KEADAAN BAYI SAAT LAHIR

Lahir tanggal:............................Jam:..............Jenis Kelamin...............

Kelahiran: tunggal/gemelli*)

NILAI APGAR

NILAI JUML
TANDA
0 1 2 AH

Denyut
Tidak ada <100 >100
Jantung

Usaha Menangis
Tidak ada Lambat
nafas kuat

Extremitas Gerakan
Tonus otot Lumpuh
fleksi sedikit aktif

Iritabilitas Tidak Reaksi

Gerakan sedikit
refleks bereaksi melawan

Tubuh
Warna Biru/pucat kemerahan tangan Kemerahan
dan kaki biru

Keterangan:  penilaian menit ke-1,  penilaian menit ke-5

Tindakan resusitasi.......................................................................................................

Plasenta: Berat......................Talipusat: Panjang...................................

Ukuran.........................Jumlah pembuluh darah..................................

Kelainan.....................................................................................................................

Hasil pemeriksaan
penunjang ....................................................................................................................................

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RANGKUMAN HASIL PENGKAJIAN

Masalah:

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Perencanaan Pulang

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(jam), (tanggal-bulan-tahun)

TTD

(Nama Perawat)