LAPORAN PRAKTEK KEPERAWATAN KELUARGA

RW 09 KELURAHAN GUNUNG SAHARI SELATAN

Nama Mahasiswa :
NPM :
PENGKAJIAN
I. Data Umum
1. Nama KK : ............................................................................................................
2. Usia : ............................................................................................................
3. Pendidikan : ............................................................................................................
4. Pekerjaan : ............................................................................................................
5. Alamat : ............................................................................................................

6. Komposisi Keluarga
No Nama JK Hubungan Usia Pendidikan Pekerjaan Status
keluarga imunisasi
1
2
3
4
5
6
7
8

GENOGRAM
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Keterangan:
Laki-laki Meninggal Bercerai
Perempuan .......... Serumah

7. Tipe Keluarga
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8. Suku
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9. Agama
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10. Status Sosial Ekonomi Keluarga
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11. Aktivitas Rekrasi Keluarga
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II. Riwayat dan Tahap Perkembangan Keluarga

12. Tahap Perkembangan Keluarga Saat ini
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13. Tahap Perkembangan Keluarga yang Belum Terpenuhi
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14. Riwayat Keluarga Inti

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15. Riwayat Keluarga Sebelumnya
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III. Lingkungan
16. Karakteristik Rumah ( termasuk denah rumah )
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17. Karakteristik Tetangga dan Komunitas
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18. Mobilitas Geografis Keluarga
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19. Perkumpulan Keluarga & Interaksi dengan Masyarakat
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20. Sistem Pendukung Keluarga
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IV. Struktur Keluarga

21. Pola Komunikasi Keluarga
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22. Struktur Kekuatan Keluarga
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23. Struktur Peran
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24. Nilai dan norma budaya
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V. Fungsi Keluarga
25. Fungsi Afektif
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 26. Fungsi Sosialisasi
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27. Fungsi Perawatan Kesehatan

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VI. Stres & Koping Keluarga

28. Stresor Jangka Pendek
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29. Kemampuan Keluarga Berespon terhadap masalah
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30. Strategi Koping yang digunakan

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31. Strategi adaptasi disfungsional

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33. Pengkajian 5 Tugas Perawatan Keluarga

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VII. Harapan Keluarga Terhadap Asuhan Keperawatan Keluarga
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ANALISA DATA
NO DATA
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MASALAH KEPERAWATAN
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SKORING MASALAH

No Masalah keperawatan Bobot Nilai Pembenaran

1 Sifat masalah .........................................................
Skala : .........................................................
 Potensial : 1 .........................................................
 Resiko : 2 .........................................................
 Aktual : 3 .........................................................
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2 Masalah diatasi .........................................................
Skala : .........................................................
 Mudah :2 .........................................................
 Sebagian : 1 .........................................................
 Tidak dapat :0 .........................................................
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3 Potensi dicegah .........................................................
Skala : .........................................................
 Tinggi : 3 .........................................................
 Sedang : 2 .........................................................
 Rendah : 1 .........................................................
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4 Menonjolnya masalah .........................................................
Skala : .........................................................
 Segera ditangani : 1 .........................................................
 Tidakperlu segera : 2 .........................................................
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No Masalah keperawatan Bobot Nilai Pembenaran
1 Sifat masalah .........................................................
Skala : .........................................................
 Potensial : 1 .........................................................
 Resiko : 2 .........................................................
 Aktual : 3 .........................................................
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2 Masalah diatasi .........................................................
Skala : .........................................................
 Mudah :2 .........................................................
 Sebagian : 1 .........................................................
 Tidak dapat :0 .........................................................
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3 Potensi dicegah .........................................................
Skala : .........................................................
 Tinggi : 3 .........................................................
 Sedang : 2 .........................................................
 Rendah : 1 .........................................................
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4 Menonjolnya masalah .........................................................
Skala : .........................................................
 Segera ditangani : 1 .........................................................
 Tidakperlu segera : 2 .........................................................
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Prioritas Masalah :
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2. .......................................................................................................................................
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3. .......................................................................................................................................
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4. .......................................................................................................................................
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