ASUHAN KEBIDANAN PADA KELUARGA

Tn. L
DENGAN
……………………………………………………………………………………
……………………………………………………………………………………
……………………………………………………………………………………
DI DESA WANGKAL RT. 13 RW. 07
WILAYAH PUSKESMAS KECAMATAN KREMBUNG

A. PENGKAJIAN (Tanggal 21 Februari 2021 Jam 18.30)

I. Data Umum
1. Kepala keluarga : Tn. L
2. Alamat : Dusun Kates Desa Wangka RT 13 RW 07 Kecamatan
Krembung-Sidoarjo
3. Pekerjaan : Wiraswasta (Peternak)
4. Pendidikan : S1
5. Komposisi keluarga :

Status Imunisasi

Status
No Nama Hub L/P Umur Pendidikan
Poli Kes.
BCG DPT Hept. B Cmpk
o

1 Tn. L Suami L 40 thn S1      Baik

2 Ny. H Istri P 35 thn SMK      Baik

3 An. D Anak L 14 thn SMP kelas 2      Baik

4 An. M Anak P 7 thn SD kelas 1      Baik

Genogram :

Keterangan
 : Laki – laki

: Perempuan

: Hubungan perkawinan

: Anak kandung

: Anggota keluarga sudah meninggal

: Anggota keluarga yang bermasalah

6. Tipe keluarga : Keluarga inti

7. Suku bangsa : Jawa
8. Agama : Islam
9. Status sosial ekonomi : Menengah keatas

II. Riwayat dan Tahap Perkembangan Keluarga.

10. Tahap perkembangan keluarga saat ini
Tahap menghadapi anak usia sekolah

11. Tugas perkembangan keluarga yang terpenuhi

Tn. L : memenuhi kebutuhan sekolah anaknya dan biaya hidup keluarga dengan
bekerja
Ny. H: menjaga kesehatan keluarga dan anaknya dengan memberi makan yang
bergizi seta membantu anaknya untuk bersosialisasi dilingkungan rumah dan

12. Riwayat kesehatan masing-masing anggota keluarga sekarang

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13. Riwayat kesehatan masing-masing anggota keluarga sebelumnya

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III.Data Lingkungan.
14. Karakteristik rumah
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Denah rumah :

15. Karakteristik lingkungan sekitar

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16. Kegiatan social di masyarakat dan fasilitas keluarg yang menunjang kesehatan
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IV. Struktur Keluarga.

17. Struktur peran masing-masing anggota keluarga ........................................................
18. Nilai atau norma dalam keluarga ................................................................................
19. Pola komunikasi keluarga antara anggota keluarga ....................................................

V. Fungsi-fungsi dalam Keluarga.

20. Fungsi Efektif (Keakraban / kerenggangan hubungan intern keluarga).......................
21. Fungsi Ekoniomis (Anggota keluarga yang bekerja, kecukupan sumber ekonomi dan
pengaturan keuangan keluarga) ..................................................................................
22. Fungsi pendidikan .......................................................................................................
23. Fungsi mendapatkan status social ...............................................................................
24. Fungsi religius .............................................................................................................
25. Fungsi rekreasi ............................................................................................................
26. Fungsi reproduksi ........................................................................................................
27. Fungsi pemenuhan (perawatan / pemeliharaan kesehatan) .........................................

VI. Stess dan Koping Keluarga.

28. Kemampuan keluarga dalam menangani permasalahan .............................................
29. penyelesaian masalah keluarga ...................................................................................
 VII.Pemeriksaan Kesehatan Tiap Individu Anggota Keluarga.
(tergantung dari kondisi keluarga) meliputi :
32. Neonatus / Bayi / Balita ..............................................................................................
33. Kehamilan ...................................................................................................................
34. Persalinan ....................................................................................................................
35. Nifas ............................................................................................................................
36. KB ...............................................................................................................................
37. Keadaan Gizi anggota keluarga ..................................................................................

Status gizi
Hubungan
No Nama Anggota Keluarga TB BB berdsarkan
dalam keluarga
IMT/NCHS
1
2
3
4
dst
.

B. DIAGNOSIS KEBIDANAN

I. Analisis dan Sintesis Data.

No Data Masalah Penyebab
Subyektif
1
Obyektif
Subyektif
2
Obyektif
Subyektif
3
Obyektif
Subyektif
4
Obyektif
dst
.

II. Perumusan Diagnosis.

No Diangnosis

III.Penilaian Diagnosis.
 No
Kriteria Skor Pembenaran
DX
a. Sifat masalah.
b. Kemungkinan masalah dapat
berubah.
c. Potensi masalah untuk dicegah.
d. Menonjolnya masalah.
Total skor
dts.

IV. Prioritas Diagnosis.

No Diangnosis Skor

dst.

C. RENCANA ASUHAN KEBIDANAN.

Diangnosis ..............................................................................................................................
Tujuan jangka panjang ...........................................................................................................
Tujuan jangka pendek ............................................................................................................

D. PELAKSANAAN ASUHAN KEBIDANAN

Diagnosis .................................................................................................................................
Implementasi
1. ..............................................................................................................................................
2. ..............................................................................................................................................
3. ..............................................................................................................................................
dst.

E. EVALUASI.

Tanggal dan
No Diangnosis Evaluasi
Waktu
1. …………………………………….. S :
O:
A:
P:
2. …………………………………….. S :
O:
A:
P:
3. …………………………………….. S :
O:
 A:
P:
dst.