Lampiran 1

FORMAT ASUHAN KEPERAWATAN ANAK PADA PASIEN

DENGUE HAEMORRHAGIC FEVER

1. PENGKAJIAN
A. IDENTITAS PASIEN
Nama Klien :...........................................................
Tempat Tanggal Lahir :...........................................................
Agama :...........................................................
Alamat :...........................................................
Nama Ibu/Ayah :...........................................................
Pekerjaan Ibu/Ayah :...........................................................
Agama Ibu/Ayah :...........................................................
Suku Bangsa :...........................................................
Status Perkawinan :...........................................................
Alamat :...........................................................

B. RIWAYAT KESEHATAN
1. Keluhan utama
...........................................................................................................
2. Riwayat kesehatan sekarang
............................................................................................................
3. Riwayat kesehatan dahulu
............................................................................................................
4. Riwayat kesehatan
............................................................................................................
5. Genogram
...........................................................................................................
 6. Riwayat prenatal, intranatal, post natal
Anak Usia Jenis Penolong Ket:
sekarang persalinan Hidup/mati

7. Riwayat Tumbuh Kembang

............................................................................................................
8. Riwayat pola asuh
............................................................................................................
9. Riwayat Imunisasi

C. PENGKAJIAN POLA FUNGSIONAL GORDON

1. Persepsi dan pola management kesehatan
............................................................................................................
2. Nutrisi dan cairan
............................................................................................................
3. Pola Eliminasi
............................................................................................................
4. Aktivitas dan latihan
Tingkat mobilasasi. :.........................................................
Masalah khusus :.........................................................
5. Pola istirahat tidur
Pola tidur :...........................................................
Keluhan :..........................................................
6. Persepsi sensori dan kognitif
Keluhan ketidaknyamanan :...........................................................
7. Persepsi diri- pola konsep diri
Status mood :..........................................................
Takut :...........................................................
 8. Pola peran dan hubungan
Respon anak/bayi terhadap perpisahan:.............................................
Ketergantungan :..........................................................
Pola bermain :..........................................................
9. Pola seksualitas dan reproduksi
Peran sebagai anak laki-laki/perempuan :........................................
10. Mekanisme koping dan stress
Penyebab stress pada anak :...........................................................
Pola penanganan masalah :...........................................................
11. Pola keyakinan
Perkembangan moral anak :...........................................................

D. PEMERIKSAAN FISIK
1. Keluhan utama :...........................................................
Kesadaran :...........................................................
2. Tanda Vital
TD :...........................................................
Suhu :...........................................................
Nadi :...........................................................
Pernafasan :...........................................................
3. Tinggi badan :...........................................................
4. Berat badan :..........................................................
5. Lingkar lengan atas :..........................................................
6. Kepala
Leher :...........................................................
Kepala :...........................................................
Mata :...........................................................
Hidung :...........................................................
Mulut :...........................................................
Telinga :...........................................................
 7. Dada
Jantung :....................................................................
Paru-paru
Inspeksi :....................................................................
Palpasi :....................................................................
Perkusi :.....................................................................
Auskultasi :.....................................................................
8. Abdmen
Inspeksi :......................................................................
Palpasi :.......................................................................
Perkusi :.......................................................................
Auskultasi :.......................................................................
9. Genetalia :.......................................................................
10. Ekstermitas
Ekstermitas atas :.......................................................................
Ekstermitas bawah :.......................................................................
11. Kulit
Turgor :.......................................................................
Warna :.......................................................................

E. THERAPI
..................................................................................................................

F. HASIL PEMERIKSAAN PENUNJANG

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

G. ANALISA DATA
No Data Fokus Problem Etiologi
2. DIAGNOSA KEPERAWATAN
........................................................................................................................

3. PERENCANAAN
No Hari/tanggal Tujuan Intervensi Ttd perawat

4. IMPLEMENTASI
No Hari/tanggal No DX Jam Tindakan Respon Ttd perawat
pasien

5. EVALUASI
No Hari/tanggal Catatan perkembangan Ttd perawat