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Download ASUHAN KEPERAWATAN GERONTIK Ny O DI PANTI RUKUN IBU NANGELENG SUKABUMI A. PENGKAJIAN 1. Identitas Klien 1. Nama : Ny O 2.Umur : 82 th 3.Alamat : Cisaat, Sukabumi 4.Pendidikan : SPR 5.Jenis Kelamin : Perempuan 6. S uku :S u nd a 7. Ag ama : Isl

am 8. St a t u s Pe rkaw in a n:K aw in (j a nd a) 9. T a ngg a l Peng ka ji a n : 04-01-2012 2 . Identitas Penanggung Jawab Klien 1. Nama : Tn. A2. U mur : -3. Al ama t : Cis aa t,S ukabum i4. Pendidi ka n : -5.

Jenis Kel am in : L ak i-l ak i6. S uku :S u nd a 7. Ag ama : isl am 8. St a t u s Pe rkaw in a n:K aw in9. H ubu ng a n Deng a n Klien : An ak 3 . Riwayat Masuk Panti 1. T a

h u n/t a ngg a l ma s uk pa nti : 03-05-20022. Di k i r i m Oleh : Tn. A3. Al a s a n di k i r i m k e pa nti : kar en a ditingg a ls uam id a n a n ak

s u d a h m eni ka hd a n b e rp is a h 4 . Riwayat Kesehatana. Keluhan utama Se r ing pu sing d a n ba d a n te ra s a p eg a lp eg a l b. Status Kesehatan sekarang Ny O m engel u h

pu sing sej ak pa gi. S ak it k e pa l a n ya b e r den yu t-den yu t. P u sing se mak in di ra s aka n ji ka Ny O b e r j a l a nd a n b e rkura ng ji

ka isti ra h a t. K a d a ng Ny O m e ra s aka n a d a ya ng kaku di lehe r n ya . Ny O m eng a t aka n kura ng pa h am m engen a i p en

yak ithi p e r tensi c. Riwayat Kesehatan lalu Ny O m eng a t aka n b e b e rapa t a h u n ya ng l a l u p e r n a h m eng a l am is ak it j a nt u ng d

a n b e roba t k e ruma hs ak it. d. Riwayat Kesehatan Keluarga Ny .O m eng a t aka n di k el uar g a n ya tid ak a d a ya ng m ende r it a p en yak it g u l

a . Ny .O m eng a t aka n aya hn ya m ende r it a p en yak it te ka n a nd ara h tinggi. 5. Pemeriksaan Fisik a . Pen amp il a n umum Ke a d aa n Ny Ot ampak sedi k itle

ma hA pab il a te r l a l u l ama b e rak tifit a s. b . Siste m p e r n apa s a nBent uk th orax n orma l, tid ak t ampak a d a r et rak si inte

rco st a l, v oca l pr e m it u s m e ra t a dise mua l apa ng paru , p e rku si te r deng ar s o n or , au s ku lt a si te r deng ar vesi ku l ar

c . Siste m kar di o v a s ku le r A u s ku lt a si tid ak te r deng ar murmur d. Siste m Pen c e r n aa n Ny O m eng a t aka n BAB l a n c e r

2-3 ka li seh ar ie. Siste m mu s ku l o s c elet a lKed ua kak i Ny Ot ampak sej a j ar d a ns ama b es ar d a n pa nj a ng. Tid ak t ampak a d a

n ya k if o sis d a ns co li o sis. Ke mampua n m eng uba h po sisi ba i k , k e kua t a n o t o tt a ng a n pa d a s aa t m e r e ma

s a g ak le ma h.f. Siste m Pe rk e m ih a n Ny O BAK 2-3 ka li seh ar i, tid ak s ak it s aa t BAK d a nl a n car .g. Siste m s yara f pu s a t y N e r v u s I (Olf ac

t or i u s ) : Ny .Od apa t m e mb ed aka n bau d ar i m in yak kayu pu tih d a n m in yak wa ngi/ par f um . y N e r v u s II (O p

ti cu s ) : Ny .Os u d a h tid ak d apa t m elih a tj au ht u lis a n, ora ng d a n b end a b end a ya ng k e c il, t ap i Ny .O tid ak m

engg u n aka n ba nt ua n kacama t a . y N e r v u s III, IV, V (O cu l omo t or is, T roc hle ar is, A b d u sen ) y N e r v u s V (T r ige m in u

s ) : Sens a si sens or i k ku lit wa j a h k lien ba i k ,d apa t m e ra s aka ng or es a n kapa s pa d a p i p i ka n a n. y N

e r v u s VII (F ac i a lis ) : Ny .O d apa t, m engge raka n a lisd a n m enge ru t ka nd a hi y N e r v u s VIII (Vesti bu l ococ le ar) :F u ngsi k esei mba

ng a n ba i k y N e r v u s IX, X (Gl a s op h ar inge u s, V a g u s ) : Refle k m enel a n ba i k y N e r v u s XI (A cc es or

i u s ) : Ny .O d apa t m engge rakka n k ed ua ba h u n ya d a n m engge rakka n k e pa l a n ya y N e r v u s XII : Ny .Od apa t b

e rb i cara deng a n jel a sd a nlid a h b e r f u ngsi ba i k h. Siste m end okr in Ny ., O m eng a t aka n tid ak m e mpu n ya i p en yak it g u l a

d a ng o nd ok .i. Siste m r e pro d uk si Ny .O m eng a t aka n m e mpu n ya i a n ak 6 . Pengkajian Kat indeks, Bartel dan pengkajian keseimbangan a .K a tz inde x No . Kegi a t a nM a ndi r

iB a nt ua nSe ba gi a nB a nt ua nPen u h1. M a ndi a 2. Be rpaka i a n a 3. Ke K amar Ke c il a 4. Be rp ind a h Te mpa t a 5. BAK/BAB a 6. M aka n/Min um a Ny .Od apa

t b e rak tivit a s se cara ma ndi r it a n pa p eng awa s a n, p eng ara h a n, a t au ba nt ua n ak tif d ar i ora ng l a in. b .B ar thel inde x

No . Kegi a t a n Deng a nB a nt ua nM a ndi r i1. M aka n/Min um 0 102. Be rp ind a hd ar i kur si ro d a k e te mpa ttid ur /se ba li k n ya 0 15

3. Ke b e r sih a n di r i( cuc i muka ,g o s ok

gigi, m en y isi r rambu t ) 0 54 Kel uara ma s uk kamar ma ndi ( m en y e ka t ubu h, m en y i ram , m en cuc i ba j u) 0 105. M a ndi 0 156. J a l a n-j a

l a n di p e rmukaa nd a t ar 0 57. Na i k t uru nt a ngg a 0 108. Me maka i ba j u 0 109. K o nt ro l BAK 0 1010. K o nt ro l BAB 0 10J um l a h 0 100Kete ra ng a n: J um l a hs kor 100 = ma

ndi r iJ um l a hs kor 50-95 = k ete r g a nt u ng a n se ba gi a nJ um l a hs kor kura ng d ar i 45 = k ete r g a nt u ng a nt o t a l c . Kesei mba

ng a n a Perubahan posisi/ gerakan keseimbangan 0 1 1. B a ng u nD ar i kur si2. D u d uk k e kur si3. Men a h a nd oro ng a n pa d a ste r n um 4M a t a te r t u t up 5. Pe rpu t ara

n lehe r 6. Ge raka n Mengg apa ises ua t u 7. Me mbu ng kuk b Komponen Gaya Berjalan 0 1 8 Be r j a l a n ses ua i p e r int a h9. Ke mampua n m eng a ng ka t kak is aa t b e r j a l a

n10. K o ntin u it a sl a ng ka h kak is aa t b e r j a l a n11. Kesi m et r is a nl a ng ka h12. Pen y i mpa ng a nj a l ur s aa t b e r j a

l a n13. Be rba li k TOTAL Kete ra ng a n: a . 0-5 :Resi ko j a t u h b . 6-7 :Resi ko j a t u h sed a ng c . 11-13 :Resi ko j a t u h tinggi

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