ASUHAN KEPERAWATAN GERONTIK

DENGAN MASALAH KESEHATAN ...

Nama Mahasiswa

Tanggal pengkajian

Metode Pengkajian

I.

IDENTITAS DIRI KLIEN

Nama

Umur

Jenis kelamin

Alamat

Status perkawinan :
Agama

Suku

Pendidikan

Sumber keuangan :
Penanggungjawab

II.

Nama

Alamat

KONDISI KEHIDUPAN KLIEN SAAT INI

Genogram :

III. RIWAYAT KELUARGA

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IV. RIWAYAT PENYAKIT

1. Keluhan utama saat ini :
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2. Apa yang dipikirkan saat ini :
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3. Siapa yang paling dipikirkan saat ini :
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4. Riwayat penyakit dahulu :

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V.

PENGKAJIAN
1. Persepsi dan pemeliharaan kesehatan :
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Pola nutrisi :
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Pola eliminasi :
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2. Pola aktivitas dan latihan

Kemampuan perawatan diri

Mandiri

Tergantung

Mandi
Berpakaian
Toileting
Transferring
Continence
Makan/ minum

3. Pola tidur dan istirahat :

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4. Pola persepsi diri
a. Gambaran diri : .........................................................................................................
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b. Ideal diri

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

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c. Harga diri

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

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d. Identitas diri

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

e. Peran diri

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

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5. Pola managemen koping stress :
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6. Sistem nilai dan keyakinan :
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VI. PEMERIKSAAN FISIK
1. Pemeriksaan fisik
a. Tingkat kesadaran : ...................................................................................................
b. TD

: ...................... mmHg

Nadi

: ...................../ menit

Respirasi : ...................../ menit

: ..........0C

Suhu

c. Ektremitas: .................................................................................................................
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2. Pemeriksaan panca indera
a. Penglihatan (mata)
-

Konjungtiva

Sclera

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

..........
-

Refleks pupil
: ...........................................................................................

b. Pendengaran (telinga) : ...........................................................................................

-

Liang telinga
: ...........................................................................................

No.

c. Pengecapan (lidah)

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

d. Sensasi (kulit)

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

e. Penciuman (hidung)

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

Data Fokus

ANALISA DATA
Masalah / Problem

Penyebab / Etiologi

DIAGNOSA KEPERAWATAN

Sesuai dengan Prioritas :