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ASUHAN KEPERAWATAN KELUARGA

Pengkajian tanggal

I. Data Umum

1. Nama KK ;

2. Usia :

3. Pendidikan :

4. Pekerjaan :

5. Alamat :

6. Komposisi :

No Nama Umur Jk Status Pendidikan Pekerjaan Imunisasi Status

Keseatan

Genogram : di!at tiga generasi dan penjelasann"a.

#. $ipe Kel!arga :

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%. &!k! :

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'. Agama ;

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1(. &tat!s &osial )konomi kel!arga :

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11. Akti*itas +ekreasi Kel!arga :

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II. Ri!a"at dan Taa# #erkem$an%an Ke&uar%a

12. $a,ap Perkemangan Kel!arga &aat ini :

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13. $a,ap Perkemangan Kel!arga -ang el!m terpen!,i :

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14. +ia"at Kel!arga /nti :

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15. +ia"at Kel!arga &eel!mn"a

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III. Lin%kun%an

'(. Karakteristik Ruma

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1#. Karakteristik tetangga dan Kom!nitas :

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1%. 0oilitas Geograis Kel!arga :

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1'. Perk!mp!lan kel!arga dan /nteraksi dengan 0as"arakat

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2(. &istem Pend!k!ng Kel!arga.............................................................................................................................................

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I). Struktur Ke&uar%a

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21. Pola Kom!nikasi Kel!arga

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22. &tr!kt!r Kek!atan Kel!arga

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23. &tr!kt!r Peran

/dentitas masingmasing peran dalam klg :

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24. Nilai dan Norma !da"a

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). Ke&uar%a

25. !ngsi Aekti

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.............................................................................................................................................26. !ngsi sosial

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2#. !ngsi Peraatan Kel!arga

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2%. !ngsi +eprod!ksi

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2'. !ngsi )konomi

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)I. Stres dan Ko#in% ke&uar%a

3(. &tresor angka pendek dan jangka panjang

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31. Kemamp!an Kel!arga erespon ter,adap 0asala,

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32. &trategi Koping "ang ig!nakan

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33. &trategi adaptasi is!ngsi

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7//. 8arapan kel!arga

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7///. ata $ama,an

34. ke!t!,an iologi

a. N!trisi

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. )liminasi.............................................................................................................................................

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9. tid!r dan /stira,at

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d. akti*itas se,ari,ari

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35. Pemeriksaan isik Kel!arga

$ael 1. Pengkajian isik Kel!arka $n.

No KomponenPemeriksaan

Tn Ny. .. An

1 Kepala2 Mata3 Telinga

4 Hidung5 Mulut !e"er dan

Tenggorokan

# $ada danparu

% &antung' A(domen1) *+tremitas

11 Kulit12 Kuku13 ,,14 T,15 Tanda -ital1 Kesimpulan

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Ta$e& *. Ana&isa Data

N

o Data Masalah Kesehatan

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$ael 3. 0asala,.

No

Kriteria ,o(ot Nilai Pem(enaran

1 i/at masala" 0

aktual

1

2 Kemungkinanmasala" dapatdiu(a" 0e(agian

2

3 Potensi untuk

diega" 0ukup

1

4 Menonolnyamasala" 0segera ditangani

1 .

&umla"

$ael 4.

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No Kriteria ,o(ot Nilai Pem(enaran1 i/at masala" 0

Aktual1

2Kemungkinanmasala" dapatdiu(a" 0 se(agian

2

3Potensi untukdiega" 0 Muda"

1

4Menonolnyamasala" 0 inginsegera diatasi

1

&umla"Dia%nosa Ke#era!atan Prioritas

ASUHAN KEPERAWATAN KELUARGA TN

DENGAN +ASALAH PERKE+,ANGAN TAHAP KE *

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NoDia%nosa

Ke#. K&%.

Tujuan Standar E-a&uasiInter-ensi

Umum Kusus Kriteria Standar

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