Download - Askep Keluarga Tn. M.docx
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ASUHAN KEPERAWATAN KELUARGA
PADA KLIEN TN. M
A. PENGKAJIAN
I. Data Umum
1. Kepala Keluarga : Tn. M (x tahun)
2. Alamat & Telepon : Komp. BLK Bawah RT. 010 No. x
3. Pekerjaan KK : Swasta
4. Pendidikan KK : SD/Madrasah
5. Komposisi Keluarga:
No Nama Jenis
Kelamin
Hubungan
dengan KK
Umur
(tahun)
Pendidikan Status Imunisasi Ket
Polio BCG DPT Hepatitis Cam pak
1 2 3 4 1 2 3 1 2 31 Ny. A Perempuan Isteri
2 Tn. X Laki-laki Orang tua/Ayah
3 An. Laki-laki Anak kandung L
4 An. Perempuan Anak kandung L
5 An. T Perempuan Anak kandung L
6 An. M Perempuan Anak kandung L
7 By. Perempuan Anak kandung
Ket:L = Lengkap
Genogram:
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6. Tipe Keluarga : ......................................................................
7.Suku Bangsa :........................................................................
8. Agama :.......................................................................
9. Status sosial ekonomi : ................................................................................
10. Aktivitas Rekreasi Keluarga: ........................................................................................
II. Riwayat dan Tahap Perkembangan Keluarga
11. Riwayat perkembangan keluarga saat ini .................................................................
12. Tugas Perkembangan keluarga yang belum terpenuhi
.....................................................................................................................................
13. Riwayat Kesehatan Keluarga Inti
AnggotaKeluar
ga
RiwayatKesehatanDahu
lu
RiwayatKesehatansaati
ni
Keteranga
n
14. Riwayat kesehatan keluarga sebelumnya
...............................................................................................................................
...............................................................................................................................
III. Data Lingkungan
15. Karakteristik Rumah
...............................................................................................................................
...............................................................................................................................
Denah Rumah :
16. Karakteristik tetangga dan komunitas
..............................................................................................................................
..............................................................................................................................
17. Mobilitas geografis keluarga
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18. Perkumpulan keluarga dan interaksi dengan masyarakat
..............................................................................................................................
..............................................................................................................................
19. Sistem pendukung keluarga
...............................................................................................................................
..............................................................................................................................
IV. Struktur Keluarga
20. Struktur Peran
...............................................................................................................................
...............................................................................................................................
21. Nilai atau norma keluarga
................................................................................................................................
...............................................................................................................................
22. Pola komunikasi keluarga
...............................................................................................................................
...............................................................................................................................
23. Struktur kekuatan keluarga
...............................................................................................................................
...............................................................................................................................
V. Fungsi Keluarga
24. Fungsi Ekonomi
...............................................................................................................................
...............................................................................................................................
25. Fungsi mendapatkan status ekonomi
...............................................................................................................................
..............................................................................................................................
26. Fungsi Pendidikan
...............................................................................................................................
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27. Fungsi Sosialisasi
............................................................................................................................
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28. Fungsi pemenuhan (perawatan/pemeliharaan) kesehatan
a. Mengenal masalah
.........................................................................................................................
.......................................................................................................................
b. Mengambil keputusan mengenai tindakan kesehatan
..........................................................................................................................
.........................................................................................................................
c. Kemampuan merawat anggota keluarga yang sakit
..........................................................................................................................
.....................................................................................................................
d. Kemampuan keluarga memelihara/memodifikasi lingkungan rumah yang
sehat
........................................................................................................................
........................................................................................................................
e. Kemampuan menggunakan fasilitas pelayanan yang sehat
.........................................................................................................................
.........................................................................................................................
29. Fungsi Religius
................................................................................................................................
................................................................................................................................
30. Fungsi Rekreasi
..............................................................................................................................
31. Fungsi Reproduksi
.............................................................................................................................
...........................................................................................................................
32. Fungsi Afeksi
................................................................................................................................
.............................................................................................................................
VII.Stress Koping Keluarga
33. Stressor Jangka pendek dan panjang................................................................................................................................
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............................................................................................................................
34. Kemampuankeluargaberesponterhadap stressor
...............................................................................................................................
...............................................................................................................................
35. Strategi koping yang digunakan
...............................................................................................................................
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36. Strategi adaptasi fungsional
..............................................................................................................................
................................................................................................................................
VII.Pemeriksaan Kesehatan Tiap Individu Anggota Keluarga
.....................................................................................................................................
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VIII. Harapan Keluarga
...................................................................................................................................
...................................................................................................................................
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B. DIAGNOSA KEPERAWATAN KELUARGA
I. Analisis & Sintesis Data
No Data Masalah Penyebab
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II. Perumusan Diagnosis Keperawatan
No Diagnosa Keperawatan (PES)
1
2
III. Penilaian Skoring & Diagnosis Keperawatan
No.
Diagnosa Kep.
Kriteria Skor
a. Sifat masalah ....................
b. Kemungkinan masalah dapat dirubah
..................................
c. Potensi masalah untuk dicegah
....................................
d.Menonjolnya masalah .........................
....... x 1
3
....... x 1
2
....... x 1
3
........ x 1
2
TOTAL SKOR
IV. Prioritas Diagnosis Keperawatan
Prioritas Diagnosa Keperawatan Skor
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1
2
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C. RENCANA ASUHAN KEPERAWATAN KELUARGA
DxKeperawatan :
................
................................................................................................................................................
................................................................................................................................................
....................
Tujuan Kriteria Hasil/standar Intervensi
D. IMPLEMENTASI
No. Tangal &
Waktu
Dx Keperawatan Implementasi
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E.EVALUASITanggal &
Waktu
No DxKep. Evaluasi