PENGKAJIAN KEPERAWATAN GERONTIK

A. Identitas Diri
1. Nama :
2. Umur :
3. Jenis Kelamin :
4. Agama :
5. Status Perkawinan :
6. Pendidikan Terakhir :
7. Pekerjaan :
8. Alamat :

B. Alasan Masuk Ke Panti

................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
..................................

C. Alasan di Kunjungi
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
........................................................

D. Riwayat Kesehatan
1. Masalah Kesehatan yang Pernah Dialami
.........................................................................................................................................
.........................................................................................................................................
..........................................................................

2. Masalah Kesehatan Keluarga

 .........................................................................................................................................
.........................................................................................................................................
.....................................................................................

E. Kebiasaan sehari-hari
a. Biologis
 Pola makan
………………………………………………………………………………………
……………………………………………………………………………………..

 Pola minum
………………………………………………………………………………………
………………………………………………………………………………………

 Pola tidur
………………………………………………………………………………………
………………………………………………………………………………………

 Pola eliminasi
BAK : …………………………………………………………………………….
BAB : ……………………………………………………………………………

 Aktivitas sehari-hari
………………………………………………………………………………………
……………………………………………………………………………………..

 Rekreasi
………………………………………………………………………………………
……………………………………………………………………………………..

b. Psikologis
 .........................................................................................................................................
.........................................................................................................................................
..........................................................................

c. Sosial
 Hubungan antar keluarga
………………………………………………………………………………………
……………………………………………………………………………….
 Hubungan dengan lingkungan
………………………………………………………………………………………
………………………………………………………………………………..
d. Spiritual
 Pelaksanaan ibadah
....................................................................................................................................
............................................................................................

 Keyakinan tentang kesehatan

....................................................................................................................................
............................................................................................

F. Pemeriksaan
1. Tanda Vital : TD ........N .......P .......S .........
2. Pemeriksaan fisik ( Head to Toe ) dan kesehatan perorangan
3. Lain-lain

G. Informasi penunjang
1. Diagnosa medik
2. Laboratorium
3. Terapi medik

H. Analisa Data
 ANALISA DATA
No Data Maslaah

1. DS : …………………………………
……………………………………… …
………………………………………
……………………………………...
DO : …………………………………….
…………………………………….

2. DS :
……………………………………… …………………………………
……………………………………… …
……………………………………...
DO : …………………………………….
…………………………………….