PENGKAJIAN PADA ANTE NATAL

Nama Mahasiswa

Tempat Praktik

Sumber Data

Metode Pengkajian

Tanggal Pengkajian

1. Pengkajian
Nama Ibu
Usia
Pendidikan
Alamat
Jam/ tgl masuk
Nama Suami
Umur
Agama
Pendidikan
Pekerjaan

:
:
:
:
:
:
:
:
:
:

2. Pengkajian Awal
a. Masalah Kehamilan
:
b. HPHT
:
c. Taksiran Kelahiran
:
d. Pemeriksaan Kehamilan :
e. Dari pemeriksaan
ANC diketahui
:
- BB janin
:
- Usia Kehamilan
:
- Jenis Kelamin Janin :
f. Pemeriksaan Fisik Ibu
Berat Badan
:
TD
:
RR
:
Tinggi Badan :
HR
:
S
:
3. Pengkajian Chepalo Caudal (Head to toe)
a. Kulit, rambut dan kuku
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
b. Kepala dan Leher
Mata
: ............................................................................................................................
Leher
: ............................................................................................................................
Telinga
: ............................................................................................................................
c. Mulut, tenggorokan dan hidung

I. mulut
: ............................................................................................................................
I. tenggorokan
: ............................................................................................................................
I. hidung
: ............................................................................................................................
d. Dada
- Jantung
Inspeksi
: ............................................................................................................................
Palpasi
: ............................................................................................................................
Perkusi
: ............................................................................................................................
Auskultasi
: ............................................................................................................................
- Paru-paru
Inspeksi
: ............................................................................................................................
Palpasi
: ............................................................................................................................
Perkusi
: ............................................................................................................................
Auskultasi
: ............................................................................................................................
e. Payudara
.............................. ............................................................................................................................
............................................................................................................................................................
...........................................................................................................................................................
f. Abdomen
Inspeksi
: ............................................................................................................................
..............................................................................................................................
Palpasi
: ............................................................................................................................
Leopod I
:.............................................................................................................................
Leopod II
:.............................................................................................................................
Leopod III
:.............................................................................................................................
Leopod IV
:.............................................................................................................................
g. Genitalia
Edema
:.............................................................................................................................
Varises
:.............................................................................................................................
Keputihan
:.............................................................................................................................
Kebersihan
:.............................................................................................................................
Skresi
:.............................................................................................................................
h. Anus/rectum
Inspeksi
:.............................................................................................................................
i. Ekstremitas
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
4. Pola Kebiasaan
a. Aspektif-biologis
1) Nutrisi
Pola makan, frekuensi, dan jumlah
..............................................................................................................................................................................
..............................................................................................................................................................................

Perubahan pola makan selama hamil

..............................................................................................................................................................................
..............................................................................................................................................................................
Alergi makanan
..............................................................................................................................................................................
Minum, jumlah dan jenis
..............................................................................................................................................................................
..............................................................................................................................................................................
Keluhan yang berhubungan dengan nutrisi
..............................................................................................................................................................................
Eliminasi
a) BAK
..............................................................................................................................................................................
..............................................................................................................................................................................
b) BAB
..............................................................................................................................................................................
.............................................................................................................................................................................
2) Istirahat dan tidur
..............................................................................................................................................................................
..............................................................................................................................................................................
..............................................................................................................................................................................
3) Seksualitas

..............................................................................................................................................................................
..............................................................................................................................................................................
..............................................................................................................................................................................
4) Kebersihan diri
..............................................................................................................................................................................
..............................................................................................................................................................................
.............................................................................................................................................................................
5) Riwayat KB
..............................................................................................................................................................................
..............................................................................................................................................................................
..............................................................................................................................................................................
6) Riwayat kehamilan Ibu yang lalu
..............................................................................................................................................................................
..............................................................................................................................................................................
.............................................................................................................................................................................

b. Riwayat psikologis selama hamil

1. Apakah kehamilan ini diharapkan
Ya...........................................................................................................................................................
................................................................................................................................................................
2. Apakah selama kahamilan ibu mengalami masalah/ stres yang mengganggu?
..............................................................................................................................................................................
..............................................................................................................................................................................
..............................................................................................................................................................................
3. Apakah suami memberikan support saat hamil?

..............................................................................................................................................................................
..............................................................................................................................................................................
..............................................................................................................................................................................
4. Apakah keluarga memberikan support saat hamil?
..............................................................................................................................................................................
..............................................................................................................................................................................
..............................................................................................................................................................................
5. Riwayat ANC
..............................................................................................................................................................................
..............................................................................................................................................................................
.............................................................................................................................................................
6. Riwayat pemberian ASI
..............................................................................................................................................................................
..............................................................................................................................................................................
.........................................................................................................................................................................
B. Pemeriksaan penunjang
1) Pemeriksaan Laboratorium:
Jenis

Nilai Normal

Satuan

Hasil