FORMAT PENGKAJIAN KEPERAWATAN PADA KELUARGA.docx

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PENGKAJIAN KELUARGA A. Data Umum Identitas Kepala Keluarga Nama :………………………………………... Umur :………………………………………... Agama :............................................. ................ Suku bangsa :....................................................... ...... Pendidikan :........................................ ..................... Pekerjaan :........................................ ..................... Alamat :............................................. ................ Komposisi Keluarga N O Nama Anggota Keluarga Umur (tahun) L / P Suku Bangsa Status Kawin Hubungan dengan KK Agama Pendidikan Pekerjaan Keadaan Kesehatan KB Immunisasi (Lengkap/Td k Lengkap) 1 2 3 4 5 6 7 8 9 10 11 12 13 1. 2. 3. 4. 5. 6. PPN ANGKATAN XXIV KEBON WARU RW 07

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keperawatan komunitas

Transcript of FORMAT PENGKAJIAN KEPERAWATAN PADA KELUARGA.docx

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PENGKAJIAN KELUARGA

A. Data Umum

Identitas Kepala Keluarga

Nama :………………………………………...

Umur :………………………………………...

Agama :.............................................................

Suku bangsa :.............................................................

Pendidikan :.............................................................

Pekerjaan :.............................................................

Alamat :.............................................................

Komposisi Keluarga

NO

Nam

a A

ngg

ota

Kel

uar

ga

Um

ur

(tah

un

)

L/P

Su

ku

Ban

gsa

Sta

tus

Kaw

in

Hu

bu

nga

n

den

gan

KK

Aga

ma

Pen

did

ikan

Pek

erja

an

Kea

daa

n

Kes

ehat

an

KB

Imm

un

isas

i (L

engk

ap/T

dk

L

engk

ap)

1 2 3 4 5 6 7 8 9 10 11 12 131.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Genogram

PPN ANGKATAN XXIV KEBON WARU RW 07

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Tipe keluarga

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Suku Bangsa

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Agama

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Status Sosial Ekonomi Keluarga

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Aktivitas Rekreasi Keluarga

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B. Riwayat dan Tahap Perkembangan Keluarga

Tahap Perkembangan Keluarga Saat Ini

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Tahap Perkembangan Keluarga yang Belum Terpenuhi

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Riwayat keluarga inti

Riwayat Penyakit Keturunan

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Riwayat Kesehatan Keluarga

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Sumber Pelayanan Kesehatan yang digunakan

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Riwayat Keluarga Sebelumnya

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C. Lingkungan

Karakteristik Lingkungan Rumah

Luas Rumah :........................................................................................................

Tipe Rumah :........................................................................................................

Jumlah Ruangan :........................................................................................................

Jumlah Jendela :........................................................................................................

Jarak Septic tank :........................................................................................................

Sumber Air Minum :........................................................................................................

Pembuangan Limbah :........................................................................................................

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Denah Rumah

Karakteristik Tetangga dan Komunitas RW

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Mobilitas Geografis Keluarga

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Perkumpulan Keluarga dan Interaksi dengan Masyarakat

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Pola Komunikasi

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Sistem Pendukung Keluarga

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Struktur Kekuatan Keluarga

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Struktur Peran (Formal dan Informal)

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Nilai dan Norma Keluarga

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D. Fungsi Keluarga

Fungsi Afektif

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Fungsi Sosial

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Fungsi Perawatan Kesehatan

Mengenal masalah kesehatan

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Mengambil Keputusan untuk Mengatasi masalah

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Merawat Anggota Keluarga dengan masalah Kesehatan

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Memodifikasi Lingkungan

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Memanfaatkan Fasilitas Layanan Kesehatan

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Fungsi Reproduksi

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Fungsi Ekonomi

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E. Stres dan Koping Keluarga

Stressor

Stressor Jangka Pendek

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Stressor Jangka Panjang

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Kemampuan Keluarga berespon terhadap situasi/ stresor

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Strategi Koping yang Digunakan

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Strategi Adaptasi Fungsional

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F. Harapan Keluarga terhadap Petugas Kesehatan

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G. Pemeriksaan Fisik

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PENGKAJIAN KELUARGA MANDIRI

No Masalah Kesehatan Masalah KeperawatanKriteria Keluarga Mandiri

Kategori Kesimpulan1 2 3 4 5 6 7 8 9 10

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ANALISA DATA

No Data Masalah

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Diagnosa Keperawatan menurut Skala Prioritas

No Kriteria Skor BobotPerhitungan untuk Diagnosa

1 Sifat masalahSkala:

- Aktual (tidak/kurang sehat)- ancaman kesehatan- keadaan sejahtera

321

1

2 Kemungkinan masalah dapat diubahSkala:

- mudah- sebagian- tidak dapat

210

2

3 Potensial masalah untuk dicegahSkala:

- tinggi- cukup- rendah

321

1

4 Menonjolnya masalahSkala:

- masalah berat, harus segera ditangani

- ada masalah, tetapi tidak perlu segera ditangani

- masalah tidak dirasakan

2

1

0

1

TOTAL SKORE

RENCANA KEPERAWATAN KELUARGA

NoDiagnosa Keperawatan

Keluarga

Tujuan Kriteria EvaluasiRencana Intervensi

Umum Khusus kriteria Standar

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IMPLEMENTASI DAN EVALUASI KEPERAWATAN KELUARGA

No Nomor Dx Tujuan Khusus Tanggal Implementasi Evaluasi

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JADWAL KUNJUNGAN KELUARGA

TANGGAL KEGIATANPARAF

KELUARGA PETUGAS

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GENOGRAM

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DENAH

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