ASUHAN KEPERAWATAN KELUARGA

A. PENGKAJIAN

1. DATA UMUM
1. Inisial kepala keluarga: ..............
2. Usia

: ................

3. Pendidikan

: ..............

4. Agama
5. Suku

: ..............
: ..............

6. Alamat
7. Tipe Keluarga

: ..............
: ................

8. Komposisi keluarga :
No

Nama

Jenis
Kelamin

Hubungan
dengan KK

Umur Pendidikan Status Imunisasi

Genogram :
9. Status Sosial Ekonomi Keluarga :
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10. Aktivitas rekreasi keluarga :
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2. Riwayat Tahap Perkembangan Keluarga
11. Tahap perkembangan keluarga saat ini :
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12. Tahap perkembangan keluarga yang belum terpenuhi :

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13. Riwayat keluarga inti :
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14. Riwayat keluarga sebelumnya :
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3. Lingkungan
15. Karakteristik rumah :
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Denah rumah :

16. Karakteristik Lingkungan

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17. Mobilitas geografis keluarga
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18. Perkumpulan keluarga dan interaksi dengan masyarakat
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19. Sistem pendukung keluarga
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4. Struktur Keluarga
20. Pola komunikasi keluarga
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21. Struktur kekuatan keluarga
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22. Struktur peran
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23. Nilai dan norma keluarga :
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5. Fungsi Keluarga
24. Fungsi Afektif :
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25. Fungsi Sosial :

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26. Fungsi Reproduksi :
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27. Fungsi Ekonomi :
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28. Fungsi Perawatan Kesehatan :

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6. Stres dan Koping Keluarga
a. Stressor jangka pendek : .................................................................................................
b. Stressor jangka panjang : ................................................................................................
c. Kemampuan keluarga berespon terhadap situasi/stressor
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d. Strategi koping yang digunakan
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e. Strategi adaptasi disfungsional
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f. Harapan keluarga
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B. DIAGNOSIS KEPERAWATAN KELUARGA

C. RENCANA ASUHAN KEPERAWATAN KELUARGA

D. IMPLEMENTASI
E. EVALUASI