ASUHAN KEPERAWATAN

1. PENGKAJIAN
A. Data Dasar Keluarga
1. Nama kepala Keluarga (KK) :
2. Usia :
3. Pendidikan :
4. Pekerjaan :
5. Alamat dan nomor telepon :
6. Komposisi Keluarga :
Jenis Hub. dgn
No Nama TTL/Umur Pendidikan Pekerjaan
Kelamin KK
1
2
3
4

7. genogram

8. Tipe Keluarga
 a. Jenis tipe keluarga : ..............................................................................................
b. Masalah yg terjadi dengan tipe
tersebut : ...............................................................................................................
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9. Suku Bangsa
a. Asal suku bangsa : ................................................................................................
b. Budaya yang berhubungan dg kesehatan : ...........................................................
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10. Agama dan kepercayaan yang mempengaruhi kesehatan :

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11. Status Sosial Ekonomi

a. Anggota Keluarga yang mencari nafkah : ............................................................
b. Penghasilan : .........................................................................................................
c. Upaya Lain : .........................................................................................................
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d. Harta benda yang dimuliki : .................................................................................
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e. Kebutuhan yang dikeluarkan tiap bulan : .............................................................
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12. Aktivitas Rekreasi Keluarga

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B. Riwayat Perkembangan Keluarga
1. Tahap perkembangan keluarga saat ini ( ditentukan dengan anak tertua)
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2. tahap perkembangan keluarga yang belum terpenuhi dan kendalanya
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3. Riwayat kesehatan keluarga inti
a. Riwayat kesehatan keluarga saat ini
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b. Riwayat penyakit keturunan
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c. Riwayat kesehatan masing-masing anggota keluarga
Tindakan
Keadaan Masalah
No Nama Umur BB Imunisasi yg telah
Kesehatan Kesehatan
dilakukan

d. Sumber pelayanan kesehatan yang dimanfaatkan

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 e. Riwayat kesehatan keluarga sebelumnya
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C. Keadaan Lingkungan
1. Karakteristik Rumah
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Denah Rumah

2. Karakteristik Tetangga dan Komunitas

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3. Mobilitas Geografis Keluarga

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4. Perkumpulan Keluarga dan Interaksi dengan Masyarakat

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5. Sistem Pendukung Keluarga

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D. Struktur Keluarga
1. Pola Komunikasi Keluarga
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2. Struktur Kekuatan Keluarga

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3. Struktur Peran
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4. Nilai dan Norma Budaya

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E. Fungsi Keluarga
1. Fungsi Afektif
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2. Fungsi Sosialisasi
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3. Fungsi Perawatan Kesehatan

a. Mengenal masalah kesehatan
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b. Mengambil keputusan
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c. Merawat anggota keluarga

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d. Modifikasi lingkungan
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e. Menggunakan fasilitas
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4. Fungsi Reproduksi
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5. Fungsi Ekonomi
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F. Stress dan Koping Keluarga

1. Stressor yang dimiliki
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2. Kemampuan keluarga berespon terhadap stressor

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3. Strategi koping yang digunakan

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4. Strategi adaptasi disfungsional

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G. Pemeriksaan Fisik
NO SISTEM AYAH IBU ANAK 1 ANAK 2
1 Kesadaran/Keadaan
Umum
2 TTV

3 Kulit

4 Kepala

5 Mata

6 Telinga

7 Hidung

8 Mulut

9 Dada

10 Abdomen

11 Ektremitas

12 Genitalia
 13 Kesimpulan

H. Harapan Keluarga
a. Terhadap masalah kesehatan
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b. Terhadap petugas kesehatan yang ada
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2. Analisa Data

NO DATA ETIOLOGI MASALAH

3. Rumusan Diagnosa Keperawatan
4. Rencana Keperawatan

No. Tujuan Kriteria Evaluasi

Intervensi
Dx Umum Khusus Kriteria Standar
5. Implementasi dan Evaluasi Keperawatan

No. Diagnosa
Tanggal Implementasi Evaluasi
Dx Keperawatan