PENGKAJIAN KEPERAWATAN GERONTIK

Nama Pasien :
Umur :
Alamat :
Diagnosa :

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

B. alasan Datang Ke Panti

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C. Alasan lansia di kunjungi

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D. Riwayat Kesehatan
1. Masalah Kesehatan yang Pernah Dialami
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2. Masalah Kesehatan Keluarga
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E. Kebiasaan sehari-hari
a. Biologis
 Pola makan
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 Pola minum
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 Pola tidur
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 Pola eliminasi
BAK : …………………………………………………………………………
BAB : …………………………………………………………………………

 Aktivitas sehari-hari
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 Rekreasi
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b. Psikologis
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c. Sosial
 Hubungan antar keluarga
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 Hubungan dengan lingkungan
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d. Spiritual
 Pelaksanaan ibadah
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 Keyakinan tentang kesehatan

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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 : …………………………………
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DO : …………………………………….
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2. DS :
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DO : …………………………………….
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I. Kemungkinan Diagnosa Keperawatan

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