ANAK
ANAK
YAYEDIRA
K I
STIKES KARYA HUSADA KEDIRI
Ijin Mendiknas RI No. 164/D/O/2005 Rekomendasi Depkes RI No. HK.03.2.4.1.03862
PROGRAM STUDI PROFESI NERS
KA
A
RY
D
Jl. Soekarno Hatta, Kotak Pos 153, Telp/Fax. (0354) 395203 Pare Kediri A HUSA
Website: www.stikes-khkediri.ac.id
FORMAT PENGKAJIAN
KEPERAWATAN ANAK
I. DATA UMUM
Nama : ……………………………………………………………
Ruang : ……………………………………………………………
No. Register : ……………………………………………………………
Umur : ……………………………………………………………
Jenis Kelamin : ……………………………………………………………
Agama : ……………………………………………………………
Suku Bangsa : ……………………………………………………………
Bahasa : ……………………………………………………………
Alamat : ……………………………………………………………
Pekerjaan : ……………………………………………………………
Penanggung jawab : …………………………………………………………
Pendidikan Terakhir : ……………………………………………………………
Golongan Darah : ............................................................................................
Tanggal MRS : ……………………………………………………………
Tanggal Pengkajian : ……………………………………………………………
Diagnosa Medis : ……………………………………………………………
Keluhan Utama :
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………………………………………
………………………………………………………………
Genogram:
3. Tindakan operasi
.............................................................................................................................
.............................................................................................................................
.............................................................................................................................
4. Riwayat alergi
............................................................................................................................
...........................................................................................................................
...........................................................................................................................
5. Kecelakaan
...........................................................................................................................
...........................................................................................................................
............................................................................................................................
6. Imunisasi
.............................................................................................................................
.............................................................................................................................
.............................................................................................................................
.............................................................................................................................
.............................................................................................................................
.............................................................................................................................
2. Motorik Halus
.......................................................................................................................................
.......................................................................................................................................
.....................................................................................................................
3. Personal Sosial
.......................................................................................................................................
.......................................................................................................................................
.....................................................................................................................
4. Bahasa
.......................................................................................................................................
.......................................................................................................................................
.....................................................................................................................
V. RIWAYAT SOSIAL
1. Pengasuh
.......................................................................................................................................
.......................................................................................................................................
.....................................................................................................................
Aktivitas 0 1 2 3 4
Mandi
Berpakaian
Eleminasi
Mobilisasi di tempat tidur
Pindah
Ambulasi
Naik tangga
Makan dan minum
Gosok gigi
Keterangan : ..............................................................................................................
....................................................................................................................................
....................................................................................................................................
Pengantar Tidur
Gangguan Tidur
Perasaan Waktu Bangun
Jenis
Porsi
Total Konsumsi
Keluhan
4) Diit khusus
.................................................................................................................................
.................................................................................................................................
...............................................................................................................
5. Pola Eliminasi
Eliminasi Uri
KETERANGAN SEBELUM SAKIT SAAT SAKIT
Frekuensi
Pancaran
Jumlah
Bau
Warna
Eliminasi Alvi
KETERANGAN SEBELUM SAKIT SAAT SAKIT
Frekuensi
Konsistensi
Bau
Warna
Praktik Ibadah
Pengetahuan tentang
Praktik Ibadah selama sakit
2) Dada/Thorak
3) Abdomen/Perut
5) Genetalia
B. ( B1 – B6 )
1) B1 (Breathing)
2) B2 (Blood)
3) B3 (Brain)
4) B4 (Bladder)
5) B5 (Bowel)
6) B6 (Bone)
C. Pemeriksaan Diagnostik
1) Laboratorium
2) Radiologi
D. Terapi
1. Oral
2. Parenteral
3. Lain - lain