Program Studi Ilmu Keperawatan A Tahun 2017

ASUHAN KEPERAWATAN KELUARGA

I. DATA UMUM KELUARGA

1. Identitas Kepala keluarga
Nama :..................................... Pendidikan :........................................
Umur :..................................... Pekerjaan :.........................................
Agama :..................................... Alamat :.........................................
Suku :..................................... No. Telepon :.........................................

2. Komposisi keluarga
Hub dgn Pendidika
No Nama L/P Umur Pekerjaan Keterangan
KK n

1 . ... ... ...

2 . ... ... ...

3 . ... ... ...

4 . ... ... ...

5 . ... ... ...

3. Genogram

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4. Tipe keluarga

Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

1) Jenis tipe keluarga

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2) Masalah yang terjadi dengan tipe tersebut
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5. Suku Bangsa
1) Asal suku bangsa
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2) Budaya yang berhubungan dengan kesehatan
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6. Agama
Kepercayaan yang mempengaruhi kesehatan
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7. Status sosial ekonomi keluarga

1). Anggota keluarga yang mencari nafkah
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2). Penghasilan

Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

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3). Upaya lain untuk menambah penghasilan
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4). Kebutuhan yang dikeluarkan setiap bulan
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5). Harta benda yang dimiliki (perabot, transportasi dll)
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6). Tabungan khusus kesehatan
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8. Aktifitas rekreasi keluarga
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II. RIWAYAT DAN TAHAP PERKEMBANGAN KELUARGA

1. Tahap perkembangan keluarga saat ini (ditentukan dengan anak tertua):
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Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

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2. Tahap perkembangan keluarga yang belum terpenuhi dan kendalanya
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3. Riwayat keluarga inti:
1). Riwayat terbentuknya keluarga inti
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2). Riwayat kesehatan keluarga saat ini

Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

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3). Riwayat kesehatan masing-masing anggota keluarga
Imunisasi Tindakan
Keadaan Masalah
No Nama Umur BB/TB (BCG/Polio/DPT/ yang telah
kesehatan kesehatan
HB/ Campak) dilakukan

..

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4). Sumber pelayanan kesehatan yang dimanfaatkan

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4. Riwayat kesehatan keluarga sebelumnya.
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III. DATA LINGKUNGAN

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 Program Studi Ilmu Keperawatan A Tahun 2017

1. Karakteristik rumah
1). Luas rumah
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2). Tipe rumah
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3). Kepemilikan
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4). Jumlah dan rasio kamar/ruangan
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5). Ventilasi dan jendela
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6). Pemanfaatan ruangan
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Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

7). Septic tank:

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8). Sumber air minum
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9). Kamar mandi/WC
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10).Sampah.
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11).Kebersihan lingkungan
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12).Denah rumah
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Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

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2. Karakteristik tetangga dan komunitas tempat tinggal
1). Lingkungan fisik
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2). Kebiasaan
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3). Aturan atau kesepakatan penduduk setempat
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Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

4). Budaya setempat yang mempengaruhi kesehatan

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3. Mobilitas geografis keluarga

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4. Perkumpulan keluarga dan interaksi dengan masyarakat

1). Waktu untuk berkumpul
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2). Perkumpulan yang ada
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3). Interaksi keluarga dengan masyarakat
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Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

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5. Sistem pendukung keluarga
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IV. 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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Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

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4. Nilai dan norma keluarga yang berkaitan dengan
kesehatan
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V. FUNGSI KELUARGA
1. Fungsi afektif
1). Perasaan saling memiliki
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2). Dukungan terhadap anggota keluarga
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Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

3). Kehangatan
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4). Saling menghargai
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2. Fungsi sosialisasi
1). Kerukunan hidup dalam keluarga
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2). Interaksi dan hubungan dalam keluarga

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Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

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3). Anggota keluarga yang dominan dalam pengambilan keputusan
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4). Kegiatan keluarga waktu senggang
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5). Partisipasi dalam kegiatan sosial
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3. Fungsi perawatan kesehatan
1). Pengetahuan dan persepsi keluarga tentang penyakit/masalah kesehatan
keluarganya
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Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

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2). Kemampuan keluarga mengambil keputusan tindakan kesehatan yang tepat
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3). Kemampuan keluarga merawat anggota keluarga yang sakit
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4). Kemampuan keluarga memelihara lingkungan rumah yang sehat
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5). Kemampuan keluarga menggunakan fasilitas kesehatan di masyarakat

Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

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4. Fungsi reproduksi
1). Perencanaan jumlah anak
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2). Akseptor:
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5. Fungsi ekonomi
1). Upaya pemenuhan sandang pangan
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2). Pemanfaatan sumber di masyarakat

Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

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VI. STRES DAN KOPING KELUARGA

1. Stresor jangka pendek
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2. Stresor jangka panjang
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Respon keluarga terhadap stresor
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3. Strategi koping

Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

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4. Strategi adaptasi disfungsional
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VII. PEMERIKSAAN FISIK

Tanggal pemeriksaan:.................................................................................................
Nama Anggota Keluarga
Pemeriksaan
Vital Sign
... ... ... ... ...
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BB, TB/PB
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Kepala
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Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

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

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Mata
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Hidung
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Telinga
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Mulut
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Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

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

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Leher
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Thorax
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Abdomen
... ... ... ... ...
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Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

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

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Tangan
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Kaki
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Genitalia
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VIII. HARAPAN KELUARGA
1. Terhadap masalah kesehatan

Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

2. Terhadap petugas kesehatan yang ada

Denpasar, .

(......)

Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

ANALISA DATA
ASUHAN KEPERAWATAN KELUARGA

Nama mahasiswa :...............................................................................

Tanggal analisa :...............................................................................
No Tgl Data Diagnosa Keperawatan
Data Subjektif :
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Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

SKORING/ PRIORITAS
DIAGNOSIS KEPERAWATAN KELUARGA

Diagnosa Keperawatan :

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Kriteria Nilai Bobot Skoring Pembenaran

Sifat masalah:
Aktual 3 1 ___________________________________
Resiko 2 ___________________________________

Potensial 1 ___________________________________
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Kemungkinan masalah
untuk diubah
Mudah 2 2 ___________________________________
Sebagian 1 ___________________________________

Tidak dapat 0 ___________________________________

___________________________________
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Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

___________________________________
Potensial masalah
untuk dicegah
Tinggi 3 1 ___________________________________
Cukup 2 ___________________________________

Rendah 1 ___________________________________
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Menonjolnya masalah
Segera diatasi 2 1 ___________________________________
Tidak segera 1 ___________________________________
diatasi ___________________________________
Tidak dirasakan 0 ___________________________________

adanya masalah ___________________________________

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TOTAL

Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

IMPLEMENTASI
ASUHAN KEPERAWATAN KELUARGA

Nama mahasiswa :.................................................................

No Diagnosa Keperawatan Tanggal Implementasi Paraf

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Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

EVALUASI
ASUHAN KEPERAWATAN KELUARGA

Nama mahasiswa :.................................................................

No Diagnosa Keperawatan Tanggal Evaluasi Paraf

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Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

PERENCANAAN
ASUHAN KEPERAWATAN KELUARGA

NO DIAGNOSIS KRITERIA EVALUASI

TUJUAN INTERVENSI
KEPERAWATAN KRITERIA STANDAR













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Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

KOMPOSISI KELUARGA
Hub dgn Pendidika
No Nama L/P Umur Pekerjaan Keterangan
KK n

1 . ... ... ...

2 . ... ... ...

3 . ... ... ...

4 . ... ... ...

5 . ... ... ...

GENOGRAM

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Praktik Profesi Keperawatan Keluarga

 Program Studi Ilmu Keperawatan A Tahun 2017

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Praktik Profesi Keperawatan Keluarga