Form Pengkajian Keluarga 2 DX

LAPORAN ASUHAN KEPERAWATAN KELUARGA TN.
DENGAN ANAK BALITA TIDAK IMUNISASI
DI RT 41 RW 07 KELURAHAN CEMPAKA
KECAMATAN CEMPAKA KOTAMADYA BANJARBARU
Disusun Untuk Memenuhi Tugas Program Pendidikan Profesi Ners
pada Stase Keperawatan Keluarga
Tanggal 25 Maret 2013 s/d 30 Maret 2013
Oleh :
M. SANDI SUWARDI
NIM . I.1B108612
PROGRAM STUDI ILMU KEPERAWATAN
FAKULTAS KEDOKTERAN
UNIVERSITAS LAMBUNG MANGKURAT
BANJARBARU
2013
LEMBAR PENGESAHAN
LAPORAN ASUHAN KEPERAWATAN KELUARGA TN.A
DENGAN ANAK BALITA TIDAK IMUNISASI
DI RT 41 RW 07 KELURAHAN CEMPAKA
KECAMATAN CEMPAKA KOTAMADYA BANJARBARU
Tanggal 25 Maret 2013 s/d 30 Maret 2013
Oleh :
M. SANDI SUWARDI
NIM . I.1B108612
Banjarmasin, ..................
Mengetahui
Pembimbing Akademik Pembimbing Lahan
Herawati, S.Kep Ns, M.Kep M. Yusuf , SKM

ASUHAN KEPERAWATAN KELUARGA
A. PENGKAJIAN
I. Data Umum
1. Kepala Keluarga : ...........................................................................................
2. Alamat & Telepon : ...........................................................................................
3. Pekerjaan KK : ...........................................................................................
4. Pendidikan KK : ...........................................................................................
5. Komposisi Keluarga:
Status Imunisasi
Hubungan
No. Nama JK Umur Pendidikan Polio DPT Hepatitis Ket
dengan KK BCG Campak
1 2 3 4 1 2 3 1 2 3
Genogram:
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6. Tipe Keluarga : ...........................................................................................
7. Suku Bangsa : ...........................................................................................
8. Agama : ...........................................................................................
9. Status sosial ekonomi : ...........................................................................................
10. Aktivitas Rekreasi Keluarga:........................................................................................
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II. Riwayat dan Tahap Perkembangan Keluarga
11. Riwayat perkembangan keluarga saat ini
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12. Tugas Perkembangan keluarga yang belum terpenuhi
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13. Riwayat Kesehatan Keluarga Inti
Anggota Riwayat Kesehatan Riwayat Kesehatan saat Keterangan
Keluarga Dahulu ini
14. Riwayat kesehatan keluarga sebelumnya

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III. Data Lingkungan

15. Karakteristik Rumah
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Denah Rumah :
16. Karakteristik tetangga dan komunitas

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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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IV. Struktur Keluarga

20. Struktur Peran
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21. Nilai atau norma keluarga
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22. Pola komunikasi keluarga
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23. Struktur kekuatan keluarga
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V. Fungsi Keluarga
24. Fungsi Ekonomi
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25. Fungsi mendapatkan status ekonomi
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26. Fungsi Pendidikan
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27. Fungsi Sosialisasi
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28. Fungsi pemenuhan (perawatan/pemeliharaan) kesehatan
a. Mengenal masalah
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b. Mengambil keputusan mengenai tindakan kesehatan
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c. Kemampuan merawat anggota keluarga yang sakit
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d. Kemampuan keluarga memelihara/memodifikasi lingkungan rumah yang sehat
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e. Kemampuan menggunakan fasilitas pelayanan yang sehat
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29. Fungsi Religius
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30. Fungsi Rekreasi
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31. Fungsi Reproduksi
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32. Fungsi Afeksi
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VII. Stress Koping Keluarga

33. Stressor Jangka pendek dan panjang
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34. Kemampuan keluarga berespon terhadap stressor
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35. Strategi koping yang digunakan
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36. Strategi adaptasi fungsional
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VII. Pemeriksaan Kesehatan Tiap Individu Anggota Keluarga

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VIII. Harapan Keluarga

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B. DIAGNOSA KEPERAWATAN KELUARGA
I. Analisis dan Sintesis Data
No Data Masalah Penyebab
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II. Perumusan Diagnosis Keperawatan
No Diagnosa Keperawatan (PES)
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III. Penilaian Skoring & Diagnosis Keperawatan

No. Kriteria Skor Pembenaran
Dx.Kep.
a. Sifat masalah ..... x 1=

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b. Kemungkinan masalah dapat dirubah ..... x 1=

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c. Potensi masalah untuk dicegah ..... x 1=

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d. Menonjolnya masalah ..... x 1=

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TOTAL SKOR
a. Sifat masalah ..... x 1=

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b. Kemungkinan masalah dapat ..... x 1=

dirubah 2
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..... x 1=
c. Potensi masalah untuk dicegah 3
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..... x 1=
d. Menonjolnya masalah 2
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TOTAL SKOR
IV. Prioritas Diagnosis Keperawatan
Prioritas Diagnosa Keperawatan Skor
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C. RENCANA ASUHAN KEPERAWATAN KELUARGA
Dx Keperawatan :
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Tujuan Kriteria Hasil/standar Intervensi
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Lanjutan Rencana Keperawatan
Dx Keperawatan :
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Lanjutan Rencana Keperawatan
Dx Keperawatan :
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D. IMPLEMENTASI DAN EVALUASI
Tangal &
No. Implementasi Evaluasi
Waktu
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Tangal &
No. Implementasi Evaluasi
Waktu
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E. IMPLENTASI DAN CATATAN PERKEMBANGAN

Tangal &
No. Implementasi Catatan Perkembangan
Waktu
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Tangal &
No. Implementasi Catatan Perkembangan
Waktu
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M.Sandi Suwardi

Form Pengkajian Keluarga 2 DX

Diunggah oleh

Informasi Dokumen

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Form Pengkajian Keluarga 2 DX

Diunggah oleh

Hak Cipta:

Format Tersedia

LAPORAN ASUHAN KEPERAWATAN KELUARGA TN.

DENGAN ANAK BALITA TIDAK IMUNISASI

Disusun Untuk Memenuhi Tugas Program Pendidikan Profesi Ners

pada Stase Keperawatan Keluarga

Tanggal 25 Maret 2013 s/d 30 Maret 2013

PROGRAM STUDI ILMU KEPERAWATAN

UNIVERSITAS LAMBUNG MANGKURAT

LAPORAN ASUHAN KEPERAWATAN KELUARGA TN.A

DENGAN ANAK BALITA TIDAK IMUNISASI

Tanggal 25 Maret 2013 s/d 30 Maret 2013

Pembimbing Akademik Pembimbing Lahan

Herawati, S.Kep Ns, M.Kep M. Yusuf , SKM

14. Riwayat kesehatan keluarga sebelumnya

III. Data Lingkungan

16. Karakteristik tetangga dan komunitas

IV. Struktur Keluarga

VII. Stress Koping Keluarga

VII. Pemeriksaan Kesehatan Tiap Individu Anggota Keluarga

VIII. Harapan Keluarga

III. Penilaian Skoring & Diagnosis Keperawatan

a. Sifat masalah ..... x 1=

b. Kemungkinan masalah dapat dirubah ..... x 1=

c. Potensi masalah untuk dicegah ..... x 1=

d. Menonjolnya masalah ..... x 1=

a. Sifat masalah ..... x 1=

b. Kemungkinan masalah dapat ..... x 1=

E. IMPLENTASI DAN CATATAN PERKEMBANGAN

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