47

DAFTAR PUSTAKA

Brunner & Suddarth. 2016. Keperawatan Medikal Bedah. Jakarta : EGC

Depkes RI. 2017. Data dan Informasi Profil Kesehatan Indonesia , dilihat 17
Januari 2019. (http : // www. Depkes .go .id / resources / download /
pusdatin / profil–kesehatan–indonesia/Data–dan-informasi_Profil-
Kesehatan-Indonesia-2017.pdf infodatin / infodatin_tb.pdf).

Digiulio Mary, dkk. 2014. Keperawatan Medikal Bedah. Yogyakarta :Rapha

Publishing

Friedman,M dkk. 2014. Buku Ajar Keperawatan Keluarga Riset, Teori, dan
Praktis. Jakarta : EGC

Heather, dkk. 2018. Diagnosis Keperawatan Definisi dan Klasifikasi 2018-2020.

Jakarta : EGC

M. Bulechek, dkk. 2015. Nursing Interventions Classification. Elsevier

Manurung, Santa. 2009. Gangguan Sistem Pernafasan Akibat Infeksi. Jakarta:

Trans Info Media

Moorhead, dkk. 2015. Nursing Outcomes Classification. Elsevier

Nurarif. 2016. Asuhan Keperawatan Praktis. Jogjakarta : Mediaction Publishing

Program Studi D III Keperawatan Universitas Bondowoso. 2019. Buku Panduan

Penyusunan Karya Tulis Ilmiah (Studi Kasus) Tahun Akademik
2017/2018. Bondowoso : Tidak dipublikasikan

Rohmah, Nikmatur & Saiful Walid. 2014. Proses Asuhan Keperawatan Teori dan
Aplikasi. Jogjakarta : Ar-Ruzz Media

Tanto Chris, dkk. 2014. Kapita Selekta Kedokteran. Jakarta : Media Aesculaptus

W. Sudoyo ,dkk. 2009. Buku Ajar Ilmu Penyakit Dalam. Jakarta :Interna
Publishing

Wahid, Abd & Suprapto, Imam. 2013. Asuhan Keperawatan pada Gangguan
Sistem Respirasi. Jakarta: Trans Info Media

Widoyono.2011. PenyakitTropisEpidemiologi, Penularan,

Pencegahan&Pemberantasannya.Semarang : PT GeloraAksaraPratama

WHO. 2018. Global Tuberculosis Report.dilihat 18 Januari 2019.

(https://www.who.int/tb/publications/global_report/en/)
 48

Lampiran 1 informed Consent

FORMULIR PERSETUJUAN SETELAH PENJELASAN

(INFORMED CONSENT)

Surat Persetujuan Respon dan Penulisan :

Nama Institusi : Program Studi DIII Keperawatan Universitas Bondowoso
Surat Persetujuan Peserta Penulisan :
Yang bertanda-tangandibawahini :
Nama :
Jenis Kelamin :
Usia :
Setelah mendapatkan keterangan secukupnya serta menyadari manfaat dan
resiko penulisan tersebut dibawah ini yang berjudul :
Asuhan Keperwatan Pada Klien Yang Mengalami Tuberculosis Paru Dengan
Hambatan Pemeliharaan Rumah di Desa Kapuran RT 09 RW 04 Kecamatan
Wonosari Kabupaten Bondowoso Tahun 2019 oleh mahasiswa atas nama Fitria
Wiwik Andriana (NIM 16-03714-0930) dari Prodi DIII Keperawatan Universitas
Bondowoso
Dengan sukarela menyetujui diikutsertakan dalam penulisan diatas dengan

catatan suatu waktu merasa dirugikan dalam bentuk apapun, berhak membatalkan

persetujuan ini.

Bondowoso, …………………. 2019

Mengetahui, Yang Menyetujui

Penanggung Jawab Penulisan Peserta Penulisan

(…………………………………….) (……………………………………)
 49

Lampiran 2 Format Pengkajian KMB

PENGKAJIAN KEPERAWATAN
ASUHAN KEPERAWATAN MEDIKAL BEDAH
PRODI DIII KEPERAWATAN UNIVERSITAS BONDOWOSO

Nama mahasiswa : ................................. Tgl/jam MRS : .....................

Tgl/jam pengkajian : ................................. No. RM : .....................
Diagnosa medis : ................................. Ruangan/kelas : .....................
................................. No. Kamar : .....................

I. IDENTITAS
1. Nama : .................................................................................
2. Umur : .................................................................................
3. Jenis kelamin : .................................................................................
4. Status : .................................................................................
5. Agama : .................................................................................
6. Suku/bangsa : .................................................................................
7. Bahasa : .................................................................................
8. Pendidikan : .................................................................................
9. Pekerjaan : .................................................................................
10. Alamat dan no. telp : .................................................................................
11. Penanggung jawab : .................................................................................
II. RIWAYAT SAKIT DAN KESEHATAN
1. Keluhanutama :
.................................................................................................................
2. Riwayat penyakit sekarang :
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................

3. Riwayat penyakit dahulu :

 50

.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................

4. Riwayat kesehatan keluarga :

.................................................................................................................
.................................................................................................................

.................................................................................................................
.................................................................................................................
.................................................................................................................
5. Susunan Keluarga (Genogram) :

6. RiwayatAlergi
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
III. POLA FUNGSI KESEHATAN
1. Persepsi Terhadap Kesehatan (Keyakinan Terhadap Kesehatan &
Sakitnya)
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
 51

.................................................................................................................
2. PolaAktivitas Dan Latihan
a. Kemampuan perawatan diri
SMRS MRS
Aktivitas
0 1 2 3 4 0 1 2 3 4
Mandi
Berpakaian/berdandan
Eliminasi/toileting
Mobilitas di tempat tidur
Berpindah
Berjalan
Naik tangga
Berbelanja
Memasak
Pemeliharaan rumah
Skor
0 = mandiri 3 = dibantu orang lain & alat
1 = alat bantu 4 = tergantung/tidak mampu
2 = dibantu orang lain
Alat bantu : ( ) tidak ( ) kruk ( ) tongkat
( ) pispot disamping tempat tidur ( ) kursi roda
a. Kebersihan diri
Di rumah Di rumah sakit
Mandi : ........................  /hr Mandi : ........................  /hr
Gosok gigi : ........................  /hr Gosok gigi : ........................  /hr
Keramas : ....................  /mgg Keramas : ....................  /mgg
Potong kuku : ....................  /mgg Potong kuku :....................  /mgg
b. Aktivitas sehari-hari
..................................................................................................................
c. Rekreasi
..................................................................................................................
d. Olahraga : ( ) tidak ( ) ya
 52

..................................................................................................................
3. Pola Istirahat dan Tidur
Dirumah Dirumah Sakit
Waktu tidur : Siang..........-............. Waktu tidur : Siang.........-..........
Malam......-............. Malam......-.........
Jumlah jam tidur :.......................... Jumlah jam tidur :......................
Masalah di RS : ( ) tidak ada ( ) terbangun dini ( ) mimpi buruk
( ) insomnia ( ) Lainnya, ...............................

4. PolaNutrisi – Metabolik
a. Pola makan
Di rumah Di Rumah Sakit
Frekuensi : ......................... Frekuensi :.........................
Jenis : ......................... Jenis :.........................
Porsi : ......................... Porsi :.........................
Pantangan : ......................... Pantangan :.........................
Makanan disukai : ......................... Makanan disukai:.........................

Nafsu makan di RS : ( ) normal ( ) bertambah ( ) berkurang

( ) mual ( ) muntah, .............. cc ( ) stomatitis
Kesulitan menelan : ( ) tidak ( ) ya
Gigi palsu : ( ) tidak ( ) ya
NG tube : ( ) tidak ( ) ya
b. Pola Minum
Di rumah Di Rumah Sakit
Frekuensi : ......................... Frekuensi : ......................
Jenis : ......................... Jenis : ......................
Jumlah : ......................... Jumlah : ......................
Pantangan : ......................... Pantangan : ......................
Minuman disukai: ......................... Minuman disukai : ......................

5. Pola eliminasi
a. Buang air Besar
 53

Di rumah Di Rumah Sakit

Frekuensi : .................................. Frekuensi : ..................................
Konsistensi : .................................. Konsistensi : ..................................
Warna : .................................. Warna : ..................................

Masalah di RS : ( ) konstipasi ( ) diare ( ) inkontinen

Kolostomi : ( ) tidak ( ) ya
b. Buang air kecil
Di rumah Di Rumah Sakit
Frekuensi : .................................. Frekuensi :.......................
Konsistensi : .................................. Konsistensi :.......................
Warna : .................................. Warna :.......................

Masalah di RS : ( ) disuria ( ) nokturia ( ) hematuria

( ) retensi ( ) inkontinen
Kolostomi : ( ) tidak ( ) ya, kateter ...........................
produksi : .................. cc/hari
6. Pola Kognitif Perseptual
Berbicara : ( ) normal ( ) gagap ( ) bicara tak jelas
Bahasa sehari-hari : ( ) Indonesia ( ) Jawa
( ) lainnya, ....................................
Kemampuan membaca : ( ) bisa ( ) tidak
Tingkat ansietas : ( ) ringan ( ) sedang ( ) berat ( ) panik
Sebab, ...................................................................................................
Kemampuan interaksi : ( ) sesuai ( )
tidak,...................................................................
Vertigo : ( ) tidak ( ) ya
Nyeri : ( ) tidak ( ) ya
Bila ya, P : .............................................................................................
Q : .............................................................................................
R : .............................................................................................
S : .............................................................................................
T : ..............................................................................................
 54

7. Pola Konsep Diri

........................................................................................................................
........................................................................................................................
........................................................................................................................
........................................................................................................................
........................................................................................................................
8. Pola Koping
Masalah utama selama MRS (penyakit, biaya, perawatan diri)
........................................................................................................................
........................................................................................................................
........................................................................................................................
Kehilangan perubahan yang terjadi sebelumnya
........................................................................................................................
........................................................................................................................
.......................................................................................................................

Kemampuan adaptasi
........................................................................................................................
........................................................................................................................
........................................................................................................................
9. Pola Seksual – Reproduksi
Menstruasi terakhir .......................................................................................
Masalah menstruasi : ....................................................................................
Pap smear terakhir :
....................................................................................Pemeriksaanpayudara/
testissendiritiapbulan : ( ) ya ( ) tidak
Masalahseksual yang berhubungandenganpenyakit : ………………….

10. Pola Peran – Hubungan

Pekerjaan : ...................................................................................................
Kualitas bekerja : ..........................................................................................
 55

Hubungan dengan orang lain : ......................................................................

Sistem pendukung : ( ) pasangan ( ) tetangga/teman ( )
tidak ada ( )
lainnya,.................................................................................
Masalah keluarga mengenai perawatan di RS:
....................................................... ......................................
11. Pola Nilai – Kepercayaan
Agama : .......................................................................................................
Pelaksanaan ibadah : .....................................................................................
Pantangan agama : ( ) tidak ( ) ya,..............................
Meminta kunjungan rohaniawan : ( ) tidak ( ) ya

I. PENGKAJIAN PERSISTEM (Review of System)

1. Tanda-Tanda Vital
a. Suhu : ................... °C lokasi : ......................
b. Nadi : ...................  /menit irama: .............pulsasi:
...........
c. Tekanan darah : ................... mmHg lokasi : ......................
d. Frekuensi nafas : ...................  /menit irama : ......................
e. Tinggi badan : ................... cm
f. Berat badan : SMRS ................... kg MRS .................... kg
2. Kepala
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
3. Mata
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
4. Telinga
..........................................................................................................................
 56

..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
5. Hidung
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................

6. Mulut
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
7. Leher
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................

8. Dada:
Jantung:
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................

Paru:
..........................................................................................................................
 57

..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................

9. Abdomen
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................

10. Urogenital
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................

11. Ekstremitas
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................

12. Kulitdan kuku

..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
13. Keadaanlokal
 58

..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
..........................................................................................................................

II. PEMERIKSAAN PENUNJANG

Laboratorium
........................................................................................................................
........................................................................................................................
........................................................................................................................
........................................................................................................................
........................................................................................................................
........................................................................................................................
..................................................................
1. Photo
........................................................................................................................
........................................................................................................................
........................................................................................................................
........................................................................................................................
........................................................................................................................
........................................................................................................................
2. Lain-lain
........................................................................................................................
........................................................................................................................
........................................................................................................................
III. TERAPI
..............................................................................................................................
..............................................................................................................................
 59

..............................................................................................................................
..............................................................................................................................
........................,……..................
Mahasiswa

(...............................)
 60

ANALISA DATA
Nama : Ruangan :
Umur : No.RM
:
No. Data (Symptom) Penyebab (Etiologi) Masalah (Problem)
 61

PRIORITAS MASALAH

Nama klien : Ruangan/kamar :

Umur : No. RM :

Tanggal Paraf
No . Masalah Keperawatan (Nama
Ditemukan Teratasi
Perawat)