Format Pengkajian Keluarga Fixx
Format Pengkajian Keluarga Fixx
Jln. Bunga Terompet No. 118, Kel. Sempakata Kec. Medan Selayang
MEDAN-0618214020-0618225509
http://stikeselisabethmedan.ac.id/, email: stikes_elisabeth@yahoo.co.id
A. PENGKAJIAN (tanggal)
I. Data Umum
1. Nama KK (Inisial) :
2. Usia :
3. Pendidikan :
4. Pekerjaan :
5. Alamat :
6. Komposisi anggota keluarga :
Nama Jenis Hub dgn TTL / Status
No Pendidikan Pekerjaan
(Inisial) Kelamin Kk Umur Imunisasi
Genogram :
Keterangan :
7. Tipe keluarga
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8. Suku
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Buku Panduan Praktek Belajar Lapangan Prodi Ners Tahap Akademik STIKes Santa Elisabeth Medan
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9. Agama
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III. Lingkungan
Buku Panduan Praktek Belajar Lapangan Prodi Ners Tahap Akademik STIKes Santa Elisabeth Medan
16. Karakteristik rumah (termasuk denah rumah)
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17. Karakteristik tetangga dan komunitas
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18. Mobilitas geografis keluarga
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19. Perkumpulan keluarga dan interaksi dengan masyarakat
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Buku Panduan Praktek Belajar Lapangan Prodi Ners Tahap Akademik STIKes Santa Elisabeth Medan
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23. Struktur peran
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24. Nilai dan norma budaya
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V. Fungsi keluarga
25. Fungsi afektif
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26. Fungsi sosialisasi
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27. Fungsi perawatan kesehatan
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Buku Panduan Praktek Belajar Lapangan Prodi Ners Tahap Akademik STIKes Santa Elisabeth Medan
30. Strategi koping yang digunakan
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31. Strategi adaptasi disfungsional
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32. Pemeriksaan fisik head to toe secara inspeksi. Palpasi, auskultasi, dan perkusi dan tanda-tanda vital
termasuk tinggi badan dan berat badan (lampirkan)
Buku Panduan Praktek Belajar Lapangan Prodi Ners Tahap Akademik STIKes Santa Elisabeth Medan
FORM 9
PRODI NERS TAHAP AKADEMIK STIKes SANTA ELISABETH
Jln. Bunga Terompet No. 118, Kel. Sempakata Kec. Medan Selayang
MEDAN-0618214020-0618225509
http://stikeselisabethmedan.ac.id/, email: stikes_elisabeth@yahoo.co.id
Data Objektif :
2 Data Subjektif :
Data Objektif :
Buku Panduan Praktek Belajar Lapangan Prodi Ners Tahap Akademik STIKes Santa Elisabeth Medan
PRODI NERS TAHAP AKADEMIK STIKes SANTA ELISABETH FORM 10
Jln. Bunga Terompet No. 118, Kel. Sempakata Kec. Medan Selayang
MEDAN-0618214020-0618225509
http://stikeselisabethmedan.ac.id/, email: stikes_elisabeth@yahoo.co.id
dst
Buku Panduan Praktek Belajar Lapangan Prodi Ners Tahap Akademik STIKes Santa Elisabeth Medan
PRODI NERS TAHAP AKADEMIK STIKes SANTA ELISABETH FORM 11
Jln. Bunga Terompet No. 118, Kel. Sempakata Kec. Medan Selayang
MEDAN-0618214020-0618225509
http://stikeselisabethmedan.ac.id/, email: stikes_elisabeth@yahoo.co.id
Total
Buku Panduan Praktek Belajar Lapangan Prodi Ners Tahap Akademik STIKes Santa Elisabeth Medan
PRODI NERS TAHAP AKADEMIK STIKes SANTA ELISABETH FORM 11
Jln. Bunga Terompet No. 118, Kel. Sempakata Kec. Medan Selayang
MEDAN-0618214020-0618225509
http://stikeselisabethmedan.ac.id/, email: stikes_elisabeth@yahoo.co.id
Total
Buku Panduan Praktek Belajar Lapangan Prodi Ners Tahap Akademik STIKes Santa Elisabeth Medan
PRODI NERS TAHAP AKADEMIK STIKes SANTA ELISABETH
Jln. Bunga Terompet No. 118, Kel. Sempakata Kec. Medan Selayang FORM 12
MEDAN-0618214020-0618225509
http://stikeselisabethmedan.ac.id/, email: stikes_elisabeth@yahoo.co.id
Buku Panduan Praktek Belajar Lapangan Prodi Ners Tahap Akademik STIKes Santa Elisabeth Medan
PRODI NERS TAHAP AKADEMIK STIKes SANTA ELISABETH FORM 13
Jln. Bunga Terompet No. 118, Kel. Sempakata Kec. Medan Selayang
MEDAN-0618214020-0618225509
http://stikeselisabethmedan.ac.id/, email: stikes_elisabeth@yahoo.co.id
Buku Panduan Praktek Belajar Lapangan Prodi Ners Tahap Akademik STIKes Santa Elisabeth Medan
PRODI NERS TAHAP AKADEMIK STIKes SANTA ELISABETH FORM 14
Jln. Bunga Terompet No. 118, Kel. Sempakata Kec. Medan Selayang
MEDAN-0618214020-0618225509
http://stikeselisabethmedan.ac.id/, email: stikes_elisabeth@yahoo.co.id
D. IMPLEMENTASI
NO TTD /
DP ke: IMPLEMENTASI
TGL & WAKTU PARAF
1
Buku Panduan Praktek Belajar Lapangan Prodi Ners Tahap Akademik STIKes Santa Elisabeth Medan
PRODI NERS TAHAP AKADEMIK STIKes SANTA ELISABETH FORM 15
Jln. Bunga Terompet No. 118, Kel. Sempakata Kec. Medan Selayang
MEDAN-0618214020-0618225509
http://stikeselisabethmedan.ac.id/, email: stikes_elisabeth@yahoo.co.id
E. EVALUASI
TANGGAL NO. EVALUASI TTD / PARAF
& WAKTU DP
1 S:
O:
A:
P:
2 S:
O:
A:
P:
3 S:
O:
A:
P:
Buku Panduan Praktek Belajar Lapangan Prodi Ners Tahap Akademik STIKes Santa Elisabeth Medan
PRODI NERS TAHAP AKADEMIK STIKes SANTA ELISABETH
FORM 16
Jln. Bunga Terompet No. 118, Kel. Sempakata Kec. Medan Selayang
MEDAN-0618214020-0618225509
http://stikeselisabethmedan.ac.id/, email: stikes_elisabeth@yahoo.co.id
Kesadaran
Cara berpakaian
Kebersihan
personal
Bentuk dan ukuran Proporsional sesuai Proporsional sesuai Proporsional Proporsional sesuai Proporsional
tubuh BB dengan TB BB dengan TB sesuai BB dengan BB dengan TB sesuai BB dengan
TB TB
TB: TB: TB: TB: TB:
BB: BB: BB: BB: BB:
Tanda-tanda vital Tgl : Tgl : Tgl : Tgl : Tgl :
TD : TD : TD : TD : TD :
Nadi : Nadi : Nadi : Nadi : Nadi :
Suhu : Suhu : Suhu : Suhu : Suhu :
RR : RR : RR : RR : RR :
2. Status mental dan
cara berbicara:
Status emosi
Orientasi
Proses berfikir
Gaya bicara
Pemeriksaan Kulit
Kuku
Buku Panduan Praktek Belajar Lapangan Prodi Ners Tahap Akademik STIKes Santa Elisabeth Medan
Pemeriksaan Kepala
Bentuk & Sensori
Rambut
Mata
Hidung
Telinga
Mulut
Leher
Dada (Pernafasan)
Dada
(Cardiovaskuler)
Buku Panduan Praktek Belajar Lapangan Prodi Ners Tahap Akademik STIKes Santa Elisabeth Medan
Auskultasi: Auskultasi: Auskultasi: Auskultasi:
Ekstremitas
Ektremitas Atas
Ektremitas Bawah
Kesimpulan
Catatan: Pemeriksaan fisik ini berlaku pada anggota keluarga yang belum dapat diisi di format
Buku Panduan Praktek Belajar Lapangan Prodi Ners Tahap Akademik STIKes Santa Elisabeth Medan