PENGKAJIAN KELUARGA

FORMAT PENGKAJIAN KELUARGAPRAKTEK KEPERAWATAN KELUARGA MAHASISWA PRODI DIII KEPERAWATAN BENGKULU JURUSAN KEPERAWATAN POLTEKKES KEMENKES BENGKULU TA. 2014/2015

I. DATA UMUM 1. Nama Kepala Keluarga: .2. Alamat dan telepon : ................................................................................. ................................................................................3. Pekerjaan kepala keluarga: ................................................................................4. Pendidikan Kepala Keluarga: ................................................................................5. Komposisi Keluarga : ................................................................................

NoNamaJKHubungan Dgn KepalaKeluargaUmurPnddkStatus ImunisasiKET

BCGPolioDPTHepatitisCampak

1234123123

Genogram (tiga generasi) :

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

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

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

9. Status Sosial Ekonomi : ................................................................................................... .....................................................................................................................................................................................................

10. Aktifitas Rekreasi Keluarga: ................................................................................................... ......................................................................................................................................................................................................

II. RIWAYAT TAHAP PERKEMBANGAN KELUARGA

11. Tahap Perkembangan Keluarga saat ini : ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

12. Tahap Perkembangan Keluarga yang belum Terpenuhi : ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

13. Riwayat Keluarga Inti : ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

14. Riwayat keluarga sebelumnya : ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

III. LINGKUNGAN 15. Karakteristik Rumah : ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

Denah Rumah :

16. Karakteristik tetangga dan Komunitas RW : ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

17. Mobilitas Geografis Keluarga : ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

18. Perkumpulan Keluarga dan Interaksi dengan masyarakat : ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

19. Sistem Pendukung Keluarga : ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

IV. STRTUKTUR KELUARGA20. Pola Komunikasi Keluarga : ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

21. Struktur Kekuatan Keluarga : ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

22. Struktur Peran Formal dan Informal : ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

23. Nilai dan Norma dalam Keluarga : ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

V. FUNGSI KELUARGA

24. Fungsi Afektif : ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

25. Fungsi Sosial ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

26. Fungsi Perawatan Keluarga :............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

27. Fungsi Reproduksi : ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

28. Fungsi Ekonomi : ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

VI. STRES DAN KOPING KELUARGA29. Stresor jangka pendek dan Panjang : ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

30. Kemampuan keluarga Berespon terhadap situasi / stresor : ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

31. Strategi Koping yang Digunakan : ............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

32. Strategi Adaptasi Disfungsional............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................

VII. PEMERIKSAAN FISIK ( HEAD TO TOE ) ( Dikaji pada setiap anggota keluarga )

NOVARIABELNAMA ANGGOTA KELUARGA

Tn.Ny.An.An.

1Riwayat penyakit saat ini

2Keluhan yang dirasakan

3Riwayat penyakit sebelumnya

4Tanda-tanda vital

5Kepala

6Leher

7Thoraks

8Abdomen

9Esktremitas

10Kulit

11Genetalia

VIII. HARAPAN KELUARGA

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

IX. ANALISIS DATA

NoDATAETIOLOGIMASALAH

Data Subjektif :

Data Objektif :

Data Subjektif :

Data Objektif :

Data Subjektif :

Data Objektif :

X. PRIORITAS MASALAH DX. I . .

NoKriteriaSkorBobotPembenaran

1Sifat Masalah Skala : Tidak / Kurang Sehat Ancaman Kesehatan Keadaaan Sejahtera

3211

2Kemungkinan Masalah dapat diubah Skala : Mudah Sebagian Tidak dapat

2102

3Potensial Masalah Untuk dicegah Skala : Tinggi Cukup Rendah 3211

4Menonjolnya Masalah Skala : Masalah Berat harus segera di tangani Adanya Masalah tetapi tidak perlu ditangani Masalah Tidak Dirasakan : 2101

Jumlah

Dx 2. . .

NoKriteriaSkorBobotPembenaran

1Sifat Masalah Skala : Tidak / Kurang Sehat Ancaman Kesehatan Keadaaan Sejahtera

3211

2Kemungkinan Masalah dapat diubah Skala : Mudah Sebagian Tidak dapat

2102

3Potensial Masalah Untuk dicegah Skala : Tinggi Cukup Rendah

3211

4Menonjolnya Masalah Skala : Masalah Berat harus segera di tangani Adanya Masalah tetapi tidak perlu ditangani Masalah Tidak Dirasakan :

2101

Jumlah

XI. DIAGNOSA KEPERAWATAN SESUAI PRIORITAS

1. 2. 3. 4.

XII. RENCANA ASUHAN KEPERAWATAN KELUARGA

NoDiagnosa Keperawatan TujuanKriteria EvaluasiRencana Intervensi

Tjuan Umum

Tujuan Khusus

KriteriaStandar

NB : Rencana dibuat untuk kelima tujuan sesuai tugas keluarga

XIII. PELAKSANAAN DAN EVALUASI

NoTanggalDiagnosisKeperawatanKeluargaTujuan KhususImplementasiEvaluasi

S

O

A

P

1