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Transcript of FORMAT PENGKAJIAN KEPERAWATAN PADA KELUARGA.docx
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
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
PPN ANGKATAN XXIV KEBON WARU RW 07
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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 :........................................................................................................
PPN ANGKATAN XXIV KEBON WARU RW 07
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
PPN ANGKATAN XXIV KEBON WARU RW 07
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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
PPN ANGKATAN XXIV KEBON WARU RW 07
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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
PPN ANGKATAN XXIV KEBON WARU RW 07
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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
PPN ANGKATAN XXIV KEBON WARU RW 07
PENGKAJIAN KELUARGA MANDIRI
No Masalah Kesehatan Masalah KeperawatanKriteria Keluarga Mandiri
Kategori Kesimpulan1 2 3 4 5 6 7 8 9 10
PPN ANGKATAN XXIV KEBON WARU RW 07
ANALISA DATA
No Data Masalah
PPN ANGKATAN XXIV KEBON WARU RW 07
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
PPN ANGKATAN XXIV KEBON WARU RW 07
IMPLEMENTASI DAN EVALUASI KEPERAWATAN KELUARGA
No Nomor Dx Tujuan Khusus Tanggal Implementasi Evaluasi
PPN ANGKATAN XXIV KEBON WARU RW 07
PPN ANGKATAN XXIV KEBON WARU RW 07
JADWAL KUNJUNGAN KELUARGA
TANGGAL KEGIATANPARAF
KELUARGA PETUGAS
PPN ANGKATAN XXIV KEBON WARU RW 07
GENOGRAM
PPN ANGKATAN XXIV KEBON WARU RW 07
DENAH
PPN ANGKATAN XXIV KEBON WARU RW 07