Format Askep Anak Keluarga
Format Askep Anak Keluarga
A. PENGKAJIAN
1. Data umum
a. Nama KK : ...........................................................………………………
b. Umur : ...........................................................………………………
c. Pendidikan KK : ...........................................................……………………….
d. Pekerjaan KK : ...........................................................………………………
e. Agama : ...........................................................………………………
f. Suku : ...........................................................………………………
g. Alamat : ...........................................................………………………
h. Komposisi keluarga :
Jenis Hub dg
No Nama Umur Pendidikan Pekerjaan
Kelamin KK
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Genogram Keluarga
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2. Natal
a. Gestasi : Aterm Prematur Postmatur
b. Tipe persalinan : Pervaginam Operasi Dengan Bantuan
c. Tempat melahirkan : ..........................................................................
d. Komplikasi persalinan : .........................................................................
3. Post natal
a. Kondisi bayi saat lahir : menangis/tidak.......................................
…………………………………………
…………………………………………
b. Komplikasi bayi saat lahir : …………………………………………
…………………………………………
…………………………………………
…………………………………………
B. Riwayat Penyakit sebelumnya
1. Penyakit yang pernah diderita : ……………….....Pada umur : ………
2. Pernah dirawat di rumah sakit : Ya Tidak
3. Riwayat Operasi : ……………………………………....
4. Riwayat kecelakaan : ………………………………………
5. Obat-obatan yang digunakan : ……………………………………
6. Alergi : Ya Tidak
C. Imunisasi
No Jenis imunisasi Waktu pemberian Frekuensi Reaksi setelah pemberian
1 BCG
2 DPT (I,II,III)
3 Polio (I,II,III,IV)
4 Campak
5 Hepatitis
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V. Riwayat sosial
1. Pengasuh anak : ...............................................................
2. Hubungan dengan anggota keluarga : ...............................................................
3. Hubungan dengan teman sebaya : ...............................................................
4. Lingkungan rumah : ..............................................................
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3. Keadaan lingkungan
a. Karakteristik rumah:
............................................................................................................................................
............................................................................................................................................
b. Karakteristik tetangga dan komunitas:
............................................................................................................................................
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c. Mobilitas keluarga:
............................................................................................................................................
............................................................................................................................................
d. Perkumpulan keluarga dan interaksi dengan masyarakat:
............................................................................................................................................
............................................................................................................................................
e. Sistem pendukung keluarga
............................................................................................................................................
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4. Struktur keluarga:
a. Pola komunikasi keluarga
............................................................................................................................................
............................................................................................................................................
Struktur kekuatan keluarga
............................................................................................................................................
............................................................................................................................................
b. Struktur peran keluarga
............................................................................................................................................
............................................................................................................................................
c. Nilai dan norma keluarga
............................................................................................................................................
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5. Fungsi keluarga
a. Fungsi afeksi
............................................................................................................................................
............................................................................................................................................
b. Fungsi sosial
............................................................................................................................................
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c. Fungsi pelayanan kesehatan
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6. Stres dan koping keluarga
a. Stresor jangka pendek dan jangka panjang
............................................................................................................................................
............................................................................................................................................
b. Kemampuan keluarga berespon terhadap stresor
............................................................................................................................................
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c. Strategi koping keluarga yang digunakan
............................................................................................................................................
............................................................................................................................................
d. Strategi adaptasi yang disfungsi
............................................................................................................................................
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7. Pemeriksaan fisik
Hasil Pemeriksaan Fisik Anggota Keluarga
Komponen
Kepala
Mata
Telinga
Hidung
Mulut dan
gigi
Leher &
tenggorokan
Dada
Abdomen
Ekstermitas
Kulit
Kuku
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Hasil Pemeriksaan Fisik Anggota Keluarga
Komponen
BB/TB
TD
Nadi
Suhu
Pernapasan
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B. DIAGNOSIS KEPERAWATAN
1. ANALISIS DATA
Data Etiologi Masalah
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2. DAFTAR PRIORITAS DIAGNOSIS KEPERAWATAN
a. .....................................................................................................................................
.....................................................................................................................................
b. .....................................................................................................................................
.....................................................................................................................................
c. .....................................................................................................................................
.....................................................................................................................................
d. .....................................................................................................................................
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C. RENCANA KEPERAWATAN
DIAGNOSIS TUJUAN
NO. RENCANA INTERVENSI
KEPERAWATAN TUJUAN KRITERIA HASIL
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D. IMPLEMENTASI & EVALUASI
Hari, Tanggal
No Implementasi Evaluasi Paraf
Waktu
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