoring
Tabel .....Skoring Masalah .............................
NO Kriteria Perhitungan Skor Pembenaran
1 2 3 4 51. Sifat masalah: .....................................................................
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2. Kemungkinan masalah dapat diubah:
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3. Potensi masalah untuk dicegah:
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4. Menonjolnya masalah: ..................................................................... ..............................................................................................................................................................................................................................................................................................................................................................................................................................
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Total Skor
Tabel .....Skoring Masalah .............................
NO Kriteria Perhitungan Skor Pembenaran
1 2 3 4 51. Sifat masalah: .....................................................................
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2. Kemungkinan masalah dapat diubah:
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3. Potensi masalah untuk dicegah:
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4. Menonjolnya masalah: ..................................................................... .....................................................................
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Total Skor
k. Diagnosa Keperawatan
1.
2.
3.
4.
5.
2. PERENCANAAN
a. Prioritas diagnosa Keperawatan1.
2.
3.
4.
5.
b. Rencana KeperawatanNo. DiagnosaKeperawata
nTujuan Evaluasi Intervensi
Kriteria Standar1 2 3 4 5 6
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3. IMPLEMENTASI DAN EVALUASI
Tabel ...........Implementasi dan Evaluasi Keperawatan ..............................
No Hari/Tgl/Jam No. Dx Implementasi Evaluasi Paraf1 2 3 4 5 6
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Tabel .................Evaluasi Asuhan Keperawatan .......................................
Hari/Tgl/Jam DxKep Evaluasi Paraf1 2 3 4
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LEMBAR PENGESAHAN
Denpasar, Desember 2013Mahasiswa
( )NIM
Mengetahui,
Pembimbing Ruangan Pembimbing Akademik
( ) ( )NIP. NIR.
