Format Pengkajian Keluarga Pendek.docx

FORMAT PENGKAJIAN KEPERAWATAN KELUARGA MODEL FRIEDMAN A. Data umum 1. 2. 3. 4.

Nama KK :…………………………………… Alamat : …………………………………… No. Telepon : …………………………………… Susunan Anggota Keluarga : Hub Tgl Sex Gol dg Lahir No Nama Pendidikan (L/P) Darah KK (umur)

Pekerjaan

Genogram ( dibuat 3 generasi )

5. Tipe Keluarga ....................................................................................................................................................... ............................................................................................................................. 6. Latar belakang kebudayaan (etnik) ....................................................................................................................................................... ................................................................................................................................................... 7. Identifikasi religius ....................................................................................................................................................... ............................................................................................................................. 8. Status kelas sosial ....................................................................................................................................................... ............................................................................................................................. 9. Mobilitas kelas sosial ....................................................................................................................................................... .............................................................................................................................

B. Riwayat Keluarga dan Tahap Perkembangan 10. Tahap perkembangan keluarga saat ini ....................................................................................................................................................... ............................................................................................................................. 11. Tahap perkembangan keluarga yang belum terpenuhi ....................................................................................................................................................... ....................................................................................................................................................... ................................................................................................................ 12. Riwayat keluarga inti ....................................................................................................................................................... ............................................................................................................................. 13. Riwayat keluarga asal ....................................................................................................................................................... ............................................................................................................................. C. Data Lingkungan 14. Karakteristik rumah Denah rumah ....................................................................................................................................................... ....................................................................................................................................................... ................................................................................................................ 15. Karakteristik lingkungan tempat tinggal dan masyarakat ....................................................................................................................................................... ............................................................................................................................. 16. Mobilitas geografis keluarga ....................................................................................................................................................... ....................................................................................................................................................... ................................................................................................................ 17. Hubungan sosial keluarga dengan masyarakat ....................................................................................................................................................... ............................................................................................................................. D. Struktur Keluarga 18. Pola Komunikasi Keluarga ....................................................................................................................................................... .............................................................................................................................

19. Struktur Kekuatan ....................................................................................................................................................... ............................................................................................................................. 20. Struktur Peran ....................................................................................................................................................... ............................................................................................................................. 21. Nilai-Nilai Keluarga ....................................................................................................................................................... ............................................................................................................................. E. Fungsi Keluarga 22. Fungsi Afektif ....................................................................................................................................................... ............................................................................................................................. 23. Fungsi Sosialisasi ....................................................................................................................................................... ............................................................................................................................. 24. Fungsi Perawatan Kesehatan ....................................................................................................................................................... ............................................................................................................................. F. Stress dan Koping Keluarga 25. Stressor jangka pendek ....................................................................................................................................................... ............................................................................................................................. 26. Stressor jangka panjang ....................................................................................................................................................... ............................................................................................................................. 27. Strategi koping keluarga ....................................................................................................................................................... ............................................................................................................................. 28. Adaptasi keluarga ....................................................................................................................................................... .............................................................................................................................

G. Harapan Keluarga …………………………………………………………………………………………………………………. H. Pemeriksaan Fisik No Jenis pemeriksaan 1. TTV : TD : Suhu : Nadi : RR : BB TB 2. Kulit, rambut dan kuku. 3.

Kepala, leher

4.

Thoraks (jantung dan paru)

5.

Abdomen

6.

Genitalia

7.

Ekstremitas atas + refleks fisiologis

8.

Ekstremitas bawah + refleks fisiologis

ayah

ibu

Anak 1

Anak 2

Anak 3