Format Asuhan Bayi, Balita Dan Anak Pra Sekolah [PDF]

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IK-POLTEKKES-SMG-01010-03-UPM-08



Lampiran 6. Format Laporan Bayi, Balita dan Anak Pra Sekolah LAPORAN ASUHAN KEBIDANAN PADA BAYI / BALITA / ANAK PRASEKOLAH



A. PENGKAJIAN Tanggal



:..................................



Waktu



:..................................



Tempat



:..................................



B. IDENTITAS a. Identitas Bayi Nama



:..............................



Tgl/Jam lahir



:..............................



Jenis kelamin



:..............................



b. Identitas Orang tua Nama ibu



: .............................



Nama Suami



: .........................



Umur



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



Umur



: .........................



Agama



:..............................



Agama



: .........................



Pendidikan



: .............................



Pendidikan



: .........................



Pekerjaan



: .............................



Pekerjaan



: .........................



Alamat



: .............................



Alamat



: ..........................



C. DATA SUBYEKTIF 1.



Alasan Datang : ................................................................................................................................... ...................................................................................................................................



`



Keluhan Utama : ................................................................................................................................... ................................................................................................................................... 2. Riwayat Kesehatan: Dahulu : ................................................................................................................................... Sekarang : ................................................................................................................................... ...................................................................................................................................



Modul Praktik Semester V Prodi DIV Kebidanan



IK-POLTEKKES-SMG-01010-03-UPM-08



Keluarga : ................................................................................................................................... 3. Riwayat kehamilan, persalinan dan nifas: Dahulu : ................................................................................................................................... ................................................................................................................................... Sekarang : ................................................................................................................................... ................................................................................................................................... 4. Riwayat tumbang Pertumbuhan BB



:……...................................……………………...............



Perkembangan anak



:..........................................................................................



Kelainan bawaan



:..........................................................................................



5. Riwayat Imunisasi



:.....................................................................................



6. Pola kebiasaan sehari- hari: Pola nutrisi



:.......................................................................................................



................................................................................................................................... Pola eliminasi :....................................................................................................... ................................................................................................................................... Pola istirahat



:.......................................................................................................



................................................................................................................................... Pola aktifitas



:.......................................................................................................



................................................................................................................................... Personal hygiene :.................................................................................................... ................................................................................................................................... 7. Pola Sosial Ekonomi



:..........................................................................................



D. DATA OBYEKTIF 1. Pemeriksaan Umum Keadaan umum :......................................... Kesadaran



:..........................................



Vital signs



: N =................x/mnt RR = ..................x/mnt T = ..................0C



Modul Praktik Semester V Prodi DIV Kebidanan



IK-POLTEKKES-SMG-01010-03-UPM-08



2. Pengukuran antropometri: BB



:................kg



Lingkar kepala/ LK



:................cm



PB



:................cm



LILA



:................cm



3. Status Present: Kepala



:...............................



Muka



:...............................



Mata



:...............................



Hidung



:................................



Mulut



:.............................



Telinga



:...............................



Leher



:.............................



Dada



:............................



Pulmo/COR



:.............................



Abdomen



:................................



Genetalia



:...............................



Punggung



:..............................



Anus



:..................................



Ekstremitas



:...........................



Kulit



:................................



E. ANALISA …...................................................................................................…………………… ……………………........................................................................................................ ........................................................................................................................................ ........................................................................................................................................ ........................................................................................................................................



F. PENATALAKSANAAN Tanggal...........................…. Jam…...........… 1. ...................................................................................................................................... Hasil : .......................................................................................................................... 2. ...................................................................................................................................... Hasil : .......................................................................................................................... 3. ......................................................................................................................................



Modul Praktik Semester V Prodi DIV Kebidanan



IK-POLTEKKES-SMG-01010-03-UPM-08



Hasil : .......................................................................................................................... 4. ...................................................................................................................................... Hasil : .......................................................................................................................... 5. ...................................................................................................................................... Hasil :........................................................................................................................... 6. ...................................................................................................................................... Hasil :........................................................................................................................... 7. ...................................................................................................................................... Hasil :........................................................................................................................... 8. ...................................................................................................................................... Hasil :...........................................................................................................................



9. ...................................................................................................................................... Hasil :........................................................................................................................... 10. ...................................................................................................................................... Hasil :........................................................................................................................... ........................, ....................................2017 Pembimbing Klinik



Praktikan



______________________



_____________________ Mengetahui



Pembimbing Institusi



___________________________



Modul Praktik Semester V Prodi DIV Kebidanan