Pendidikan
: SMP
Umur : 44 tahun
Pekerjaan
Agama : Hindu
Alamat
Suku : Bali
No. Telepon
: 0812233445566
2. Komposisi keluarga
No
Nama
Hub dgn
Pendidika
KK
L/P Umur
Pekerjaan
Keterangan
Ni Wayan Rinten
35 th
Istri
SD
Buruh Lepas
...
10 th
Anak
Siswa
...
G.Md.Bintang Candra
4 th
Anak
...
72 th
Ibu
...
3. Genogram
4. Tipe keluarga
[1]
Ny. Jati (Ibu dari kepala keluarga) memiliki kebiasaan meminum lebih dari
3 gelas kopi sehari. Padahal Ny. Jati memiliki riwayat hipertensi, saat
diingatkan oleh keluarganya untuk mengurangi minum kopi, Ny. Jati akan
2.
6. Agama
Kepercayaan yang mempengaruhi kesehatan
[2]
2.
hari, untuk itu total penghasilan Tn. Dogler per bulan adalah RP 750.000.
Ny. Rinten adalah seorang buruh harian lepas. Beliau biasa bekerja
membantu menjadi buruh cuci, membantu menjadi buruh panen apabila
musim panen tiba, dengan penghasilan rata-rata per hari Rp 20.000, untuk
itu total penghasilan Ny. Rinten adalah kurang lebih Rp 600.000/bulan.
Rp 1. 350.000
Rp 150.000
Rp 350.000
Rp 850.000
No.
Jenis Pengeluaran
Biaya
1.
Biaya Sekolah Anak (SPP, buku, uang jajan, seragam, Rp 150.000
dll)
[3]
Biaya Makan
Listrik, Air, Keperluan Rumah Tangga
Transportasi (uang bensin)
Biaya Tak Terduga (sakit, kecelakaan, musibah)
TOTAL PENGELUARAN
Rp 300.000
Rp. 150.000
Rp 150.000
Rp 100.000
Rp 850.000
meningkat
termasuk
biaya
kehidupan dan
1.
Dogler
44th
68/175
Baik
Imunisasi
(BCG/Polio/DPT/
HB/ Campak)
-
2.
Rinten
35th
55/160
Baik
3.
Bulan
10th
35/140
Lemah
No
Nama
Umur
BB/TB
Keadaan
kesehatan
BCG
Tindakan
yang telah
dilakukan
-
Masalah
kesehatan
Asma
Rawat jalan
Puskesmas
4.
Bintang
4th
18/98
Lemah
BCG
5.
Jati
72th
48/155
Lemah
Malnutrisi
Asma,
Rawat jalan
hipertensi
Puskesmas
, luas bangunan 36
[8]
[10]
3.
Struktur peran
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4.
[11]
FUNGSI KELUARGA
1. Fungsi afektif
1). Perasaan saling memiliki
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1). Dukungan terhadap anggota keluarga
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2). Kehangatan
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3). Saling menghargai
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2. Fungsi sosialisasi
1). Kerukunan hidup dalam keluarga
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[12]
[13]
[14]
[16]
Vital Sign
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BB, TB/PB
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Kepala
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[18]
(......)
[22]
:...............................................................................
Tgl
Data
Diagnosa Keperawatan
Data Subjektif :
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[23]
Kriteria
Sifat masalah:
Nilai
Bobot
1
Skoring
Pembenaran
Aktual
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Resiko
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Potensial
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Kemungkinan masalah
untuk diubah
Mudah
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Sebagian
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Tidak dapat
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[24]
Tinggi
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Cukup
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Rendah
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Menonjolnya masalah
Segera diatasi
Tidak segera
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diatasi
Tidak dirasakan
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adanya masalah
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TOTAL
[25]
:.................................................................
No Diagnosa Keperawatan
Tanggal
Implementasi
[26]
Paraf
:.................................................................
No Diagnosa Keperawatan
Tanggal
Evaluasi
[27]
Paraf
KRITERIA EVALUASI
KRITERIA
STANDAR
....
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DIAGNOSIS
KEPERAWATAN
TUJUAN
[28]
INTERVENSI
Nama
L/P
Pendidika
Umur
Pekerjaan
KK
Keterangan
...
... ...
...
... ...
...
... ...
...
... ...
...
... ...
GENOGRAM
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[29]
[30]