FORMAT PENGKAJIAN ASUHAN KEPERAWATAN ANAK SEHAT

DALAM KONTEKS KELUARGA

I. IDENTITAS
Nama : ............................................................................................
Tempat/tgl Lahir : ............................................................................................
Jenis Kelamin : ...........................................................................................
Agama : ...........................................................................................

Nama Bapak : ............................................................................................

Nama Ibu : ............................................................................................
Alamat : ............................................................................................

II. PERKEMBANGAN FISIK ANAK:

III. PERKEMBANGAN KOGNITIF ANAK:

IV. PERKEMBANGAN PSIKOSOSIAL ANAK:

V. PERSEPSI KESEHATAN MENURUT KELUARGA:

VI. RIWAYAT Kesehatan:
A. Susunan Aggota :.........................................................................................................
Keluarga (genogram)

B. Penyakit yang pernah diderita keluarga:

1. Orang tua :.............................................................................................
2. Saudara kandung :.............................................................................................
3. Anggota keluarga lain :.............................................................................................

C. Penyakit yang sedang diderita keluarga:

1. Orang tua :.............................................................................................
2. Saudara kandung :.............................................................................................
3. Anggota keluarga lain :.............................................................................................

D. Analisa faktor resiko:

 Ginjal : .............................................................................................
 Jantung : ............................................................................................
 DM : ............................................................................................
 Kanker : ............................................................................................
 Epilepsi : ...........................................................................................
 Allergi : ..........................................................................................
 Gangguan mental : ...........................................................................................
 TBC : ...........................................................................................
 Hypertensi : ...........................................................................................
 Lain-lain : ............................................................................................
 E. Bayi/ anak :
F. Makanan dan minuman
1. Pemenuhan kebutuhan nutrisi ASI/ PASI:
Jenis susu : ...........................................................................................................
Adakah kesulitan : ...........................................................................................................
2. Makanan yang disukai:.......................................................................................................
3. Makanan yang tdk disukai:................................................................................................
4. Selera makan : ..........................................................................................................
5. Alat makan yg di gunakan :..............................................................................................
6. Jam makan : ..........................................................................................................
7. Jumlah minum/hari: ...........................................................................................................
8. Jenis minuman : .............................................................................................................

VII. PEMERIKSAAN FISIK DAN ANTROPOMETRI

1. Tinggi badan :
2. Berat badan :
3. Lingkar kepala :
4. Lingkar lengan atas :
5. Lingkar dada :
6. Keadaan kepala :

7. Keadaan dada :

8. Keadaan ekstremitas :

9. Keadaan kulit :
D. ANALISA DATA
N DATA FOKUS ETIOLOGI MASALAH
O
E. DIAGNOSA KEPERAWATAN
1. ..........................................................................................................................................
2. ...........................................................................................................................................
3. ..........................................................................................................................................

F . RENCANA KEPERAWATAN
NO TUJUAN DAN K.H INTERVENSI RASIONALISASI
DX
KEP
G. CATATAN PERKEMBANGAN
NO TGL/JAM IMPLEMENTASI EVALUASI TTD
DX
 TUGAS INDIVIDU
ASUHAN KEPERAWATAN ANAK SEHAT
DALAM KONTEKS KELUARGA
DI TK..................................

DI SUSUN OLEH:
NAMA:....................................................
NPM................................

Arga Makmur, Februari 2014

Ci pendidikan Ci Praktek Klinik

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UNIVERSITAS RATU SAMBAN BENGKULU UTARA

FAKULTAS ILMU KESEHATAN (FIK)
PRODI D.3 KEPERAWATAN
TAHUN 2014